1.
We pediatricians are mostly a benign lot, slow to get angry and quick to have empathy. But if a parent refuses to vaccinate her child for non-medical reasons--well, that can make the most avuncular pediatrician feel alternately angry, frustrated and sad. With good reason.
Many of you have heard by now about the recent measles outbreak in the United States. The cause of the epidemic is due to ignorance; the measles vaccine, combined with vaccines against rubella (German measles) and mumps and known as MMR, is safe and has been widely available for years. It is extremely effective; measles was on the way to extinction a decade ago due to the high immunization rate among people of all races and classes.
Measles is a serious disease. About one--or maybe even two--per 1,000 cases ends in death. Another one in a thousand cases results in severe brain damage. Not to mention more frequent but less severe complications such as ear infections and diarrhea.
I belong to an age group in which virtually everyone contracted measles during childhood. I was about eight; it was a typical case--I had a rash and fever. What most annoyed me was that the eye irritation which is common in measles--I had that bad-made reading impossible for several days. I was one of the 996 per thousand who had a typical case. What if I had been among the remaining four? What sane person would run the risk of non-vaccination that might prove fatal to his or her child--or to someone else's?
In a world with billions of people, a serious-complication rate of 4 per thousand would result in deaths and disabilities in great numbers. Here is an important statistic: the Centers for Disease Control in Atlanta estimates that 15.6 million lives have been saved worldwide from 2000-2013 solely due to the measles vaccine. That's 15.6 million.
A statistic like that gives rise to the inevitable conclusion that a parental refusal to vaccinate their children is a form of child abuse.
Opponents to measles vaccination have pointed out the fact that there have been no measles deaths in the United States since 2003--which, they fail to mention, is solely due the widespread use of the vaccine. Even during the current epidemic, there have been only 644 cases. Stop vaccinating and deaths and disabilities from measles will definitely increase--horribly increase.
Causing the death of one child is, for that child, destroying the entire world. Death is still death whether it comes from a terrorist or from a doting, ignorant parent.
2.
What is to be done? Should children who are unvaccinated be excluded from school? Should pediatricians discharge from their practices parents who refuse to vaccinate their children?
Such questions did not arise when I worked in public health. In the early eighties, I was the Director of School Health for a city that had over one hundred schools. My duties included the administration of the immunization program. Most of the wealthy parents in Baltimore send--then as now--their children to private schools. It was mostly the poor who were poorly vaccinated, not because of opposition to vaccines, but because many lacked ongoing medical care. Many parents were unaware of the importance of vaccines.
We had a strategy to get everyone vaccinated--unvaccinated children were excluded from school and, if parents remained recalcitrant, they were charged with child neglect. The United States, however, has a long history of freedom of religion; soon there was a grass roots movement in the state to allow religious exemptions. The state health department, cognizant of the importance of vaccines, did its best to limit them. At first, only members of religions which specifically forbade vaccinations were exempted--there were two, with few adherents. That worked for a while; public pressure, however, mounted. Then we allowed people who merely asserted that they had a religious objection to vaccines to be exempted. That worked for a while; what we eventually had to accept is that anyone who opposed vaccination for whatever reason would be exempted.
But, in the name of public health, we were a bit devious. We didn't inform people whose children were unvaccinated that they had this option. Very few parents were aware of the exemption--nearly everyone got vaccinated.
We are dealing with a different problem now. It is the affluent and more articulate that are now causing the problem. In certain wealthy California schools, the immunization rate for measles is about 50%. Unscientific misinformation is, unfortunately, all over the Internet and television. Many adhere to so-called alternative medicine, and live psychologically, as far as science is concerned, in an alternate universe. For those unfamiliar with how science works--which is apparently a very large segment of the population--vaccinations are toxins the adverse effects of which greatly outweigh the benefits.
Denying the benefits of vaccines has strange bedfellows--the denial of evolution and the denial of climate change are also snoozing along under the same covers. It is a crime when preventable suffering continues to occur.
We need to do better, much better, in educating everyone about science. Anecdotes are not data! When one administers millions of vaccines, an adverse event is going to occur now and then, which has no statistical connection to the vaccine! (This is called background noise.)
Vaccination is one of the greatest successes of public health. In the arena of truth, holistic dada is no match for scientific data. In the arena of ignorance, however, science--in Santa Monica and elsewhere--is getting clobbered. Something must be done!
