Tag: Jay Gordon

Who Are the Anti-Vaccine Pediatricians?

Surprisingly, not all of the members of the American Academy of Pediatrics are on the side of advocating for vaccines!

Who Are the Anti-Vaccine Pediatricians?

Sure, except for a few outliers, most of the members of the AAP are typically strong advocates for vaccines.

In fact, one of the very first actions of the AAP was to establish the Committee on Immunization Procedures in 1936. They soon published the first vaccine recommendations for kids in the 1938 pamphlet, Routine measures for the prophylaxis of communicable diseases.

So what happened?

How did we end up with anti-vaccine pediatricians?

In 1954, Dr. Roger L. J. Kennedy, the president of the AAP, declared that he would not allow his own children to get Salk’s polio vaccine during the Polio Pioneer trials.

Was he right, considering what happened with the Cutter Incident?

Since none of the polio vaccines produced directly by Jonas Salk caused any problems, no, Kennedy wasn’t right and could have put the whole trial at risk if folks had listened to him.

We next saw Dr. Robert Mendelsohn, a pediatrician who was against many standard practices, including ultrasounds in pregnancy, “water fluoridation, immunization, coronary bypass surgery, licensing of nutritionists, and screening examinations to detect breast cancer.”

He appeared on Donahue in the early 1980s, making claims that “The greatest threat of childhood diseases lies in the dangerous and ineffectual efforts made to prevent them through mass immunization.”

Mendelsohn also appeared as an “expert” in Vaccine Roulette, falsely calling the pertussis vaccine “probably the poorest and most dangerous vaccine that we now have.” Of course, none of the claims against the DPT vaccine ended up being true, but we are still left with the DTaP vaccine which is less effective.

Although he wasn’t the last anti-vaccine pediatrician, he was the last to be formally called out by the American Academy of Pediatrics.

Dr. Jay Gordon, a celebrity pediatrician in California and Fellow of the AAP, appeared on Good Morning America with Cindy Crawford in 2000, saying afterwards that “They edited the segment to make me sound like a vaccination proponent. We also have to understand the impact of a person as well-known as Cindy Crawford delaying vaccines for over six months.”

Jay Gordon thinks infants should get vaccines slower, with fewer shots at one time. — Delaying vaccines and leaving infants at risk to get a vaccine-preventable disease doesn’t make any sense to most pediatricians.

Since then, he has continued to push the idea that kids should get vaccines on a slower schedule, perhaps only getting one or two at a time.

Also in California, Dr. Bob Sears, ~~also a Fellow of the AAP~~, published his Vaccine Book in 2007, pushing his own alternative vaccine schedule and creating a list of vaccine-friendly pediatricians.

Bob's warning about not sharing their fears appeared in the first edition of his book. — Bob’s warning about not sharing their fears appeared in the first edition of his book.

Although the AAP hasn’t formally called out today’s disease friendly pediatricians by name, they have repeatedly stated that there are no alternative immunization schedules.

“There is no ‘alternative’ immunization schedule. Delaying vaccines only leaves a child at risk of disease for a longer period of time; it does not make vaccinating safer.
Vaccines work, plain and simple. Vaccines are one of the safest, most effective and most important medical innovations of our time. Pediatricians partner with parents to provide what is best for their child, and what is best is for children to be fully vaccinated.”
Karen Remley, MD, MBA, MPH, FAAP, Executive Director, American Academy of Pediatrics

And the AAP has said that the views of pediatricians who push alternative immunization schedules “are counter to scientific evidence and clearly they do not reflect Academy policy or recommendations.”

“No alternative vaccine schedules have been evaluated and found to provide better safety or efficacy than the recommended schedule, supported by the Advisory Committee on Immunization Practices of the CDC and the Committee on Infectious Diseases of the AAP (the committee that produces the Red Book).
Pediatricians who routinely recommend limiting the numbers of vaccines administered at a single visit such that vaccines are administered late are providing care that deviates from the standard evidence-based schedule recommended by these bodies.”
Countering Vaccine Hesitancy

Are there others?

Unfortunately, there are.

“Most of my patients make the educated decision not to give one vaccine-hepatitis B – to their infants. This is because you catch hepatitis B from sex and IV drug use so if a child is born to a mother that does not have hepatitis B, the child is at no risk of getting this disease. Preschool and young school-aged children are not at risk for hepatitis B, which is why most countries in the developed world only recommend this vaccine for at-risk groups and not for everyone.”
Paul Thomas

Paul Thomas is another pediatrician and Fellow of the AAP who has written a book about vaccines that pushes his own alternative vaccine schedule.

