Category: Vaccine Education

Which Vaccines Need to be Refrigerated?

Vaccines have to be stored properly.

Mostly that means that they must be kept at a proper temperature, not getting too hot or too cold, “to protect quality and potency” of the vaccines.

While that can be a challenge in some parts of the world, as they go to great lengths to maintain the cold chain for vaccines, in developed countries, it typically means knowing whether to put the vaccine in the refrigerator or the freezer.

Even in the most industrialized city, a power failure can happen or someone can just unplug the refrigerator by mistake.

Which Vaccines Need to be Refrigerated?

Post a list on your refrigerator so that you don't put vaccines in the fridge that should be frozen.
Post a list on your refrigerator so that you don’t put vaccines in the fridge that should be frozen.

While some vaccines are stored frozen, most must be refrigerated.

Vaccines that are kept refrigerated should be stored in a vaccine refrigerator at a temperature between 36°F and 46°F (2°C and 8°C), with a target of 40°F (5°C).

Of available vaccines, those that must be refrigerated include:

  • Hepatitis A
  • Hepatitis B
  • Hib
  • Gardasil9 (all HPV vaccines)
  • influenza (all flu vaccines)
  • IPV (polio)
  • Menactra, Menveo, Bexsera, Trunembra (Meningococcal)
  • MMR*
  • Prevnar 13, Pneumovax (Pneumococcal)
  • RotaTeq, RotaRix (Rotavirus)
  • Pentacel, Pediarix (all DTaP containing vaccines)
  • Tdap (Adacel and Boostrix)

*The MMR vaccine vaccine can be stored in a freezer or a refrigerator.

Making things a little more confusing, refrigerator stable versions of Varivax and ProQuad, which are usually stored frozen, are also available. They have a shelf life of 24 months when refrigerated, but may also be stored in a freezer.

What do you do if something goes wrong and your refrigerated vaccines have gotten too warm or too cold?

“If you find that a vaccine has been exposed to an inappropriate temperature, determine the reason for the temperature alteration, mark the vaccine “Do Not Use,” and contact the manufacturer or the state or local health department to determine if the vaccine can be used.”

Immunization Action Coalition on Ask the Experts about Vaccine Storage and Handling

Getting educated about proper vaccine storage and handling can avoid many incidents and help you be well prepared if something does go wrong. Once you are all set up and ready to store your vaccines, you just have to know where to put them.

What To Know About Storing Vaccines in a Refrigerator

Vaccines must be kept at a proper temperature, not getting too hot or too cold, “to protect quality and potency” of the vaccines.

More About Storing Vaccines in a Refrigerator

Strategies for Increasing Childhood Vaccination Rates

How do we improve vaccination rates?

A very clever immunization reminder system for parents.
A very clever immunization reminder system for parents.

One way is to help parents get educated about vaccines, so that they understand that vaccines work, vaccines are safe, and that vaccines are necessary.

Strategies for Increasing Childhood Vaccination Rates

Vaccine-hesitant parents who might delay or skip some of their child’s vaccines aren’t the only reason vaccination rates aren’t where they should be though.

“Immunization levels in the United States are high, but gaps still exist, and providers can do much to maintain or increase immunization rates among patients in their practice.”

CDC on The Need for Strategies to Increase Immunization Levels

How do we fix these gaps in immunization rates?

Some easy things to do that can help increase vaccination rates might include:

  • regularly posting vaccine education material on your social media accounts
  • maintaining a good supply of vaccines
  • reminding parents to bring their immunization records with them to each appointment, especially if they are new patients
  • keeping accurate immunization records on each patient
  • carefully recording vaccines that have been given outside your office
  • using an immunization information system or immunization registry to make it easier to keep track of immunization records
  • generating lists of patients who’s vaccines are past due
  • using reminder and recall messages, either phone calls, text messages, or postcards, etc., so that parents are notified when vaccines are due soon or past due
  • using an electronic health record system to automatically generate prompts when vaccines are due at well visits and sick visits
  • manually reviewing your patient’s vaccination status at each visit, whether it is a sick visit, well visit, or just a nurse visit, to see if they need any immunizations. Remember, a mild illness is not usually a contraindication to getting vaccinated.
  • reducing missed opportunities to vaccinate kids by using standing orders and “nurse only” or “shots only” visits for vaccinations
  • having extended hours for some scheduled or walk-in vaccination clinics
  • enrolling in the Vaccines for Children program to provide free vaccine to families who are uninsured

