the vaccine war

Interview: Robert W. Sears, M.D.

&ldquo[Parents] are refusing all vaccines. And I think if more and more keep making those decisions, we're going to run into a lot of trouble with these diseases.”
Robert W. Sears, M.D.

A practicing pediatrician and co-author of several parenting books, he wrote The Vaccine Book: Making the Right Decision for Your Child. This is the edited transcript of an interview conducted on Jan. 7, 2010.

Relate your first encounter with an anti-vaccine book with the DTP [diphtheria, tetanus, pertussis] vaccine.

I got interested in the topic of vaccines way back in medical school. A friend of mine convinced me to read a book about vaccines, and it ended up being a very anti-vaccine book. It was all about an old vaccine called the DTP vaccine that we don't use anymore. But the book talked a lot about the risks and the dangers of that vaccine. The author of that book was calling for that vaccine to no longer be used.

A number of years later, it turns out that they did discover that vaccine was causing a lot of very severe, life-threatening, even fatal side effects, so they did end up taking that vaccine off the market.

So it kind of opened my eyes to the fact that there are some very severe, fortunately very rare, side effects to vaccines, and I wanted to learn more about this issue. I started reading a lot more books.

And unfortunately, when you look at vaccine books on the market, you'll see they're for the most part very anti-vaccine. They only tell all the dangers and risks of vaccines, only that side of the story. I found there were no books out there that gave both sides of the story: the risks of vaccines versus the risks of the diseases. So that's what I set out to write about, was something that gave both sides of the issue so that parents can read something that helps them make an informed, educated decision.

How were your patients' attitudes toward vaccines changing?

The biggest fear I think every parent has about vaccines is that they don't want their child to be one of those very rare statistics in which their child suffers a very severe vaccine reaction. ... Something like 1 in 100,000 babies has a very severe reaction.

But it's very scary for a parent to think that they could be one of those, so that just causes parents to raise questions. Exactly how safe are vaccines, and how likely is it that my baby's going to have a severe reaction? Parents want to know those kinds of numbers so that they can feel that they're making a more educated decision about vaccines.

I see a growing problem in America, in which more and more parents are choosing not to vaccinate. There's a growing distrust about the safety of vaccines, so I wanted to put something together that parents can read, that gave them a fair look and an educated look about vaccines so they could understand what the possible reactions are. Fortunately they're very rare. But parents also need to understand what the risks of the diseases is so that parents can weigh both sides of the story so they're understanding what's going on and they can make a decision for their child.

With the growing mistrust of vaccinations in our country, more and more parents are saying no to vaccines. They're refusing all vaccines altogether. And I think if more and more parents keep making those decisions, we're going to run into a lot of trouble with these diseases. Illnesses that are very rare right now, that most parents don't have to fear, could escalate and could start killing babies left and right if fewer and fewer parents are vaccinating. ...

Describe your alternative vaccine schedule versus the CDC [Centers for Disease Control and Prevention] schedule.

I see a lot of parents questioning the CDC vaccine schedule. They worry that it's too overloaded. There's too many shots at too young of an age, and parents simply are looking for a safer way to do it, something they're more comfortable with.

I created my alternative vaccine schedule that allows parents to go ahead and vaccinate, simply in a more gradual manner. And I find a lot of worried parents who otherwise would refuse vaccines altogether are very happy to go ahead and vaccinate if they're doing it in a way that they feel safer about.

Let's take a look at the two different schedules. One of the main differences that the CDC schedule dictates is they suggest the hepatitis B vaccine be given the day a baby's born, one month later, and then six months later. Now, if you look at hepatitis B, it's a sexually transmitted disease. The only way a baby can catch it is through blood or body-fluid exposure, and that's extremely unlikely to happen for any baby or young child in the United States.

So what I did on my schedule is, I took a more logical look at hepatitis B, and I realized that babies have no risk of catching this disease, so let's not do the hep B vaccine while a baby's young and small and more vulnerable. Let's do a hepatitis B vaccine when a child's more of a preschool age, where he or she is going to be entering school and be running around with a lot of other kids, and there could be some blood or body-fluid exposures in those kinds of situations. To me, that's just a more logical time frame to do the hepatitis B vaccine. And some parents would even take it a step further and decide to delay their children's hep B vaccine until their children are teenagers and the real risks of hepatitis B, such as sexual activity or [intravenous] drug abuse, come into play.

