Close Encounters with the Vaccine Schedule
Scene: A pediatrician’s office. Behind the desk is the doctor, a pleasant, middle-aged woman in a white coat. Seated in front of the desk are the expectant parents, prosperous, educated, self-confident, and, in the case of the woman, exceedingly pregnant.
Doctor: So, what questions did you have for me today?
Mother: We are concerned about the current vaccine schedule.* We know that babies should be protected from serious diseases, but the current schedule is getting…well, strange. (Pulls a scroll from her purse and starts unwinding it, reading off the schedule as she goes, and inserting comments) So, at birth, they want our baby to get a Hepatitis B vaccination. We both test negative and are not at risk for that disease.
Father: Does our baby really need that one?
Doctor: Why yes, it is recommended by the Centers for Disease Control.
Mother: (absorbed with her scroll and ignoring the doctor’s comment) And another Hepatitis B at one month of age, and then at two months things really get going: seven vaccines?
Doctor: (smiling in an almost laughable manner) It isn’t that many shots. We can put off the Hepatitis B shot to two months and give Pediarix which is HepB, DTaP, and Polio in one shot. Then the baby will only have to get three injections. The other injected vaccines are Hib and PCV. Rotateq is given orally. Plus, only giving one shot doesn’t always confer immunity into adulthood.
Father: (swallowing and looking a little nauseated). You want to give our two month old baby eight different disease doses in one day? Has this been tested for safety?
Doctor: Of course. Vaccines are the most thoroughly tested of all drugs.
Mother: (unrolling the scroll some more) At four months we get the same 8 vaccines that we did at 2 months. (She passes one end of the scroll to the father to hold) Aren’t most of these diseases pretty rare in the U.S. right now?
Doctor: Not all of them. And the vaccinations are the only thing keeping us from having major outbreaks of vaccine preventable diseases. We cannot allow the vaccination rate to drop!
Father: Right. We are up to seventeen vaccines and the baby is only four months old. When was the last time you had 17 vaccines in four months, doctor?
Doctor: My vaccines are not the question here. We need to stay focused on what is needed for public health. After all, vaccination helps develop their immune systems by giving them some challenges and it keeps serious disease low…that’s called establishing herd immunity. You don’t want to be responsible for causing an epidemic, do you?
Mother: No, of course not (looks worried). But this schedule is so intense. Couldn’t we spread things out a bit?
Doctor: You need to follow the recommended schedule. I don’t accept families who don’t vaccinate on schedule.
Father: (both parents are staring at her, incredulously) So if we don’t agree to follow this schedule then you won’t be our baby’s doctor? (Turns to his wife) Let’s review the rest of the schedule before we end the discussion.
Mother: (Looking at the scroll with trembling hands, it is hard to tell if she is angry or frightened). At six months you and the CDC want us to give our baby nine more vaccines. On top of a repeat of all the vaccines given at four months, you are adding an influenza vaccine because our baby will be turning 6 months during “flu season”.
Father: (quietly) Nine vaccines. (Looks down at the scroll and reads off the diseases/vaccines). Hepatitis B, diptheria, tetanus, pertussis, Hib, IPV, PCV, rotavirus, influenza. Doctor, I think I need to research these diseases some more…
Doctor: (interrupting) You can’t trust anything you read off the Internet, you know!
Father: (very quietly and with great force) Not even what’s on the Centers for Disease Control web-site, Doctor?
Father: I just don’t feel comfortable giving our baby 26 vaccines in the first 6 months of his life.
Mother: (smiles at her husband and then unrolls some more of the scroll) I want to go through the rest of the schedule. At one year the baby gets 7 vaccines, 4 of them live virus vaccines, MMR which is for measles, mumps and rubella, plus VariVax, for chickenpox. The other 3 are Hepatitis A, PCV again and Hib again. Oh, I forgot the second dose of influenza which is supposed to go in there sometime between 6 months and 1 year.
Doctor: (she is looking angry now) Babies die of influenza, you know. And vaccine reactions are uncommon. Usually the only side-effects of vaccines are minor soreness at the injection site.
Mother: (continuing to unroll the scroll, looking very grim) I’m not going to look at the doses required to get into kindergarten, let’s just go through 18 months. Five more vaccines. Five more. Hep B, DTap again, IPV, Hep A and another influenza shot. For a total of 39 vaccines.
Father: We want to discuss a modified schedule.
Doctor: No, absolutely not. I’ve already told you that I will not have your baby as a patient in my practice if you don’t follow the schedule. The schedule has been carefully worked out, it is safe, it is recommended by the Centers for Disease Control, the American Academy of Pediatrics, it is approved by the Food and Drug Administration.
Father: Doctor, I think you’re forgetting that you would be working for us, not for the FDA, the CDC or the AAP. This has been a most enlightening discussion. Thank you for your time. (rolls up the scroll and hands it to his wife who returns it to her large purse. They both rise and start walking out of the office.)
Doctor: (aiming for the last word) It is irresponsible not to vaccinate your child for every imaginable disease!
Mother: (puts her hands protectively on her huge pregnant front) Thirty-nine vaccinations in 18 months? I don’t think so.
*Schedule outlined in the skit is from the CDC.