And most importantly, office staff need to get educated about vaccines too, especially about the anti-vaccine talking points that might keep some kids from getting vaccinated on time. They should also understand the immunization schedule and catch-up immunization schedule, so they can easily recognize which vaccines are due.

“Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine.”

Sturm et al, on Pediatrician-Parent Conversations About Human Papillomavirus Vaccination: An Analysis of Audio Recordings

Pediatricians who are getting frustrated talking to parents who have been refusing vaccines might also learn a few new things, including how to use presumptive language.

What is presumptive language?

In the HPV vaccination study quoted above, it was defined as “a matter-of-fact statement that the child was due for or would receive HPV vaccine that day or at a future date, conveying a positive stance toward vaccination.” This is in contrast to a nonpresumptive style that “involved questions or uncertainty,” such as “do you want to get a shot today?”

“High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them.”

Gilkey et al, on Provider communication and HPV vaccination: The impact of recommendation quality

In addition to using presumptive language, another study has found that “By endorsing HPV vaccine highly, recommending same-day vaccination, and emphasizing cancer prevention, providers may be able to promote HPV vaccine initiation and completion while discouraging vaccine refusal and delay.”

Can these strategies work for your office?

What to Know About Increasing Childhood Vaccination Rates

From using reminder systems and standing orders to changing how you talk to parents, there are a lot of things that can be done to increase childhood vaccination rates.

More on Increasing Childhood Vaccination Rates

Which Vaccines Need to be Frozen?

Post a note on your vaccine freezer as a reminder about the proper place to store each vaccine.
Post a note on your vaccine freezer as a reminder about the proper place to store each vaccine.

Vaccines must be stored properly.

Mostly that means that they must be kept at a proper temperature, not getting too hot or too cold, “to protect quality and potency” of the vaccines.

While that can be a challenge in some parts of the world, as they go to great lengths to maintain the cold chain for vaccines, in developed countries, it typically means knowing whether to put the vaccine in the refrigerator or the freezer.

Unless of course something goes wrong…

Did your power go out?

Or did someone leave a freezer door open?

Maybe your older freezer just stopped working?

Or maybe someone just unplugged the freezer by mistake.

What do you do if something goes wrong and your frozen vaccines aren’t frozen anymore?

“If you find that a vaccine has been exposed to an inappropriate temperature, determine the reason for the temperature alteration, mark the vaccine “Do Not Use,” and contact the manufacturer or the state or local health department to determine if the vaccine can be used.”

Immunization Action Coalition on Ask the Experts about Vaccine Storage and Handling

Getting educated about proper vaccine storage and handling can avoid many incidents and help you be well prepared if something does go wrong. Once you are all set up and ready to store your vaccines, you just have to know where to put them.

Which Vaccines Need to be Frozen?

While most vaccines are refrigerated, some must be frozen.

Vaccines that are kept frozen should be stored in a freezer at a temperature of 5°F (-15°C) or colder.

Of available vaccines, only non-Refrigerator stable Varivax (chickenpox), non-Refrigerator stable ProQuad (the combo of Varicella and MMR or MMRV), and the shingles vaccine (Zostavax) must be frozen.

The MMR vaccine can be stored in either a freezer or a refrigerator.

The only time non-Refrigerator stable Varivax and non-Refrigerator stable ProQuad can be stored in a refrigerator (36° to 46°F, 2° to 8°C), is if you are going to reconstitute and use them within 72 hours. If the vaccines have been out of a freezer, and you don’t use them within 72 hours, then they must be discarded. You can’t put them back in the freezer.

