Parents are often torn between what they hear about the risks from vaccinating, and what we know are the risks from not vaccinating. They’re surprised when I tell them I support vaccination. Here is how I look at it, and why.
When I was two years old, one of my cousins died from the after effects of polio. My mother would tell me the story of how my aunt was taking him to the hospital yet again, and stopped to get him a drink of water at a gas station. When she came back out, cup of water in her hand, my cousin had simply stopped breathing. He’d caught polio as a baby, before the Salk vaccine came out. It had twisted his body and compressed his lungs, and when he was thirteen, it killed him.
My mother would also tell me what she witnessed when, as a teenager in the 1940’s, an infant cousin living with them came down with diphtheria. He clawed at the faces at those who held him, as he struggled to breathe. That cousin survived; but the lack of oxygen caused permanent brain damage. (My mother’s family were poor rural folk, and doctors and hospitals were luxuries out of their reach. And for those of you who want to know why they didn’t go to the nearest county or charity hospital, it appears there were none that they could get to.)
When I was two, it was 1963, and that was the year that they started measles vaccination. In the following years, the great measles epidemics that had been a feature of childhood fell silent, at least in the United States. But there was still the echo of the damage it had caused. There were the dead, for measles kills one to two out of a thousand that it infects, even in recent epidemics in developed countries (such as the Netherlands in 1999 and the US between 1985-1992). There were the children who were blinded and deafened and otherwise scarred by measles encephalitis, which still occurs in two out of a thousand that measles infects. There were the seemingly healthy children who, six to eight years after measles, would start the progressive neurological and mental deterioration of subacute sclerosing panencephalitis, losing memory and muscle function, sight and hearing, and dying one to three years after diagnosis.
There was a reason that we started vaccinating against measles and polio and diphtheria, against tetanus and yes, against Haemophilus influenzae type b and chickenpox and others. We vaccinated because these highly contagious infections killed and maimed, in ways that we could see without a randomized controlled study to tell us it was so. Rubella (German measles) infected children in their mother’s wombs, deafening them and blinding them and damaging their cognitive abilities significantly. Mumps, even in in the early 2000’s in England and Wales, caused hospitalizations, orchitis, encephalitis and pancreatitis at a fairly significant rate, with 6.1% of males older than 12 years experiencing orchitis. (The authors of this paper note that they do not yet know what will be the rate of infertility in these cases.) And Haemophilus influenzae type b caused life threatening illness in 20,000 children annually before vaccines became available in the late 1980’s. Each year, it killed 1200 of those children, and left 2000-4000 a year with severe neurological damage or hearing impairment.
In 1963, my mom didn’t have any questions about how harmful it would be for me to get measles, or polio, or a number of other infections. Not surprisingly, I was vaccinated for “everything but inborn toenails” as my parents put it. I, and those in my age group, were the first to grow to adulthood without those illnesses. And not surprisingly, I tend to believe strongly that vaccinations are one of the great achievements of medicine.
Vaccines are such a great achievement, that we’ve forgotten why they were needed in the first place… Until something like the Disneyland measles outbreak happens, and we get reminded that these diseases are not just for developing countries.
Humans are wired so that we pay attention to the dangers that are current and present, rather than ones that are more intangible. And because most kids in the USA are vaccinated, and have been for years, the dangers of the diseases vaccines protect against are off our radar. Parents in the USA nowadays don’t worry about polio, or measles. They do worry about autism in all its variations, which has risen in incidence to the point that it affects 1 out of 68 children born in 2002. They know that the scientific consensus is that this is not just improved diagnosis, but a real increase. And despite the scientific consensus, many of them are concerned that this is somehow linked to vaccination.
