Monday, September 10, 2012

One Size Fits All Vaccination

There are a number of frequent refrains heard from those opposed to vaccines. There are too many. Oh, the toxins! If vaccines work, then what are you worried about? Vaccination laws take away parents' rights. The list goes on and on. They get repeated so often that it becomes very easy to just gloss over them and ignore the strident ululations of anti-vaccine activists. Between posting here and commenting on various blogs and news stories, I feel like I've addressed these arguments (if you can call them that) more than enough times. But then I remember that as long as the noise keeps going, there will be a need for reality-based individuals to speak out against them.

Recently, one such complaint caught my interest a little more than usual. Perhaps it was because I happened to be rereading the CDC Pink Book at the time. Much is made among anti-vaccine types of personal liberties and how each person is different. Every little snowflake is precious and unique, they opine, so how can anyone support a "one size fits all" vaccination schedule?

The problem with this idea is that it is wedded to the exceedingly simple-minded belief that the recommended schedule is some rigid document from which a physician wanders at their peril. These individuals seem to have gotten it into their mind that doctors are mindless automatons, ritualistically going through the motions programmed into them by their governmental overlords.

Or something.

While there might be some health care providers out there who are too lazy, busy or lack the necessary education and stick unerringly to the schedule, all other factors be damned, I'd wager a hefty sum that this is not the norm. At the very least, physicians are readily encouraged to alter the schedule based on the specific needs of the child (or adult). This could be based on responses to screening questionaires (PDF), family history,adverse reaction to previous doses of a vaccine, current state of health or other factors. The CDC, AAP and ACIP all encourage physicians to take into account numerous factors that may play a role in determining whether a vaccine should be delayed or avoided altogether for a given individual. Vaccine safety is something that regulatory agencies like CDC and FDA take very seriously.

For example, when determining whether a current fever is a reason to delay or avoid a vaccine, the Pink Book states (emphasis added):
ACIP has not defined a body temperature above which vaccines should not be administered. The decision to vaccinate should be based on the overall evaluation of the person rather than an arbitrary body temperature.
A quick read of the General Recommendations on Immunization chapter will reveal that far from being "one size fits all", the schedule is meant to be applied in a manner that takes into account the specific child being vaccinated. It is designed to apply to the greatest number of children to provide them with protection as soon as their body is developed enough to gain immunity to a disease and can safely receive a vaccine. The timing of subsequent doses in a series is the minimum required to develop a robust immune response (too close may decrease efficacy); longer periods between doses won't reduce most of the vaccines' efficacy but will leave a child more susceptible to infection than a child immunized on time. The risk of the disease and likelihood of being infected is also taken into account. While these are defined quite broadly to apply to as many children as possible, there is also room for nuance. And indeed, as should be clear from what I wrote above and the links provided, the schedule is meant as a guideline, rather than an unwavering protocol. I guess that's why it's called the recommended schedule of vaccination.

But that is not what you will hear from places like the National Vaccine Information Center. For example, on their page "About The International Memorial for Vaccine Victims", they state:
Our work has always been dedicated to the children, who had no voice and had no choice, and who lost their lives or their health because of one-size-fits all mass vaccination policies promoted and enforced in the absence of adequate scientific knowledge about how and why vaccines cause harm.
From the "National Vaccine Information Center Archives":
In other words, these are children who have potentially identifiable genetic or other biological high risk factors which are not being factored into a one-size-fits-all national vaccine policy that today allows a baby to be injected with 9 or more vaccines on one day.
In another post from their archives, "National Vaccine Advisory Committee: Immunization Registries Workgroup on Privacy and Confidentiality" :
Educated health care consumers instinctively know that a one-size-fits-all, narrow-minded approach to disease control is dangerous when genetic variability and unique environmental factors can put some children more at risk for vaccine-induced injury and death than other children and, yet, almost no child is screened out of the mass vaccination program.
And from the post "Vaccine Freedom of Choice", which was presented at the Rally for Conscientious Exemption to Vaccination:
Among us are parents with healthy children and those with children who have been hurt by one-size-fits-all vaccine mandates that ignore the genetic and biological differences which make some people more vulnerable than others for having severe reactions to prescription drugs and vaccines.
In short, they have page after page promoting the myth that the vaccination schedule is "one size fits all".

