Member Report: Vaccine Advisory Committee

This is a brief update about the Vaccine Advisory Committee (VAC) at the WA state Department of Health (DOH) and includes some of my own recommendations about vaccination and naturopathic medicine.  The VAC’s purpose is to advise the DOH on matters related to vaccination and is made up of 15-20 voluntary members from Public Health Epidemiology, Pediatrics, Family Practice, Internal Medicine and Naturopathic Medicine. For more information click here.

The WANP Board of Directors nominated me in 2011 to represent the naturopathic profession on the VAC and have attended quarterly meetings since. I am to be succeeded by our highly competent colleague Mary Alison Koehnke, ND.  It is a testament to both the success of the WANP in promoting the naturopathic profession and the foresight of the DOH that we have an ND on this board.  Why?  As a small, minority healthcare profession and our contribution could have easily been overlooked.  The VAC is composed mainly of representatives of the various majority, allied health professions.  Our profession is included because although we are small, NDs are recognized in statute as a primary care providers in Washington State. As the WANP representative, I have had the opportunity to share my naturopathic knowledge and perspective at the VAC, and in turn, I have been the recipient of knowledge from this diverse group of physicians that I have come to respect. Thank you WANP for the opportunity to represent WA ND’s in this important public health collaboration!

While serving on the VAC I have participated in discussions that have direct effect on all providers of vaccines in WA, including NDs.  Some of the subjects addressed in the last few years include:

  • How to make the Vaccine Exemption Form a usable tool (it is based on “Informed Consent”),
  • Adapting CDC recommendations (ACIP) to the needs of WA state citizens,
  • Local vaccine topics related to the procurement and distribution of vaccines and
  • Addressing and preventing outbreaks of vaccine-preventable disease such as Measles, Pertussis and Tetanus.

Here are some significant updates for 2014, with thanks to Chas DeBolt, RN, MPH, Epidemiologist, Department of Health, for presenting this data at October’s VAC meeting:

  • Measles: There have been 32 cases in Washington. Most were not immunized, a few were.
  • Pertussis: No cases in Washington this year. There is concern that California’s current cases will result in spread to Washington in the coming months.
  • Tetanus: There were 2 cases this year. One non-immunized two year old was hospitalized in serious condition, and one elderly gardener with uncertain immunization status died.

I realize that some ND colleagues may have alternative perspectives on the utility and safety of vaccination. My perspective is that vaccination is congruent with naturopathic principles namely: The Healing Power of Nature, First Do No Harm, Treat the Cause and Prevention. While I respect that each physician has a right to his or her perspective, I do believe such perspective needs to be “informed”. This is the basis of the “Informed Consent” idea underlying my naturopathic perspective of vaccination.

In my review of the available research, I have found an overwhelming amount of evidence supportive of vaccination and the Advisory Committee on Immunization Practices (ACIP) schedule as a safe and effective way to best protect people from vaccine-preventable diseases. Much has been improved in the safety and efficacy of vaccine technology but the idea of all immunization remains this: utilizing the body’s own inherent healing ability by specifically providing experiential education for the immune system. In my opinion, this is great example of our principle to Treat the Cause.

If immunity is provided prior to infection, higher force interventions can be avoided consistent with the Therapeutic Order. To best fulfill the principle of “Doctor as Teacher”, please consider updating your knowledge of vaccinology through participation in the many resources provided by the Washington Department of Health, the federal Center for Disease Control and numerous other resources within and without our community.

My personal plea is to please put in perspective the non-evidenced approaches to immunization that exist. Alternative approaches may be effective but they need to be able to sustain scientific rigor, just like any intervention, including vaccination. Many approaches, including alternative vaccine schedules, have not proven to be any more effective or safe than the standard ACIP schedule.

The recent Pertussis outbreak and the current Measles outbreak has provided good evidence that under-immunization does harm. The 2013 Pertussis outbreak caused several deaths in babies less than 6 months of age. This could have been prevented by properly “cocooning” these babies within a fully vaccinated community. The Pertussis vaccines (DTaP and TDaP) are not sufficiently effective so that everyone who can be vaccinated, and/or boosted, should do so. The current DOH recommendation is that young children be vaccinated with DTaP, beginning at 2 months of age. A booster is scheduled to occur at 11 years of age. For adults that have not received the TDaP, it is encouraged to get a onetime booster as a substitute for the Td at the recommended interval. Pregnant women are encouraged to get the TDaP in the third trimester of each and every pregnancy to protect their newborn.

As best evidenced with the Pertussis outbreak, physicians need to consider that choosing to not encourage vaccination hurts “Community Immunity”, and in my perspective, is not consistent with “First Do No Harm”. For those that do primary care pediatrics, please consider participating in the Vaccines For Children (VFC) program. This is the federal program, that bolstered by the Washington Vaccine Association (WVA) is able to provide vaccines free to persons under age 18. If you would like to participate in the VFC but don’t want to carry all childhood vaccines you can do so. For more information click here.

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