What's next down the list?

The next point on the vaccine schedule where I differ [from] the CDC schedule is what to do at 2, 4 and 6 months of age. The CDC groups six vaccines all together at 2 months, 4 months and 6 months, and they recommend that pediatricians give all these vaccines in this three-dose series to babies. I think that's what a lot of parents are worried about.

What I do instead is I give two vaccines at a time, at 2 months, 4 months and 6 months. I also give two of the vaccines that I'm skipping on alternative months: 3 months, 5 months and 7 months. And I'm avoiding a big overload. I'm giving only a couple vaccines at a time. I feel that babies will experience fewer vaccine reactions; I think babies' bodies can handle them better. Their immune system can handle them better that way, and I think a lot of parents simply feel more safe about that kind of approach.

What I do on my schedule is I take the most serious diseases and I make sure I'm vaccinating for those right away for babies. I don't want to delay any vaccine that could protect a baby from a very potentially life-threatening or very common serious illness. And what those illnesses are that I focus on are whooping cough, or pertussis, and rotavirus. Those are two very serious illnesses that I vaccinate babies at 2 months, 4 months and 6 months. What I do at 3, 5 and 7 months is, I give them meningitis vaccines: Hib and pneumococcal meningitis. Those are the four different vaccines that I give in the staggered schedule during the early months of a baby's life so that the baby's protection from those vaccines isn't delayed.

The Centers for Disease Control, on the other hand, groups all those vaccines together at 2 months, 4 months and 6 months, along with polio vaccine and in some cases hepatitis B vaccine as well.

The reason I delay the polio vaccine on my alternative schedule is that we don't have polio in the United States. We haven't had it here for over 30 years. We've been very fortunate because the vaccination program for polio has been so successful, now we're reaping the rewards of not having to worry about this disease. Now, I don't want to delay the polio vaccine too long, because if no children get the polio vaccine, then we are almost guaranteed to see polio come back into our country. So what I do is, I give polio vaccine at 9 months, 12 months and around 2 years of age. I've just delayed it a little bit. ...

The safety profile of the CDC schedule is thoroughly tested and vetted. Is yours?

Some experts might question changing the vaccine schedule, or doing an approach that's outside of the CDC's schedule, where in fact these vaccines are studied in different time intervals and given apart from each other instead of grouped together. They're studied that way initially, in the initial safety research. The studies that are down to show that vaccines are effective are often done isolated from the regular schedule. So we do know these vaccines work just as well when they're given staggered or separated from other vaccines as they do when they're grouped all together.

What isn't studied separately is the safety profile. We don't know whether or not it's safer or more dangerous to group vaccines together versus spreading them apart. For me, it's a logical approach. It makes common sense to me that giving fewer vaccines at a time should create fewer reactions, but we haven't researched that to prove whether or not that's true. I think it's an approach that parents feel safer about, and I would like to see the CDC do some safety research that compares a staggered, spread-out vaccine schedule and compares the rates of reactions and severe side effects to the current CDC schedule.

Is part of the rationale for a staggered schedule the younger, more vulnerable body versus an older, preschool-age body?

Every parent is worried about their little tiny baby. They don't want to put anything artificial into their baby. The young babies are at a very critical developmental stage in the first couple years of life, so parents worry about chemicals and metals and artificial things, and parents just want to be careful. I think it's a logical approach to look at these young babies and to try to limit as much artificial exposures they get. If there are some vaccines that a baby really doesn't need in the first few months of life, then why give them? Why not delay them until a baby's brain is more fully developed, their nervous system is healthier? Wait until their immune system is a little healthier before you overload them with so much.

This whole concept about young babies being more vulnerable versus older toddlers being able to handle vaccines better, we don't know. No one's ever researched to see what happens if you delay vaccines. And do babies handle vaccines better when they're older? This is really just a typical fear that parents have when their babies are young and small and more vulnerable. Since I don't know one way or the other, I'm just happy to work with these parents, understand their fears and their worries, and agree to vaccinate them in a way that they feel is safer for their baby.

