Educating parents about vaccine scheduling is failing

I am disappointed to see yet another editorial statement that suggests we can eliminate the alternative schedule vaccine issue merely by educating our patients better (Brady M. Alternative vaccine schedules are not safer and should be obsolete. Contemp Pediatr. 2013;30[6]:4-5).

I would posit that pediatricians are already providing adequate education to parents . . . and that simply educating parents is not sufficient. Those of us who are doing this on a daily basis would consider Dr. Brady’s suggestions to be naïve. Dr. Brady does not distinguish between the different types of vaccine refusing/alternative schedule people. While I have not seen the following categories published in a formal study of the issue, my descriptions will be readily recognizable to anyone who attempts to counsel parents about vaccines.

1. The Worried Well. These are people who . . . really do want to vaccinate, but they have read articles/seen on the Internet/heard from family or friends that vaccines may pose some vague sort of harm. Often, this is related to overwhelming the immune system or that somehow all vaccines cause autism. This group is the largest and is readily reassured by information.

2.Alternative Schedule. They often come in asking if I am familiar with “the” alternative schedule. . . . Some of these people may be reassured by information and, in that respect, are similar to group 1. Some come in with their own schedule already printed and ask if this is “OK.” . . . Sometimes, after seeing that the first few vaccines haven’t harmed their child, they will consent to more vaccines at a time. However, this consent is related to their own direct observations and not to any counseling that I have provided.

3. Die-hard Refuseniks. They have done their “research,” made their conclusions, and are not interested in being counseled. They view provision of vaccines as a belief system, not as a scientific decision. They generally do not change their views.

4. Refusers of most medical interventions, including vaccines. . . . Fortunately, [they are] few in number.

Group 1 is not a problem. They are asking for information, just like they would for side effects of amoxicillin. . . . They are easy, and this group, only, is the group reachable by Dr. Brady’s suggestions. Group 4 is reachable by no one and is, fortunately, the rarest. Groups 2 and 3 are the ones who are dangerous to their children and dangerous to society and who are not reached by education. . . . [T]heir decision about vaccines is based on an emotional response to the perceived risk of harm from vaccines, weighed against the intangible risk of diseases they have never seen. To suggest that mere provision of facts and education will change their decision is incorrect and does not account for the emotional response, fear, that these people have. . . .

The simple answer is that if simply educating patients about vaccines were sufficient, then we would not have a problem in the first place. The fact that this editorial is necessary points to the proposed solution being ineffective. Continued focus on getting pediatricians to provide better education to parents is doomed to fail.

David A Horowitz, MD

Triangle Pediatric Center, PA

Cary, North Carolina

Pediatric policies will defeat alternate vaccine schedules

I take strong issue with your recent editorial article by Michael Brady, MD, titled "Alternate vaccine schedules are not safer and should be obsolete (Contemp Pediatr. 2013;30[6]:4-5)," but perhaps not for the reasons you expect.

What's my beef? My concern is that Dr. Brady inadvertently gave "alternate vaccine schedules" much more respect than they ever, ever deserved by implying that there was once a time that they were not obsolete. Just as a $3 bill never was legal currency in the United States, any vaccine schedule not from the ACIP/CDC should have been labeled illegitimate from the moment of its conception. . . . This most especially includes those schedules promoted and sold to parents by Robert Sears, MD, FAAP, and Jay Gordon, MD, FAAP.^1-3 Sears has schedules that tell parents to delay and skip vaccines, and Gordon openly recommends not giving infants any vaccines until they are at least 6 months of age. In my opinion, as a practicing pediatrician, the schedules promoted by these 2 board-certified FAAP pediatricians constitute medical malpractice by these licensed doctors.

As vaccination rates continue to fall in the United States, I have been deeply disappointed by the lack of any public denouncement by pediatric groups (and pediatric publications as well) of these alternate schedules,.. . . [W]eekly, parents come to my pediatric practice demanding I vaccinate their children based on the alternate schedules. . . . Sadly, I don't have any direct, by-name, statement-of-fact refutation of these schedules by any professional organization, including the AAP, AAFP, or CDC. . . . Most notable is the complete lack of any policy statements or parent handouts that tell parents clearly and in no uncertain terms that the schedules of Sears and Gordon should never be followed. (The Offit and Moser article, “The problem with Dr Bob’s alternate vaccine schedule,”⁴ was not written for parents . . . .)

A recent poll of Washington-[State] pediatricians show[ed] that over 77% of them are regularly asked by parents to use alternate vaccine schedules.⁵ Even more worrisome, a recent article found that 1 in 10 parents of young children are using alternate vaccine schedules.⁶ Also alarming is recently published research showing that alternate vaccine schedules have directly caused a large part of the recent decrease in vaccination rates in a large metropolitan area.⁷ Finally, this lack of denouncement is critical because a recent abstract has shown what many of us in primary care have suspected for the last decade: “. . . [T]he variable most predictive of parents’ vaccination decisions was the percent of parents’ people networks recommending nonconformity.”⁸

. . . [S]o far, all the help I've received from those living in the higher echelons of pediatric medicine is to be told to talk longer and harder to parents who are vaccine hesitant. Well, I hate to break the news, but that isn't working  . . . and I really need some help from someone bigger than me (such as the AAP, the AAFP, or the CDC). If, as physicians, we can't all agree that such gross and reckless medical misdirection by our own colleagues is not worthy of our group professional criticism, then why bother having professional physician organizations at all?

 It is my hope that physician groups grappling with vaccination fears by parents will realize they must join and help us primary care physicians "in the trenches" to convince parents that the only right thing to do is vaccinate their children according to the ACIP/CDC schedule. Silent tolerance of physicians who advocate deviation from that schedule is not an option anymore. If we are to stem the rising tide of vaccine-preventable disease outbreaks in the United States, we must call out those antivaccinationists in our ranks who are trying to "hide in the herd" of the vast majority of pediatricians who do vaccinate by the ACIP/CDC schedule. There should be no herd immunity for Drs. Sears and Gordon.

Chris Hickie, MD, PhD

Cottonwood Pediatrics PLC

Tucson, Arizona

REFERENCES

1. Sears R. The Vaccine Book. Making the right decision for your child. New York: Little, Brown, 2007.

2. Gordon, J. Dr Jay’s FAQs. Vaccination schedule.  http://drjaygordon.com/faq/vaccinations/schedule. Accessed July 24, 2013.

3. Gordon, J. Vaccinations? A parent's guide to decision making. http://drjaygordon.com/vaccination-dvd. Accessed July 24, 2013.

4. Offit PA, Moser CA. The problem with Dr Bob's alternative vaccine schedule. Pediatrics. 2009;123(1);e164-e169.

5. Wightman A, Opel DJ, Marcuse EK, Taylor, JA. Washington State pediatricians' attitudes toward alternative childhood immunization schedules. Pediatrics. 2011;128(6):1094-1099.

6. Dempsey AF, Schaffer S, Singer D, Butchart A, Davis M, Freed GL. Alternative vaccination schedule preferences among parents of young children. Pediatrics. 2011;128(5):848-856.

7. Robison SG, Groom H, Young C. Frequency of alternative immunization schedule use in a metropolitan area. Pediatrics. 2012;130(1):32-38.

8. Brunson EK. The impact of social networks on parents' vaccination decisions. Pediatrics. 2013;131(5):e1397-e1404. 

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