Vermonters Wrong on Vaccine Choice

It makes no public health sense to run the risk of new outbreaks of rubella and other preventable diseases.

I’m usually on the frontline when it comes to defending Vermont and its unique (and generally more humane and freer) way of life. This time, though, I must take issue with my Green Mountain friends pushing the idea of allowing parents to opt out of having their children immunized. Vermont needs to play Big Brother on this one and tell parents they cannot, in the name of small risks, expose their children and the public to much larger dangers.

This will make some people furious with me, but I’ve looked at the data and, though I agree that Big Pharma is not to be trusted, I think the books have been cooked on the claim that it’s a bigger threat than homeopathy and that adverse drug effects kill over 800,000 Americans per year. (One big way the data is cooked is to blame chemo poisoning for the deaths of already-terminal cancer patients. Another way is to quote data from the medical dark ages. Quite a few websites say, for example, that 6,000 people died from smallpox vaccines. Scary until you read the fine print; those numbers come from a 1921 study!)

Homeopathy has its benefits, but a lot of it is simply magical thinking. One takes a risk when anything is added to the human diet. I looked into red rice yeast as a substitute for Statins when my cholesterol went up. Guess what? This natural product has a higher risk of liver damage than Lipitor. Lots of people take St. John’s wort instead of Prozac, but it has so many side effects that France has banned it. Heck, when it comes right down to it, food is more dangerous than most drugs; one of six Americans gets food poisoning each year and about 5,000 die from it. 

The anti-drug drumbeat comes from an unlikely coalition of alt-lifestyle devotees and anti-government paranoia. It would be facile to argue that nobody has adverse, even deadly, reactions to drugs. Big Pharma is at its worst when a new drug comes to market; that’s when the drive for immediate profit bypasses safety valves. But this isn’t the case for most of the vaccines under question, especially the two most under the Vermont microscope: the ones for measles and for pertussis (whooping cough). Some kids don’t react well to either vaccine. But we have data–very strong data collected over decades–that tells us what difference the vaccines make. About 450 children per year died of measles before vaccines came into effect in the 1960s; when the rubella strain (“German measles”) was present, death rates soared; according to the Center for Disease Control, it killed at least 11,000 babies in the United States between 1963 and 1965. Do the math; a rubella vaccine has saved the lives of more than a quarter-million infants since then. Vaccines have nearly eradicated measles of all varieties; since 2000 there have been about five dozen cases per year and no deaths.

A major reason for the reduction in deaths is that most new measles cases are isolated; that is to say, it’s no longer a public infectious disease that weakens public health overall (especially in those little disease incubators we call “public schools”). Whooping cough is even more dramatic; before a vaccine became widely available after World War II, about 175,000 Americans (disproportionately children) got whooping cough each year and an average of 700 died. By the 1990s there were just several thousand cases per year. Alas, anti-vaccine forces have contributed to dramatic rise and there are now more than 25,000 whooping cough victims per year.

Let us imagine a world without vaccines. Do we want a repeat of Spanish influenza like the one that killed 100 million people in 1918 (675,000 in the USA–three times the number of U.S. soldiers killed in World War I)? Do we want a return to pre-vaccine smallpox epidemics, polio outbreaks, bubonic plague and cholera endemics? I wish a mumps vaccine had been available when I was a kid; my bout left me with hearing loss. 

Parents, naturally, think they should have the right to make vaccine decisions. Christian Scientists say the same thing! I say that fear is just as bad a foundation for public policy as loony beliefs. We must view health as a public issue, not a private decision. 93% of Vermont children were immunized for whooping cough in 2005; now it’s just 83% and the disease is on the rise (102 cases in then first four months of 2012). This is fair neither to other Vermonters, nor to the children catching the disease.

Vaccines can indeed cause negative reactions, but the decision to immunize should be made by doctors, not frightened parents. By all means have children tested before immunization, but let those with expertise make life-and-death decisions. If I might put it crudely, if a doctor makes the wrong call, that individual is culpable. But who would want to be the parent who said “no” to the vaccine that would have saved their child’s life? 

1 comment:

Deb said...

outstanding post on an important public health topic