Tags: Current Research | Vaccines

In this month’s New England Journal of Medicine, there is an editorial about the people I call the ‘vaccine hesitant,’ and it's titled “ Improving Childhood Vaccination Rates .” Author Douglas Diekema, MD, MPH begins by recounting his encounter with a new mother who knew of no children who were vaccinated according to the recommended immunization schedule. He goes on to delineate all the disease outbreaks in our country that have occurred as a result of vaccine refusal and proposes ways in which physicians can educate and bridge the gap between the vaccine hesitant and accurate public health science.

I face the challenges he describes sometimes daily, and it’s a great article: well worth the read. I specialize in the doctor-patient-family partnership based on mutual respect, but I firmly believe in the value of vaccines. It is often difficult to find a place of respect for parents who are certain there is a ‘better’ vaccine schedule than the World Health Organization schedule that I support, but I always do my best. A parent who chooses to create a variant vaccine schedule MUST be certain that their alternative vaccine schedule is better, lest why would they actively choose a lesser option for the child they love?

What if they are right? What if an infant in the United States does NOT need four doses of polio vaccine to confer the same immunity of one or two doses, timed properly, and what IF there would be no increased risk of contracting polio with fewer doses of vaccine? WHAT IF THE VACCINE HESITANT ARE RIGHT? Are we too busy as researchers and physicians to design and conduct the research to prove them wrong and validate the position that Diekema in the NEJM so eloquently states? Or would research prove that it is time to revise the current vaccine schedule?  We add new vaccine recommendations readily (chicken pox, hepatitis A & B, Human Papilloma Virus, menningococcal meningitis, rotovirus in my career,) but we rarely revise those recommendations. (Changing oral polio to injectible polio vaccine is the only change that readily comes to mind.)

With the rising numbers of parents who are choosing to defer or vary the vaccines administered to their children, there is a large study population already on the Internet seeking information about vaccines. Perhaps it’s time for the NIH to have a sponsored link at the top of every Google search for vaccines that invites the vaccine hesitant to participate in a PatientsLikeMe.com type data collection to study the current immunization schedule. It is very possible that with good epidemiological and immunologic titer data, we could simplify the current vaccine recommendations and still protect our children from communicable disease.

The answer to the vaccine debate lies in understanding what the least number of vaccines, given at the most advantageous intervals, will confer the most protective immunity for the children we love. If we give fewer vaccines, we save money; children save tears. If we give vaccines at 2, 4, and 6 months because that’s what we’ve always done, we ignore the important statistics of declining disease that we are so proud of… and we fail to closely attend to a creeping rise in disease that results from popular vaccine refusal.

It is time to study communicable disease and vaccines in a new way. Pediatricians and researchers have moved too slowly through the stages of Denial, Anger and Bargaining. We have ignored the problem being busy with the day-to-day work in our offices. We often find ourselves mad at the Jenny McCarthy’s of the media world, and although we have sent our doctor-experts to discuss the issue publicly, by the time we did, it was Depressing that parents trusted a former model over my doctors and research colleagues.  And then there are Andrew Wakefields of the world to further erode our cause.

It’s time for Acceptance. The NEJM article brings us full circle to clearly state the problem today. We have suboptimal immunization rates. The next article must focus not on immunization rates, but on developing a new immunization schedule that will reduce both the burden of disease and that of vaccinating the children.

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