An additional factor is the drive and social pressure to reduce any and all hazards that a child might be exposed to (understandably). Parents are urged to avoid anything that might bring about even the shadow of harm, no matter how remote. This is good (and understandable) parenting. We keep our young safe. But sometimes it can have unexpected consequences, and can help distort our perception of risk. In this atmosphere, with the diseases that they protect against seemingly vanquished, the rumored (and sometimes real, though small) risks of vaccination loom large for some.
Regardless of the science and the studies, for many parents the fear that vaccinations will harm their child is a real concern. It is more real than the concern that they will get measles, or polio, or a disease that they hear about on occasion from the news. And as you know, when people are convinced that there is a problem, dismissing their concerns out of hand rarely works. Nor does putting down the person and their views as ignorant, benighted, or backward. These approaches usually harden the other person’s viewpoint and bring the discussion to a halt.
So what can be done?
If you’re a parent who is concerned about vaccinations, I’d ask you to consider this. Vaccination, in my opinion, operates on the same principles that underlies functional and natural medicine. It utilizes your kid’s own immune system to keep him or her safe. It gives your kid’s immune system a chance to build up defenses against some pretty serious illnesses – without having to actually get them. This is as crucial as teaching your child to recognize possible signs of ”stranger danger” from afar. It takes the immune system about a week and a half to build up its defenses against first-time threats. Unlike colds, vaccine preventable diseases can maim or kill a child (or adult) in that length of time. You do not want your child’s first encounter with vaccine-preventable diseases to be with the full-blown infection.
And while no one has done a study on it, if a person is going to have problems with a vaccination against a disease, I suspect they are probably likely to have far more of a problem with an encounter with the actual disease itself. If you’re concerned (due to family history, your child’s medical history, etc.) that your child may be at risk for an adverse reaction, talk to your doctor. Rather than forgoing vaccinations, work with your provider to address any health concerns that your child may have, so that they can receive vaccinations. Obviously, If your child is medically fragile or immunocompromised, and your doctor has told you to not vaccinate them, you should not do so.
If you’re a pro-vaccine advocate, and you want to know how to reach parents who are against it, then consider this: contempt does not build bridges. The parents who are avoiding vaccination are typically better educated than the average. Despite perceptions, they appear to span the political, spiritual and lifestyle spectrum. They do research on the web. They read scientific papers. (Whether or not they interpret them correctly, and in the context of the body of the literature, may be another matter. But they do read them.) These parents are not going to be placated with a standard, one page handout written for an 8th grade reading level. Nor will peremptory if well-meant statements that simply say “it’s safe” (without any links to the studies). Addressing the concerns of parents who oppose vaccination will require detailed discussions that go into detail about the points of their concern. And it will involve acknowledging what we do and don’t know about some of these points.
Both sides, I think, would benefit from a good, neutral survey of the history of vaccination, and how vaccine opposition may be rooted in situations and conditions that do not exist today. We would all also benefit from a discussion of what “public health” involves. Eula Bliss’s excellent “Sentimental Medicine” (Harpers, January 2013) is a thoughtful look at some of these aspects – including the surprising biases inherent in the viewpoint that vaccines are for poor children or those overseas, not the middle class.
Finally, I think that one thing that has not been acknowledged on both sides, is this: the reality is that we do not live in a zero risk world. As parents, we constantly juggle risks: private risks, communal risks, global risks, seemingly petty risks. (If my 16 year old has a flip phone instead of a smart phone, does the misery of being seen as “out of it” counteract the benefit of having a less distracting electronic device?) Sometimes we have to choose, not between “no risk” and “risk”, but between one risk and another. Frequently we don’t have full information on what the potential ramifications are for either of the choices. This can be paralyzing. What do we do?
The answer – at least for me – has been to recognize that at the end of the day, the question is not avoiding risk, but reducing it, and managing what you can’t reduce. Vaccines are there to reduce some very real problems. At this time, the evidence is that vaccines don’t cause autism. The evidence is that what risks vaccines may have are far outweighed by the very real harms that they prevent. And based on what we know at this time, I urge you to vaccinate your child.
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