NEJM Gets It Almost Right on Vaccine Topic

I have always liked to read the New England Journal of Medicine (NEJM). It reminds me of the larger world of healthcare issues beyond my own narrow view as a pediatrician. It makes me feel smarter, too, just to carry around a copy.

In a February, 2012 issue of the 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 like to think I specialize in  the  doctor-patient-family partnership , one based on mutual respect; and 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. Parents who choose 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 enthusiastically.  Chicken pox, hepatitis A & B, Human Papilloma Virus, menningococcal meningitis, rotovirus are all examples from my career,  We rarely revise those recommendations or issue recommendations to administer fewer vaccine doses. (Changing oral polio to injectible polio vaccine is the only change that readily comes to my 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 prevelance… and conversely, we may fail to closely attend to a creeping rise in preventable diseases that may be attributable to 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 created by the vaccine-hesitant 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 doctors and my esteemed research colleagues.  And don’t get me started on the Andrew Wakefields of the world; they only serve to further erode the cause.

It’s time for Acceptance. The NEJM article brings us full circle to clearly state the problem today. We have suboptimal immunization rates.  Accept it.  The next article must focus not on immunization rates, but on developing an immunization schedule that will reduce both the burden of disease and that of vaccinating the children.  It is time to study the vaccine schedule as a whole.  Prove that it is the superior choice for preventing disease or revise the number and timing of vaccines given.  The data set is ready to be collected thanks to those with variant vaccine schedules and those of us following the WHO immunization schedule for our children.

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