Last year 10 children died
in California in the worst whooping cough outbreak to sweep the state since
1947. In the first six months of 2011, the Centers for Disease Control and
Prevention recorded 10 measles outbreaks—the largest of which (21 cases) occurred
in a Minnesota county, where many children were unvaccinated because of
parental concerns about the safety of the standard MMR vaccine against measles,
mumps and rubella. At least seven infants in the county who were too young to
receive the MMR vaccine were infected.
These troubling statistics
show that the failure to vaccinate children endangers both the health of
children themselves as well as others who would not be exposed to preventable
illness if the community as a whole were better protected. Equally troubling,
the number of deliberately unvaccinated children has grown large enough that it
may be fueling more severe outbreaks. In a recent survey of more than 1,500
parents, one quarter held the mistaken belief that vaccines can cause autism in
healthy children, and more than one in 10 had refused at least one recommended
vaccine.
This sad state of affairs
exists because parents have been persistently and insidiously misled by
information in the press and on the Internet and because the health care system
has not effectively communicated the counterarguments, which are powerful.
Physicians and other health experts can no longer just assume that parents will
readily agree to childhood inoculations and leave any discussion about the
potential risks and benefits to the last minute. They need to be more
proactive, provide better information and engage parents much earlier than is
usually the case.
Peril
of Business as Usual
Right now pediatricians typically bring up the need for vaccines during the well-baby
checkup held about two months after birth. That visit has a jam-packed agenda.
In the usual 20 minutes allotted for the appointment, the physician must learn
the answers to many questions, of which the following are but a sample: How
many times is the baby waking to feed at night? Is the child feeding well?
Where do measurements of height, weight and head circumference fall on a
standard growth chart? Do the parents know how and when to introduce solid food
and how to safely lay the child down to sleep? Are various reflexes good? Can
the sounds of a heart murmur be heard through the stethoscope? Are the hip
joints fitting properly in their sockets, or are they dislocated?
Generally in the final
seconds of the visit, assuming all has gone well to this point, the doctor
mentions the required schedule for six recommended inoculations: the first DTaP
shot (for diphtheria, tetanus and pertussis, also known as whooping cough), the
polio shot, a second hepatitis B shot (the first having been given in the first
few days after birth), the pneumococcal conjugate shot (for bacterial pneumonia
and meningitis), the HiB shot (for another type of meningitis) and finally the
rotavirus vaccine (to prevent a severe diarrheal infection). This is the point
in the visit at which more and more pediatricians report a disheartening turn
of events: although most parents agree to the inoculations without hesitation,
a growing number say they would like to delay or even refuse some or all of the
vaccinations for their infants.
A proper conversation that
respects the reluctant parents’ concerns, answers their questions and reassures
them that the inoculations are indeed necessary—that countless studies by
hundreds of researchers over many decades have shown that vaccinations save
millions of lives—will likely take at least another 20 minutes. Meanwhile,
though, other families sit in the waiting room, itching for their own well-baby
checkups to start.
This all too common scene
should never happen. Having this discussion at the two-month well-baby visit is
too late. By then, parents may have read about any issues on the Web or chatted
with other moms and dads in the park. Discussion with medical professionals
should begin long before, usually during, or even prior to, the pregnancy. The
evidence summarized below should form the basis for these exchanges.
Fears
and Facts
Although parents give many reasons for not wanting to vaccinate their children,
we have noticed at least three recurring themes. Some do not believe their
children are at risk for diseases such as polio, measles and tetanus, which are
now rarely seen in the U.S. Others do not believe that certain
vaccine-preventable diseases, such as chicken pox and measles, are particularly
serious. And many worry about the safety of vaccines. The concerns may be about
immediate, well-defined side effects such as fever or may take the form of
anxiety that vaccines might harm the immune system or cause chronic diseases
years later. Each of these concerns can be met with a careful review of the
evidence.
