Pro vs Con: Should We Immunize Our Children?

Two powerful arguments for an issue dividing the nation

It’s a decision that many new parents struggle with: To vaccinate or not? Everyone has an opinion on the subject, from pediatricians who refuse to see children who aren’t fully vaccinated, to parents who swear by the Dr. Sears Alternative Schedule, to those who won’t let a needle touch their little ones on religious grounds. But which is the right path for your family?

We asked folks on both sides of the debate to make their case. Dr. John Snyder, associate director of the Pediatric Residency Program at Baystate Children’s Hospital is on the pro side; that is, he thinks children should be vaccinated according to the schedule recommended by the U.S. Centers for Disease Control and Prevention (CDC). On the other side is Barbara Loe Fisher, president of the National Vaccine Information Center, a nonprofit she co-founded in 1982 to “prevent vaccine injuries and deaths through public education.” We asked both the exact same questions; their answers have been edited only for clarity and space. Give it a read, then head to the comments to tell us where you fall in this debate. Let the discussion begin:

Loop 21: How and why was the CDC/AAP/AAFP-recommended child immunization schedule developed?

John Snyder (PRO): The recommended schedule of childhood immunizations contains vaccines to prevent the most serious vaccine-preventable infectious diseases posing a threat to infants and children. Many of these diseases were true scourges of humanity in the not-so-distant past, killing or seriously harming large numbers of children every year. Because of these vaccines, many parents today have never seen or perhaps even heard of some of these diseases. Most pediatricians base their vaccine recommendations on those put forward by the CDC’s Advisory Committee on Immunization Practices (ACIP), which are usually echoed by the American Academy of Pediatrics (AAP) and the American Academy of Family Practitioners (AAFP). Before these recommendations are made, however, a vaccine must undergo a long and rigorous process of basic science and clinical trials, and subsequent FDA approval. These include:

• Preliminary academic research
• Three phases of pre-licensure trials which look at different aspects of the vaccine, from efficacy to safety
• Post-licensure trials if the FDA approves the vaccine
• Scrutiny by the ACIP, a panel of medical and public health experts (including virologists, infectious disease specialists, and epidemiologists) that weighs the safety and efficacy data as well as the public health ramifications for each vaccine, and advises the CDC on vaccine recommendations

The decision to include a vaccine in the recommended schedule of routine childhood immunizations involves close consideration of the public health benefits as well as the safety and efficacy data for that particular vaccine. The timing and frequency of doses is determined by a variety of factors, including when is the threat of the disease greatest, what is the efficacy of the vaccine at different ages, and how safe is it at that age.

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Barbara Loe Fisher (CON): A century ago, only one vaccine was recommended by public health officials and doctors and was mandated by states for children to attend school: smallpox vaccine, which was given to children at age 1. In 1949, the DPT (diphtheria, pertussis, tetanus) vaccine was licensed and five doses recommended for infants and children by the CDC and AAP. After that, the polio vaccine was licensed in 1955 and measles vaccine in 1963 and added to the list.

For the past 30 years, the CDC and medical trade associations, such as the AAP, have issued additional vaccine use recommendations for children following the licensure of new vaccines, including those for Hib, hepatitis B, chickenpox (varicella zoster), pneumococcal, rotavirus, hepatitis A, HPV, meningococcal and influenza.