Arguably the greatest success story in public health, vaccines demonstrate the triumph of human achievement over disease. But during the last decade or so, I’ve watched through my fingers as vaccine risks get more attention than the diseases they prevent.
Before I retired from neonatal intensive care a couple of years ago, convincing parents to immunize their infants was getting to be the most difficult part of my job. It’s hard to describe how bizarre it felt to be unsuccessfully promoting vaccines to parents whose everyday lives depend on the science and technology used in their smartphones … in a room full of machines so technologically advanced and personnel so highly trained that we can save a baby so tiny it resembles a baby bird fallen from the nest.
When vaccine rates drop, “herd immunity” is compromised and diseases return. Take, for example, measles. The inoculation against this highly contagious and deadly disease was introduced in the 1960s. It’s been so effective that the disease was classified as “eliminated” by the United States and the United Kingdom in 2002. Yet in 2013, U.S. health officials reported nearly 200 cases, nearly triple the annual number.
Pertussis may be the local canary in the coal mine. According to data from the Texas Department of State Health Services, 2013 marked the state’s worst whooping cough outbreak since 1959 with nearly 4,000 cases; Williamson and Travis counties reported more than 400 cases.
What are the reasons for our snatching defeat from the jaws of victory?
• The diseases are not real to us. Before systematic vaccination, diseases like polio (think President Franklin Roosevelt), measles, mumps, tetanus and whooping cough were front and center in American life, a source of great morbidity, tragedy and fear. Two generations of Americans have no experience with those diseases.
• In 1998, a study published in the Lancet, a British medical journal, started a worldwide vaccine scare from which we still have not recovered. The study claimed to identify a link between the vaccine for measles, mumps and rubella and the onset of autism. The flames were fanned when celebrity Jenny McCarthy claimed the MMR vaccine caused her son’s autism and began a high-profile campaign against vaccines. Affecting one in 68 U.S. children, autism is a source of great fear among parents.
In 2010, the Lancet retracted the article, and 10 of the 13 authors have denounced it, but the damage had been done. On March 27, the New England Journal of Medicine published a study finding that autism begins when certain brain cells fail to properly mature within the womb. Hopefully the study will lay to rest the notion that vaccines cause autism.
• A high degree of skepticism exists. A research letter published in the March 17 JAMA Internal Medicine, found that 49 percent of adult Americans believe the federal government, corporations (especially pharmaceutical companies) or both are involved in at least one conspiracy to cover up health information. Skepticism plays a key role in the persistence of misinformation, and conspiracist beliefs are correlated with health behaviors such as avoiding vaccines and other traditional medicine.
• Misinformation is resistant to correction. A 2012 study published in the journal Psychological Science in the Public Interest found that people more readily accept statements that are consistent with their beliefs. Conversely, suspending a belief requires a high degree of attention and considerable implausibility of the message. It’s easier for minds to trust a myth if it supports existing convictions than it is to reject information that requires energy to assess.
• A relatively new breed of “empowered” patients with all the information in the world available at their fingertips has emerged. Many lay researchers do not seem to be able to distinguish unscientific from scholarly sources when searching for medical information via the Internet.
• The suggestion or pressure to vaccinate may be viewed as a power play or an attack on personal freedom. Should food-service workers have the freedom not to wash their hands after visiting the restroom?
A large and growing grassroots movement contemptuous of science and government opposes systematic vaccination against deadly diseases. But those who choose not to get vaccines serve as potential vectors of disease transmission to unsuspecting persons, especially to those who can’t be immunized such as immunosuppressed children and adults — or those too young to be immunized such as the Travis County infant who died of pertussis in March.
Maintaining community immunity is a job for all of us, not for some of us.
Austin, Texas