I see this as a glass half-full, glass half-empty issue. Yesterday, a study was published in Pediatrics detailing research conducted in May of 2010 about parents’ preferences to use alternative vaccination schedules versus following the recommended CDC vaccination schedule. The majority of the media coverage focused on the finding that over 10% of parents followed a schedule other than the one recommended by the CDC. Not perfect and not ideal from a public health stand point. Yet, of course, the other way to see this is that nearly 90% of parents did follow the physician-recommended schedule. That’s a pretty good success rate for doctors.
As a pediatrician practicing in Washington State, I saw this study half-full. As I read through the methods, results, and discussion, I took notes on the cover page. I actually made that little doodle. I couldn’t help but think about the nearly 90% of families (87%) who followed the recommended schedule to protect their children and their communities. Clearly 87% is not 100% (I get that) and it leaves our communities and our children at risk, but I believe we can continue to improve trust with ongoing education.
Focusing on the group that does vaccinate their children on the schedule may be a good strategy to understanding where we can improve our communication about the benefits of vaccination. We often focus on the group that doesn’t vaccinate but we miss insight from those of us who do immunize our children on the schedule.
Details: The study was conducted on over 2000 respondents, where 771 families qualified by reporting having a child between 6 months and 6 years of age. They were asked if they followed the CDC schedule and then if they didn’t, they were asked to answer a series of closed-ended questions regarding the nitty gritty of the schedule they used. Parents’ age, gender, race/ethnicity, and level of education and family insurance were collected.
Glass Half Full Findings:
- Only 2% of all the families interviewed refused all vaccines for their children. Two percent simply isn’t much.
- 13% of parents reported following an alternative vaccination schedule, with most families stating they only refused certain vaccines (53% of them). This means that nearly 90% of parents reported following the CDC recommendations. That’s nearly an A minus!
- Of the “alternative vaccinators,” a large minority of parents reported having initially following the recommended schedule.
- 55% of families that were on alternative schedule ended up giving all of the recommended vaccines but on a delayed schedule.
- Of the “alternative vaccinators,” only 8% of that group followed a well-known alternative schedule such as that offered up by Dr Bob Sears or Dr Donald Miller.
- Several families free-text responded that they had worked with their child’s physician” to develop the schedule.” Fantastic. A true partnership between the patient and physician and one that is transparent and necessary for catch-up immunizations.
Now I can imagine physicians screaming at me at this point, directing me to all of the issues with the above findings and why they aren’t necessarily positive. I’m not ignorant, but I still experience those findings as hopeful for our communities. Our job really may be activating those parents who do vaccinate and who do follow the CDC schedule to share their stories and their “whys” behind protecting their children from harm with vaccines.
For me, the most concerning finding resided in a group that followed doctors’ advice but doubted their own choice. Of the group that vaccinated their young children on the CDC’s recommended schedule, 28% reported that they felt the alternative schedule was actually safer. What? Oh no. This certainly serves as a wake-up call that we clearly aren’t doing a good job explaining the benefits of the schedule. And we may not be checking back in with families after vaccinations. As I stated in the mission of this blog, what I know in my heart is that parents want to do what is right for their children. This statistic challenges that parents feel reassured after vaccine-visits. And it serves as a reminder for physicians everywhere.
Glass Half Empty Finding:
- 1 in 5 parents who followed the recommended CDC schedule felt that delaying vaccines was safer than the CDC schedule they had used with their children. Unsettling. As the authors point out, this finding represents that 1 in 5 families may be “at risk” for changing to an alternative vaccination schedule. This would assume that housing doubt (about anything) would stop a parent from immunizing. In my experience, that’s not exactly how parenting works. Sometimes, we do what is recommend by those we trust (our children’s physician, a vaccinologist) because they are more expert than we are and understand more about the risks and benefits. And we sometimes remain concerned. I suspect this group represents that sentiment. And from my vantage point, late tonight after a long day in clinic, it seems like this is simply part of parenthood at times…
- Most families indicated that they came up with the new schedule themselves (41%), or took advice from a friend (15%) or family member.
