As many people know, I believe vaccination is something every family should educate themselves about and make the decision that best fits their family beliefs, needs, and history. I don’t believe that there is a one-size-fits-all answer to the question of vaccination because I simply can’t tell a family with a history of severe allergic reactions to suck it up and risk their child’s well-being for the greater good. I also know that I myself have questions about vaccines – for example, can we identify people most at risk for severe reactions and can we do more research on the adjuvants please? – so how can I ask others to not ask questions. But asking questions and asking for more research is not akin to saying “don’t do it”. Most people I know vaccinated on schedule and fully and have no regrets on their decisions. I know people who have family histories of severe reactions and so opted not to vaccinate (sometimes after their first child had severe reactions) and I know people who have family allergies to ingredients in vaccines and opted to wait to get their child tested for the allergy before doing vaccines. I also know those who have read the research, spoken to health professionals, and decided to forego vaccination altogether. The one thing that the people I know have in common is that they all are well-educated on the topic. They didn’t go to sites that promote “quack” theories, etc., but did their research from credible sources and came to a conclusion. It may not be mine or yours, but they were certainly educated about it and considered their own family variables in the process.
But not all people do that. In a time when fear runs rampant and numerous anti-vax sites exist that are not based on research, people can end up reading information that is based on fear, not facts; I have also seen pro-vax sites and individuals make claims about vaccination that isn’t supported by research, but instead also is based on fear. What I wish we had was an unbiased place where we could really summarize what we know and what we don’t know and just leave it at that so families can make their decisions. (Better yet, I wish all the research was being done on questions that parents want to know the answer to, but sadly it seems that won’t happen anytime soon.) However, there are resources that are offer good, solid information which I will share here (if you feel I’m missing something feel free to email me and I will look it over and add it if I feel it is worthwhile). What you conclude based on that information will be up to you.
The Center for Disease Control (CDC): Offers lots of research-based information on vaccines, vaccine efficacy, and side effects for vaccines. They also have a Q&A section for certain vaccines where they are quite honest about interpretation of the findings. For example, although many people believe the higher peaks in Whooping Cough are due to non-vaccinating individuals, the CDC argues that it is actually due to the switch to the DTaP vaccine which is acellular and does not carry the same length of protection as the previous whole-cell vaccine. Thus the issue is that people are not getting boosters yet they actually need them to protect themselves and those younger who are not protected. (You can read on the acellular waning times here.)
Cochrane Collaboration Reviews: Considered the best systematic reviews on any topic they look at, they examine vaccine efficacy across all studies that meet criteria. Their criteria tend to be quite strict (which is good) but it means they will examine fewer studies or be clear about the poor methodological quality of studies, as they have shown with respect to Hepatitis B vaccination. Anything you read here will be clear and up front about the quality of studies, the outcomes, and how applicable the findings are.
World Health Organization (WHO): The WHO is incredibly pro-vaccine and offers a lot of research to back their view; however, the quality of research is not always considered as stringently as it is for other sources. They will cite papers that the Cochrane reviews would not due to lower methodological qualities; for example, Hepatitis B vaccine at birth is widely promoted by the WHO whereas the Cochrane Collaboration has concluded that the evidence for mass vaccination for Hepatitis B is of very poor methodological quality and high quality studies are mixed. However, they focus a lot of their vaccine work in developing nations with very high rates of disease and where the risks of vaccination are far less than the risks of disease.
Project Tycho: From the University of Pittsburgh, this is a compilation of health records from 1888 to the present from the USA. You can search for diseases pre- and post-vaccine, rates relative to vaccine refusal rates, etc. Now, you can’t necessarily interpret the data in only one way (and in fact you will need to be careful not to make causal conclusions based on the data because it cannot account for things like 3rd variable problems), but you can at least get some hard numbers.
Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver by Arthur Allen. Less a guide for parents and more a history of vaccines in the USA with all the political and financial issues surrounding vaccination programs, this book is one for people who truly want to understand the history of vaccines (as the majority of the book focuses on the first efforts). Mr. Allen also discusses the very crux of the vaccine debate: How do you ask parents to put their child at risk for the greater good?
Vaccine Safety Research, Data Access, and Public Trust by the US Institute of Medicine. If you prefer your information in book-form, this is a summary of some of the CDC data that you can access online.
Polio: An American Story by David M. Ochinsky. Basically a verbal documentary of the fear caused by polio in the United States, the fight to find a cure and vaccine, how disease has been and is portrayed in the United States, and also the real truth about what polio was: a rare, but serious disease that somehow led to fear and myths about its preponderance.
