How I Feel About Vaccines

Photo by Caleb Woods via unsplash.com

When measles cases in Brooklyn and Rockland county shot  past the hundreds last spring,¹ I began to realize the gravity of the situation at hand. In the hospital where I was working, we had already admitted several children with severe measles infections and a young boy with a superinfection of his chickenpox rash that required intravenous antibiotics. In our pediatric ICU, a strong, healthy high school track star was intubated and fighting for her life after contracting pneumonia following a severe bout of the flu. These children could have avoided significant pain and suffering had they been vaccinated. 

I wish vaccine-hesitant parents could see what I see. Measles, flu, even varicella- these diseases can cause tremendous suffering, and even death. In 2019 more people in the Democratic Republic of Congo died of measles than of Ebola.² In the U.S. the 2017-2018 flu season left an estimated 80,000 people dead.³ 186 of those were children.

When I reassure vaccine-hesitant parents that there is incredibly strong evidence that vaccines are safe and effective, and that the study suggesting an association between vaccines and autism has long since been debunked,⁵ it doesn’t seem to work. It’s a matter of choice, they tell me. Of their individual right as a parent. But the problem is that this is a choice that affects the health and safety of other people, too.

Viewing vaccine choice as an individual right and issue does not take into consideration the dual purpose of vaccines. Yes, vaccines will prevent an individual from becoming ill. But they also have another crucial effect: herd immunity.⁶ When at least 90%-95% of a population is vaccinated (the number varies slightly by vaccine,) the illness becomes less common and everyone is protected,⁷ including those who cannot be vaccinated because of their age or health. They can go to school, to parks, or to other public places with little worry of becoming ill, because the herd of vaccinated neighbors, schoolmates and cohabitants protect them. What should these children do now that vaccination rates in some communities hover as low as 50%? Measles is so aggressively contagious that we shut down our entire urgent care clinic for cleaning when a patient was diagnosed. For children who are to sick or too young to get the MMR vaccine, even walking into your doctor’s office during an outbreak becomes unsafe.  

Photo by Hyttalo Souza via unsplash.com 

To be fair, the medical community shoulders some responsibility for vaccine refusal and hesitancy in the United States. In the age of endless information, perhaps it’s been too easy for us to be dismissive of parental concerns and hesitation, without delving deeper into where these concerns are coming from. Some communities have genuine reason to view the medical community with doubt and suspicion, given the Tuskegee syphilis experiment,⁸ or the coerced sterilization of some minority women.⁹ Perhaps we have been too quick to tell parents to stop googling, when we should have been having open conversations about why families seek out alternative, questionable sources for information in the first place.

Shortly after the outbreak was declared I was back on the wards. The child with chickenpox had lost his IV, and I was asked to help replace it using an ultrasound machine, since his severe rash was making the task difficult. Even before I entered the room, I could hear him crying. He had been miserable for days with significant itching and pain. As I prepared to place the intravenous line in what was probably a third or fourth attempt that day, a strange thought popped into my head. I wondered if this little boy was given the option of getting vaccinated or being subjected to this, what would he have chosen? 

Note: certain details in this story have been changed to maintain patient privacy. All of the cases discussed are real. All words, thoughts and opinions are my own. 

References

1.     Goldschmidt, D. (2019, May 13). More than 800 cases of measles in US, with NY outbreak continuing to lead. CNN. Retrieved from https://www.cnn.com/2019/05/13/health/measles-update-cdc-800-cases/index.html

2.    Rossman, J., & Badham, M. (2019, September 18). Over 3,000 people have been killed by a deadly virus in DR Congo this year —and it’s not Ebola. Quartz Africa. Retrieved from https://qz.com/africa/1711485/measles-is-killing-more-people-in-dr-congo-than-ebola/

3.  Center for Disease Control. (2018). Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2017–2018 influenza season. Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2017–2018 influenza season. Retrieved from https://www.cdc.gov/flu/about/burden/2017-2018.htm

4.  Vaccine Safety: The Facts. (2018, October 10). Retrieved October 23, 2019, from https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Vaccine-Safety-The-Facts.aspx.

5.   Eggertson, L. (2010). Lancet retracts 12-year-old article linking autism to MMR vaccines. Canadian Medical Association Journal, 182(4), E199–E200. doi: 10.1503/cmaj.109-3179

6.     Boyd, R. (2016, April 18). It Takes a Herd. Retrieved October 23, 2019, from https://www.aap.org/en-us/aap-voices/Pages/It-Takes-a-Herd.aspx.

7.  Funk, S. (2017). Critical immunity thresholds for measles elimination. Critical immunity thresholds for measles elimination. London School of Hygiene and Tropical Medicine. Retrieved from https://www.who.int/immunization/sage/meetings/2017/october/2._target_immunity_levels_FUNK.pdf

8.  Brown, D. N. (2017, May 16). ‘You’ve got bad blood’: The horror of the Tuskegee syphilis experiment. The Washington Post.

9.    Ko, L. (2016, January 29). Unwanted Sterilization and Eugenics Programs in the United States. Retrieved October 23, 2019, from http://www.pbs.org/independentlens/blog/unwanted-sterilization-and-eugenics-programs-in-the-united-states/