At the second Republican primary debate Donald Trump claimed that spacing childhood vaccines out, and giving them in smaller doses would reduce the ‘autism epidemic’. Ben Carson and Rand Paul also supported spacing out the vaccine schedule, and Carson claimed many pediatricians recognize that too many vaccines are given in too short a period of time, but denied any autism link.
Dr. James Cherry, Distinguished Research Professor of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (webpage):
Expertise: pediatric infectious diseases, epidemiology and vaccine prevention strategies of Bordetella pertussis worldwide
“The vaccine schedules in the United States have been worked out very carefully and most of the western hemisphere follows our schedules. Vaccines are given as early as possible to mitigate risk of disease. Diseases like pertussis, pneumococcal disease and H influenzae type b (Hib) are actually worse when caught early in life, so that’s why those vaccines are given at 2, 4 and 6 months, with a booster dose in the second year of life.
“For measles, mumps and rubella the vaccines don’t work as well before 12 months of age. The measles outbreak in California earlier this year demonstrated that when vaccine schedules were spaced out, some children got severe measles.
“The point is that the vaccine schedule works and has absolutely no relation to autism or to any adverse events. Altering the schedule can lead to infections with vaccine-preventable diseases early in life when they may be particularly severe. Measles is a prime example of that.”
Dr. Mark Schleiss, Professor of Paediatrics and Director of Division of Infectious disease and Immunology, University of Minnesota (webpage):
Expertise: Vaccines; Pediatric Infectious Diseases; Viral Infections; Molecular Virology
“I strongly disagree with Donald Trump’s assessment that vaccines are a trigger for autism in some children. This statement is dangerous; patently false; has been proven inaccurate; and put children and society at risk for outbreaks of vaccine-preventable illness. I believe Mr. Trump should apologize for his remarks and retract these statements immediately.
“Although his position on vaccines was the most “moderate” position on the stage, many of the things that Ben Carson said about vaccines were untrue, and simply not supported by any evidence, though I do agree with Dr. Carson what “we have extremely well documented proof that there is no autism associated with vaccinations” and I applaud him for this statement
“There is no evidence that pediatricians “recognize” that we give too many vaccines in too short a time. Pediatricians do not believe this, and there is no scientific plausibility to support this claim. Any claim that an excessive number of vaccines can “overwhelm” the immune system is false and not supported by any scientific evidence or, for that matter, even any biological plausibility.
“In fact, children today get far, far fewer vaccine antigens that they did in the 1960s. The total number of antigens the immune system “has to deal with” from vaccines has been steadily decreasing over the past 40 years. These numbers are not subtle. In 1960, in the well-child immunization series that was universally recommended for all children, a child would be exposed to ~3,217 vaccine antigens through the vaccine cocktails we would give. In 1980, the average child would be exposed to ~3041 vaccine antigens. In the year 2000, that number had been reduced to ~126 antigens.
“Dr. Carson is probably correct that some pediatricians are choosing to space out vaccines more and give fewer inoculations at some visits, but the motivation for this is the pressure that pediatricians feel from parents to do so. It’s not a decision motivated by public health, or science, or, importantly, by any consideration for what’s best for the child. Some pediatricians will acquiesce to the parents, rather than lose that child and family as patients. But again, the key point is that such decisions are not motivated by what’s best for the child; nor do they reflect any official recommendations from thought leaders or national organizations such as the CDC or American Academy of Pediatrics.
Dr. John Swartzberg, Clinical Professor, Emeritus, UC Berkeley School of Public Health (webpage):
Expertise: Specialist in infectious disease; Medical Education.
“There’s no debate about whether vaccines are linked to autism. They are not. This has been proven time and again. So it’s disturbing to see Donald Trump make that canard in a presidential debate. And it’s especially disturbing to see two doctors, Ben Carson and Rand Paul, suggest that the schedule for childhood vaccines may be too aggressive (it’s not) and that some vaccines are not all that important (they all are).
“The CDC have reported that vaccines given between 1994 and 2013 will save 732,000 lives and 21 million hospitalizations! It’s too bad these politicians did not avail themselves of these facts.