Together we have conducted a
series of studies to better quantify the risks of not vaccinating—information
that speaks to the mistaken belief that today’s children are unlikely to come
down with whooping cough, measles or the like if they skip their inoculations.
Our investigations looked at hundreds of thousands of children in Colorado and
compared the risk of various vaccine-preventable diseases in children whose
parents had refused or delayed vaccines, compared with children whose parents
had had them vaccinated. We found that unvaccinated children were roughly 23
times more likely to develop whooping cough, nine times more likely to be
infected with chicken pox, and 6.5 times more likely to be hospitalized with
pneumonia or pneumococcal disease than vaccinated children from the same
communities. Clearly, the parental decision to withhold vaccination places
youngsters at greatly increased risk for potentially serious infectious
diseases. These results also show the flaws in the “free rider” argument, which
erroneously suggests that an unvaccinated child can avoid any real or perceived
risks of inoculation because enough other children will have been vaccinated to
protect the untreated child.
Vaccinated children who
develop chicken pox (no vaccine is perfectly effective all the time) usually
suffer much milder symptoms.
Even when parents appreciate
the peril of not vaccinating, they want to know that vaccines are safe. Because
vaccines are given to huge numbers of people, including healthy infants, they
are held to a much higher safety standard than medications used for people who
are already sick. Nothing in medicine is 100 percent safe, however, and the
absolute safety of vaccines cannot be proved. Safety can be inferred, though,
by the relative absence of serious side effects in multiple studies.
Studying the safety of
vaccines is a complicated, labor-intensive process. Fortunately, the U.S. has a
sophisticated system, a federally funded program that does not receive any
money from vaccine manufacturers. This system can both test specific hypotheses
and perform general monitoring of the safety of newly licensed vaccines. As a
new theory arises, it can be rigorously tested.
Perhaps the biggest boost to
the antivaccine movement came in 1998, when, in a paper in the Lancet, Andrew J.
Wakefield and 12 colleagues proposed that the measles vaccine could cause
autism in susceptible children. In the years since, more than a dozen studies
have convincingly shown that vaccines do not cause autism. In fact, it is rare
in science that published scientific findings have been so thoroughly, and
publicly, disproved. The Lancet retracted the Wakefield article in
early 2010. Most of the co-authors no longer vouch for the study findings. And
Wakefield himself was accused of falsifying the data and lost his medical
license.
That this cycle—debunked
links followed by ever grander speculation—keeps repeating itself is a clear
indication that the scientific community is more reactive than proactive when
engaging the public about vaccine safety. Investigating narrow, specific
theories about vaccines does not seem to provide adequate reassurance to
parents with broad and vague worries about vaccines.
So where does this leave the
conversation between health professionals and parents? A good place for talks
to begin would be in a prenatal class devoted to vaccines or through Web chats
with physicians and vaccine researchers. Web interactions, in particular, might
encourage prospective parents to openly air their concerns and raise sensitive
questions they may not feel comfortable asking in a face-to-face visit with
their child’s own pediatrician. Education campaigns should also be carried out.
But many moms and dads will still need a forum where they can find accurate information,
voice their worries, and engage in a full discussion about the benefits and
risk of vaccines. And many will still want their infant’s doctor to look them
in the eyes and say, “This is one of the best things you can do for your
child’s health.”
The key facts parents need
to know, though, are that vaccines prevent potentially fatal diseases, that
vaccines have a high degree of safety, and that their safety is constantly
evaluated and reevaluated in a system operating independently from the pharmaceutical
companies that make vaccines. Unless this message gets spread widely and well,
too many doctors and parents are going to find themselves in emergency rooms
and isolation wards, watching children suffer with the devastating effects of
measles, whooping cough or some other readily preventable infectious disease.
My question
is easy. Are you for or against vaccination and why.
I thinks that vaccination is so helpful and is good for our society and it has permitted to remove some diseases and prevent of them.
However, it's clear that we have to continue to be awake about pharmaceutical industry to prevent that people's health don't end up to be a business.
