Today we are going to talk a little bit about celebrity pediatrician, and public health nuisance, Dr. Bob Sears. Even if you don’t know Dr. Sears by name, you know him by his most famous work to date: the alternative vaccine schedule. Though there are certainly other alternative schedules out there, Dr. Bob has become almost synonymous with the idea of delaying (even avoiding) some childhood vaccines.
In 2007, Dr. Sears published The Vaccine Book: Making the Right Decision for Your Child. In it, Dr. Sears attempted to address the concerns parents of young kids have about vaccines. In fairness, the book does contain a some accurate information on the recommended vaccines and the purpose for these vaccines. What Dr. Sears also devised in his book was the “alternate schedule” which he describes as “getting fewer shots at each infant checkup and spreading the shots out over more time.” According to Dr. Sears, kids should not get more than 2 shots at any one time and the recommended shots can be given at much later than the traditionally recommended dates. So for example, the recommended age (recommended by the CDC and AAP) for the first dose of the measles-mumps-rubella vaccine (MMR) is twelve months. But Dr. Sears says its ok to wait until the children are in school before getting MMR. He figures: what’s the likelihood they’ll come in contact with the diseases before then?
I know what you are thinking. So what? At least these kids are getting vaccinated or sort of vaccinated. A little vaccinated?
Here’s the problem. The schedule that the CDC recommends that we follow was based on recommendations from a panel of medical and public health experts called the Advisory Committee on Immunization Practices (ACIP). In order to develop recommendations for each vaccine, ACIP meets regularly throughout the year to review data on new and existing vaccines, and considers, among other things:
- The safety and efficacy of vaccines when given at specific ages
- The severity of the disease that the vaccine is aimed at preventing
- How many children get the disease if there is no vaccine
- The differences in how well vaccines work at different ages
Notice something? In recommending a vaccine schedule, these experts take timing and age into account. It’s not a random coincidence or what-the-hell approach to have so many vaccines given before age 2. Nope. There’s actually a really good reason. When a baby is born, she emerges into the world protected by the mother’s antibodies against some diseases. A infant born to a mother vaccinated against measles will have some antibodies to these diseases at birth — that is, for a time being after birth the baby is protected against disease just because of a vaccinated Mom.
But as time goes on, the baby loses it’s inherited immunity. By the time babies are 6 months old, 99% of them (born to vaccinated moms) will have lost all maternal antibodies to measles. (The number is similar for children born to mothers with natural immunity — ie., Mom had measles at some point). The CDC recommends the combined MMR vaccine between ages 12 months and 15 months. Why that age? Well, it turns out that the vaccine is not proven to be maximally effective in kids younger than 12 months. So, the recommendation is based on the scientific data showing the earliest and most effective (and safe) time to give the MMR vaccine.
Dr. Sears, on the other hand, made his schedule up. Out of thin air. It is not based on anything — no research, no studies, no meeting of great, well-trained medical minds. It’s his invention. It is not based on the best way to get your child protected from serious disease. Dr. Sears says its ok to wait until your child is age 3 or older to get a measles shot (he also says you should request three separate shots rather than the combined MMR, and does so, once again without an iota of substantiation). Why? Because Dr. Sears is betting on the fact that a lot of other people are responsible and vaccinate their children according to the recommended schedule. He fully recognizes that vaccines work and are the reason for our country’s low rate of disease. And because of this — because of vaccines — he can tell his individual patients, Hey, its ok for YOU not to vaccinate. I mean, so long as everyone else pretty much does.
He’s kind of a genius in this regard. He gets to be this nice, understanding doctor who has been elevated to near-hero status among the anti-vaccine movement by standing up to the CDC, the AAP, and mainstream medicine. He reaffirms unfounded patient fears about vaccine safety by providing a made-up schedule based on avoiding those same unfounded fears. And so far, he can get away with it, without causing a massive public health crisis because of you and me and everyone else who does vaccinate on time. He’s freeloading. Riding the immunization wave around him. Letting his patients assume — wrongfully — that their kids will be protected from diseases because their friends and neighbors are vaccinated. To convince people that his schedule is safe, he even goes so far as to downplay the seriousness of diseases like measles.
All of which makes Dr. Sears’ advice not just irritating but also bad medicine. Measles is a actually a very contagious disease — if one person has the disease, 90% of people who are exposed and not vaccinated will contract the disease. In the school district in which Dr. Sears’ office is located, almost 10% of kindergarteners had personal belief exemptions (compared with a state average of roughly 3%). The 22 measles cases Dr. Searss’ area this year? All of them started with unvaccinated travelers to other countries who brought the disease back to a bunch of unvaccinated kids.
See what happens when people buy into your advice, Dr. Sears? Children get sick. Sometimes very sick. I don’t blame the parents who follow your advice — you’re a doctor. A pediatrician. You should be someone they can trust.
But I would venture to guess, that sooner or later, your misleading advice to parents that not vaccinating is a “safe enough choice” is going to come back to bite you in the —