Also, a reconstituted ProQuad vaccine can be stored at room temperature, protected from light, for up to 30 minutes. You must discard the vaccine if you don’t use it within that time though. It can’t be refrozen or refrigerated.

Making things a little more confusing, refrigerator stable versions of Varivax and ProQuad are also available. They have a shelf life of 24 months when refrigerated, but may also be stored in a  freezer.

What To Know About Storing Vaccines in a Freezer

Vaccines must be kept at a proper temperature, not getting too hot or too cold, “to protect quality and potency” of the vaccines.

More About Storing Vaccines in a Freezer

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Six People Who Should Be Vaccinated

Even the staunchest anti-vaccine advocates, even if they want to believe that some vaccines are optional, must admit that there are some kids that really need to be vaccinated.

After all, there can’t be anyone so anti-vaccine that they wouldn’t allow their child to get the rabies vaccine after they were bitten by a rabid dog, right?

Optional Vaccines

Wait, some vaccines are optional?

“The main reason I feel that vaccines should be optional for parents is that every vaccine has the potential to cause a fatal reaction… And no government should be able to force parents into putting their child through something that puts that child at risk of dying. I think that’s just a fundamental right that every parent should have.”

Dr. Robert W. Sears on Why Partial Vaccinations May Be an Answer

Parents do sometimes ask about optional vaccines.

Which vaccines can they safely skip or delay?

That’s easy to answer.

Which disease do you want to risk your child getting?

Which disease, if more and more parents decided to make that vaccine optional, would you like to see come back?

“And if parents want to accept the disease risk because they don’t trust the vaccines, I think they have the right to make that choice.”

Dr. Robert W. Sears on Why Partial Vaccinations May Be an Answer

All vaccines are important and none are optional, despite what you might read on those so-called alternative immunization schedules that have been pushed by ‘vaccine friendly’ or disease friendly pediatricians for years.

Of course, parents do have the option of skipping one or more vaccines, even if the great majority of pediatricians advise against them doing so. That’s the fundamental flaw in Dr. Bob’s reasoning. The government, even with mandates to attend daycare and school, isn’t forcing parents to vaccinate their kids.

It’s not the only flaw though…

Essential Vaccine Situations

Do parents who delay or skip vaccines worry that their kids might get sick?

Some likely do, especially those who have been on the fence about vaccinating their kids.

For others, it is likely easier to be anti-vaccine when you think that you are hiding in the herd – you don’t get vaccinated and you don’t vaccinate your kids, and instead, you simply rely on the fact that everyone else around you is vaccinated to get protection from vaccine-preventable diseases.

That gamble doesn’t always work though.

“I think our Constitution guarantees parents the right to make health care decisions for their children, as long as they’re not putting their children’s life in danger. And by not vaccinating, you’re not putting your children’s life in immediate danger. Yes, you are taking some risk with diseases, but it’s not such a high risk where that should counteract or take away your freedoms as a parent to make your own health care decisions.”

Dr. Robert W. Sears on Why Partial Vaccinations May Be an Answer

So how high a risk are you taking by not vaccinating your kids?

It depends, but there are certainly special situations in which you would be putting your children’s life in more immediate danger if you didn’t get them vaccinated, including:

  1. a child bitten by a rabid dog, coyote, or bat – needs HBIG and a rabies vaccine series
  2. a completely unvaccinated teen who gets a deep puncture wound while playing in a field – needs TBIG and a tetanus vaccine (keep in mind that a child might still need a booster if they are up to date, but it has been more than five years since their last tetanus shot)
  3. an unvaccinated older teen living in a dorm on a college campus where there is an ongoing outbreak of meningococcemia – needs the meningococcal vaccine
  4. a preschooler with a cochlear implant – needs the pneumococcal vaccines because of an increased risk of pneumococcal meningitis
  5. an unvaccinated 1st grader who’s sibling is starting chemotherapy for leukemia – needs to get caught up on all age appropriate vaccines, including live vaccines
  6. unvaccinated kids traveling out of the country to parts of the world where vaccine-preventable diseases are still endemic – needs to get caught up on all age appropriate vaccines, but especially the MMR vaccine and likely needs more travel vaccines depending on the destination

What if a family member with chronic hepatitis B was going to be visiting or moving in with you? What if you had hepatitis B and you were having a baby? Would you get your baby vaccinated?

