When I was little, I was vaccinated for the things that were recommended at the time: polio, measles, German measles (rubella), diptheria, tetanus, whooping cough (pertussis). I had the mumps and chicken pox when I was little, and was re-vaccinated for measles before college (because the late 60's vaccine wasn't effective enough, I think). My kid's list of vaccinations has been much longer, and includes a lot of diseases I didn't recognize immediately (Hib, for instance). A lot of parents I know are skeptical of vaccinations - aren't they potentially dangerous, and maybe better when kids get older and have stronger immune systems, and aren't they a bit of a scam from drug companies?
This year there are going to be two flu vaccines: one for the expected type of seasonal flu, and one for the pandemic H1N1 "swine" flu. The swine flu vaccine, in particular, is especially recommended for pregnant women, children, young adults, and people who work with children. The parenting blog for my local paper, Kid Row, recently raised the Vaccine Question: yes, the CDC is recommending that kids be vaccinated, but should we listen to them?
And another vaccination-related issue has come up locally. We've been having outbreaks of pertussis (whooping cough). Major outbreaks. Big enough that Center for Disease Control investigators have come to town to try to figure out what's happening, and especially why there are cases with different symptoms from normal.
The only commenter on the Kid Row blog suggested that everyone "think twice" about vaccines. Ok. I'm a scientist (though one whose methods are very different from those of biomedical science, and one with a lousy biology education that ended in my sophomore year of high school with a teacher who told us that evolution was wrong and that girls couldn't do science). And I'm a parent. And I can read. So, this is me, thinking.
First question: what's being prevented? I grew up in a time and place where diseases such as diptheria and polio were unheard of, except when the time came to vaccinate. And in the case of other diseases, I only knew the common name ("chicken pox," "meningitis"), not the name that goes with the vaccine ("varicella," "Hib"). So it's difficult to get a feel for the risks associated with the diseases that have become rare as a result of vaccination. This post from Making Light does a great job of combining the medical information with stories from the days when the diseases were common. The descriptions alternate with the wording from headstones from a graveyard in Vermont - gravestones for infants, toddlers, pre-schoolers. (Back when I was doing fieldwork in Vermont, I ran across a similar graveyard from the early 1800's - so many headstones for young children. Some of the saddest were stones where several children, all dead in the same year, were buried.)
The short version: some of those diseases (such as diptheria and whooping cough) were major childhood killers. Others (such as chicken pox and the mumps) are worse for adults than for children (luckily for me, since I had both when I was little). By making a large proportion of the population immune, vaccines prevent these diseases from spreading the way they once did. And that protects even those who can't be immunized (because of allergies or other risks of complications).
Second question: what are the risks of the vaccination? That's the question that my acquaintances want answered. After all, this isn't 1830, and we don't know anyone who has had these diseases (except chicken pox, and we all survived). Are the benefits worth the risks these days?
There are a bunch of answers to this. Some are on the information sheets that everyone is given before vaccination. They list the reasons not to get a particular vaccine - which factors make people more likely to have an adverse reaction. So I read those carefully, and ask the doctor questions, and try to figure out if the kid is in one of those risk groups. (He hasn't been.)
And then my acquaintances shake their heads, and pass me an issue of Mothering magazine, and ask me if I've heard about vaccines and autism.
Yes, I have. I read Mothering for a year. I've also read Chris Mooney's recent piece in Discover about this history of the vaccine/autism claims. (And I blog on the same site with biomedical bloggers such as Orac, Tara, Revere, and PalMD, all of whom discuss vaccinations.) And between the lack of a decrease in autism when the US stopped using thimerosal in vaccines and the amount of other research evidence that has piled up, the evidence for autism being caused by vaccines seems pretty weak. (And I mean that in the same way that I mean "the evidence that earthquakes can be predicted from lists of runaway dogs seems pretty weak.") I may use different methods from biomedical scientists, and I might not fully trust drug companies, and I might be jealous of medicine's prestige and appeal to students (Nobel prizes... you'd think they were going to cure cancer or something). But when a lot of scientists come to the same conclusion based on different sorts of studies, I'm willing to trust them. Yes, even though I know scientists are human, and even when it involves my kid.
Third question: fine, take the risks for your kid. But shouldn't everyone choose for themselves? Well... I'm going to defer to the local ethicist on this one. Janet Stemwedel took on the ethical issues involved in taking advantage of herd immunity back in June. And it's a powerful argument: people who live in a society that vaccinates are getting all the advantages of herd immunity without taking on the risks. And if there are enough people who refuse the vaccinations, the herd can lose its immunity. Polio could come back. Whooping cough could become common, like it has in some communities. (Is vaccine refusal the reason why whooping cough has been making the rounds in Durango during the past few years?) And then the people who can't be vaccinated (because they belong to a group that the CDC says has a higher risk: age, allergies, etc) have a much greater risk of getting infected.
