Republican candidates cast doubt on vaccines in US presidential debate

A Donald Trump administration would change vaccination schedules to stop an “epidemic” of autism, the candidate said at the Republican Party’s presidential debate on 16 September.

Two other Republican candidates who are doctors also drew criticism from the watching physicians for their equivocal defense of vaccination. Ben Carson, a neurosurgeon, and Rand Paul, an ophthalmologist, both said that parents were justified in rejecting recommended vaccination schedules and instead demanding single shots spread out over a longer period.1

Carson, who retired in 2013 from a distinguished career as a professor of neurosurgery and division director at Johns Hopkins Hospital in Baltimore, Maryland, has surged in recent polls to command support from 20% of Republican voters, second only to Trump’s 32%, while no other candidate has polled above 10%. Skepticism about vaccines is widespread among Republican voters.

Referring to a recent measles outbreak in California the debate’s moderator, Jake Tapper, asked, “Dr Carson, Donald Trump has publicly and repeatedly linked vaccines, childhood vaccines, to autism, which, as you know, the medical community adamantly disputes. You’re a pediatric neurosurgeon. Should Mr Trump stop saying this?”

Carson responded that no evidence existed of a correlation between vaccination and autism. But he continued, “Vaccines are very important. Certain ones. The ones that would prevent death or crippling. There are others, there are a multitude of vaccines which probably don’t fit in that category, and there should be some discretion in those cases. But, you know, a lot of this is . . . pushed by big government.”

Tapper then asked Trump, “Mr Trump, as president, you would be in charge of the Centers for Disease Control [and Prevention] and the National Institutes of Health, both of which say you are wrong. How would you handle this as president?”

Trump responded, “Autism has become an epidemic. Twenty five years ago, 35 years ago, you look at the statistics, not even close. It has gotten totally out of control. I am totally in favor of vaccines. But I want smaller doses over a longer period of time.”

Trump, a vaccine skeptic of long standing, then related an anecdote about an employee’s child who “just the other day . . . went to have the vaccine, and came back, and a week later got a tremendous fever, got very, very sick, now is autistic.” He has related the same anecdote on several occasions over the years. He continued, “I’m in favor of vaccines, do them over a longer period of time, same amount. But just in—in little sections. I think you’re going to see a big impact on autism.”

Carson responded, “We have extremely well documented proof that there’s no autism associated with vaccinations. But it is true that we are probably giving way too many in too short a period of time. And a lot of pediatricians now recognize that, and, I think, are cutting down on the number and the proximity in which those are done, and I think that’s appropriate.”

Trump agreed, noting, “And that’s all I’m saying, Jake. That’s all I’m saying.”

Rand Paul seemed to support this viewpoint when he said, “I’m also a little concerned about how they’re bunched up. My kids had all of their vaccines, and even if the science doesn’t say bunching them up is a problem, I ought to have the right to spread out my vaccines a little bit at the very least.”

The Centers for Disease Control and Prevention and the American Academy of Pediatrics have stated that receiving multiple vaccines at once is safe and that delaying the vaccination schedule exposes especially vulnerable younger children to added risk of communicable disease.

A survey of physicians published this March in Pediatrics found that 93% of respondents heard frequent requests to ignore vaccination schedules and to space out shots. Most said that they complied but did so against their clinical judgment.2

Even before the debate ended, dozens of pediatricians and other specialists had taken to social media to condemn Trump’s remarks and to lament what many saw as a missed opportunity for the two doctors to publicly correct him.

Paul A Offit, an infectious diseases specialist at the Children’s Hospital of Philadelphia, Pennsylvania, took issue with Carson’s claim that some vaccines were unnecessary. Of 14 diseases that young children are immunized against, Offit noted that “the only one you could reasonably say does not kill is mumps.”

James Cherry, professor of pediatrics at the University of California, Los Angeles, said that California’s measles outbreak this year had struck children whose vaccinations had been delayed. “Altering the schedule can lead to infections with vaccine preventable diseases early in life when they may be particularly severe. Measles is a prime example of that.”

Mark Schleiss, professor of pediatrics at the University of Minnesota, said that “there is no evidence that pediatricians ‘recognize’ that we give too many vaccines in too short a time. Pediatricians do not believe this, and there is no scientific plausibility to support this claim.

“Any claim that an excessive number of vaccines can ‘overwhelm’ the immune system is false and not supported by any scientific evidence or, for that matter, even any biological plausibility. In fact, children today get far, far fewer vaccine antigens that they did in the 1960s.”