Want to clear a room fast? Tell people your kids aren’t vaccinated. Then say, “Not only is that why they’re so healthy – it helps your kids stay healthier too.” Wait. What? Unvaccinated kids, healthier? Aren’t they walking cesspools of infection, recklessly spreading disease in their wake? Aren’t they leeches, getting a free ride away from infections, on the backs of all those good parents who vaccinate their kids?

The CDC maintains that they can’t solve this question for us. Their posture is that it’s unethical to study vaccinated versus unvaccinated kids, presumably because it isn’t safe to not vaccinate anybody. But ongoing survey data show that unvaccinated kids are healthier. They have fewer allergies and asthma, less autism, fewer chronic conditions  and are sick less often. Even though these data come from an uncontrolled voluntary survey (over 13,000 participants worldwide and growing), the differences are enough to give anyone pause – and plenty big to warrant formal investigation. By factors of double, triple, or tens of times, vaccinated kids show a higher illness burden than their unvaccinated peers, for conditions like epilepsy, diabetes, thyroid disorders, autoimmune conditions, autism, allergy, asthma, and more.

Meanwhile, the argument that a pool of vaccinated kids is needed to quash a return of infections is starting to crumble (bolstering the position held by some that vaccines can’t confer herd immunity): Even with compliance for most immunizations at over 90% across the US –  above the level considered necessary for successful herd immunity – we still have outbreaks of pertussis, measles, mumps, chickenpox, polio, and flu in  vaccinated groups. The global level of pertussis vaccine coverage was 83% in 2012 – pretty darn good – but, still: Outbreaks. In fact, vaccinated people may spread infections they are recently inoculated against, as they shed viral and bacterial material from vaccines – just as occurs with wild type, naturally acquired infection. This has been documented for those recently vaccinated against pertussis, polio, flu, chickenpox, rotavirus, and measles.

If vaccines are working less and making kids more sick, do we keep using them? How? Tough questions. Since we began using vaccination some two hundred years ago, we have fiddled more deeply than we know with how immunity travels from generation to generation. For an example, dive into this blog series on polio, which describes how this once mostly benign virus morphed into deadly and debilitating with sanitation, less breastfeeding, and the introduction of vaccines.

Long short: Immunizing our way out of infection hasn’t worked.

The magic bullet idea of it is alluring (not to mention profitable beyond belief), but, perhaps the bill has come due. Vaccination as a one-size-fits-all path to disease eradication is undeniably a pipe dream now: There is not a single disease on the planet that vaccines have wiped out, as was still being promised when I was a public health graduate student in the 1980s. Some infectious diseases (flu, pertussis, varicella) persist at same or even higher levels now than before vaccines were introduced for them. Not only that, it appears we have traded exposures to routine, typically benign childhood infections for chronic disability and illness, thanks to comprehensive scrambling of the immune system early in life with routine vaccinations and less breastfeeding, generation after generation.

When a debate gets this heated, typically, more fear than fact starts flying. No exception here. There are pertinent facts from the realm of infant and child nutrition, as well as public health nutrition and basic epidemiology, that usually go missing from this conversation.

Can we afford to omit that stuff any longer? I don’t think so. It’s time to get solutions oriented, and consider kicking Pharma out of the conference room. Profitability  is the driver of the vaccine pipeline, and as long as people fear that only vaccines can save them, they’ll keep buying them. We don’t need fear mongering, or  even bigger profits for already-bursting-with-cash Big Pharma. We need a shift in the belief that all infections are bad, and more vaccines are better. We need effective, safe tools that do not leave kids disabled or saddled with chronic illness.

There are pearls from maternal and child nutrition, plus some nutritional epidemiology, that belong in the mix. These aren’t the only factors in play. Environmental toxins, sanitation, living conditions, and even the vagaries of climate change are exerting their influence on our global microbiome. But for sure, host immune response is dependent on nutrition – which is a variable we can leverage.