- 22% disagreed with the statement that the best vaccination schedule to follow was the one recommended by vaccination experts. Befuddling. If we don’t let our national and world vaccine experts hold our trust, who should get it? Simply don’t understand this. Remember earlier this year a study found the far majority of parents trusted their child’s pediatrician most when getting information about vaccine safety. Regardless, the 22% statistic confirms we need to do more to explain how vaccine research is conducted and why it is best to immunize early to maximize protection for children.
- 86% of families using the alternative schedule had refused the H1N1 vaccine for their children. Gasp.
- 76% of families using the alternative schedule had refused the seasonal influenza vaccine for their children. Did you see my recent video about influenza?
- The vaccines most commonly spaced out were the MMR (45%) and the DTaP (43%). As many of you know, we have widely elevated circulating rates of pertussis (whooping cough) in the US. An infant died in the county where I practice last month from whooping cough, while 2 other infants were hospitalized. Many studies have found that underimmunization in communities significantly increases the risk of contracting and spreading vaccine-preventable diseases. Further, for 2011, the Health District in Snohomish County (where I see patients in clinic) has had 80 laboratory-confirmed or epidemiologically-linked cases of pertussis reported. In contrast, for all of 2010, Snohomish County had only 25 cases, and for 2009–only 33 cases.
Glass half empty or glass half full? How do you see it? How do these numbers make you feel? Since no vaccine is 100% effective, all of our children (and all of us) are dependent on an entire community being immunized to avoid vaccine preventable disease. Does this study make you upset?
Do you use an alternative schedule against your doctor’s and vaccine experts’ advice? Why?
Natasha Burgert, MD says
Dr. Swanson,
Thank you for openly discussing a topic that so many parents and doctors only discuss behind closed doors.
I am on the front line of vaccine education, awareness, and promotion. I believe in the efficacy, safety, and important of vaccines; and I discuss the evidence with my patient families everyday.
I am very happy to report that the vast majority of my families do vaccinate according to the recommended AAP/CDC schedule. In addition, it is our practice’s philosophy to work with families who choose to alter the recommended vaccine schedule versus shutting the doors completely. In that regard, I do have families who choose to change the vaccine schedule against my medical advice, but with a defined plan in which we both feel comfortable. I agree this is all “half-full.”
What troubles me most about the study, and a point you made clear, was the number of families who take the doctor’s advice… but, still are not firm or happy? with their decision. I know these families exist in my practice. And, as a provider, it makes me equally uncomfortable giving vaccines to a family who says, “Well, I guess I will if you say so….”
A “half-empty” experience, indeed.
My lofty, outrageous, hairy goal is to consent parents for vaccination, fully knowing that they are confident and comfortable with the decision that was made with their doctor. That parents are empowered with great information in order to share with their friends and family why they DID choose to vaccinate their children, being ambassadors for positive health choices for all the children of their community.
Clearly, we are far away from that, regardless of what the rates of immunization show.
I would love to hear from parents and readers, what providers could offer those families who do vaccinate with hesitation or doubt. Is there anything we can do to empower, encourage, and comfort that decision? Or, will this feeling always remain “simply a part of parenthood?”
Thanks for providing a forum to share. Great post, Dr. Swanson.
NB
Parent says
We are a family who worked with our pediatrician to come up with an alternate schedule that worked for us and for our daughter. We made fully informed choices on what vaccines to get and when to get them. For example, we did not have our daughter vaccinated with the Hepatitis B vaccine. I stayed home with her, she wasn’t left at childcare centers or with babysitters. There was no risk of that particular disease for her. Our pediatrician concurred with this decision.
What doesn’t sit well with me is the fact that vaccines and vaccine schedules are not necessarily based on health concerns. The piling on of vaccines soon after birth is not necessarily due to health concerns–it is a worse case scenario based the concept that the medical industry thinks that it’s the only time they can “get” the kids. This is based on studies of populations who don’t have ready access to health care. Those of us with access to ready and good health care want a more thoughtful schedule. Also, another issue is economics versus health. It is written plainly in the medical literature that the chicken pox vaccine wasn’t developed based on a health issue so much as a business issue–too many parents were missing work to stay home with kids who had chicken pox. This type of thing concerns me greatly.