“Research has proven without doubt that vaccines are not linked to autism. Delaying vaccines does not protect kids; in fact, it leaves children at risk. And there’s no medical reason to think that today children receive too many vaccines.
“Have we forgotten the children whose legs were deformed by polio? Can we ignore the real risks of deafness, brain damage, or even death caused by measles? It’s time for the ‘debate’ about vaccines to end. There’s no debate, but as these politicians demonstrated there is a great deal of ignorance.“
Dr. Brian J. Zikmund-Fisher, Associate Professor, Health Behavior and Health Education & Research Associate Professor, Internal Medicine, University of Michigan (webpage):
Expertise: Decision psychology and behavioral economics to study factors that affect individual decision making about a variety of health and medical issues.
“We all would like to believe that we could reduce or eliminate autism spectrum disorders by doing something as simple as spreading out the timing of vaccines. The problem, however, is not just that such a belief is incorrect. The problem is that neither autism nor vaccine risks are that simple, and false simplicity leads to false hope.
“Parents can reasonably wonder whether giving multiple vaccines at once might be more risky, and engaging with parents about the question about vaccine timing may be important in helping parents face the somewhat scary idea of giving otherwise healthy kids something that comes from a disease. The risks of spreading out vaccinations, however, are significant. Doing so means that our children are unprotected for longer periods of time even as diseases like measles and pertussis are returning in force across the U.S.
“Giving a kid a new vaccine isn’t like giving an infant a new food: Our children’s immune systems are already “tasting” thousands or millions of new things every day, whether we want them to or not. Their bodies are developing and changing constantly, and many conditions first develop at the same ages as the timing of many vaccines. Just because something happens to a kid shortly after vaccination does not mean that the vaccine definitely caused it.
“So, wishing that changing the timing of childhood vaccinations could solve the autism puzzle is understandable, but the reality of both vaccination risks and autism is more complicated. While open conversations about vaccination schedules are needed, such discussions must acknowledge that neither the risks nor the benefits of schedule changes are as simple as they might seem.”
Dr. Walter A. Orenstein, Professor, Department of Medicine, Division of Infectious Diseases and Associate Director, Emory Vaccine Center, Emory University School of Medicine (webpage):
Expertise: Evolution, emergence, transmission and pathogenicity of influenza viruses, vaccine safety and effectiveness. Dr. Orenstein was the former director of the United States’ National Immunization Program.
“Vaccines recommended for children are critical in protecting them from serious infectious diseases as well as protecting their communities. The immunization schedule for children is developed and approved by a number of immunization expert committees and is approved by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.
“Children in the first year of life are recommended to be protected against 9 diseases. This includes hepatitis B, a cause of liver cancer, diphtheria, tetanus, pertussis (whooping cough), rotavirus (a major cause of serious diarrhea leading to dehydration in infants), Haemophilus influenzae type b (Hib, a disease which caused an estimated 12,000 cases of serious severe meningitis in the pre-vaccine era), pneumococcus (a major cause of pneumonia and other severe diseases), polio, and influenza ( virus that can be particularly severe in young infants).
“According to the American Academy of Pediatrics, children every day fight 2000-6000 antigens from the many germs they are exposed to. In contrast, the schedule has 150 for the whole immunization schedule. Thus, the young infant immune system is fully capable of handling the few additional antigens vaccines add given what the immune system must do every day to combat all of the organisms children are exposed to.”
Declared interests (see GENeS register of interests policy):
Dr. James Cherry: “I give talks for Sanofi Pasteur, mainly on pertussis vaccines”
Dr. Mark Schleiss: “My laboratory has had funding for pre-clinical vaccine research for cytomegalovirus vaccines from a European vaccine company, Hookipa Biotech, in Vienna, Austria. However, this is for basic R and D, and this company does not manufacture any commercial vaccines.”
Dr. Brian J. Zikmund-Fisher: “I have been a consultant on a research project funded by PCORI through Kaiser Permanente related to vaccination.”
Dr. Walter A. Orenstein: “I was Director of the National Immunization Program and its predecessor, the Division of Immunization, at the CDC from 1988-2004. I was a consultant for GSK at a meeting on the Grand Convergence in Health to support use of vaccines in minimizing health burdens globally.”