Polio Vaccine - don't wait until it's too late.
Who are you going to listen to?

Would you still skip or delay your child’s vaccines in any of these situations?

If you believe one or more anti-vaccine talking points or believe in any of the “experts” of the anti-vaccine movement, then you might.

Of course, none of the vaccines on the childhood immunization schedule are optional and delaying or skipping any of them increases your child’s risk of getting a vaccine-preventable disease.

The problem is that many vaccine hesitant parents greatly underestimate the risk of getting a disease and overestimate the risks of side effects from the vaccines.

And often, the immediate danger isn’t so obvious.

So instead of a dog who is obviously rabid, foaming at the mouth, what if your child was scratched by a stray cat that had never been vaccinated against rabies, or:

  • instead of a deep puncture wound, what if he just gets pricked by a thorn and gets tetanus?
  • instead of a possible exposure in an ongoing outbreak, what if your child is exposed before the outbreak of meningococcemia is widely known to be happening?
  • your unvaccinated child gets chicken pox and exposes a classmate who is immunosuppressed because they are being treated with chemotherapy?
  • your unvaccinated child gets measles after being exposed to an unvaccinated friend who had recently traveled to Europe, where there are many ongoing outbreaks?

The bottom line is that you can wait too long to get your child vaccinated and you may end up regretting your decision to skip or delay those vaccines. Partial vaccinations aren’t the answer.

The answer is to get educated about vaccines and to understand that vaccines are safe and necessary and that vaccines work.

What To Know About Kids Who Should Be Vaccinated

Whether you are anti-vaccine, on the fence, or a vaccine advocate, you should understand that there are some high risk situations in which kids can be in immediate danger if they weren’t vaccinated. And many other situations in which you may regret skipping or delaying your child’s vaccines.

More About Kids Who Should Be Vaccinated

Vaccine Testing and Development Timeline and Myths

New vaccines must go through a long journey before they are finally approved by the FDA and get added to the recommended immunization schedule.

vaccine-dev-testing

Vaccine Testing and Development Myths

There are many myths and much misinformation surrounding vaccine testing and development that is used to scare parents away from vaccinating their kids.

Have you heard that vaccines aren’t tested together?

Or that flu vaccines or Tdap were never tested on pregnant women?

Then there are the myths about fast-tracking, and that important steps are skipped when a vaccine is on fast track for FDA approval, or that the whole vaccine testing and development process happens very quickly.

Vaccine Testing and Development Timeline

The vaccine development process is anything but quick.

“Vaccine development is a long, complex process, often lasting 10-15 years and involving a combination of public and private involvement.”

The History of Vaccines on Vaccine Development, Testing, and Regulation

During this time of the exploratory and pre-clinical stage research and then phase 1,2, and 3 trails, vaccines are:

  • tested on animals
  • tested on small groups of people
  • tested on larger groups of people
  • tested alone
  • tested together with other vaccines
  • tested for safety
  • tested for efficacy (to make sure they work)

This often includes double-blind, placebo controlled vaccine trials.

Fast tracking does speed the process up, but not because any of the testing is skipped. The researchers just get more frequent meetings and communication with the FDA and “Eligibility for Accelerated Approval and Priority Review, if relevant criteria are met.”

“Vaccine development is a complex multidisciplinary activity, combining understanding of host-pathogen interactions at the molecular level, with clinical science, population-level epidemiology and the biomechanical requirements of production.”