We pediatricians are mostly a benign lot, slow to get angry and quick to have empathy. But if a parent refuses to vaccinate her child for non-medical reasons--well, that can make the most avuncular pediatrician feel alternately angry, frustrated and sad. With good reason.
Many of you have heard by now about the recent measles outbreak in the United States. The cause of the epidemic is due to ignorance; the measles vaccine, combined with vaccines against rubella (German measles) and mumps and known as MMR, is safe and has been widely available for years. It is extremely effective; measles was on the way to extinction a decade ago due to the high immunization rate among people of all races and classes.
Measles is a serious disease. About one--or maybe even two--per 1,000 cases ends in death. Another one in a thousand cases results in severe brain damage. Not to mention more frequent but less severe complications such as ear infections and diarrhea.
I belong to an age group in which virtually everyone contracted measles during childhood. I was about eight; it was a typical case--I had a rash and fever. What most annoyed me was that the eye irritation which is common in measles--I had that bad-made reading impossible for several days. I was one of the 996 per thousand who had a typical case. What if I had been among the remaining four? What sane person would run the risk of non-vaccination that might prove fatal to his or her child--or to someone else's?
In a world with billions of people, a serious-complication rate of 4 per thousand would result in deaths and disabilities in great numbers. Here is an important statistic: the Centers for Disease Control in Atlanta estimates that 15.6 million lives have been saved worldwide from 2000-2013 solely due to the measles vaccine. That's 15.6 million.
A statistic like that gives rise to the inevitable conclusion that a parental refusal to vaccinate their children is a form of child abuse.
Opponents to measles vaccination have pointed out the fact that there have been no measles deaths in the United States since 2003--which, they fail to mention, is solely due the widespread use of the vaccine. Even during the current epidemic, there have been only 644 cases. Stop vaccinating and deaths and disabilities from measles will definitely increase--horribly increase.
Causing the death of one child is, for that child, destroying the entire world. Death is still death whether it comes from a terrorist or from a doting, ignorant parent.
2.
What is to be done? Should children who are unvaccinated be excluded from school? Should pediatricians discharge from their practices parents who refuse to vaccinate their children?
Such questions did not arise when I worked in public health. In the early eighties, I was the Director of School Health for a city that had over one hundred schools. My duties included the administration of the immunization program. Most of the wealthy parents in Baltimore send--then as now--their children to private schools. It was mostly the poor who were poorly vaccinated, not because of opposition to vaccines, but because many lacked ongoing medical care. Many parents were unaware of the importance of vaccines.
We had a strategy to get everyone vaccinated--unvaccinated children were excluded from school and, if parents remained recalcitrant, they were charged with child neglect. The United States, however, has a long history of freedom of religion; soon there was a grass roots movement in the state to allow religious exemptions. The state health department, cognizant of the importance of vaccines, did its best to limit them. At first, only members of religions which specifically forbade vaccinations were exempted--there were two, with few adherents. That worked for a while; public pressure, however, mounted. Then we allowed people who merely asserted that they had a religious objection to vaccines to be exempted. That worked for a while; what we eventually had to accept is that anyone who opposed vaccination for whatever reason would be exempted.
But, in the name of public health, we were a bit devious. We didn't inform people whose children were unvaccinated that they had this option. Very few parents were aware of the exemption--nearly everyone got vaccinated.
We are dealing with a different problem now. It is the affluent and more articulate that are now causing the problem. In certain wealthy California schools, the immunization rate for measles is about 50%. Unscientific misinformation is, unfortunately, all over the Internet and television. Many adhere to so-called alternative medicine, and live psychologically, as far as science is concerned, in an alternate universe. For those unfamiliar with how science works--which is apparently a very large segment of the population--vaccinations are toxins the adverse effects of which greatly outweigh the benefits.
Denying the benefits of vaccines has strange bedfellows--the denial of evolution and the denial of climate change are also snoozing along under the same covers. It is a crime when preventable suffering continues to occur.
We need to do better, much better, in educating everyone about science. Anecdotes are not data! When one administers millions of vaccines, an adverse event is going to occur now and then, which has no statistical connection to the vaccine! (This is called background noise.)
Vaccination is one of the greatest successes of public health. In the arena of truth, holistic dada is no match for scientific data. In the arena of ignorance, however, science--in Santa Monica and elsewhere--is getting clobbered. Something must be done!