And even though he has written a book about vaccines, it seems clear that he doesn’t really know which vaccines most countries in the developed world actually give to their kids.

Larry Palevsky spoke at an anti-vaccine rally in New York in the middle of a record setting measles outbreak.

Then there is Larry Palevsky, the pediatrician “who utilizes a holistic approach to children’s wellness and illness…”

Some folks are likely wondering how Larry Palevsky still has a medical license after the things he said at the so-called vaccine symposium in Rockland County this year. Yeah, that Rockland County with the longest active measles outbreak since the endemic spread of measles was declared eliminated.

“The pediatrician who spoke on Monday night, Dr. Lawrence Palevsky, is regularly cited in pamphlets circulated in New York City that urge women not to get their children vaccinated. His views have no basis in science, experts said.”
Despite Measles Warnings, Anti-Vaccine Rally Draws Hundreds of Ultra-Orthodox Jews

Most others who are familiar with things he has said in the past aren’t surprised by his statements though. After all, he was an “expert” for the anti-vaccination movie The Greater Good.

Are you really going to pay extra for a pediatrician that follows a made up schedule that leaves your kids at risk to get a vaccine-preventable disease? — Are these alternative pediatricians encouraging parents to only give their kids one vaccine at a time?

And they are familiar with other holistic and integrative pediatricians who are obviously anti-vaccine.

What Makes a Pediatrician Anti-Vaccine?

Although none consider themselves anti-vaccine, preferring to think of themselves as pro-safe vaccine, pro-vaccine choice, or pro-informed consent, as they continue to push myths and misinformation about vaccines, it should be clear who they are and what they are doing.

No, a pediatrician isn’t anti-vaccine just because some of their patients follow a non-standard, parent-selected, delayed protection vaccine schedule. They are anti-vaccine if they encourage parents to skip or delay vaccines, scaring them away from vaccinating and protecting their kids.

“The American Academy of Pediatrics is dedicated to the principle of a meaningful and healthy life for every child. As an organization of physicians who care for infants, children, adolescents, and young adults, the Academy seeks to promote this goal by encouraging and assisting its members in their efforts to meet the overall health needs of children and youth; by providing support and counsel to others concerned with the well-being of children, their growth and development; and by serving as an advocate for children and their families within the community at large.”
preamble to AAP Constitution

It’s time that more pediatricians call them out, even if they aren’t members of the AAP, as we see more outbreaks and more parents following their advice, leaving more kids unvaccinated, unprotected, and at risk to get vaccine-preventable diseases.

Why Are Vaccine Schedules Different in Each Country?

Anti-vaccine folks often point in differences in the immunization schedules in various countries to try and make a case that some countries do things better than others.

Is that true?

Why Are Vaccine Schedules Different in Each Country?

The ACIP and CDC set the immunization schedule in the United States, but it shouldn’t be surprising that other countries have their own systems to set their schedules.

Each country vaccinates according to their own needs, so none of their schedules are wrong, even though they are all a little different.

And no, just because they are all a little different, that doesn’t mean that any are wrong.

That’s easy to understand once you do just a little research on how these immunization schedules are set up.

The WHO immunization schedule is set by the Strategic Advisory Group of Experts (SAGE) on Immunization.

WHO vaccine position paper development is "a complex, rigorous, multifaceted process." — WHO vaccine position paper development is “a complex, rigorous, multifaceted process.”

It’s basically a summary of WHO position papers.

The WHO recommendations help other countries develop optimal immunization schedules.

The Communicable Diseases Act in Sweden regulates the 13 factors that the Public Health Agency of Sweden must account for when proposing changes in the national vaccination programme to the Government.

Many countries also have their own National Immunization Technical Advisory Group that sets their immunization schedule.

So their immunization schedule is right for their country, even if it doesn’t match the United States schedule.

Australia’s Vaccine Schedule

In Australia, for example, the National Immunisation Program (NIP) Schedule is set by National Immunisation Committee (NIC), which reports to the Australian Health Protection Principal Committee (AHPPC) of the Australian Health Ministers Advisory Council (AHMAC) through the Communicable Diseases Network Australia (CDNA).

The Australian Technical Advisory Group on Immunisation (ATAGI) also provides technical advice on the operation of the National Immunisation Program.

Combination vaccines mean infants in Australia get fewer shots, but the same number of vaccines.