First on my list? The Cycle Of Nutrition And Infection has been well understood for decades, but it’s virtually absent from general pediatric practice today in the US. It goes like this: When a child is malnourished, they get sick more often; and, when they get sick, they get sicker than kids who are well nourished.

This cycle is active even in mildly undernourished kids – like so many I meet right here in my pediatric nutrition practice in the US. The course of their infections is longer, more severe – because they don’t have the nutrient and tissue stores to mount a good fight. Then, once they’ve battled an illness, they’re left even more malnourished, having exhausted whatever stores they had. In this weakened nutrition status, they get more sick, again. Then they deplete nutrition further. And so on it goes, in a vicious cycle that can quickly become deadly for infants and young children.

Malnutrition begets infection and vice versa

I’ll say it again as I’ve seen it so often: This Cycle is active even when kids are only mildly to moderately malnourished.

In poor countries, or in poor regions of the developed world (including in the US), malnutrition starts in utero. Children who don’t have enough high value food to eat will get sick and die more often, whether they are vaccinated or not. Nutrition status is so intertwined with immune function that UNICEF priorities for global health don’t separate the two. This doesn’t just apply to severely malnourished kids with ribs poking out, stick-like limbs, sunken eyes, and pot bellies.  Many kids I’ve encountered in my pediatric nutrition practice meet nutrition failure criteria. A child who is below 90% of his ideal body weight is mildly malnourished. An example of this would be a four year old child with an expected weight of 40 pounds (based on birth weight, parents’ stature, and other factors), who weighs 36 pounds or less. Or, a thirteen year old whose body mass index is hovering around the sixth percentile. Or, an eight year old whose progress for stature has flattened from 40th percentile last year, to 15th this year. Or, a child with chronic loose wet stool, or chronic constipation. Is this your kid?

Next question: When was the last time your pediatrician asked you for a food diary, to show exactly what your child eats day in and day out? Has s/he ever assessed grams of high value protein taken in on most days? Weak protein intake means weak immune response. Anyone do testing to rule out food allergy and sensitivity? These can deplete nutrition status and immune reserves if not managed correctly. At your last office visit for your child’s colds, flu, or ear infections, did anyone check status for vitamins A or D, intake of varied healthy fats and oils, or look at zinc and iron? All are critical for vigorous immune response, and for ideal responses to vaccines. Nutrition is a symphony, not a single note. All pieces need to be present at the same time, doing their jobs.

How much not-food do your kids eat?

These are first world examples. Kids can grow, more or less, and still be eating pretty horrible diets – especially with the bounty of processed, vacant, genetically modified food heavily marketed here to moms and kids. After fifteen years evaluating food intakes of kids across the US, I can tell you this: Most kids I’ve encountered have suboptimal food intakes, bad enough to impair growth, behavior, learning, sleep, focus, attention, and infection fighting. And, nobody noticed – not their pediatricians, gastroenterologists, neurologists, psychiatrists, biomed/DAN doctor, or most any other specialist they’ve been to. Nobody actually looked at the food.

Now, that’s just dumb. Because nutrients and food, not vaccines, provide the building material that we use to fabricate an immune system, regardless of vaccination status. The physical components of an immune system come from whatever nourishment a child got in utero or takes in himself. Eating well builds up the savings account for the rainy days when the immune system needs to make a big withdrawal. It takes a lot of energy, and unusual amounts of certain nutrients, to mount a fever and fight infection – especially when you are growing, a demanding daily metabolic task for every cell in the body of a child.

This is why unvaccinated children in strong nutrition status who eat healthy, well-rounded diets will fight infection better than vaccinated peers who are underweight, have failure to thrive, chronic diarrhea, or constipation, or who eat limited diets. The nutritionally sound child may get infections and get sick, but will have a more vigorous response, will be sick for a shorter period of time, and will then have stronger, longer-lasting immunity than vaccines give. This process of naturally developing immune competence may be crucial to averting allergies, asthma, or other chronic disease later in life.

