Last week, President Donald Trump announced a new executive order that calls to change childhood vaccine recommendations. The order promotes his discredited theory that there are too many childhood vaccines given, and that they need to be more spaced out. Dr. Andrew Koehler is a pediatrician with NWA Pediatrics. He says he views vaccinations as the most important thing he does on a day-to-day basis.
Koehler: It's the thing that I can track the impact of my career and how many lives it saved, how many children's health is improved. And so I love talking about vaccines in the sense of what they do for our community, for our families. But it is incredibly frustrating that we have to have these conversations over and over again, especially when we have such good scientific data that this is not the way.
Moore: I want to read just a few excerpts from this executive order that we can discuss. Someone as an expert in this field, you can talk a little bit about some of the arguments being made in the order and talk about what do you have to say about this? I want to start by talking about the Department of Health and Human Services. At the federal level, completed a scientific assessment which identified a set of consensus vaccines that are consistently recommended in all peer countries and found that the United States currently recommends more childhood vaccines than any peer nation, including more than twice as many vaccine doses as some European nations. The scientific assessment also found that instead of implementing vaccine mandates, most peer nations maintain high childhood vaccination rates through public trust and education. In the United States, by contrast, individual states set mandatory vaccination requirements that children must meet to attend school.
Koehler: So I think there's a couple of things to unpack there. One, the idea that others don't require mandates and instead do it by public trust really speaks to our current environment where we don't have a lot of trust, and it's a lot of that is being fueled at the federal level at the moment. And I can't imagine that these kind of comments really help improve the overall trust in those vaccines.
If you look at those peer countries, a lot of them have significant support for family leave and community support structures that allow patients to handle illnesses in a better way. They also have significantly improved oversight when it comes to health issues. And that is not something that I think the U.S. will ever, ever go for, having a centralized service that's tracking all this.
In addition, if you look at those vaccine schedules for our peer countries, one, the first thing you notice is that they are overwhelmingly identical to ours, or at least similar enough, where there's only a very small difference in timing of those vaccines. And in fact, some of our peer countries do vaccines that we don't do, and that there could be an argument that would be reasonable in the U.S., particularly meningococcus vaccine. In addition, some of those European countries do TB vaccine, which we no longer do because it's not been necessary in our community.
We also have different demographic factors that allow for some of those decisions. Hep A would be a big example of one that is not commonly done in the U.S., or is done in the U.S., is not commonly done in Europe, and that is related to kind of factors in our country. Hep A initially had very high levels, especially in a lot of our Western states. We tried to do targeted implementation of it, which is actually what the European strategy is, where countries that have high hep A tend to mandate it, whereas countries that don't, don't. But in the U.S., we have a lot more mobility. And so the lack of universal vaccine led to increasingly high levels of people having disease. And thus it was recommended countrywide. But part of that is just the nature of 50 states, whereas each European country is its own little, much smaller area.
Moore: The language that sticks out to me about this, and you pointed at it too, is this idea of a mandatory element to it. What happens, in your opinion, when we look at vaccines at a mandatory level versus a recommendation level?
Koehler: So I think it's really important to know that for all of history, the ACIP, which is the CDC's infectious disease arm, which we've talked about in the past meetings, is a little bit suspect at the moment anyway, but they have never made mandates. They have always made recommendations. The categories are universal recommendation versus selective recommendations. The states then decide basically for a school population whether they're going to have mandates or not. They generally follow what the ACIP recommends, as you know, universal recommendations, though there are some variations out there.
What I have seen in practice is that state-based mandates help families get shots done, because there are a lot of families out there that's not that they are anti-vax. They just have a lot of stuff on their plate. And so all of a sudden that kid gets to kindergarten age and they maybe haven't had a well check in a couple of years and they forgot to get the 4-year vaccines. Not because they're opposed to it, but because it just didn't cross their radar. And so all of a sudden, getting that reminder from the school like, hey, you're due for this is a thing where they're like, oh yeah, whoops. And they come in and we get it done and they're happy about it.
We do the same thing for meningococcal vaccine at age 11, 16, where, again, families don't know what they don't know. They didn't realize they needed to get one. Oh, hey, school's telling me now I'm here, I'm getting it. And so it absolutely significantly improves compliance. And one of the things we know with vaccines in general is that the higher the rate of overall vaccine in the community, the less likely these diseases are to affect our community.
Moore: Another portion of this executive order I want to read to you. This executive order reaffirms that is the policy of the United States that the core childhood vaccine recommendations should be aligned with scientific evidence and best practices from peer developed countries, while preserving access to vaccines currently available to Americans. Further, it is the policy of the Trump administration that federal programs and funding should support maximal parental choice over childhood vaccines, consistent with the federal government's constitutional and statutory obligations and the fundamental principles of personal autonomy and informed consent.
Koehler: I think so. To start with the first part of that one, the scientific community as a whole is an international community, and each community is looking at data from each other. The U.S. is absolutely using data from Denmark and other European countries, which have all shown the safety of vaccines when they're making their recommendations, just like those European countries are using American data when they make their decisions. Those decisions are then made in light of their individual populations and situations. With each country, again, different demographic factors differ. Exposure factors, different social support factors all inform their individual decisions on what to do vaccine-wise.
