Pushing back against the war on vaccines

It was bound to happen eventually on my pediatrics rotation: coming across parents who for one reason or another refuse to vaccinate their children.

The most recent anti-vaccination movement stems from a 1998 Lancet article that ostensibly showed a link between the measles, mumps and rubella (MMR) vaccine and a so-called "bowel-brain syndrome" that involves non-specific bowel inflammation and a regressive type of autism. Vaccination opponents seized upon this article as legitimization of their views while the medical community collectively gasped.

Much has been written about the methodological and ethical problems with the study; a lot of time and energy was invested into reproducing or disproving the results of this study. Ultimately, though, it was an investigative journalist who showed that the author of MMR-autism study had allegedly cooked the data for financial gain (How the case against the MMR vaccine was fixed, British Medical Journal, 5 JAN 2011). This led to a formal investigation, public censure of the primary author, and the paper's retraction more than a decade after its publication.

But not before the damage was done. The authors of this paper used a respected and authoritative medical journal as a platform to spread what appear to be lies, the result of which was millions of parents questioning whether they should give their children the MMR vaccine - or any vaccine - for fear that it will cause autism. Many parents who had the misfortune of learning that their child has autism, desperately searching for reason, have stumbled upon the falsehoods spread by this article that seemingly explain the unexplainable.

Vaccinating children: Keeping the dialogue open

This is a dilemma faced by pediatricians worldwide, dealing with parents who are skeptical of vaccines or who flat-out refuse to vaccinate their children.

One such parent stood out over the course of my pediatrics rotation. She is the mother of an autistic child who hadn't received any vaccinations since 18 months and was coming in for a well-child visit. My preceptor warned me that this child's immunizations were not up to date and that the mother would likely continue to refuse all vaccinations. "What's your approach to such a parent?" I asked because some pediatricians (including one provider who I worked with previously) just have the parent sign a form without any discussion. "I always keep the patient in my practice, and I try to keep the dialogue open," she replied.

So, when it came time to talk about immunizations, I jumped right in:

"It seems that he's not up to date on his immunizations. Which shots do you want him to get today?"

Mom replied: "I don't want him to get any shots."

Feigned surprise: "Why not?"

"I just don't. He doesn't need them."

"Why do you think he doesn't need immunizations?"

"He just doesn't. He's not going to get sick."

My preceptor interjected: "Do you think there's a link between vaccinations and your son's autism? The only scientific publication that suggested a link was--"

"No, I don't believe that."

I sat back and thought for a few moments, perhaps slightly theatrically. "Tell me, what's your understanding of the diseases that these vaccinations protect against?" This question seemed to catch Mom off guard. The door was cracked slightly open, so I took the opportunity to educate Mom about hepatitis A and measles and mumps and rubella and chicken pox....

Oops, tactical error. Mom jumped on the chicken pox: "See, why does my son have to get a shot for chicken pox? I had it when I was a kid, and I did just fine!"

My preceptor rescued me: "Before we started vaccinating against chicken pox, a few hundred kids died from it every year. Percentage-wise, that might not sound like a lot, but if it's your kid who doesn't come home from the hospital because of chicken pox, then those chances are 100% for you. Did you have any complications from your chicken pox?"

"Yes, I was hospitalized for two days."

Then my preceptor closed the deal: "Well, it would be a horrible shame if your boy had to go through something like that if he didn't need to."

In the end, Mom agreed to vaccinate her boy against hepatitis A, influenza, and chicken pox, all that same day. She also agreed to vaccinate him against measles, mumps, and rubella, only if we could give those as separate shots.

Done!

I felt a real sense of accomplishment. Partially because of me, this little boy would now be protected against several serious diseases.

My opinion: Why every child should be vaccinated

Vaccines in general arguably represent the single most important development in medicine, ever. Some people may counter that antibiotics are a more significant advancement, and I'll give them that it would be a good debate.

But think for a moment: What would the world be like today if no vaccine had ever been developed? Just for starters, the world would still be ravaged by smallpox, a disease that few people can truly appreciate how devastating it really was. To put this in perspective, the Wikipedia page refers to smallpox in the past tense, citing its eradication in 1979! Then there's polio, which is so very close to also being referred to in the past tense thanks to a coordinated worldwide campaign to eradicate polio. Warehouses full of people living inside iron lungs are a nightmare of the past; we will never again have a President of the United States confined to a wheelchair because of polio.

Measles (one of the M's in MMR) is a great example of a horrific disease that practically disappeared because of population-wide vaccination but has recently made a resurgence, partly owing to the people who were never vaccinated against it. Measles is an incredibly infectious disease, which means that it's very easy to spread from one person to another. That in turn means that eradicating it will be that much more difficult, especially if there are significant pockets of the population who are susceptible to it. Recently, PBS reported on a mini-outbreak of 13 measles cases after the 2012 Super Bowl; all 13 cases had opted out of the MMR vaccine. In developed countries, one person will die of measles for every 1000 people who get the disease; mortality jumps to 5-10% for measles infections in developing countries (PLoS Med. 2007 January; 4(1): e24). Those are odds I wouldn't want to play around with.

The logic is simple: If you're vaccinated against Disease X, then you will not get Disease X. Given that the consequences of getting many of these preventable diseases include permanent disability, or worse, death, it's hard for me to understand why loving parents would would choose to not vaccinate their child.