*This post first appeared on The PediaBlog on February 17, 2015.
This Isn’t The Wild West
A reader expresses what’s on the mind of many parents recently:
I’d love to see some information on what we should do to protect our newborns until they can get vaccines? It seems like there is just not really anything we can do short of keeping them in the house for a year and it’s very scary to have a baby on the way.
The measles outbreak that started in Disneyland and spread to 18 states and the District of Columbia (so far) has parents who pay attention to such things (ie. most of them) spooked. Even though the vast majority of parents vaccinate their children (and see to it that they themselves remain up-to-date on adult immunizations), the fact is there are pockets of unvaccinated/undervaccinated communities all over the United States. And you can be sure that an unvaccinated/undervaccinated child or adult is coming to a store/airport/doctor’s office/hospital/workplace/school near you. A generation and more ago, it was the lack of access to vaccines that led to unprotected children, most of whom lived in poverty. Nowadays, access and cost are seldom barriers to adequate herd immunization. Instead, those who oppose vaccines — despite the overwhelming evidence-based, peer-reviewed scientific consensus that vaccines are safe, effective, and life-and-limb-protective — tend to be wealthier, “educated” (though, they must have flunked science, as well as math, history, religion, and the social sciences), and connected to high-speed Internet. The other thing to keep in mind is that these people — and we all know at least one — ARE NOT GOING TO CHANGE THEIR MINDS, no matter what factual evidence or moral arguments are pushed under their noses. In fact, a recent study in Pediatrics indicated that vaccine-resistant parents are tone-deaf when societal benefits of vaccination to protect the “herd” (in this case, with MMR vaccine) are emphasized.
Adding to this are the growing numbers of parents who subscribe to thoroughly debunked fears (usually around the “too many, too soon” meme), misinformation (the “vaccine-autism connection”), and reassuring nonsense (“Dr. Sears recommends spreading out the vaccines,” to which I reply: “Who the heck is Dr. Sears?”) that it’s okay to split up, spread out, or otherwise delay vaccinations until a later date. Our reader who posted the query must understand that this behavior also endangers her children here today and yet-to-be-born.
The vaccine schedule adopted by the Advisory Committee on Immunization Practices (ACIP), the Centers for Disease Control (CDC), and the American Academy of Pediatrics (AAP) is evidence-based in its origin. The schedule is put together in such a way as to maximize efficacy (through a process known as “synergy”, whereby one vaccine helps another reach protective immune levels), compliance (“I’ll come back next week for another shot” doesn’t work if you don’t bring your baby back — this happens all the time), and safety (as our reader would concur, the sooner my child is vaccinated, the safer she’ll be), at the same time minimizing risks of not getting vaccines on time. The current immunization schedule is the standard of care precisely because it maximizes the benefits and minimizes the risks to your child and to the rest of society.
The practice of modern medicine is guided by such standards of care. These standards of care aren’t made up by pointy-headed geeks in “White Tower” academic institutions, or by “justice”-seeking lawyers looking to sue everybody with a degree after their surnames. Standards of care emerge over time, borne out of experience and painstaking peer-reviewed research, and not anecdotes and gut reactions, which often misguide.
The “art of medicine” isn’t painted in the Wild West. It’s okay to question standards of care (physicians do this every day), but it’s not okay to stray from them. Asking a pediatrician to separate or delay vaccines for no good reason other to soothe a gut fear — however unsubstantiated that fear may be — might reflect healthy skepticism, but insisting on it is foolish and dangerous. Eventually someone is going to get hurt. Our reader — and so many other parents who are worried about this anti-vaccine mentality — doesn’t want that someone to be her kid.
*** On January 22, 2018, Pediatric Alliance and some of our pediatric colleagues from around the United States began participating in an 8-week AAP-sponsored immunization advocacy campaign on social media. Please follow all our social media posts during this project on Facebook and Twitter.