I am also extremely put off by the concept that I am a “stupid” or “uneducated” parent if I don’t rush out and vaccinate my child with every last vaccine on the market without question. Our family is extremely conscientious about our health. I think the medical industry needs to acknowledge that parents like us aren’t “wackos” and start addressing some of the parental concerns about vaccines in a respectful and non-arrogant way.
Linda Pourmassina, MD says
I am an internist (primary care). While the topic is about childhood vaccinations, I share your concerns, echoed in Dr. Burgert’s comment. That is, I feel concerned about patients who consent to a vaccination but might not fully agree and not voice their disagreement, despite a thorough discussion. So, if a patient seems uncertain, I often say, “I do not want you to feel as if I’ve twisted your arm, so you can think about it further, if you’d like” and provide pertinent handouts/websites to review. That being said, I try not to downplay the importance of vaccination – a tricky balance, no?
Of course, adult vaccinations, while important, are not quite as time-sensitive as childhood vaccinations, so an internist’s job is a little easier. My patients often do have the time to think about it. So I admire pediatricians (like you and Dr. Burgert) who try to educate parents/caregivers about vaccinations in such short windows of appointment time and through other avenues, such as social media (Twitter, Facebook, blogging, etc.). And it is because more doctors are engaging in educating the public through social media, I choose to look at the situation as “half full.”
I, too, would like to hear thoughts and comments of parents/patients for a better understanding of their perspective.
Thanks for this post, Dr. Swanson.
Melissa says
I appreciate your balanced viewpoint. I also went with an Alternative schedule that we essentially planned with our Pediatrician. As the other reader pointed out Hep B is not essential to provide at birth. It is an easy way to complete the vaccination, but there is little risk for my daughter in the near future. That being said, we have started the Hep B series now that International travel is on our agenda. There are prudent ways to make these decisions outside of the APA recommendations. That being said if I had a son, I would want him to vaccinated against HPV to help him protect the ones he loves.
What concerns me is the very low rate of compliance with vaccinations of school children in Seattle suggesting that we have a real problem locally. Rather than focusing on when or how vaccinations are given, let’s focus on IF they are getting them. Your study cites 2% of a very small group and does not reflect our very real local problem. I think there is some false information out there guiding peoples choices. One example is the idea that getting chicken pox is very safe. While it may be “safe” (v. unpleasant and preventable, but relatively safe) for your young child, it poses a real danger to your pregnant neighbor that never had chicken pox as a child. Effectively your child’s “safe” chicken pox can cause great harm to her and puts her baby at great risk.
We live in a global community and have to act like it. Measles has not been present due to the high rate of vaccination. If we stop vaccinating, all it takes is one plane trip to cripple our schools and children.
Meagan says
My bub (4 months) gets all vaxes (got most recent round yesterday in fact) and husband and I got our Tdap (or whatever the grown up version is) right after he was born. I have asthma, and my dad has copd. That combined with having a young infant makes me a little touchy when anti-vaxers talk about how it’s a personal decision. 2% seems like a lot to me… low percentage but many many people.
Wendy Sue Swanson, MD says
Meagan,
Well if you really do the math, 2% of the population is A LOT. So I agree with you on some level, but my point is, it could be worse. If you’d asked me what percentage of “alternate vaccinators” refused all vaccines–my answer would have exceed 2%.
Jen says
Great post. We did everything on schedule with our 8 year old. With my now 2 1/2 year old who is Autisitc we have done an altered schedule from birth. More of a spread out 4 shots over 2 weeks 2 at a time delay not a huge delay. My kids are very small not on the growth charts and working very closely with our doc she helps us make the best decisions for our kids. I have never once believed vaccines played a part in my son’s Autism. He was born with issues from day 1 and never saw any regressions or changes after vaccines. he is now after 9 months of intensive therapy doing amazingly well. We are doing the same with our now 15 month old who goes in tomorrow for his well child and will get 2 shots. All kids are up to date and covered by the time they are two and we got all the kids H1N1 as well as yearly flu shots. I too live in Snohomish county and was shocked to see the article with the number of Whooping cough cases up here. And that a little baby died broke my heart. As soon as I heard the recommendation to get a booster when my third child was born I got a booster to make sure we were all covered. I couldn’t imagine watching my child suffer with something that is so easily preventable. Everyone has their own choice and I am very happy with mine.
