Great America

We Need to Defend the Miracle of Vaccination

Infectious diseases that used to claim the lives of 1-in-6 children before their fifth year are making an alarming comeback in the United States. The culprits are parents who should know better—and the politicians who accommodate them.

Parents of small children today no longer know the fear—much less the reality—of deadly childhood diseases. It wasn’t so long ago that epidemics of highly communicable diseases such as diphtheria, measles, and whooping cough regularly killed large numbers of children and left others with permanent disabilities. As a child in the 1950s, my parents prevented me from going to public swimming pools during the summer because of the threat of polio.

But thanks to the miracle of vaccines, arguably the greatest public health triumph of the 20th century, these outbreaks became rare and well contained.

A kind of amnesia about the threat of infectious diseases, however, combined with a fraudulent scare that supposedly linked autism to vaccines and a small but vocal anti-vaccine movement that was birthed in the aftermath of that scare have conspired to cause diminished compliance with vaccination schedules, and this has led to the resurgence of certain diseases. This worldwide phenomenon has caused the World Health Organization to include “vaccine hesitancy” on its list of the 10 greatest threats to global health currently.

The Needless Return of Measles

Measles is the prototype of an almost-extinct viral illness that has returned with a vengeance. Between 2001 and 2008, a median of 56 measles cases in the U.S. were reported each year to the Centers for Disease Control and Prevention (CDC). However, from January 1 to July 3, 2019, 1,109 individual cases of measles were confirmed in 28 states. This is the greatest number of cases reported in the United States since measles was declared eliminated in 2000.

There is no way to immunize against adults’ ignorance and bad judgment, but we can at least demand that children not be endangered.

Such infections not only cause unnecessary morbidity and mortality but also exact significant health care costs. A measles outbreak in Arizona among only 14 patients cost the two hospitals involved $800,000 as they responded to and contained the cases.

Measles is highly contagious, and the CDC cites several factors that facilitate its spread: (1) The majority of people who got measles were unvaccinated; (2) the disease is still common in many parts of the world; (3) travelers with measles continue to bring the disease into the United States; and (4) measles can spread when it reaches a community of people in the United States where many are unvaccinated.

Pertussis, or whooping cough, is another once nearly extinct, highly infectious disease that has made a comeback. 20 years ago, vaccines had reduced the incidence to about 7,000-8,000 cases annually in the United States, but there were more than 48,000 cases in 2012 and just under half that each year since.

“Personal Belief Exemptions,” Russian Agitprop, and Other Follies

All 50 states have legislation requiring specific vaccines for students, but there are some exceptions to the requirement.

Although exemptions vary from state to state, all school immunization laws grant exemptions to children for medical reasons, such as a vaccine allergy (which is quite rare). Forty-five states and Washington, D.C. grant religious exemptions for people who have religious objections to immunizations, and 15 states allow philosophical exemptions—also known as “personal belief exemptions,” or PBEs—for those who object to immunizations because of moral or other beliefs. In the states that permit PBEs, parents need only sign a form stating their wish to exempt their children from the vaccination requirement; no specific reason is required.

Given the periodic resurgence of various illnesses that had almost disappeared, permitting nonmedical exemptions from vaccination is a threat to individual children and to the community at large. Although adults should be permitted to make decisions about their own medical care—however unwise they may be—the capricious rejection of vaccines for children is tantamount to withholding a needed blood transfusion or operation.

Putting a single child at risk also puts the community at risk. Some of the recent outbreaks occurred when unimmunized or under-immunized international travelers returned home, became ill, and gave rise to other cases that swept through communities, infecting the unprotected.

The higher the rate of vaccination in a community, the less likely it is for an epidemic to gain a foothold and spread. An important determinant of spread is whether there is “herd immunity,” a kind of immunological barrier to the dissemination of an infectious disease that appears when a large fraction of a susceptible population (about 75–94 percent, depending on the infectious agent) is vaccinated. The spread of the pathogen is blocked in person-to-person transmission when it confronts immunized, resistant individuals.

When community-level protection falls below a certain level, the infection rate rises precipitously. Thus, a high rate of immunization is essential, because it serves to protect everyone in the community, including those few who legitimately cannot be vaccinated or who have a sub-optimal immune response, such as the elderly.

Another confounding factor is Russian agitprop intended to create concerns and confusion about vaccination in the United States. A study by academics published last year in the American Journal of Public Health found that thousands of Russian social media accounts spread anti-vaccine messaging.

From the examination of almost 2 million tweets posted between 2014 and 2017, the researchers found that Russian troll accounts were significantly more likely to tweet about vaccination than were Twitter users generally. Russian tweets like “Apparently only the elite get ‘clean’ #vaccines. And what do we, normal ppl, get?!” seem intended to exacerbate socioeconomic tensions and to elicit concern here about the safety of vaccines.

What Can Be Done?

The underuse of vaccines should be approached in several ways:

  • Public health agencies, local and national, should more aggressively educate the public about the importance of vaccination. U.S. Surgeon General Jerome Adams has been largely AWOL on this issue; inexplicably, promoting vaccination is missing from the priorities listed on his official webpage.
  • Health care workers should be required to be vaccinated against flu and other common infectious diseases; in the absence of a confirmed allergy to a vaccine, any who refuse it should be removed from patient contact or have their employment terminated.
  • Physicians whose practice includes caring for children should decline to treat families who refuse vaccination. This should be done not out of malice or a desire to punish, but to protect other children and their families who might be exposed to virus-shedding in the doctor’s office.
  • Philosophical exemptions from immunizations should be eliminated, and we should reconsider whether “religious exemptions” are legitimate, particularly for children. Although idiosyncratic belief systems should be respected, we cannot jeopardize public health by compromising herd immunity.
  • Social media outlets should consider carefully whether anti-vaccine messages, which by definition are fake news, should be rejected as a threat to public health.

There is no way to immunize against adults’ ignorance and bad judgment, but we can at least demand that children not be endangered.