History is a great teacher. It always repeats itself. And if we can learn from past mistakes we can be better prepared for the future.
The United States had more cases of measles in the first month of 2015 than the typical number diagnosed in a full year. Measles is one of the most highly contagious viral infection in the world.
In the absence of widespread vaccination, the average person with measles will infect an average of 12 to 18 other people. Symptoms can be managed with common anti-inflammatory drugs, hydration and rest, but like many other viral illnesses, there is no cure and antibiotics will have no effect. Death rates are much higher in developing countries.
In 2000 the disease had been declared eliminated in the United States. Yet a new wave of cases, tied to an outbreak at Disneyland, began in December 2014. At least 40 people who visited or worked at the theme park contracted measles, and the disease spread to at least six other states. Dozens of newborns had to be put into isolation.
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The vaccine controversy is as old as the vaccination itself.
When Edward Jenner discovered the vaccine for smallpox in 1796, he faced as much criticism as praise. The church advised that vaccinations went against the Lord’s great plan for mankind; economists worried that vaccinations would lead to overpopulation; and everyday people were repulsed at the thought of injecting animal material into the human body. Children would sprout cow horns from their heads…
Today we are faced with yet another debate on the merits vs perils of vaccination, but for different reasons.
A vaccine is a substance created from living or once living material to provide an immunity to a particular disease. They are so successful that health and medical scholars have described vaccination as one of the top 10 achievements of public health in the 20th century. Critics of vaccination have ranged from early opposition to the smallpox vaccine in England and the United States (mid to late 1800s), to more recent vaccination controversies that focused on the safety and efficacy of two early childhood vaccines — the DTP (diphtheria, tetanus and pertussis) and the MMR (measles, mumps and rubella), and the use of a mercury-containing preservative called thimerosal. Despite the lack of scientific evidence linking it to any health hazards, thimerosal has been removed from most childhood vaccines.
The panic and confusion began in 1998, when British physician Andrew Wakefield recommended the investigation of a possible relationship between autism and the MMR vaccine. He alleged the vaccine was not properly tested before being put into use. To note, The Lancet, the journal that originally published Wakefield’s work, stated afterward that it should not have published the paper. In fact, evidence showed that Wakefield had been paid by a law board to suggest evidence that would support a litigation case by parents who believed that the vaccine had harmed their children. Wakefield had committed scientific fraud by falsifying data. Since this time, a large number of research studies have been conducted to assess the safety of the MMR vaccine, and none of them has found a link between the vaccine and autism.
Today, many critics and skeptics (referred to as antivaxxers), who either avoid vaccinations or delay or undervaccinate their children, have come to their position through worry and doubt. Many come from religious communities and practitioners of alternative medicine to those who shun governmental interference. Some are insecure about the ingredients used in vaccinations and the profitability versus accountability roles of pharmaceutical companies who make them. Critics state that even a long held faith and trust in scientific authority has the potential to be eroded. Daniel Henninger of the Wall Street Journal proposes that the systems to ensure the reproducibility and validity of research experiments can fail when the lure of grant monies, security of tenure and the public’s desire to believe in breakthroughs become paramount to scientific ethics and morals.
Yet countless lives of children and adults have been saved due to vaccinations for serious and sometimes fatal diseases such as smallpox, polio, pertussis, tetanus, diphtheria, influenza, pneumonia, meningitis, chickenpox, rabies, hepatitis, human papilloma virus (associated with cervical cancer) and several others. Current work continues on vaccines for viruses such as ebola and HIV (the virus that causes AIDs) and others. A compilation of vaccine information can be found at http://www.historyofvaccines.org/content/articles/different-types-vaccines
Vaccinations and the Law
According to the National Vaccine Information Center, the first vaccine mandated in the U.S. was smallpox vaccine. By 1922, some states had passed laws requiring that children show vaccination proof in order to attend school. In the early 1980s, the CDC recommended/most states mandated that children receive 23 doses of seven vaccines (polio, diphtheria, tetanus, pertussis, measles, mumps, rubella) to attend kindergarten.
By 2014, the CDC recommended that children get 69 doses of 16 vaccines between day of birth and age 18. Most states mandate that children get 29 doses of nine vaccines to attend kindergarten. Children enrolled in daycare are typically required to get multiple doses of 13 vaccines.
Supporters of routine vaccines compare opting out of vaccination to drinking alcohol. They say that while people may have their own beliefs about how and when they drink alcohol, once they run the risk of harming others, it belongs in the state’s interest — just as a preventable outbreak is.
Significance of exemptions or opting out
Overall, vaccination rates in the United States remain high. Parents who seek an exemption from vaccination requirements are a very small minority. The Public Health Reports study found that families of unvaccinated kids are more likely to be wealthier on average, non-Hispanic white, married couples in English-speaking households, with college degrees and covered by private health insurance.
According to the CDC, the median total exemption rate for kindergartners during 2013-2014 was only 1.8%, but other schools and communities have reported exemption rates as high as 60%. Exemptions from vaccination range from medical and religious exemptions to personal belief exemptions.
More Miami-Dade kindergarteners, about 2,500 last year, enter school without their shots than in any other Florida county. The state says 92 percent of kindergarteners were fully immunized in 2013, the most recent year of data available. That’s close to the state’s health department goal of 95 percent but still places the county in the bottom 10 in Florida, according to health department data.
CNN has great information on the number of unvaccinated children and where they live: www.cnn.com/2015/02/03/health/the-unvaccinated/
Many experts wonder what the effect will be on future public health if increasing numbers of children being exempted from vaccination. One U.S. study showed that children with nonmedical vaccination exemptions were 35 times more likely to contract measles or whooping cough than vaccinated children. And several measles epidemics have been traced to religious communities that do not commonly practice vaccination.
A mix of several factors are being blamed for the recent outbreaks, yet only one of them is preventable. These include: parents who have opted out for personal reasons — typically based on fear; some children just never got vaccinated because it wasn’t an option; newborns are too young to be vaccinated; many children and adults have medical conditions that leave them extremely vulnerable due to compromised immune systems; and the scariest one is that for some people their vaccination wasn’t 100% effective.
Where do we go from here?
Arthur Caplan, a prominent bioethicist at NYU and an expert on vaccine policy, feels that unless there is a health reason certified by a physician, all parents have a duty to prevent harm to their children and to others by vaccinating.
Some argue that we should spend more money promoting vaccinations or lobby vaccine opponents until they understand why they are wrong. But Dan Diamond in his Forbes article Measles Can Kill, And It’s Spreading. Sue Parents Who Didn’t Vaccinate? Absolutely reveals that it’s not that simple. Research shows that trying to educate anti-vaccine parents only forces them to retreat further into their shell and incites more fear.
Diamond proposes that we turn to the law — basic tort law or criminal law can affect positive public health changes. Maybe the fear of lawsuits might encourage some parents to move past their fear of vaccines.
Until this happens, cultivating a strong patient-doctor relationship is probably the most successful method of reversing vaccine opposition. That means creating the opportunity where the family physician is granted the time to truly understand the family, while at the same providing the family with scientifically supported medical guidelines.
Laurie Futterman ARNP is a former Heart Transplant Coordinator at Jackson Memorial Medical Center. She now chairs the science department and teaches gifted middle school science at David Lawrence Jr. K-8 Center. She has three children and lives in North Miami.