Now, the flu isn't polio. I've survived it without complications, more than once, and so have most people I know. But its complications do kill people. And the new H1N1 "swine" flu is likely to spread fast. And the populations at the greatest risk seem to be pregnant women, kids, and young adults.
My kid is in an elementary school. There are teachers at the school are pregnant, or who have young babies. And I teach young adults - and there are pregnant faculty members at the college, too. Maybe the vaccine will come too late - odds are that swine flu will start to spread rapidly through the community as soon as the students get back to campus on Monday. But if we haven't all come down with it before October, my kid and I will get vaccinated. (And I'm going to get re-vaccinated for whooping cough, too.) Because it's not just about the two of us. It's about the herd.
And I like living in a world where graveyards aren't full of toddlers' headstones.
None of my kids have got the swine flu yet, I see it happening to children all around me, I am pretty sure the reason that we haven't got it is because of the fantastic guidance I've received from this website: www.swineflukids.com
Swine Flu Kids They have some really great home remedies that are gentle for little ones. I downloaded their book and
was very satisfied with it. Good luck!
Good read! Can I use this as material for my debates? Thanks in advance.
I grew up in a world where the kids with polio were only two or three years older than me. I am strongly in favor of vaccinations, though born too late for any measles, mumps, or chicken pox vaccines. I would gladly have done without the chicken pox and at least one set of measles. As for autism, the data is against any correlation between autism and vaccines, as you noted. One data point: a nephew with autism was diagnosed prior to the suspect vaccines - as was Temple Grandin, who speaks strongly in favor of vaccines.
Good for you!
My budding scientist stepdaughter had herself tested at the university health services (free) and found she's not immune to anything any more, so she has started re-doing the whole series: total cost, about $35 for a couple of the less common shots. Let's hear it for the Canadian healthcare system!
My mother's brother died of diptheria. My swimming teacher died of flu turned to pneumonia (age about 22). Someone died of meningitis at my university.
And it's not only vaccination that's subject to hysterical opposition. Someone, years later, bled to death trying to abort herself in my old dormitory one week after the Conservative legislature passed a law re-criminalizing abortion (fortunately, it died in the Senate). It hadn't happened in the previous 20 years, since abortion was legalized, and it hasn't happened since. The only good thing about the good old days is that they're gone.
And now to read the official email from my university about H1N1.
Brava! Dr. Kim!
Good points well made. I'd recommend this blog http://www.badscience.net/category/mmr/ for more on this subject.
Thank you so much for this. There has definitely been a ressurgence in whooping cough. There is now a website (don't know the link) that has a short video of a toddler suffering from the disease - you get to see the struggle he's having just to breathe because of the coughing. Its heartbreaking. Unfortunately, ideas as well as illnesses can affect herds and now you have some people saying you aren't a good parent if you vaccinate your children and these people believe it fully. Hysteria spreads like wildfire and truth moves like molasses.
You've perfectly articulated this non-scientist's thoughts on vaccination.
If we're offering anecdata, I nearly died of complications from seasonal flu when I was pregnant with my daughter. (I had foregone the flu shot because I was taken in by the "what if the thimerosal hurts the fetus" gambit.)
My uncle had polio. My aunt is deaf in one ear due to either mumps or measles (I forget which). A friend is disabled from a childhood bout with meningitis. Another friend's brother is, too (two bouts, in his case.)
All of these things happened after the advent of "good hygiene, clean water, good nutrition"--the very things that anti-vaxxers believe will protect us.
Wonderful, wonderful post. Thank you.
I don't understand parents who think it's better to wait until "kids get older and have stronger immune systems". Vaccines make the immune system better at knowing and fighting ennemies: shouldn't it be a recommandation for vaccination in young children, as soon as possible?
One of my colleagues at the high school where I teach argued against vaccination. When I started to say, "As a parent..." she lost her temper (she doesn't have kids) and told me that being a parent doesn't give me special knowledge. Well, sorry, I've actually had to make this decision for my kids (all of whom are fully vaccinated). There was just as much anti-vaccination hysteria when my daughter was born almost 28 years ago as there is today. I have to decide whether to trust the H1N1 flu vaccine because my 15-year-old has asthma (his first hospitalization was because of complications from having chicken pox--it can be lethal for some kids). Since the argument with my colleague ended with her storming out of the room, I realized that reason has no chance in arguing against anti-scientific emotion. It's a scary world.
I'm the parent of a child with autism and I vaccinate!
The evidence that vaccination saves lives is overwhelming and while there is risk with any medical intervention the risk balance between vaccinating and not vaccinating is ridiculously weighted in favour of vaccination.
Great post and clear thinking (again!)