Evolution of the book, Alternative Schedules, and Updates

The Vaccine Book

Evolution of The Vaccine Book: How my view on my Alternative Vaccine Schedules has changed

The Vaccine Book was originally published in 2007. This First Edition reflected my understanding of the vaccine decision at that time based on my initial 8 years of experience as a pediatrician and my thorough review of all the research. Back then, many of my patients wanted an alternative vaccine schedule that emphasized on-time vaccination against the illnesses that posed a realistic threat to their infants while delaying or skipping altogether the ones their children were not at risk from. Many parents shifted away from following the full CDC schedule of getting 8 or 9 vaccines at each infant check up and preferred an alternative schedule that gave fewer doses at a time. 

In 2011 I updated the book as a Second Edition with some new research and ideas that broadened the discussion. I’ve been the recipient of some interesting criticism from both sides of the debate. The mainstream criticizes me for discussing vaccine options that fall outside of the recommended CDC vaccine schedule, which “clearly is safe, effective, and saves lives.” But some on the other side have been even more harsh, bashing me for suggesting that kids get any vaccines at all. However, these fringe groups aren’t my audience. They don’t need my book, since they’ve already decided what to do, or not to do. My audience are the middle majority – the 95% of people who just want education and are trying to decide what to do.

The truth is, I’ve never advised anyone to get a vaccine in any of my books. That’s because I don’t give direct medical advice in my book. I don’t advise people too vaccinate, just as I don’t advise them not to vaccinate. I simply provide information and ask the reader to decide in partnership with their doctor. Some readers misconstrued my alternative vaccine schedules as an active recommendation that parents should do all those vaccines. That wasn’t my intention. My alternative schedules were there for people who, in partnership with their doctor and after doing all their research, wanted to do some vaccines and wanted a way to logically space them out. Basically, if you decide to vaccinate, here’s how you can do it. I also became aware that some were simply following my schedules without reading the rest of the book, so they weren’t understanding all the information they should have to make an informed decision. Thus, the Third Edition was born in 2019. 

Over the past 15 years I’ve seen a shift away from following alternative vaccine schedules. More and more parents, both in America and worldwide, are choosing not to vaccinate at all in the early years. Some start vaccines later and most do not. At the same time, I’ve seen more and more pediatricians make vaccines mandatory for their patients. No shots, no service. Since I’m almost the only pediatrician in my county who will see these families, my practice has become about 99% vaccine free in my infant and toddler population. No one in my practice even seems to want an alternative schedule anymore. They raise their kids vaccine-free for the first several years (their choice, not mine), and then about 10% of them will do the 14 injections required for California schools spread out over a couple years. 

So, the Third Edition (2019) reflects my experience working with these families and observing these trends. I no longer feel comfortable publishing a specific alternative vaccine schedule, and I ask my readers to develop an alternative schedule with their own doctor if they decide they should do some vaccines. I added a whole new chapter on how to navigate this decision and I more clearly and openly discuss my opinions based on all my research. 

Another reason for my shift is the growing threat of mandatory vaccination laws. I think if certain state governments had just left well enough alone (meaning, people could freely make their own choice about vaccines without discrimination or suffering economic and societal penalties), then many of us would still be calm and quiet about this issue. But no more. They drew first blood. They are trying to make vaccines mandatory in more and more states, so we are working harder to grow the health choice movement so that everyone can enjoy the freedom to make all medical choices for themselves and their children. 

My podcasts and my two video series have been even better outlets for me to educate parents worldwide on this topic, and I will likely continue in those endeavors as well.

Thank you for your readership. We are on this journey together, and it’s nice that every day that passes we become a bigger people. 

Dr. Bob


Updates to The Vaccine Book


There are currently three, and soon-to-be four, vaccines recommended during pregnancy (Flu, Tdap, Covid, and possibly RSV). Readers often ask me if I recommend any of these. At this time, there is not enough safety or efficacy research for me to actively recommend any of these to people during pregnancy. There has not been sufficient research done since writing the most recent version of this book for me to change my opinion. Since I don’t offer direct medical advice on this website, I can’t tell you what to do. I give each patient a discussion on the pros and cons of these vaccines during pregnancy and each patient makes their decision. I would say that 99% of my patients do not get any of these during pregnancy. 

  • Flu shot updates. It was my hope to be able to provide updates on each year’s offering of flu vaccines, but I have not been able to keep up. You can review this info, if you need to, by reading each product insert for the current year’s flu shots on the FDA website. 

  • RSV vaccine. A new vaccine is in development to help prevent this respiratory illness. Pharmaceutical companies have been trying to make an RSV vaccine for infants for over 50 years now, but serious side effects have blocked all attempts. Now Pfizer and GSK are attempting to make a different type of vaccine that is, instead, given to pregnant women in order to provide newborn babies with transplacental immunity. CNN published a thorough and useful report on the progress of these two endeavors (link below). GSK’s vaccine development was halted in 2022 in the final stages of human trials when it was found that the vaccine may significantly increase the risk of premature birth and neonatal death (see the CNN article for data and details). So far, Pfizer’s vaccine is only showing a very slight increase in the risk of premature birth with no increased risk of neonatal death. The FDA and Pfizer are moving forward with safety and efficacy trials and I will keep you updated when we know more. This vaccine is not yet available to the public. Click here to read the CNN article.