Does indulging or validating parents' fears weaken their trust in the CDC? By offering an alternative, is that indirectly diminishing CDC's message?

As a doctor, I don't like to undermine the CDC and to help parents mistrust the CDC. Obviously the CDC does so much good for us. They have our best intentions in mind, and they do so much research. And I think parents can overall trust what the CDC says. Now, as a doctor, I also recognize that no matter how much I say you can trust the CDC, some parents aren't going to trust them. They don't trust the conspiracies of Big Pharma and all the financial ties between Big Pharma and the CDC. A lot of parents just worry about that, so they're not going to listen to what the CDC says.

As a doctor, how I approach that is, I say: "OK, you have the right to your opinion. Let's figure out how I can work with you as a doctor in a way that understands your worries, understands you don't trust the CDC. So how can I, as a doctor, work with you?'' I don't want to just kick you out of my office, like most doctors do. If parents question the system, then they often get kicked out of doctors' offices, and that doesn't help anybody. ...

Are you saying the science isn't enough to convince parents?

There's so much safety research behind vaccines that most parents should feel very confident in their safety. But parents just don't always buy the science. They don't always trust it. They worry about who's funding the science. Of course all doctors know that virtually all vaccine safety research is performed by the pharmaceuticals themselves. They're the ones making the product. They're the ones that have the responsibility to do and fund the research. And then the CDC and other parts of the government oversee that research to make sure that it is trustworthy. But it just makes common sense to me that some parents would naturally mistrust that, because the basic funding often comes from pharmaceutical companies. ...

I think what would increase that trust is if we created completely objective and unbiased advisory panels of physicians and researchers that parents could trust, doctors that have absolutely no ties to the pharmaceutical industry and no ties to vaccine policy and the outcome of the decisions they're making.

There's an interesting study [PDF] that came out just about a month ago that took a look at the CDC's advisory panel on vaccine policies. They looked at all the physicians that are on that panel, doctors that help approve vaccines and decide which vaccines should become part of our nation's vaccine policy. And they found some very concerning results, in that many of the doctors on the panel had never filled out conflict-of-interest forms. There are some doctors that had very clearly received funding from pharmaceutical companies, that had a clear interest in the outcome of the decisions they're making, and those doctors weren't always declaring those conflicts of interest. There were even some cases where doctors voted on vaccine policy decisions after the CDC's ethics committee had asked them not to, because of a conflict of interest.

It's situations like that that cause parents to mistrust the system. And I think the CDC has heard this. They understand these worries, and I think they're taking steps to address them and to improve the system. I hope in the future we can have a completely unbiased vaccine policy system that parents can have more trust in.

Do you believe there's a conflict of interest? Do you mistrust the system?

As a physician, I do trust the CDC, and I trust the whole system. But I feel like it could be better. We need to identify those areas that we need to change so that parents can have more trust.

A big news story just came out that really has interfered with parents' trust, and that is that a doctor who was the head of the CDC's vaccine advisory panel, Julie Gerberding, who just stopped working for the CDC, was just hired by [Merck & Co., Inc.], a vaccine pharmaceutical maker. Parents are naturally going to wonder how much was that doctor's decision-making influenced by the pharmaceutical companies. It kind of calls into question the decisions that doctor made and the Merck vaccines that that doctor approved while the head of the CDC. Is that somehow, in any way, influenced by the promise or the fact that this doctor was then hired by Merck to make who knows how much money for the rest of her career as a physician? Those kinds of things shouldn't be allowed to happen. Doctors who are going to take public service [jobs] and serve the public good and work for the government shouldn't have financial influences on them that could influence their decision making. ...

Is Dr. [Paul] Offit a case of a revolving-door scenario?