Anthony L. Cunningham, et al on Vaccine development: From concept to early clinical testing

Testing doesn’t stop once a vaccine is approved by the FDA and is added to the immunization schedule either. We often continue to see testing for vaccine safety and efficacy using phase 4 trials and with our post-licensure vaccine safety system, including VAERS and the Vaccine Safety Datalink.

And of course testing continues long after we begin using vaccines to see how long their protection will last. For example, because of continued testing, we now know that Gardasil and Cervarix are providing protection that lasts at least 8 and 9 years.

What To Know About Vaccine Testing and Development

From pre-clinical studies and years of phase 1, 2, and 3 trials to continued monitoring after a vaccine is approved and added to the immunization schedule, the vaccine testing and development process helps make sure that vaccines are safe and that they work.

More About Vaccine Testing and Development

Is the Anti-Vaccine Movement Growing?

Boston Reverend Cotton Mather  actively promoted smallpox inoculation during a local epidemic.
Boston Reverend Cotton Mather actively promoted smallpox inoculation during a local epidemic.

We often have to remind people that the anti-vaccine movement didn’t start with Bob Sears, or Jenny McCarthy, or even with Andy Wakefield.

Did you know that the Reverend Cotton Mather’s house was bombed in Boston in 1721? Well, someone through a bomb through his window. Fortunately, it didn’t go off.

That’s 77 years before Jenner developed his smallpox vaccine!

What was Mather doing?

He had started a smallpox variolation program. He was trying to protect people in Boston from smallpox during one of the most deadly epidemics of the time.

So essentially, the anti-vaccine movement started before we even had real vaccines…

Is the Anti-Vaccine Movement Growing?

You see reports of more and more outbreaks of vaccine-preventable diseases, hear about new vaccine laws and mandates, and depending on who your friends are, may see a lot of anti-vaccine articles and vaccine injury stories getting shared on Facebook.

You have probably even heard about pediatricians firing families who refuse to vaccinate their kids.

So what’s the story?

Is the anti-vaccine movement growing?

Is there a growing resistance among parents to getting their kids vaccinated?

“Parents are taking back the truth. It is my expectation that this crack in the dam will serve to sound an alarm. To wake women up. To show them that they have relinquished their maternal wisdom, and that it is time to wrest it back.”

Kelly Brogan, MD

Is the world finally “waking up to the dangers of vaccines,” like many anti-vaccine experts have been claiming for years and years?

The Anti-Vaccine Movement is not Growing

Many people will likely tell you that the anti-vaccine is in fact growing.

You can read it in their headlines:

  • The worrying rise of the anti-vaccination movement
  • Will 2017 be the year the anti-vaccination movement goes mainstream?
  • Pediatricians calling anti-vaccine movement a growing problem
  • There’s Good Evidence That The Anti-Vaccine Movement Is Growing
  • I was skeptical that the anti-vaccine movement was gaining traction. Not anymore.

But the anti-vaccine movement is not necessarily growing.

The overwhelming majority of parents and adults are fully vaccinated.

What we do have is a very vocal minority of people who do their best to push misinformation and conspiracy theories about vaccines and vaccine dangers, and not surprisingly, they have some new ways to do it. Unfortunately, they use their anti-vaccine talking points to scare vaccine hesitant parents and those who might now be on the fence about vaccines to sometimes delay or skip some vaccines.

Most parents do their research though, don’t jump on the anti-vaccine bandwagon, and know that vaccines work, vaccines are safe, and vaccines are necessary.

The Anti-Vaccine Movement is Changing

A lot about the anti-vaccine movement hasn’t changed over the last 100 plus years.

Many early critics of vaccines were alternative medicine providers, including homeopaths and chiropractors, just like we see today. And like they do today, they argued that vaccines didn’t work, vaccines were dangerous, and that vaccines weren’t even necessary.

alicia-silverstone

The big difference?

Unlike when Lora Little, at the end of the 19th century, had to travel around the country to distribute her anti-vaccine pamphlet, Crimes of the Cowpox Ring, anti-vaccine folks can now just tweet or post messages on Facebook. It is also relatively easy to self-publish an anti-vaccine book and sell it on Amazon, put up your own anti-vaccine website, post videos on YouTube, or even make movies.

