Eliminating dogma emphasizes science and makes guidelines more credible
It seems to me that if we want to make a credible case for vaccines, we ought to be clear to separate the science from the dogma, in a manner that is accessible to average new parents. Not only that, but I think that thinking so rigidly sometimes prevents doctors and other medical professionals from looking at the evidence and making adjustments accordingly.
Reading the article, it is clear that much of the information called "evidence based" has to do with "local considerations" such as cost of delivery. Only part of the rationale has to do with critical issues of science, such as age relationships to the efficacy of the vaccine. I think that it would be not only perfectly reasonable, but also more effective in countering anti-vaxxer falsehoods parents might hear, if medical professionals actually presented this as a suggested vaccine schedule that fit with the normally scheduled (and thus hopefully insurance covered) well baby visitation schedule. Any adjustments ought to be made with efficacy in mind, and also the need to accommodate what the doctor's office vaccine administering nurse is paid to provide.
I think that measles, as studied in the outbreak at Disneyland, is a case in point to both arguments above.
First, a place like Disneyland where large numbers of people from all over the world are coming into close contact with each other in the course of a day, blows up any of the usual statistics for likely contacts that are the backstop of herd immunity. This makes it all the more imperative that everyone be immunized. Employees of places like Disneyland ought to be immunized. Disneyland fought providing health care coverage to its largely part time work force for years. In theory, such workers now ought to be covered by Obamacare, in many cases under their parent's policies. Still, in the aftermath of the outbreak, among the first things Disneyland did was to rush its lobbyists to the California State Capital in Sacramento to ensure that blame was not pointed in their direction.
Secondly, this means that we ought to question our currently rather cavalier attitudes towards taking too young to be immunized infants to such large crowd public places as Disneyland. Those known to be immune compromised or on immune compromising drugs ought to observe similar precautions.
Thirdly, this means, depending on what an individual family might be doing, they might want to reconsider their family's vaccine schedule in accordance with increased exposure risk. From the article above: "Consider also the primary vaccination schedule for infants. The EPI schedule recommends immunisation at 6, 10, and 14 weeks in central Africa based on the early burden of vaccine preventable diseases and the need for efficient vaccine delivery when infants are most accessible. In contrast, the primary schedule in North America and much of Europe is 2, 4, and 6 months; in these populations, the lower risk of acquisition of many infectious diseases and better access to care permit vaccination to be incorporated into established well child visits through the first six months of life."
Fourth, we should re-visit the booster schedule. In secondary transmissions that occurred outside of Disneyland, some took place in small communities where contacts could be closely traced. In these instances there were cases where there appeared to be more transmission than expected to older individuals who were older than those required to receive booster shots. Perhaps we should reconsider re-administering booster shots. This requires Pharmaceutical companies to administer vaccines outside of the National Childhood Vaccine Injury Act (NCVIA) liability coverage window, not always a popular thing with these corporations.
Fifth, we need to look at the ability of our health care system to handle epidemics and focus on in hospital microbiological control. This is particularly crucial for measles which can be transmitted if airborne. At least in the US and other advanced developed nations, our health care facilities ought to be prepared to handle these situations. People whose immune systems are weakened or compromised are going to be in hospitals as a matter of course, and ought to have greater assurance that the hospitals were not the source of potential infections.
And sixth, the measles vaccine is an old vaccine. We need to focus immunological research and vaccine development to see if we can both decrease the age at which the vaccine can first be administered and decrease the numbers of people who receive the vaccine but do not acquire immunity.
Overall, I believe that parents are much more likely to positively accept advise from medical professionals if it is couched in terms of scientific uncertainties and guidelines for effective practices, than if it is presented as an absolutist dogma, into which opponents can readily punch holes.