One of the most popular figures in the pro-vaccine side is Dr. Paul Offit, an infectious disease specialist at probably the best children's hospital in America, [The Children's Hospital of Philadelphia]. He's very well respected among his peers, and he's a very outspoken advocate of vaccines. Some parents worry, however, because he's one of the doctors that created a vaccine and made many, many millions of dollars selling the vaccine to a company. A lot of parents are disinclined to trust his information, or they're worried that he's one of the doctors that has been influenced by the system. I can understand that worry, but I don't know Dr. Offit, I've never met him personally, and he's very well respected. I'm sure he definitely has the best interest of kids in mind.

But I would think that he shouldn't be surprised when parents don't trust him. He has a very clear financial stake in the success of vaccines. So why wouldn't that cause some mistrust among parents? He seems very shocked by that, however. He seems to not understand why parents wouldn't trust his word on it. And I would like to see, personally, the American Academy of Pediatrics and the Centers for Disease Control utilize doctors who don't have such a clear financial stake in vaccines. Use other doctors that parents can trust so that we can help parents feel more comfortable with the vaccine system.

Offit wrote a critical review of your alternative vaccine schedule. What was your reaction?

I know Dr. Offit is very outspoken against anybody who even questions vaccine issues, and he's come out against my own advice and my own vaccine schedule, speaking out against it. He wrote an article about my book in the Pediatrics journal, really coming down on my book and unfairly painting it as a very anti-vaccine book, and painting myself as an anti-vaccine doctor.

But the truth is that most of the stuff that Dr. Offit wrote in his article about myself or my book is actually false. He had to make up a lot of anti-vaccine arguments and portray them as being in my book to help make his case. But if you really look at my book, you'll find very little anti-vaccine information in there. You'll find it's very pro-vaccine. And so seeing a doctor like Dr. Offit print some false statements about somebody else, in my mind, really does call [in]to question whether or not parents can trust him.

What is an example, one of his false claims?

For example, he claims that in my book I don't recommend the teenage meningitis vaccine, whereas it's very clearly written in my book how severe teenage meningitis is, and the vaccine very clearly shows up right there on my vaccine schedule. I definitely recommend the teenage vaccine.

Dr. Offit also claims in my book that I don't recommend the flu shot for young babies, whereas it's right there in black and white, very clearly on my vaccine schedule, that I recommend babies get a flu shot, starting around 6 months of age.

You wrote about herd immunity, and Dr. Offit said your message is, hide in the herd; just don't tell anybody you're hiding. Explain.

There's a concept called herd immunity in which people are protected in our country from diseases because almost everybody in the herd is vaccinated. If a disease comes into our country, our herd is so well protected that the disease won't take control and won't take hold in our country, so that if there's one or two members in the herd that are not vaccinated, they'll still be protected, because the disease won't reach them because of the protection that surrounds them in the herd. It's a very important concept for our country, and we all really enjoy herd immunity from diseases such as measles, for example, and we eradicated smallpox through herd immunity. And many diseases are very low in our country because of herd immunity.

Now, on my vaccine schedule, when I delay some of the vaccines or I recommend that people delay the vaccine on my schedule, that calls into question, is that person taking advantage of herd immunity? Are they being selfish? Or are they risking our nation's herd immunity? And I was very careful on my schedule not to recommend any delayed vaccines that would compromise herd immunity. All the delays that I recommend I feel don't put any babies at risk for any increased cases of disease. Nor does it put our nation at risk as a whole.

Is there really herd immunity for the under- or unvaccinated child anymore, with globalized travel?

Parents wonder if it's safe to remain unvaccinated or undervaccinated. Just how risky are these diseases, and how likely is it for an unvaccinated child to catch a very severe illness in our country? I believe that there is some risk there. I don't think it's a dangerous choice to go unvaccinated. Parents need to have a clear understanding of what the risk is.

Right now, there's enough herd immunity in our country where a certain percentage of children can safely remain unvaccinated and not have to worry about disease risk. The problem is, if more and more parents make that kind of decision, we will reach the tipping point where our herd immunity is no longer adequate, and diseases will come back into our country. You've heard the saying, ''Polio is only a plane ride away,'' and that's true. Now, it hasn't entered our country in 30 years, so it's a very unlikely plane ride away, but you have to admit it is possible. And if we have big gaps in our herd immunity, somebody could bring polio into our country, and then any unvaccinated children in the area could come down with a very serious illness.

