On my left shoulder is a small mark that my children have always assumed was a scar. Actually, it is a mark left after I received the smallpox vaccine as a child. There are records of small pox disease causing death and blindness dating back to the time of the Egyptian mummies. History tells us of its effects on monarchs, middle ages crusaders, and its devastation to Native Americans after the Plymouth Rock settlement. It killed between 300 and 500 million people in the 20th century alone. My parents made the choice to vaccinate me as a child against a very real disease even though there was a real risk to vaccination; one or two people per million died secondary to smallpox-associated vaccine complications. However, the benefit of the protection far outweighed the risk. Smallpox disease was globally eradicated in 1979 as a direct result of vaccinations. A generation later, our children have only heard about the disease from history.
The polio vaccine is another example of risk that my parents were willing to take. I vaguely
remember receiving the oral polio vaccine (OPV) as a child. My parents tell of receiving their vaccine on a sugar cube. OPV has real risk: three cases per million of vaccine-associated paralytic poliomyelitis (a polio-like illness). During my residency training, I would counsel my patients’ families concerning this risk. I never remember a family refusing the vaccine because they had seen and knew the damage polio disease caused, particularly to children (e.g. life-long paralysis/partial paralysis, iron lungs, death, etc.). Having seen these consequences of the disease, they gladly accepted the risk. Because of the success of the vaccination and the resulting decline in polio in the U.S., the oral polio vaccine has been replaced in our country by an inactivated polio vaccine (IPV). It carries no risk of acquiring the disease. Many countries still use OPV because it is cheaper and easier to administer. Polio was eradicated in the U.S. in 1979 and in the western hemisphere in 1991. Global extinction is a real possibility but our global community must accept some risks.
In contrast to the real risk associated with the smallpox and polio vaccines, there is currently a perceived risk to vaccinating that doesn’t have a factual foundation, causing parents to be afraid without cause. Consider the MMR (measles, mumps, and rubella) vaccine. Most Americans have never seen any of these diseases. In fact, measles was declared eliminated from the U.S. in 2000. However, a fraudulent paper using falsified data was published in 1998 claiming a possible connection between the MMR vaccine and autism. It catapulted our world into fear and mistrust. With no memory of the disease and therefore, little understanding of the true risk, many Americans allowed unfounded fear to override authentic medical studies and counsel from trusted physicians. This paper has since been utterly discredited, but the damage has been great. Pockets of measles have returned to our country – largely in unvaccinated areas of the population. New York is currently experiencing its worst measles outbreak in the last 25 years. In Europe, there have been nearly 65,000 reported cases of measles between November 2017 and October 2018. For measles to be eradicated from a population, 95% of the people need to have received two doses of the vaccine. The other 5% can benefit from the vaccine protection of others (known as herd immunity). MMR vaccine does not carry any true risk like the oral polio or the smallpox vaccine did. Unfounded fear has led many parents to deny their children the vaccine, and as a consequence, the diseases are returning.
One current vaccine that enjoys almost complete acceptance is the meningococcal
vaccine. Why? Many of us have either known someone or at least heard about someone dying or being extremely disfigured from meningococcal disease, commonly known as bacterial meningitis. Growing up, the typical story I remember hearing was the otherwise healthy college freshmen student that thought they contracted a viral illness and died a few hours later. Thanks to meningococcal vaccine, that story is fading, as is the disease. Since there is still an awareness of this illness and how severe it can be, most people understand the true risk of the disease and the true benefit of the vaccine.
Another illness that almost everyone is familiar with is the “flu”. The current injectable
inactivated influenza vaccine (“the flu shot”) cannot cause, spread, or make you more susceptible to acquiring influenza, yet a surprising number of families refuse the vaccine. The CDC reported 80,000 Americans died from influenza last year – 80,000! This is the highest rate in four decades. Young children and children with underlying medical conditions are particularly at risk of complications from influenza. Every year, we see children become very ill with the flu who could have had protection from a safe vaccine. For those of us in the healthcare field, when we see children suffering from severe cases of influenza, it becomes difficult to understand the fear of the vaccine.
Because of vaccines, newly-trained pediatricians typically have never taken care of patients with Haemophilus meningitis, pneumococcal sepsis (blood infection), varicella encephalitis or cerebellar ataxia (infections of the brain), tetanus (lock jaw), or liver failure from hepatitis B. These diseases can become part of history like smallpox, and hopefully so will polio and measles. Due to the overwhelming success of the vaccination program as a whole, most parents haven’t seen nor even had second hand knowledge of these severe illnesses from which we hope to protect children. This causes the real risk of disease to seem smaller and the unfounded, fear-based risk of the vaccine to seem larger (fears usually based in non-scientific sources, stories, and conjecture).
We cannot let fear dictate our parental responsibilities or decisions. Instead, let’s continue an open conversation about facts and fears, about real risks and real benefits. As your pediatricians, we always want to help you make the best decisions about the health of your children. We truly believe in the benefit of vaccinations and are always happy to discuss these issues with you. This generation of parents (selves included) have the opportunity to choose to use the absolutely miraculous gifts of science and medicine to protect our children from diseases that terrified parents in generations past. Let us not give in to a culture of fear.
– Dr. S. Clark Newton, MD, ACP
For more information about Dr. Newton, click here.