Vaccines don’t alter the cycle of nutrition and infection. The only way to interrupt this cycle is with food (and supplements in some cases). Without it, malnourished children get sick and die more often, period.

So. Do malnourished kids need vaccines even more? I’ve met many families with frail underweight children or children with chronic conditions who are loyal to the vaccine schedule. Their children still get sick often, even for some of the diseases they are vaccinated against. They’ve been told at every turn that their child needs vaccines most because they are more vulnerable. True, those kids are. But do more vaccines help or harm in these cases? Even with shots, there is a demand  placed on the immune system to respond – that is the whole point of vaccinating, after all. This response will consume more nutrient stores.

And, besides injecting antigens, vaccines also rely on toxins (like aluminum) to jump start the body’s immune response. An already weakened system may not be able to manage additional toxins. Immune response is impaired in children with compromised nutrition, and this will be true whether an antigen is injected or encountered through natural infection. Children may be more vulnerable to adverse vaccine events if they are vaccinated while sick – intuitively, because they are already moving available resources to manage the illness underway, and can’t respond properly to an injected antigen plus toxins as well. Instead of dosing weak children with multiple shots, it may be safer and more effective to resolve their poor progress for weight, height, and food intake.

Next on my list would be breastfeeding – a topic I’ve covered in an earlier blog. Spoiler: It may well trump vaccination for preventing infections in babies, depending on mom’s immune status. It is so potent an immune booster that it somewhat disables rotavirus vaccine, and possibly others. But now, thanks to vaccination, childbearing women in the industrialized world may have never experienced measles, mumps, chickenpox. If they breastfeed, they don’t pass the immunity to their babies that my mother would have – born in 1926, she had all of the above, including scarlet fever. At 92, she’s never had a flu shot, is sharp as a tack, still drives, and still works part time selling real estate.

These are sweet enough to substitute for candy if you grow your own or find locally

So let’s bring this piece to the table: Nutrition status, not vaccination, has the more profound impact on illness severity and frequency in infants and children. Meanwhile, we can adjust the focus on our lens for child health in the US. It’s not all about vaccines. Here are the top ten causes of death for US infants for 2010, according to the CDC (children up to 1 year old):

1. Congenital malformations, deformations and chromo­somal abnormalities (congenital malformations)

2. Disorders related to short gestation and low birth weight, not elsewhere classified (low birth weight)

3. Sudden infant death syndrome (SIDS) (accounted for 2,063 deaths in 2010, or 8.4% of all infant deaths in the US).

4. Newborn affected by maternal complications of pregnancy (maternal complications)

5. Accidents (unintentional injuries)

6. Newborn affected by complications of placenta, cord and membranes (cord and placental complications)

7. Bacterial sepsis of newborn

8. Respiratory distress of newborn

9. Diseases of the circulatory system

10. Necrotizing enterocolitis of newborn (the baby’s intestinal tissue dies, and the baby starves to death)

None of these are “vaccine preventable” conditions – ironically, with the exception of SIDS, which is an acknowledged side effect of a vaccine adverse event, reimbursable by the government’s Vaccine Injury Compensation Program. Infectious diseases aren’t in the top ten. Is it because we vaccinate? Or is it because we are better-fed, have cleaner water, have access to antibiotics or other treatments, and cleaner living conditions than the developing world?

It likely is not either-or, but we clearly need a new vision for our children. US children face shorter life spans than their parents, and have more chronic disease and disability than any generation of children before them. Vaccines as we now use them have arguably created a stunning and costly burden of chronic disease and disability. As health insurers wise up, will they opt out of the usual carte-blanche coverage for every vaccine Pharma produces? Sooner rather than later, the cost burdens of over-vaccinating will come to light. And we can at the very least use the well pedigreed body of evidence in child nutrition to support robust immune function, any time you’re ready.