“Whatever you think about Andrew Wakefield, the real villains of the MMR scandal are the media.”

Ben Goldacre on The MMR story that wasn’t

Fortunately, all of that is balanced by something they don’t have anymore.

No, it’s not science. That was never on their side.

It’s that the media has caught on to the damage they were doing and isn’t as likely to push vaccine scare stories anymore.

Explaining the Popularity of the Anti-Vaccine Movement

The anti-vaccine movement has always been around and they are likely not going anywhere, whether or not they are growing.

Looking at the history of the anti-vaccine movement, it is clear that they have their ups and downs, times when they are more or less popular, but they are always there.

“By the 1930s… with the improvements in medical practice and the popular acceptance of the state and federal governments’ role in public health, the anti-vaccinationists slowly faded from view, and the movement collapsed.”

Martin Kaufman The American Anti-Vaccinations and Their Arguments

Why so many ups and downs?

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Chart by WHO

It is easily explained once you understand the evolution of our immunization programs, which generally occurs in five stages:

  1. pre-vaccine era or stage
  2. increasing coverage stage – as more and more people get vaccinated and protected, you pass a crossover point, where people begin to forget just how bad the diseases really were, and you start to hear stories about “mild measles” and about how polio wasn’t that bad (it usually wasn’t if you didn’t get paralytic polio…)
  3. loss of confidence stage – although vaccine side effects are about the same as they always were, they become a much bigger focus because you don’t see any of the mortality or morbidity from the diseases the vaccines are preventing. It is at this point that the anti-vaccine movement is able to be the most effective.
  4. resumption of confidence stage – after the loss of confidence in stage three leads to a drop in vaccine coverage and more outbreaks of a vaccine-preventable disease, not surprisingly, more people understand that vaccines are in fact necessary and they get vaccinated again. It is at this point that the anti-vaccine movement is the least effective, as we saw after outbreaks of pertussis in the UK in the 1970s and measles more recently. You also see it when there is a report of an outbreak of meningococcal disease on a college campus or a child dying of the flu on the local news, etc.
  5. eradication stage – until we get here, like we did when smallpox was eradicated, the anti-vaccine movement is able to cycle through stages two to four, with ups and downs in their popularity,

So the anti-vaccine movement is able to grow when they have the easiest time convincing you that the risks of vaccines (which are very small) are worse than the risks of the diseases they prevent (which are only small now, in most cases, because we vaccinate to keep these diseases away, but were life-threatening in the pre-vaccine era).

“As vaccine use increases and the incidence of vaccine-preventable diseases is reduced, vaccine-related adverse events become more prominent in vaccination decisions. Even unfounded safety concerns can lead to decreased vaccine acceptance and resurgence of vaccine-preventable diseases, as occurred in the 1970s and 1980s as a public reaction to allegations that the whole-cell pertussis vaccine caused encephalopathy and brain damage. Recent outbreaks of measles, mumps, and pertussis in the United States are important reminders of how immunization delays and refusals can result in resurgences of vaccine-preventable diseases.”

Paul Offit, MD on Vaccine Safety

Fortunately, most parents don’t buy into the propaganda of the anti-vaccine movement and don’t wait for an outbreak to get their kids vaccinated and protected. They understand that you can wait too long.

The bottom line – except for pockets of susceptibles and clusters of unvaccinated kids and adults, most people are vaccinated. If the anti-vaccine does grow, it eventually gets pulled back as more kids get sick.

What to Know about the Growing Anti-Vaccine Movement

Although they may have an easier time reaching more people on Twitter, Facebook, YouTube, and with Amazon, the overwhelming majority of parents vaccinate their kids and aren’t influenced by what some people think is a growing anti-vaccine movement.

More on the Growing Anti-Vaccine Movement

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Hiding in the Herd

The term herd immunity has been used for almost 100 years, since about 1923.