Notice any differences between Australia’s vaccine schedule and the US schedule?

they give the routine second dose of MMR earlier, at 18 months
they don’t give a second dose of the chickenpox vaccine
they give the routine first dose of the meningococcal vaccine earlier, at 12 months
the hepatitis A and flu vaccines are only given to high risk kids

While there are some minor differences, it is fairly similar to the US immunization schedule.

“There is a legislative requirement for all vaccines provided under the NIP or the PBS to undergo a thorough and objective assessment process.”
National Immunisation Strategy for Australia

Why the earlier dose of meningococcal vaccine?

This is a good example of why immunization schedules vary between countries.

“The notification rate for meningococcal disease to the National Notifiable Diseases Surveillance System peaked at 4.3 per 100 000 in 2002 and declined to 0.4 per 100 000 in 2013.”
Meningococcal disease

Meningococcal disease incidence rates in the United States were much lower, about 0.6 per 100,000, when they started giving meningococcal vaccines in Australia (2001).

The UK Vaccine Schedule

But aren’t the immunization schedules from other countries supposed to be a lot different from the US schedule?

Let’s look at another…

The Joint Committee on Vaccination and Immunisation (JCVI) advises UK health departments on immunisation.

It’s not the easiest schedule to read, but you should notice that vaccines for hepatitis A and chickenpox are missing, but younger children get extra meningococcal shots.

You may also have noticed yet another dosage schedule for the Prevnar 13 vaccine.

While the United States gives a three dose primary series and a booster, many other countries give either a three dose primary series alone or a two dose primary series with a booster.

“A large and growing body of evidence from immunogenicity studies, as well as clinical trials and observational studies of carriage, pneumonia and invasive disease, has been systematically reviewed; these data indicate that schedules of 3 or 4 doses all work well, and that the differences between these regimens are subtle, especially in a mature program in which coverage is high and indirect (herd) effects help enhance protection provided directly by a vaccine schedule.”
Whitney et al on Dosing schedules for pneumococcal conjugate vaccine: considerations for policy makers.

That doesn’t mean that they are all guessing at the dose! All of these schedules are well studied and in this case, there isn’t much difference.

There are even studies that suggest giving only one primary dose, combined with one booster dose might work, but only in areas where pneumococcal disease is already well controlled and infants would be protected by indirect herd immunity.

But that doesn’t mean that other schedules would work just as well too. For example, giving the doses later or on a slower schedule would not be better.

Why not?

Infants are most at risk for many of these diseases, especially Hib and pneumococcal disease, when they are young and delaying when infants get vaccinated simply leaves them unprotected and at risk to get sick for a longer period of time. You also want infants to be protected by the time they lose the passive protection they get from their maternal antibodies.

What about the chickenpox vaccine?

Will the UK get the chickenpox vaccine soon?

While the UK has not added the chickenpox vaccine to their schedule because their models predicted an increase in cases of shingles (which has happened anyway) with a decrease in exogenous boosting (the theory that exposure to chickenpox lowers your risk of shingles), they are now looking at this again.

“This study confirms that severe complications of varicella, including death, continue to occur in the UK and Ireland.”
Cameron et al on Severe complications of chickenpox in hospitalised children in the UK and Ireland

Mostly it has been said that the chickenpox vaccine isn’t on the schedule because they have not thought it to be cost effective.

Iceland’s Vaccine Schedule

When anti-vaccine folks talk about immunization schedules from other countries, they aren’t usually talking about the UK or Australia though.

They are talking about Iceland, the country that they believe gives far fewer vaccines than the United States.

You thought they gave even fewer vaccines in Iceland, didn't you? — You thought they gave even fewer vaccines in Iceland, didn’t you?

Vaccines for flu, chickenpox, hepatitis A, and hepatitis B and also available for those who are considered high risk.

Extra vaccines are available for high risk kids.

Want to follow Iceland’s immunization schedule?

Then you should move to Iceland.

Hopefully you are starting to see that immunization schedules are different in each country because each country has different rates of disease, different populations, and different healthcare systems.

Iceland is a small country (338,349 people), with high vaccination rates, and universal health care. Compare that to the United States, with 327,200,000 people, clusters of unvaccinated people, and lots of people without health care.

It should be easy to see that what works in one country might not work in the other…

Vaccine Schedule Comparison by Country

What about other countries?

Austria’s immunization schedule for 2019 includes all of the same vaccines as the US schedule, plus the vaccine for Japanese encephalitis (if high risk).

On the immunization schedule in Austria, the columns in red are for vaccines that are recommended and free. The blue columns are also recommended, but they aren’t free.

