Vaccine Schedule: This Doctor Argues Against a Flexible Schedule

She sees no reason to leave any child unprotected against a vaccine-preventable disease.

  • Margaret Fisher, chair of the American Academy of Pediatrics's section onf infectious disease, spoke with U.S. News about her views opposing flexible scheduling of childhood vaccinations. The following is based on an interview with her.

I don't see any logical rationale for it. We haven't found any problems with the standard schedule, and every vaccine we administer protects your child from a harmful infectious disease. There was a lot of research involved in establishing this schedule endorsed by the American Academy of Pediatrics, the American Academy of Family Physicians, and other medical organizations. Parents who deviate from it are choosing to err on the side of unknown health risks against actual proven benefits.

The other problem I have with a flexible schedule is deciding which vaccine to skip or delay. Should I leave your child susceptible to measles or pertussis? What if we suddenly have a mumps epidemic, and I told you it was OK to delay the measles-mumps-rubella vaccine until kindergarten? If I were to allow parents to create their own vaccine schedules, I would be allowing them to use something that hasn't been tested for efficacy or safety. The current schedule has been. There's no evidence that getting five shots at once is risky. Many parents may have heard about Hannah Poling [who won a Vaccine Court settlement when she developed autismlike symptoms after receiving multiple shots] and think that her case proves that getting many vaccines at once is dangerous, but I don't think court cases should give us our science.

And let's consider the science. The hepatitis B vaccine given to newborns prevents transmission of the disease from mother to baby. Now most babies won't be exposed to this blood-borne infection, but when we stopped giving the birth dose in 1999, we saw an immediate increase in neonatal infections due to failure to adequately screen the mother for the disease or a failure to communicate the results and get her baby vaccinated immediately. So while many babies probably could safely wait, it would be bad public-health policy to delay, given the cost of treating infected newborns. A delay in the rotavirus vaccine also doesn't make sense since the greatest chance of severe dehydration from this diarrhea-causing disease is during infancy. And while diphtheria and tetanus are extremely rare in this country, pertussis is alive and well in most of our communities, and it's a nasty and sometimes lethal disease—so babies really need that diphtheria-tetanus-pertussis vaccine.

With this in mind, I can't come up with a reason, in my heart of hearts, for why I want to leave children unprotected from any vaccine-preventable disease. There are no vaccines that I would tell parents it's OK to skip or delay.

Margaret Fisher
Chair, Section of Infectious Disease
American Academy of Pediatrics
Medical director of the Children's Hospital at Monmouth Medical Center in Long Branch, N.J.

Corrected on : Clarified on 2/02/09: An earlier version of this article omitted the first paragraph introducing Margaret Fisher.