I am a pediatrician in private practice and am therefore consulted about one child at a time rather than about the effects of vaccines on an entire population. This creates a problem for me each day because I am not certain that the benefits of vaccinating a healthy American child outweigh the risks.

I don't believe that vaccines are "poisonous" or that the tremendous increase in the incidence of autism is directly and solely linked to the "MMR" or mercury in the shots. I do think that there are adverse impacts on a child's immune system and central nervous system from some immunizations and the preservatives in the solutions, but I don't agree that we have figured everything out. Nor do I agree with the vaccine opponents who continue to shout at us all about the shots "not even working" and harming everyone who gets them.

The Institute of Medicine reported last year and Dr. Neal Halsey stated (in the Journal of the American Medical Association in November of 1999) that there are enough questions about mercury's toxicity to warrant eliminating this metal from shots "as soon as possible" to use the IOM's words. Other constituents of vaccines have not received the same scrutiny but may also have at least minimal side effects that could be cumulative in a 10-pound baby receiving four separate inoculations on the same day.

While there is a huge amount of scientific research to support the fact that vaccines protect against illness, there is very little science supporting the way we give vaccines in America and many other countries. Many children receive the Hepatitis B vaccine within hours of birth and then six weeks later receive another Hep B shot along with a DPT, Hemophilus Influenza B (HIB) Polio vaccine and the newest recommended shot, the Prevnar vaccine. The timing of four or five shots with seven components and a multitude of preservatives and "inert" ingredients is very possibly the wrong thing to do. Two months later this same regimen is repeated and 3 or 4 shots are also given at the six-month visit. The one-year checkup is the time for the measles/mumps/rubella combination vaccine and the chickenpox shot.

Many countries begin vaccines later and slower and I strongly believe we should do the same things. The expedient and economically superior method, which we use now, doesn't serve our babies well.

I would like to summarize my point of view by making it clear, once again, that very few responsible experts have reservations about the way we give vaccines. I do.

I also don't like the financial ties that vaccine researchers have to the manufacturers because some of these same experts help make the official decisions about which shots will be approved and/or required.

The diseases against which we vaccinate used to be much more common (and still are in some other countries) but we are now down to an average of one case of diphtheria (the "D" of the DPT) per year in the U.S., a few thousand cases of Pertussis ("P") and 30 or so cases of Tetanus each year.

We have not had a case of "wild" polio in America since 1979 and the entire Western Hemisphere has been free of the disease for some years.

HIB bacteria used to be the most common bacterial cause of meningitis in young children. Meningitis is a dangerous, potentially fatal infection of the lining of the brain and spinal cord. This vaccine is extremely effective and has eliminated over 95% of this illness. I personally have not seen a case if HIB meningitis in at least 7 or 8 years, maybe more. This shot was a godsend but some scientists and others now think that the vaccine may cause "autoimmune" problems -- the immune system mistakenly attacks one's own body -- such as diabetes. This is very much a minority point of view but some data have been gathered which support this possibility.

The Prevnar vaccine was invented to protect higher-risk individuals from a particular group of dangerous bacteria. It was never intended to be, and is not very effect as, an "ear infection" shot. The diseases that it prevents are extremely rare.

The MMR vaccine merits an entire page of its own. Virtually no reputable American authority agrees with the research of Dr. Andrew Wakefield who tied the vaccine to intestinal infection that might lead to autism. But there is enough evidence that these "live-virus" vaccines may not be as safe as we thought to convince me that we need much more study before we can stop looking. The idea of separating these vaccines strikes me as having no advantage.

Chickenpox is a relatively benign disease in childhood and a potentially dangerous disease in adult years. Doctors may have forgotten that this is not a new vaccine but a shot invented in the 1970s to protect children on chemotherapy or high dose steroids for asthma and other illnesses. These very high-risk kids could get severe complications from varicella (chickenpox) but normal kids get immunity from the illness which might actually have been better than that acquired from the shot. My take on this shot is to try to get your child natural chickenpox for 4 or 5 years and then get the shot later if you're not successful.

The Hepatitis A vaccine may become part of the California State law next year and very few pediatricians would have supported that some years ago. While Hep A might ruin an adult's vacation ("food handlers' hepatitis") this viral illness passes virtually unnoticed in children. This is in marked contrast to the great danger and possible permanence of Hepatitis B and Hep C. The Hep B shot works very well but may have autoimmune complications (again, this belief is held by only a very small minority of physicians) and should be given after careful evaluation of the risks and benefits to the child. There is no Hepatitis C vaccine yet. Hepatitis B and C are diseases transmitted through high-risk behavior involving sex and intravenous drugs.

Smallpox and Anthrax vaccines are not available now and neither is as safe nor effective as it needs to be. These diseases have gotten far more "press" than they deserve at the present time.

Perhaps the most frequently asked questions involve coming in contact with ill people while our families travel and the possibility of immigrants or visitors from other countries bringing rare illnesses to the U.S. "Possible but highly unlikely," is the short answer with a full discussion beyond the scope of this short article. A family planning a two-year sojourn to Africa or Asia or Eastern Europe needs a completely different discussion of vaccination. There are no diseases in Europe that will threaten an unvaccinated child any more than in the USA. Again, this is beyond the scope of this present discussion.

In my office, with families I know well, I believe that the main idea I convey is that we should vaccinate later and slower. One shot at a visit starting later in the first year and perhaps in the second year of life. I have many families in my practice who have chosen to give their children no vaccines.

My one request is that you thoroughly discuss with your physician all of the benefits and risks of vaccines with an absence of the usual scare tactics we doctors sometimes use.