Vaccine A by Gary Matsumoto. Not anything related to the childhood vaccines that dominate discussions of parents today, but this is a rather disturbing look at how US Army has served as guinea pigs for new vaccines, specifically one that is implicated in Gulf War Syndrome. It is one research journalist’s work and take, but definitely offers food for thought that many might find interesting.
Schedules by Country
If you are thinking of an alternate schedule, these are the schedules of different countries. I know in the USA there is a big push to follow the US schedule, but as many families are not comfortable with it, looking at the schedules in other countries may provide either reassurance or ideas for an alternate schedule that is also based on the research out there (and can highlight the potential arbitrariness of a given schedule, though some decisions are based on country-specific factors).
One thing that is rarely, if ever, discussed as an alternate to schedules is the use of titers. A titer, in brief, is a measure of how many antibodies we have in response to either exposure to a virus or from a vaccine. This can tell us if a given vaccine has been effective in having our body produce the antibodies needed to fight off infection. As many know, one of the concerns people have about vaccines is that they are not 100% effective. Using titer tests, individuals may discover that one shot is enough for them to have developed an antibody response or they may need more than the recommended dosage in a vaccine schedule (for example, one friend reported that her husband needed four shots to obtain an appropriate antibody level for a particular vaccine).
The cons of using titers include more blood work, more needles (because of drawing blood), and cost if it is not covered by your insurance. Titers also do not address some of the other concerns parents have about vaccines. However, the pros are potentially fewer vaccines and an awareness of the efficacy of a given vaccine for your child and the other members of your family (if you are considering getting boosters while pregnant or when your baby is young). In line with research on the efficacy of vaccines, typically 6-8 weeks or so is needed after a vaccine to do a titer test so this may delay the vaccination schedule (talk to your doctor or the lab where titer testing will be done to determine the exact interval needed for a particular vaccine/test). Some doctors may not want to do this, instead preferring to stick to the set schedule. This is something you will have to discuss with your doctor or find an alternate way around if this is something you’d like to do. Note that getting the tests is generally quite do-able as many people need these tests to prove immunity in certain fields of work, like nursing.
Note that people who want to use titer tests are not “anti-vaccine”. They are anti-unnecessary-vaccines and may end up taking more vaccines than recommended in order to get a sufficient immune response. It is a personalized view of vaccination instead of a mass one, and as such, it actually requires more visits, more tests, and more time. It won’t be for everyone, but it may be something some families are interested in exploring.
Contrary to some beliefs, there are real scientists who question vaccination as it is currently done, or question the safety testing, or question specific vaccines. They are not “anti-vaccine”, but rather skeptical of various issues in current vaccination programs. Instead of looking to sites that pedal in fear-mongering, if you are interested in reading the other side, you should be reading it from people who have been there and been knee-deep in the research and science. There is a great article here that summarizes the views of some very prominent vaccine-skeptics including Dr. Bernadine Healy, former head of the National Institute for Health, Dr. Walter Spitzer, professor of epidemiology at McGill University and former chair of the department (now deceased), and Dr. Peter Fletcher, former chief scientific officer at the United Kingdom Department of Health. None of them are against vaccines, but as Dr. Healy has mentioned, we need to try to identify those who are most vulnerable to the effects of vaccines and work to make them as safe as possible, and sadly that is something that is being pushed against by the current “powers that be”.
Taking Risks and Changing Minds
For many parents, the risk of a side effect is what detracts them from vaccination. We must remember that as parents we take risks regularly and vaccines are no exception. As Katie Hinde (Harvard professor and creator of the awesome blog Mammals Suck – go read it) said to me when chatting about the subject of vaccine risk, “We still put our kids in cars despite the risk of car accidents.” We cannot guarantee our children will not be hurt by vaccines; however, based on statistics, the likelihood is very small, like getting into a car accident – it can happen, but it’s highly unlikely. Most people will live their lives without ever being in a serious car accident, but some will, even through no fault of their own, and the same risk is there for vaccine injury but the question families have to ask is which risk they are willing to take: That of the disease or that of the vaccine. Now, as I responded to Katie in our discussion, “Exactly, and it’s why we also need to respect that some people are at higher risk through family histories or known reactions, kind of like how we wouldn’t put our kid in the car with a drunk driver because the risk is substantially higher.” This is why I personally believe that families need to take their own situations and histories into account when making a decision, but these decisions should also be based on the evidence we have, not fear.
So please, go out and educate yourself. If only so that when someone asks you why you made your decision, you can feel confident about the answer you give.