The problem with alternate vaccine schedules

A recent article in Pediatrics takes on the middle of the immunization debate: parents who neither fully reject nor accept vaccines, but opt for delayed, alternate, or partial immunizations for their children. Alternate schedules, popularized by famous child-health author Dr Sears, encourage parents to negotiate with their health care providers about what vaccines their children really "need." The result is better than completely unvaccinated children, but partially-vaccinated individuals still risk contracting and spreading diseases that can be life-threatening. Chickenpox is less severe than meningitis, for instance, but it can still result in hospitalization and serious complications for rare unlucky folks. 

The article provides an excellent breakdown of the misleading ideas propagated by Dr Sears book, but one that struck me as I read it is Dr Sears encouragement of parents to think of themselves as experts. The article quotes from Dr Sears The Vaccine Book: Making the Right Decision for Your Child (2007): "Doctors, myself included, learn a lot about diseases in medical school, but we learn very little about vaccines."

The implication- that a parent who does a Google search for "vaccine side effects" will be more educated than the doctor in vaccination- is problematic and misleading. For one thing, the source of a Google-searching-parent's information is less trustworthy; for another, doctors give medical advice based not only on their own expertise but on the consensus of the medical community. That an individual doctor is not an expert in all details of vaccination matters less than the fact that the medical community is overwhelmingly agreed on the value of vaccination to both individuals and communities.

Another damaging concept suggested in the book is that parents "hide in the herd;" that is, that parents who don't vaccinate their children can assume that their kids are safe anyway, because most other people are. In the past few years, there have been serious outbreaks of preventable diseases such as pertussis, mumps and measles due to decreased immunization coverage. The notion that unvaccinated children are only putting themselves at risk is also false: many children cannot be vaccinated, due to serious health conditions like cancer and autoimmune disease; they are the individuals that the herd is supposed to protect. 

The problem with The Vaccine Book is it fosters a false notion of control: that parents can determine what risks their child will be exposed to, and act accordingly to protect them. Vaccines have been successful- and necessary- because they provide protection in a world where we cannot prevent our children from being exposed to harmful germs. Recently, a five-week-old baby girl in Minnesota contracted pertussis because her big sister sat next to a girl in school who had the disease. Most young infants are infected by their unknowing parents, who carry germs on their bodies and clothes. The risks to everyone increase with each parent who decides not to vaccinate. The illusion of control, while comforting in theory, is ultimately working against the health and safety of people everywhere.

Citation: Offin PA, Moser CA. The Problem With Dr Bob's Alternative Vaccine Schedule. Pediatrics. 2009 Jan 1; 123(1):e164-e169. Permalink.