What’s the harm?

Thad Woodard, MD, has practiced pediatrics in Anchorage for more than 30 years and produces/hosts “Line One, Your Health Connection” on the Anchorage National Public Radio affiliate, KSKA. He, his wife and four daughters are fully immunized, including against shingles and yearly influenza.

Vaccine hesitancy and alternative vaccine schedules

By Thad L Woodard, MD

It was December, 2012 and 7-year-old New Zealander Alijah Williams was not playing outside as he was days earlier when he cut his foot. He was in Auckland’s Starship Children’s Hospital suffering violent muscle spasms, spasms causing his back to arch severely, spasms so severe that in others have caused bones to break, spasms so severe that his physicians paralyzed him and induced a three-week coma to control them. Alijah had tetanus.

The bacterium that causes tetanus is a common resident of soil and the human intestinal tract. It‘s hard to avoid exposure, but very easy to prevent this illness through routine vaccination. Alijah’s parents chose not to provide him one of our oldest and best vaccines — the tetanus vaccine. They researched the issue of vaccines and believed they were making the proper decision. They now admit they were wrong, did not do enough research, did not know enough, did not trust the experts. As a result Alijah came close to dying of tetanus, which kills one in 10 who gets it. You can read Alijah Williams’ full story here.

Alijah’s parents are intelligent and educated, but despite their own scientific background and research (or perhaps because of it), they were wrong not to immunize their son. Like them, we all commonly make mistakes in judgment. Science is revealing why. To begin with, we have the illusion that we are smarter and know more than we really do. In addition, as TV journalist Andy Rooney put it, “People will generally accept facts as truth only if the facts agree with what they already believe.” Psychologists call this phenomenon cognitive bias. This is why, even when presented with overwhelming evidence, we sometimes refuse to change our minds.

Another reason for errors in judgment is that the human mind is innately weak at evaluating risk since personal accounts influence us more than evidence. A story about a rare occurrence, say a vaccine reaction, whether true or not, will often trump well-established facts, such as the fact that serious reactions to vaccines are very rare and much less common than the diseases they prevent.

Misinformation can also cloud our judgment. For example, the public was misinformed by Dr. Andrew Wakefield’s fraudulent study linking the measles/mumps/rubella vaccine to autism. After numerous large, well-designed studies, it has been established that there is actually zero known risk of autism from any vaccine, yet the misinformation continues to impact people’s decisions.

Finally, we burden ourselves with the consequences of action (giving a vaccine) more than the consequences of inaction (not giving a vaccine) even when, as in Alijah’s case, the risk of inaction (potentially life-threatening illness) is unquestionably greater.

Health authorities around the world recommend childhood vaccinations starting about six weeks of age (as well as at birth to prevent hepatitis B), before protective immunity acquired from a mother’s antibodies wanes, and before exposure to the diseases that are being prevented. In our country recommendations are developed by The Advisory Committee on Immunization Practices (ACIP), consisting of experts in vaccinology, immunology, pediatrics, internal medicine, nursing, family medicine, virology, public health, infectious diseases, preventive medicine and a consumer. These appointed volunteers convene three times a year in meetings open to the public and available via webcast to re-evaluate the risks of getting vaccinated versus the risks of not being vaccinated, taking numerous factors into account. They also evaluate the best ages to give vaccines in order to achieve maximum effect and to give the best protection. Current vaccines safely and effectively prevent deadly illnesses like tetanus, diphtheria, whooping cough (pertussis), measles, polio, influenza, hepatitis A and B, meningitis, rotavirus, chicken pox (varicella), shingles and, most recently, cervical cancer. Another misconception is that all these vaccines overwhelm our immune system, but just think about it. Every day our immune system is interacting with more bacteria just in our intestines than we have cells in our body. Reacting to our current vaccines is a very tiny fraction of the daily work of our immune system.

Vaccines must be clearly safe and effective to be included in the childhood series, and newer, safer and/or more effective vaccines are often developed to replace older ones and to combat additional illnesses. If the risks of a vaccine are deemed too great, authorities recommend withdrawing it (for example: smallpox vaccine is no longer recommended as this vaccine successfully eradicated the disease, making even minimal vaccine risk unacceptable) or substituting a good vaccine with an even safer one (live polio vaccine is no longer routinely used in the United States due to a less than one in a million risk of vaccine causing polio in certain susceptible individuals, so a safer inactivated polio vaccine is now used).

When asked if they are going to have their children vaccinated some parents say that they intend to but they are going to use an alternative schedule that deviates from the recommended guidelines. When asked what alternative schedule they are going to use, rather than the one recommended, they respond that they are choosing the one Dr. Bob Sears recommends, or one a friend or someone on the internet recommends, or a schedule they conclude is better – none of which provide evidence of safety and efficacy. In fact the evidence is that any of these schedules increases the risk of infection to vaccine preventable illnesses primarily because they delay the vaccines during the time the risk of illness is present.

Alijah’s parents, despite their own research, scientific background, and best intentions, were not sufficiently trained to evaluate all the information available to make the best decision. As a result, they overestimated their knowledge and underestimated the risks. They acknowledge their mistake and now work to prevent others from a similar error. Their error is not unique and concern about vaccines is not new. In the 1700s, Benjamin Franklin wrote pamphlets against the use of that era’s smallpox vaccine, but then one of his sons died of smallpox. His autobiography reveals his remorse and wisdom, wisdom that still guides immunization recommendations today.

It is in our nature to deny evidence if it doesn’t fit prior belief. When our minds close to new information, we are prone to make errors in judgment. By recognizing and accepting that our minds are imperfect, by being open minded, we can learn, we can change and we can make better decisions. The current US immunization schedule is safe, effective, proven and recommended because no other schedule is safer or more effective in protecting children.