UPDATE: The Pfizer RSV vaccine during pregnancy IS NOW FDA Approved. You can click here for the full vaccine Produce Insert. 

How this vaccine is made and ingredients. Two proteins from the RSV virus are genetically engineered by producing the proteins within hamster ovary cells. These proteins are purified and put into a saline solution with tromethamine, sucrose, mannitol, and polysorbate 80. The product also contains trace amounts of DNA and protein from the hamster ovary cells. The injected RSV proteins are intended to stimulate immune responses in the pregnant woman so she passes these antibodies to the baby, thus theoretically protecting the baby from RSV during the early months of the baby’s life. 

Safety and efficacy. This product is too new to know much about the safety and efficacy, but it did past the FDA’s requirements for approval. There is a small concern of premature labor however.


The FDA has just granted fast-track approval for a new version of this already-existing vaccine. The Product Insert is now available here. 

This new product, however, isn’t actually a vaccine. Vaccines technically are the germ components that stimulate an immune response (antibodies) in the body to provide protection from infection. Nirsevimab contains the actual antibodies genetically engineered then injected to provide some artificial immunity in a baby. An older version of this preventive treatment, called Synagis, has been around for decades and has been recommended mainly for premature babies (in whom RSV can be much more severe). This new version is recommended for ALL newborns to help reduce the severity of RSV during their first winter. It can also be given to infants with severe heart and lung disease for their second winter as well. 

The injection is given as a single one-time dose before the start of RSV season (around October). 

How it is made/ingredients: This is a genetically-engineered monoclonal antibody produced in a laboratory using hamster ovary cells to generate batches of these proteins. The antibodies are then mixed with two amino acids, some sucrose, polysorbate 80 and water. 

Side effects: The main side effect of concern is allergic reaction. The exact risk of this rare reaction is not yet known. 

I have not yet given any patients this injection, but will begin discussing it with them. If I experience any problems with it, I will update this information here. 


As you read in Chapter 2, the original PC vaccine (brand name Prevnar) provided artificial immunity against 7 strains of this bacterium. This was upgraded to 13 strains with the Prevnar 13 version in 2017. Now there is another upgrade:

Prevnar 20: This is manufactured using the same techniques and ingredients as the original, just with more strains of the germ. It has the same 125 micrograms of aluminum as the original. 

Vaxneuvance: This is a new version made by Merck and was approved in the U.S. in 2021. It provides artificial immunity to 15 strains of PC. It has the same amount of aluminum as Prevnar 20 and is manufactured in a similar manner with similar ingredients. 

I don’t have a preference between these two brands. 99% of my patients don’t opt in for PC vaccines anymore. 


My opinion on aluminum has not changed since publication. There have not been any new studies that have made aluminum appear safer. I have, however, written some better and more up-to-date discussions on aluminum in vaccines that I would like to direct you to. 

  • A Tale of Two Sides book and podcast. Chapter 3, in my opinion, presents the most objective and science-based discussion on both sides of the aluminum debate. All research resources for this info is also listed here on A Tale of Two Sides Resource page

  • The Vaccine Conversation podcast. Scroll through the titles and you’ll see several episodes that dive very deeply into this issue, including interviews with Dr. Chris Shaw and Dr. Chris Exley. 


This vaccine combines DTaP, Hib, Polio, and Hep B all into one shot for the 3-dose series given to infants and toddlers (not approved for 5 years and older). The DTaP and Polio components are the same as the Sanofi DTaP and Polio formulations described in those chapters, and the Hep B and Hib components are the same as Merck’s Hib and Hep B described is those chapters. 

The ingredients are as follows:

  • Protein components of each of the six germs as described in each chapter of each vaccine component

  • 319 micrograms of aluminum 

  • Polysorbate 80

  • formaldehyde

  • glutaraldehyde

  • cow blood proteins

  • three antibiotics

  • ammonium thiocyanate

  • yeast proteins

Overall, this combined injection has the least amount of aluminum than any other combination of these 4 vaccines given separately (319 mcg per dose for the three doses). In comparison, the DTaP with the least aluminum has 330 mcg per dose and Hep B has 250 mcg per dose. I have not yet used this vaccine in my office, however, as my patients prefer to spread vaccine components out in separate shots. 


The status of Covid infections and the three vaccines used in the U.S. hasn’t really changed much since publication, so I don’t have any significant updates. A reliable source for updates that you might find valuable is Childrens Health Defense. Click here to read their most recent article on Covid vaccines and the latest on VAERS data (Vaccine Adverse Events Reporting System). 

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