The chickenpox vaccine was just added to Japan's routine vaccine schedule, but they still don't give the combined MMR vaccine. They do still have autistic kids, so does that finally prove that the MMR vaccine is not associated with autism? — The chickenpox vaccine was just added to Japan’s routine vaccine schedule, but they still don’t give the combined MMR vaccine. They do still have autistic kids, so does that finally prove that the MMR vaccine is not associated with autism?

Japan has two separate schedules – the routine schedule for everyone (in dark blue above) and the voluntary schedule, with extra vaccines. Note that the primary series of infant vaccines are given at 2, 3, and 4 months.

Germany also gives their primary series of infant vaccines at 2, 3, and 4 months.

In contrast to the 16 diseases that kids in the US are vaccinated against, Sweden uses vaccines for just 9.

Sweden is the other country that anti-vaccine folks like to talk about a lot. Mostly because they think that Sweden recently banned mandatory vaccination. They didn’t.

And note that kids in Sweden can get vaccinated at school!

The Norwegian immunization program makes heavy use of combination vaccines.

Norway is studying adding chickenpox and Shingles vaccines to their schedule.

Switzerland now offers a few optional vaccines for folks who want them, including the meningococcal vaccine, HPV vaccines for boys, and the shingles vaccine for seniors.

Although they only use a two dose primary series, Switzerland gives many of the same vaccines as the United States.

The 2018 vaccination schedule in the Netherlands. New additions in 2020 will be the rotavirus vaccine or high risk infants, Tdap in pregnancy, and MenACWY for teens.

Are you surprised to see that infants in Denmark get more vaccines before they turn 12 month old than infants in the United States and an extra set by four months?

While most vaccines are free, you can pay extra to get vaccines that are already on the United States schedule in most other countries.

Even if they aren’t routine in other countries, all of the same vaccines that are offered in the United States, including vaccines to protect kids against rotavirus, chickenpox, and hepatitis A, are available in most other countries.

Vaccination schedule for children and adolescents in Israel.

The latest immunization schedule in Israel includes hepatitis B, DTaP, polio, pneumococcal, rotavirus, MMR, chickenpox, HPV, and flu vaccines.

The 2019 Immunization Schedule for South Korea includes almost all of the US vaccines, plus BCG and Japanese encephalitis vaccines.

What’s missing in South Korea’s immunization schedule? Meningococcal vaccines. But they do have some that we don’t give in the United States.

What don’t these different immunization schedules influence? Prevalence rates of autism, SIDS, and other things that scare parents away from vaccinating and protecting their kids.

The One Wrong Way to Give Vaccines

Since the immunization schedules from all of these countries are just a little bit different, does that support the idea that an individualized approach to vaccinating kids is a good idea?

There is no science and nothing that says altering any vaccine schedule is a safer or more effective way to do things.

Of course not!

"Later and slower" is not part of any immunization plan. — “Later and slower” is not part of any immunization plan.

In many countries, even if they are missing protection against a few diseases that we routinely vaccinate against in the United States, many get their vaccines earlier! And all start by three months and don’t split up the schedule to just give one or two vaccines at a time.

Everyone knows that later and slower just leaves kids unprotected for longer periods of time. More risks. No extra benefits.

How is the Immunization Schedule Developed?

For some reason, there still seems to be a lot of confusion out there about just how the immunization schedule is developed.

Jay Gordon wonders about the research used to set the current immunization schedule... — ICYMI – Jay Gordon was Jenny McCarthy‘s pediatrician.

Who decides which vaccines we give and get?

How do they make that decision?

History of Immunization Schedule Development

While the current immunization schedule is developed by the CDC based on recommendations of the Advisory Committee on Immunization Practices (ACIP), that’s not how it was always done.

It has just been since 1995 that we have had this single, simple vaccine schedule and format.

The first unified immunization schedule was developed in 1995.

Before that, we had separate vaccine schedules from the:

American Academy of Pediatrics Committee on Control of Infectious Diseases
Centers for Disease Control Advisory Committee on Immunization Practices (ACIP) – established in 1964
American Academy of Family Physicians (AAFP)
Armed Forces Epidemiological Board

Even earlier, we had recommendations and schedules from

WHO Expanded Programme on Immunization (EPI)
AAP’s Special Committee on Prophylactic Procedures Against Communicable Diseases – from its start in the early 1930s, it evolved into today’s Committee on Control of Infectious Diseases
American Public Health Association Subcommittee on Communicable Disease Control

Differences in those schedules, which could lead to confusion, lead experts to create a simpler, unified schedule.