Other terms relating to herd immunity, like ‘hiding in the herd’ and ‘free-riding’ have come into use more recently.

Hiding in the Herd

Some people can get away with hiding in the herd.

Actually, they depend on it.

“Herd immunity is present in a community when such a high percentage of its members have been immunized from a particular disease that the disease cannot gain a foothold in the community. Thus, achieving and maintaining herd immunity protects not only those who have been vaccinated, but also those with compromised or weak immune systems, such as the elderly, babies, and those afflicted with HIV.”

Anthony Ciolli on Mandatory School Vaccinations: The Role of Tort Law

That’s because we don’t need 100% of people to be vaccinated and protected for herd immunity to work.

Many children with cancer and other medical conditions benefit from herd immunity.
Many children with cancer and other medical conditions benefit from herd immunity. (CC BY 2.0)

So people who are too young to be vaccinated or fully vaccinated, people who can’t be vaccinated because they were born with an immunodeficiency or get cancer and are on chemotherapy and other true medical exemptions, and even people who are vaccinated but their vaccine didn’t work, can still hope to be protected from vaccine preventable diseases because everyone around them is vaccinated.

These people still get the benefits of herd immunity. Even though they are unvaccinated and susceptible to getting a disease, they probably won’t, because most others in the herd are vaccinated and protected.

But it is not just those people with medical exemptions who try and hide in the herd.

“These numbers have led the National Vaccine Advisory Committee to conclude that religious and philosophical exemptions do not pose a threat to public health.”

T May on Free-riding, fairness and the rights of minority groups in exemption from mandatory childhood vaccination

And that was okay too for a while. It wasn’t that long ago that “free-riding” by those using philosophical or religious exemptions wasn’t a problem, because their numbers were small and herd immunity rates could still be maintained.

Can You Hide in the Herd?

Hiding in the herd can’t work for everyone though.

Surprisingly, Dr. Bob explains that well in his vaccine book that scares parents about toxins in vaccines, while reassuring them that it is okay to space out their child’s vaccines.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

Basically, if too many people are trying to hide in the herd and have skipped their vaccines, then we have a breakdown in herd immunity and we start to see the return of many vaccine-preventable diseases.

These aren’t people who can’t be vaccinated though.

They are people who refuse to be vaccinated and intentionally don’t vaccinate their kids.

“In other words, hide in the herd, but do not tell the herd you’re hiding; otherwise, outbreaks will ensue. Sears’ advice was prescient. Recent outbreaks of measles in 15 states, caused by an erosion of herd immunity in communities where parents had chosen not to vaccinate their children, were the largest in the United States since 1996.”

Dr. Paul Offit on The Problem With Dr Bob’s Alternative Vaccine Schedule

And that seems to be exactly what happened as more and more parents have walked into their pediatrician’s offices with a copy of Dr. Bob’s Alternative Vaccine Schedule.

While he predicted that it would “increase vaccination rates in our country,” as most others knew,  they went down instead, and we continue to see more and more clusters of unvaccinated children.

Of course, Dr. Bob didn’t create the modern antivaccine-movement, but the bandwagoning effect he and other “thought influencers in the anti-vaccine movement” have on parents isn’t hard to see. Parents get scared by their anti-vaccine talking points and they go on to scare other parents into not vaccinating and protecting their own kids.

Tragically, the consequences of all of this was predictable too.

“If more parents insist on Sears’ vaccine schedules, then fewer children will be protected, with the inevitable consequence of continued or worsening outbreaks of vaccine-preventable diseases.”

Dr. Paul Offit on The Problem With Dr Bob’s Alternative Vaccine Schedule

More outbreaks of vaccine-preventable diseases.

What to Know About Hiding in the Herd

When too many people try and hide in the herd, it makes it hard to maintain necessary levels of herd immunity, which puts everyone, including medically fragile children and adults, at higher risk for getting a vaccine-preventable disease.

More About Hiding in the Herd