Tiffany says
Great post…I was concerned with all the “media” around vaccinations when I had my little one. But I found a ped that I trusted completely. She was willing to talk to my husband and I about the schedule and the why’s behind them. But the most convincing part was when I asked her what she did with her three kids and she responded quickly and confidently, vaccinated them all on schedule. I am comfortable with her treating my child the same why she would treat her own children. Did I mention that I love our ped? 🙂
Sarah says
I firmly believe in the CDC schedule. My oldest child had a seizure from her DTP vaccine, which put her on a delayed schedule of sorts. I still completely followed the doctors recommendations for when and how to vaccinate her. While I was going through discussions with the pediatrician on my youngest child I told her about my concern with DTP because of my daughter’s severe (although admittedly rare) reaction. We decided to give him the components separately but keep close to the recommended schedule with these and other vaccines.
Many parents in my (largely attached parenting method) circle thought I was insane for continuing vaccines in any way with my children. However, I work in non profit (providing health care to homeless individuals) and I see how much value there is in prevention. Was it risky to allow my daughter to finish her vaccination schedule? With a trusting relationship with our doctor and an open conversation about risks and benefits my husband and I decided that her long term safety and health was leading the doctor, and after our independent research we agreed with her approach and went for it. I saw far more risk in allowing my child with a compromised immune system to enter the school system without being fully vaccinated. I also felt a deep sense of responsibility for every child who comes into contact with my children, and therefore felt it was my responsibility to protect everyone’s children by vaccinating my own.
Our decision was tough, but ultimately I believe it was the right one.
Pablo says
Pretty insightful. Thanks!
Kathy says
Great post WSS. I stuck to the schedule as recommended by our doc. However, I am also a fairly “attachment parent” type though (no circ, breastfeeding, co-sleeper, etc). Go figure.
I am not familiar with the “economic” argument for vax as suggested by the pp . Can you speak to this claim at all for us? It was my understanding that Chicken Pox was not only extremely uncomfortable (I still remember my own kindergarten, week long, feverish and itchy experience), but also rather dangerous, especially to adults. I would assume that vaxing kids has also reduced rates (and mortality) in adults.
I have yet to meet a parent who is choosing to skip vaxing who is also an unvaxed person — I find that a little ironic.
Jenny says
I had both my kids vaccinated according to the CDC schedule. While there were a lot of scary claims floating around linking vaccines to autism, we tried to read as many different viewpoints as possible on the subject, asked as many questions as we could and made our decisions based upon logic instead of emotion.
I must admit that I felt a lot better when I asked a good friend, who was a scientist working part-time in the health field and one of the most reasonable people I know, about her thoughts on vaccinations. She felt that it made complete sense to havie her kids vaccinated according to the CDC schedule. I might add that this friend was also very much an “attachment parenting” type, so I think the stereotype that these types of parents are anti-vaccine is quite untrue.
Because of this, I wholeheartedly agree with your statement that focusing on the parents who DO follow the CDC schedule is just as important as focusing on those who DON’T. I’m sure we would have decided to follow the schedule even without my friend’s input, but having her confidence in the schedule played a huge role in putting my mind to ease about vaccines.
DK says
I don’t follow the CDC schedules and i’m not the one that needs educating. Most doctors have been consumed by medical school propaganda not really based on science. There have been very few long term studies that have proved vaccine safety, and to claim they are safe right now is pretty silly considering they are full of known toxins which have pretty much not been studied for long term effects. There have been no major studies on aluminum for example, the government just said it would be too expensive, so we are just supposed to trust it is “safe” even though it is a known toxin. If vaccines are so safe I would love to know why the government feels the need to shield the drug companies from liability, while at the same time the supreme court has rejected lawsuits against the same companies on the grounds that vaccines are unsafe by design. It seems pretty clear the people at the top understand the real risks.