Well, at least in the United States. Of course, other countries still set their own schedules…

The Science Behind Setting the Immunization Schedule

Now that you know who sets the immunization, you are probably wondering how they set the immunization schedule.

To truly understand how the immunization schedule gets set up, it is best to go to an ACIP meeting when they make those decisions.

Can’t make it to Atlanta for one of the ACIP meetings?

You can watch them online!

Thoughtful discussions on setting the immunization schedule at ACIP.

Past ACIP meetings, agendas, minutes, slides, and videos, are archived online too.

Reading the minutes from the third meeting of the Advisory Committee on Immunization Practices on November 19-20, 1964 shows how they work, looking at data to make decisions about our vaccines and set the immunization schedule.

Review them and you will get a very good idea of how the immunization schedule gets set up.

The first flu vaccine was developed in 1945.

ACIP basically told folks to go back to the drawing board and make a better flu vaccine at this 1966 meeting.

Did you ever wonder why it took so long to get it on the immunization schedule?

Why was the primary series of polio vaccines made up of three doses?

At the Advisory Committee on Immunization Practices meeting on May 24-26, 1967 they discussed polio vaccine scheduling.

Hopefully you are starting to understand how this works…

And no, all of this work doesn’t get done over a couple of days a few times a year. ACIP members belong to workgroups which focus on specific vaccines and they gather, analyze, and prepare information and research about those vaccines throughout the year.

It is at the ACIP meetings where the workgroup findings are presented.

“Development of vaccine schedules is based on a large body of basic sciences and epidemiologic research. There is constant review of evidence, adverse events, and epidemiology by a panel of experts.”
Shetty et al on Rationale for the Immunization Schedule: Why Is It the Way It Is?

And yes, among that body of research are studies of vaccines tested together, vaccines tested with placebos, vaccines tested vs unvaccinated kids, vaccines tested for long periods of time, and studies looking at risk factors to make sure vaccines don’t cause long-term health problems.

It’s a very thorough process!

And that’s why the great majority of folks understand that following the immunization schedule is the best way to keep their kids protected from vaccine-preventable diseases.

Vaccines are safe, with few risks, and are obviously necessary.

What’s not safe? What hasn’t been well studied?

Following a non-standard, parent-selected, delayed protection vaccine schedule.

Thinking that an individualized approach is better doesn't trump the 55 years of ACIP meetings that went into setting the current immunization schedule... — Thinking that an individualized approach is better doesn’t trump the 55 years of ACIP meetings that went into setting the current immunization schedule…

Studies have actually shown that delaying or skipping vaccines offers no benefits and actually puts kids at extra risk.

It puts the rest of us at risk too.

Why Should Medical Exemptions Be Based on CDC Contraindications?

Getting a medical exemption for vaccines isn’t controversial.

Or at least it shouldn’t be.

Why Should Medical Exemptions Be Based on CDC Contraindications?

As many people know though, some people have been taking advantage of the fact that medical exemptions weren’t clearly defined in California’s vaccine law.

Who are the doctors handing out fake medical exemptions in California?

Are there just a few doctors taking advantage of the California law?

“But at 105 schools in the state, 10% or more of kindergartners had a medical exemption in the school year that ended last month, according to a Los Angeles Times analysis of state data.”
Pushback against immunization laws leaves some California schools vulnerable to outbreaks

Is 10% a lot?

In one recent report, Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year, the median rate of medical exemptions in the US was just 0.2%, with a range of <0.1 to 1.5%.

In West Virginia and Mississippi, states that don’t allow non-medical exemptions and where criteria for medical exemptions are fairly strict, the rates were 0.1 and 0.3% respectively.

And that’s about what you would expect, as there are very few true contraindications or precautions to getting vaccinated.

So yes, 10% is an awful lot and that’s a good sign that it is more than just a few doctors taking advantage of the law.

“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”
Dear Colleague letter regarding guidelines for use of immunization exemptions

Why do most other states have so few medical exemptions?

Mostly because there are very few true medical reasons to skip or delay a child’s vaccines!

They include, but aren’t limited to, the contraindications and precautions listed in the package insert for each vaccine (the contraindications and warnings sections…) and by the Advisory Committee on Immunization Practices.

They don’t include many other things that are “incorrectly perceived as contraindications to vaccination,” such as things in the family medical history of the child, eczema (unless they are getting the smallpox vaccine), colic, sleep apnea, or being a picky eater.

It should be obvious.

Medical exemptions for vaccines should be based on CDC criteria because some folks think that everything is a vaccine injury.

VAXOPEDIA

Who Are the Anti-Vaccine Pediatricians?