Talk about exemptions, freedom of choice.

Approximately 20 states in the United States allow personal exemptions from vaccines. To put it simply, vaccines are not mandatory in 20 states. In the other 30 states, you have to have a religious reason to opt out of vaccines. So while [vaccination is] a little bit more mandatory in those states, you could still view that as somewhat optional if you can claim a religious exemption. There are only two states in the country [Mississippi and West Virginia] that actually don't allow personal or religious exemptions, two states where vaccines pretty much are mandatory and parents in those states don't have a choice.

I believe that vaccines are a health care decision that parents should have the power to make for their own children. I don't think it should be mandatory in any state, and I do worry that those rights will be taken away from parents. There's actually an ongoing battle in every single state legislature, where the groups on both sides of the issue are constantly battling, trying to take away the rights or trying to keep the rights, and trying to change the policy.

What's the fundamental reason for believing in the right to choose?

I think our Constitution guarantees parents the right to make health care decisions for their children, as long as they're not putting their children's life in danger. And by not vaccinating, you're not putting your children's life in immediate danger. Yes, you are taking some risk with diseases, but it's not such a high risk where that should counteract or take away your freedoms as a parent to make your own health care decisions.

The main reason I feel that vaccines should be optional for parents is that every vaccine has the potential to cause a fatal reaction. Whether it's a severe allergic reaction, a neurologic reaction or some sort of other immunological reaction, fatal reactions do occur from vaccines. It's very rare, but it does occur. And no government should be able to force parents into putting their child through something that puts that child at risk of dying. I think that's just a fundamental right that every parent should have.

What is passive and active risk?

... I talk to a number of parents who have chosen not to vaccinate. I'm always curious to hear what their reasoning is. And one of the very common reasons I hear is very interesting. It's the idea of passive risk versus active risk, or an artificial risk versus the natural risk of the course of day-to-day life. Many parents view vaccinating as an active risk. They're actively making a decision to do something for their baby that has a very small risk to it, a risk of the severe reaction. And the risk of choosing not to vaccinate is what I call a passive risk, that parents are taking a risk by not doing something. I find a lot of parents that don't want to vaccinate are more comfortable with that passive risk. They're more comfortable with just taking the day-to-day risks of the natural course of life and disease and health, and then life and death, and they're less comfortable with taking that active and artificial risk of injecting something that they're not comfortable with into their baby.

One reason people are vaccine-hesitant is that we see autism but we no longer see diphtheria, etc. Some say it's a matter of time before enough children die, the tide will turn, and vaccination rates will climb again.

As parents' fears of vaccines grow, I think we may see fewer and fewer parents decide to vaccinate. And then we could see what used to be very rare illnesses become more common. We might see measles escalate. We might see diphtheria come back into the United States. God forbid, we might see polio come back. Then children are going to start dying. And then a lot of those parents that had chosen not to vaccinate might change their mind, and they might start vaccinating again, and then new parents might be more inclined to vaccinate their babies if we see these diseases come back.

Now, I hope and pray that doesn't happen. I hope that we can maintain adequate herd immunity in our country so we don't see these diseases return. But that worry of diseases coming back into our country, and the worry of diseases running rampant and killing a lot of babies, I don't think that supersedes the parents' basic right to choose what they want to do for their children. And if parents want to accept the disease risk because they don't trust the vaccines, I think they have the right to make that choice.

The good of the group outweighs the good of the one. But for parents who choose not to vaccinate, that's the opposite. ... Some say it's selfish of parents to not vaccinate, that they're ignoring that principle.

There's a famous statement: ''The good of the many outweighs the good of the few.'' And I think that's true. Many people would look at the decision to not vaccinate, the decision that the few are making, as a selfish decision. You could look at it that they are being selfish. They want to keep their own children safe, they don't want to take the risk of side effects, and so they're going to be selfish and be one of the few that don't vaccinate. ...

I think when most parents make decisions for their own children, they actually don't have the public health's benefit in mind. They're not thinking [about] the good of the many. As parents, most of us are going to make selfish decisions when it comes to our children. We'