And so the idea that somehow our vaccine record isn't in line with the data is just flat incorrect. When the ACIP historically has made these decisions, when it was an unbiased or science-driven panel, these were done using large pools of data from across the world.
When it comes to the comment about parent choice, that is where things get challenging because at its heart, public health is a balance between individual decision making and community and how it impacts that community. Your decision whether to vaccinate or not has an impact on everyone in our community. It has the biggest impact on our community in folks who are immune compromised. My patients who are on chemotherapy, my patients who are transplant patients and who are immunosuppressed in order for them to live. They are dependent on us having a vaccinated community that keeps those illnesses at bay. And while I am sympathetic to the concerns that parents have for their children, we have overwhelming data that the vaccines are safe and we have overwhelming data that they protect not only your child, but every child around them.
Moore: There's an element of the executive order that I think has gotten a significant amount of attention here. And it's around the measles, mumps, rubella vaccine, the MMR vaccine. Here's what it says in the executive order. The recommendations recognize that the combined MMR vaccine should be administered in three separate single-disease shots once such products are domestically available, and that to the maximum extent feasible, all childhood immunizations should be administered at separate medical visits.
Koehler: This is the part that's got the most attention, because it's the most ludicrous of all the things in here. One, I am unaware of any peer nation who does single-dose MMR. I believe Japan tried it for a while, but I don't believe it ended up staying. What we would be doing is tripling the number of visits, tripling the number of times a child is poked with literally no evidence of any benefit. We'd also significantly increase cost. We would significantly increase times that parents have to miss work to come in. For literally no benefit. And so I think, yeah, that's the reason it gets so much attention because it doesn't make any sense.
In addition, there is not a product available and it acknowledges it in the executive order. There is not. I cannot purchase single-dose measles vaccine. It is not available in the U.S. and it will take five plus years, maybe 10 to get one on the market for, again, no benefit. And the reality is, I can't imagine many pharmaceutical companies are jumping at the opportunity to make a single-dose measles vaccine, knowing that this executive order has no actual teeth to it, knowing that there is significant pushback from the medical community. This is just something done to get headlines.
Moore: Is there anything in this in particular, when you think about like trust in this health care system and trust in people who are looking for the best interest in both your individual health and the public health, that you've seen successes? You talked a little bit before we hit record about RSV as one of those for you.
Koehler: Yeah, I think this is one of these new success stories. So we have the RSV monoclonal antibody. So not a true vaccine, a little bit different, but still in that world of preventative health. And it has made such an impact in the health care of kids under 2 over the past two winters. We've had it widely available now. It's technically available for three years. That first year availability was a struggle. These past two years, anybody who wants it has gotten it.
I've been bored sometimes in the wintertime. We've been slow in these windows where RSV would usually be coming in. Last year, I think. I can't remember if I sent anyone to the hospital with RSV, which is shocking because in every other winter, I mean, I've been doing this 15 years. Every other winter I'm going to send one every week or two. So those are kids not going to the hospital. These are kids not ending up in the ICU. These are kids who are not miserable for weeks and weeks and weeks because we now have a product that helps prevent.
And so it actually has been really kind of refreshing, in this world of pediatrics, to have something that we can do that really makes an impact on something that we were pretty helpless about before. There's not a treatment for RSV, other than supportive care and making sure that they're doing okay. And there's lots of stuff that people try, but none of it really makes a huge difference. And it really is just like we have to support them through that illness. And now we have something that can make a huge impact, at least in those first couple of years.
And it may be that these kids end up getting some RSV a little later in life, because the antibodies do wane in their system. But there's a huge difference in a 2- or 3-year-old getting RSV versus a 2-month-old. And so we're actually making an impact in patients' quality of life.
And I think it's actually a nice tie-in to vaccines because we've said it before, vaccines are a victim of their success. Most of our things that we're vaccinating for, we've been vaccinating for 20 to 30 or many more years. So there are very few parents nowadays who remember what it was like to have Haemophilus influenzae. Putting kids with meningitis every week in my clinic. Pneumococcus. Putting kids with meningitis. I don't even remember those times. You have to go back to my founders, Joe T. Robinson, Terry Payton, when they started our group in '83, when they were having to do lumbar punctures in clinic every single week. And I don't do that in my practice anymore because vaccines keep these kids from coming in.
Same with measles, same with chickenpox. I mean, yes, most kids got better from those, but they were miserable for weeks. And some kids didn't get better from them, and we don't see that because vaccines work. And so I am hoping that 10 years from now, parents really don't understand how much of a scourge RSV was for our little ones, because it just works. And we have a way to keep these kids from getting sick. And we're actually being proactive rather than having to just be on the back foot.
Dr. Andrew Koehler is a pediatrician with NWA Pediatrics. He joined me yesterday in the Bruce and Ann Applegate News Studio Two.
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