Vaccine Schedule: This Doctor Supports a Flexible Schedule

• Lawrence D. Rosen, vice chair of the American Academy of Pediatrics's section on complementary and integrative medicine, spoke with U.S. News about his views supporting flexible scheduling of childhood vaccinations. The following is based on an interview with him.

Dr. Lawrence Rosen

My main argument for supporting a flexible approach is that it is more likely to increase overall vaccination rates at a time when were are seeing a critical drop in public trust in government agencies, like the Centers for Disease Control and Prevention, that set the recommended schedule. Already, decreases in some areas in vaccine coverage may have led to measles and Haemophilus influenzae type b (HiB) outbreaks. Flexible schedules encourage parents who would otherwise not have their child vaccinated at all to come in for regular well care and get started on some vaccinations. I've seen parents who haven't taken their kids to the pediatrician for two or three years because their vaccine beliefs were ridiculed or they were told they're going to kill their child. These are families who have checked out of the system and who probably won't come back without some flexibility.

I encourage parents to really talk to me about their vaccine concerns and believe they should take an active role in partnering with their pediatricians when considering the risks and benefits of vaccination. Most become more willing to vaccinate after we have these conversations and they see that I'm willing to work with them.

I understand my views are in the minority among pediatricians, but I don't believe we should take a one-size-fits-all approach to vaccines. I might feel reluctant to give the same vaccines to a premature baby with terrible reflux and eczema (because of potential differences in her immune system), as I would to a healthy 6-month-old. We must take into account individual health differences, and I would consider such things myself if I had a newborn baby today.

I think there are still unanswered questions regarding vaccine safety and efficacy. While vaccine trials and the government's current system for monitoring adverse events are set up to look for acute problems that occur shortly after vaccination, they are not equipped to look at long-term chronic health effects like asthma and allergies. We're seeing a huge increase in these problems, yet we've never had a study to compare vaccinated with unvaccinated kids to see if there are any differences in health outcomes.

Additionally, I think we're starting to see that all vaccines are not created equally. Preventing predominantly deadly diseases like HiB, pneumococcal meningitis, and pertussis must take priority over requiring chicken pox and hepatitis B vaccines for all children at young ages. Data now suggest both varicella and hepatitis B vaccine immunity wears off in a significant portion of adolescents vaccinated in infancy. Perhaps these vaccines should be offered later in childhood and not mandated for school entry. And I'm not certain the scientific data really support mandatory flu vaccination for preschoolers in New Jersey.

The Hannah Poling case shows clearly that it's plausible for certain children—even if we're just talking about a minority—to develop problems from multiple vaccinations given at the wrong time in the wrong clinical setting. I am also intrigued by a Canadian study that found that babies who had their first DTP vaccine (the whole-cell version which is no longer used) at 4 months wound up with half the rate of asthma as those who were vaccinated at 2 months. We can't draw firm conclusions from a single study or case report, but they both suggest to me that maybe there's more to this than we think. Asking these questions does not mean I am antivaccine: I very much support vaccination as a public health measure. But I am also for the safest, greenest vaccines we can have.

—Dr. Lawrence D. Rosen
Vice chair, Section on Complementary and Integrative Medicine
American Academy of Pediatrics
Pediatrician in primary care practice in Oradell, N.J.

• See the other side of the debate: Dr. Margaret Fisher arguing against a flexible schedule