Likewise, the anti-vaccination organization SaneVax has numerous articles discussing the supposed "one-size-fits-all" schedule. Age of Autism also promotes the "one-size-fits-all" myth in posts like "Letter in Portland Tribune: Only trusted research will quell vaccine fears":
The grab 'em and stab 'em, as one physician puts it, the one-size-fits-all approach to vaccinating every child in this country with 49 doses of 14 vaccines before the age of 6 is not pristine or pure as fallen snow.
 And a post titled "Dr. David Berger on Minimizing Autism Incidence" states:
His attitude is similar to Dr. Robert Sears who also doesn’t blindly accept that a “one size fits all” vaccine schedule is safe for all children. He works with each family individually to come up with a vaccine plan that the family is comfortable with.
Each of these anti-vaccine sites make the same mistake: asserting that the recommended schedule (and the doctors administering it) does not take the individual patient into account. It is a very easy position to attack, which is probably why they try to make people believe the lie. I mean, who in their right minds could support mindlessly giving a drug to someone without any consideration at all for the patient? Only a monster would do that.

And that, I think, is the key to why anti-vaccine organizations and activists promote this myth. It dehumanizes those who support immunization. If you can paint supporters of vaccination as cold, heartless monsters, it makes it much easier to hate them and to speak out against them. And when they leave out what actually occurs when vaccines are administered, that physicians screen patients to tailor the schedule to the individual, it's very easy to believe. Who cares that the hatred and arguments are based on a lie? Clearly, these organizations don't. Though, to be fair, maybe they actually believe their own lies and aren't cognizant of the fact that they aren't telling the truth. But that doesn't make it any less wrong.

The next time you hear someone arguing against vaccines, take a moment to consider what they aren't telling you. If they try to convince you that the vaccine schedule is one-size-fits-all, do your own research and find out what the truth really is. At best, they're probably leaving something out or twisting the truth just a little bit to make vaccines seem like the most devilish thing ever conceived. At worst, they're outright lying.


  1. Wait. Wait. You mean to tell me that one size does not fit all? That physicians and other providers take the person into account and not just blindly vaccinate left and right? That I and others in my family have not been vaccinated "on schedule" because of factors unique to ourselves?

    Nuts, Mr. W. Nuts.

    Great writing.

  2. The trouble is you do not (and have not) presented any evidence that, in practice, any sizable segment of the child-target vaccination population ever receives a medical exemption or deviation from the schedule. Please provide evidence. It is my understanding that medical exemptions are to be granted only for specific vaccines. That is, if a child is facing (how many now?) a dozen different vaccines, one would have to prove somehow the child would be at risk for each and every vaccine in order to be exempted from the mandates.

    Over the years I have read a number of horrifying stories about children within families demonstrating a genetic (or other unknown cause) disposition to vaccination "adverse reactions" whose doctors insisted on sticking to the schedule. These reports will scare the crap out of anybody.

  3. "Over the years I have read a number of horrifying stories about children within families demonstrating a genetic (or other unknown cause) disposition to vaccination "adverse reactions" whose doctors insisted on sticking to the schedule."

    Sources please. Please specify the specific genetic condition. Link to PubMed indexed case reports would be useful.

    My son had a history of neonatal seizures so only got the DT vaccine, not the DTP. Though later research found out that the risk was not so great. Many of the cases turned out to have a genetic condition known as Dravet Syndrome.

    But you could start your own research here:

  4. All those case reports about mule-headed doctors that kept to the schedule despite contraindications or reactions written by the mule-headed doctors about their own mule-headedness? Do you only accept domestic violence allegations from victims who can present you with an admission of guilt by the perpetrator documented on a police statement? Who is to write these case reports may I ask? Not everyone is as lucky as you and has a diligent and knowledgeable doctor to work with. There are large clusters of these anecdotes on forums and websites who would love to have it documented in a case study. But they feel failed by the system and don't know where to turn. Their stories ARE scary. Science is great in general (well it's got a few problems if you're talking science industry), but you're a fool if you think it can provide evidence for all current events.

    1. The plural of anecdote is still not data. The Vaccine Information Sheets that federal law require to be given whenever a vaccine is given in the USA have the phone numbers and web addresses of how to submit stories of vaccine reactions to both VAERS and to the National Vaccine Injury Compensation Program.

      If you did not receive a Vaccine Information Sheet before a vaccine, then you have a legitimate claim against the doctor. If you were given one and failed to actually read it, then you are the one to blame. Since you are commenting on a three year old article without identifying who it is addressed to, I would more likely believe the latter is true.


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