Dr. Jonathan Schwab doesn’t read newspapers and doesn’t engage in politics. But the Northampton pediatrician, who has practiced for 35 years, closely follows medical journals and scientific literature. He says the Trump administration’s new vaccine recommendations don’t add up.
President Donald Trump signed an Aug. 10 executive order calling for revamped childhood vaccine recommendations that promote his long-held theory that childhood shots should be spaced out across separate medical visits.
The order advocates separating the measles, mumps and rubella (MMR) vaccine into three single-disease shots and administering childhood immunizations at separate appointments whenever possible. Schwab said there is no scientific basis for changing the current schedule.
“When you mix politics with science, you just get politics,” said Schwab, quoting historian John Barry.
Public health experts have raised concerns that spacing out shots as Trump suggests could increase the risk that children become infected with a vaccine-preventable disease before returning for another appointment. Childhood vaccines, including how and when they are given in combination, undergo rigorous testing, with safety monitoring continuing for years after they are introduced.
“There is absolutely no scientific reason to do that, and there are certainly scientific reasons to continue the current schedule,” Schwab said. “The schedule has been proven to be extremely safe and effective.”
Spacing out vaccinations can only delay immunization, Schwab said, while requiring parents to make additional trips to the doctor.
“By spacing out vaccinations, it can only delay the immunization process, which you want to do as soon as you can,” he said. “It also results in multiple visits to the doctor, which most parents would rather avoid, particularly if there’s no reason to come in and see the doctor.”
There is also currently no practical way to separate the MMR vaccine. The three components are packaged together.
“I could not order just a measles, mumps or rubella vaccine — so he is suggesting something that’s not possible,” Schwab said.
While the vaccines could potentially be packaged separately in the future, Schwab said there is no medical reason to do so.
“What he is implying is based on some information that came out in the late 1990s,” he said.
That information traces in part to Andrew Wakefield, a former British physician who published a fraudulent 1998 study in “The Lancet” falsely linking the MMR vaccine to autism. The paper was later retracted, and Wakefield lost his medical license after an investigation found serious ethical violations.
“There are numerous studies that show that link does not occur, that autism is not caused by MMR vaccination,” Schwab said. “And it’s not fair to parents to suggest that autism is caused by vaccines when we know it’s linked to a mix of factors, including genetics and environment.”
Part of the problem, Schwab said, is that “vaccinations have become a victim of their own success,” since they have prevented the spread of disease so effectively.
Schwab and his colleagues in the health care industry have witnessed the consequences of not getting vaccinated. Schwab said he has seen children die from chickenpox.
“Once you see a child die from a disease that’s preventable, you are certainly more likely to get that vaccination,” he said.
A ‘major victory’
Trump called the announcement a “major victory for parents’ rights, religious and constitutional rights, and for the gold standard science.”
Speaking about the order in the Oval Office, Trump repeatedly suggested the number or timing of vaccines could play a role in rising rates of autism spectrum disorder.
The order also includes several changes to the childhood vaccine schedule that his health department has already attempted but that have been blocked by a federal judge. A White House official who insisted on anonymity to brief reporters said Trump was within his rights to provide his own recommendations through an executive order and said the lawsuit blocking the Department of Health and Human Services’ schedule was a separate issue.
Dr. Andrew Racine, president of the American Academy of Pediatrics, said the announcement spreads uncertainty, fear and confusion where “there doesn’t need to be any of that.” He disputed Trump’s recommendations and said previous recommendations should stand.
“Science about vaccines and their efficacy has not changed,” he said. “The distribution of viruses and other pathogens in our environment has not changed. Children in this country have not changed in the last 48 hours.”
Sen. Bill Cassidy, the Republican chair of the Senate Health Committee, also criticized the executive order in a social media post, saying vaccines are safe and do not cause autism.
“I’m a doctor. This executive order is wrong,” the Louisiana senator wrote. “The president does not have the expertise to make these changes.”
Who is in charge of vaccine policy?
Even as the order calls for revised vaccine recommendations, states, not the federal government, have the authority to require vaccinations for schoolchildren. The order advises states with school vaccine mandates to consider updating their laws to reflect the administration’s preferred schedule, according to a White House fact sheet.
Last December, Trump ordered the Department of Health and Human Services to review how peer nations approach vaccine recommendations and consider revising U.S. guidance accordingly. The department responded by cutting the number of vaccines it recommends for every child, a move that has since been blocked in court.
Changes to federal childhood vaccine recommendations customarily require approval from the director of the Centers for Disease Control and Prevention.
The newly Senate-confirmed CDC director, Dr. Erica Schwartz, oversaw policies promoting vaccination of service members while in a leadership position at the U.S. Coast Guard.
However, public health law expert Lawrence Gostin of Georgetown University said the Supreme Court’s interpretation of the president’s power may allow him to supersede Schwartz if she does not agree to new recommendations.
“This is clearly the first test for Dr. Erica Schwartz,” Gostin said in an email. “The president is placing her in an untenable position.”
Kush Desai, a Trump spokesperson, told The Associated Press that the president is “one of countless parents who have voiced questions and concerns about the combined MMR vaccine” and said the plan to develop single-disease vaccines would “give parents more options on timing and frequency for their children,” ultimately increasing vaccine uptake.
Studies involving babies and toddlers in the United States have shown that using combination shots for childhood vaccines, rather than single vaccines, increases the likelihood that children will complete all recommended vaccinations by age 2.
Reporting from the Associated Press was used in this article.
