Flexible Approach to Vaccinations Comes Under Fire

Pediatrics journal airs only one side of a complex debate.

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The American Academy of Pediatrics rolled out its new immunization schedule for kids in its latest issue of the journal Pediatrics , released today. The big change for this year is a new recommendation for an annual flu vaccine for all kids ages 6 months to 18 years—which follows the new guidelines of the Centers for Disease Control and Prevention.

Along with this policy statement and numerous research papers, the journal contains a "special article" that quite frankly shocked me for its one-sided treatment of a very important issue with regard to vaccinations. The article is an attack on doctors who take a flexible approach to vaccinations, working with parents who, say, don't want their 2-month-old to get vaccinated against eight different diseases at once, which is what's recommended on the AAP schedule.

It targets one particular pediatrician, Robert Sears, who described several alternative approaches to vaccination in a popular consumer book called The Vaccine Book: Making the Right Decision for Y our Child. Sears calls for spacing out some vaccinations by adding office visits and delaying some shots until a child is older. More controversially, he also has a plan for those who may want to skip some immunizations, such as the chickenpox vaccine. I spoke with Sears for this parents' guide to managing vaccinations.

Unfortunately, instead of allowing a pro-and-con debate about the benefits and drawbacks of pediatricians working with parents who wish to have some flexibility, the Pediatrics journal editors chose to feature just one side of this debate. The authors of the special article take a firm stand against allowing any deviation from the current vaccine schedule, arguing that in offering a middle ground, Sears is sending "antivaccine messages."

What's worse, the lead author, Paul Offit, who heads the vaccine education center at the Children's Hospital of Philadelphia, clearly has a conflict of interest. He's one of the patent holders of RotaTeq, a vaccine against rotavirus that's on the AAP's vaccine schedule. That means he stands to lose money if parents shun RotaTeq.

Offit, who didn't respond to a request to be interviewed late last week, lays out his valid concerns with Sears's book, and, as a widely respected expert in the vaccine field, his opinions deserve some attention. But he also fails to acknowledge any flaws in the government's system of monitoring adverse effects or the scarcity of good research studies that doctors could use to predict which patients may be vulnerable to adverse vaccine reactions. A host of government officials admitted there's a real need for more vaccine research, as I noted in a recent article that scrutinized vaccines.

This makes me wonder why Pediatrics chose to include this volatile paper as a stand-alone article rather than as part of a debate over what doctors should do to increase vaccination compliance. In an E-mail exchange, Sears told me he submitted a request to respond in the next issue of the journal but hasn't yet heard back from the editors. He also takes issue with Offit's slapping the "antivaccine" label on his book. Sears wrote:

The Vaccine Book is very pro-vaccine, and I believe that Dr. Offit has greatly misrepresented the book as anti-vaccine. He selectively quotes areas of the book that discuss some negative aspects of vaccines or some parental worries about shots, without revealing the pro-vaccine ideas I also share in such areas to give a BALANCED viewpoint from both sides. The vast majority of criticism I have received on the book has come from ANTI-vaccine activists who were hoping I'd come out against vaccines. That tells me I'm doing my job correctly.

You can read Sears's full rebuttal on his website.

Offit makes the argument that allowing flexibility will reduce the proportion of kids who get fully vaccinated, while Sears argues that parents will be driven away from vaccinations altogether by inflexible doctors. (For its part, the CDC recommends that doctors work with parents who wish to deviate from the schedule in an effort to get children as fully immunized as possible.)

So, which is better: a one-size-fits-all approach or a flexible one? That's a question I wish the journal editors had decided to address in a full-fledged debate.