Then there is the issue of thousands of common reports that are generally ignored and minimized by doctors – such as if you read autism reports on the web you will found a huge amount of mothers report their children had a vaccine shots, followed by seizures, followed by autism symptoms – yet when those mothers tell the doctors that, the doctors ignore it since it’s against their religion to challenge the medical establishment and to suggest vaccines might have safety issues. Instead the drug companies have spent millions in marketing dollars to debunk one poorly done autism study – as if debunking a study means a drug is safe when the very real evidence shown to doctors everyday, shows otherwise.
Stardancer says
I just wanted to say I appreciate this discussion, and have chosen to vaccinate my child on an alternative schedule. DK raised many of the concerns I have had with vaccines, the main ones being cytotoxins, or chemical adjuvants indicated as being helpful to speed up the body’s response to the vaccine on the CDC website, despite the complete lack of research supporting such a stance, and the majority of research showing cytotoxins like aluminum posing threats to the neurological system. The other involves aborted fetal cell lines being used to generate vaccines…a mainly ethical and religious issue for me. My main reason for choosing to vaccinate at all is centered on possible travel to Mexico later on, with part of my husband’s fam residing in Mexico. I am taking my 3 month old daughter in for her first shot today, and we are discussing an alternative schedule with our pediatrician.
As a highly educated individual graduating with a Masters degree in a helping profession, I find the dimunitive way in which pro-vaccine people refer to or discuss anti-vaccine people particularly offensive, when a study out there has shown many anti-vaccine parents are actually highly educated individuals who came to such conclusions after extensive research, while pro-vaccine people were often not as highly educated or of a low socioeconomic status that is often not quick to challenge the medical authorities! There is a reason why! They read the research and think outside the box of the CDC, and there are many risks involved.
We need to get away from the linear thinking that equates vaccines with guaranteed wellness. There are multiple factors, and vaccines are not for everyone! Factors like proper nutrition, congested population density, environment, lifestyle, and the overall quality of one’s medical system in their respective country are all worth consideration. For example, a polio vaccine administered orally in Nigeria had caused an outbreak of polio in the children there, since there is an issue of malnourishment present. Check it out if you don’t believe me.
That being said, due to the change of environment and population exposure involved with international travel, I am choosing to vaccinate my daughter on an alternative schedule. And for pro-vaccine people who say I am putting their children at risk by doing so, I say: we are not standing in a pasture like cattle, and don’t believe the hype. So much of the medical literature and media is centered on fear, and fear is subjective–but fear is also not a means to an end. Some things require faith, and your own collective reasoning as a parent. By seeing how many threats there are in the US to parents’ rights to choose whether or not to vaccinate, one can only wonder. Especially with Gulf War Syndrome being connected to forced anthrax vaccines administered to US troops. But to each their own. Choose your side on the issue, and know that no matter what, a parent will not intentionally choose to harm their child–pro-vaccine or not!
rachel says
Having moved here from the UK I find the vaccination schedule very confusing. The schedule is different in the UK and,we now have a ton of vaccines to implement before school. At home we don’t vaccinate against hep b or chickenpox (my kids have had chickenpox but I have no proof as they didn’t visit the doctor) and I’m not sure why hep b is necessary for kids living in middle class suburbia? Pre school vaccinations are given at the age of 3 in the UK but here school requirements are that they have to be given after the age of 4 so I need to give another round. I’m not convinced that all these are necessary, I feel like I’m just ticking boxes to get her into school – can you reassure me otherwise?
Wendy Sue Swanson, MD, MBE says
I do think Hep B is important, even in suburbia.
Read this:
https://www.chop.edu/service/vaccine-education-center/a-look-at-each-vaccine/hepatitis-b-vaccine.html
And in regards to the numbers and the times and the conflict in schedules btwn US and UK, I’m certain it is not only confusing but overwhelming. I would suggest you talk with your child’s pediatrician in more length. I really think we are afforded opportunity here with vaccines early in our children’s lives to prevent and avoid infections.
Should be noted: if your child has had chicken pox NO NEED for vaccine.