The vaccination conundrum

This week I started a 6 month nursing rotation at a primary care clinic. Seeing as it’s flu season (and a particularly nasty one), we had a meeting about offering each client a flu shot. We then went on to discuss our vaccination policies in general, and it got me thinking about the entire anti-vaccine movement.

The biggest change that’s happening in our clinic in regard to vaccination is when parents want to opt out of immunizing their children. I’m not entirely sure whether this is just an Oregon thing, but starting soon any parents who want to refuse immunizations for their child will have to watch a video that visibly shows the courses of various illnesses and weighs the risks and benefits. I personally think that this is a good idea for two reasons. First, the literature that comes with each vaccine isn’t always health literate, and our population at the clinic generally has pretty poor health literacy, so clients might not be able to understand all of the information simply by reading it. Second, I think people tend to underestimate the severity of diseases that prior to the anti-vaccine movement didn’t manifest in society. Things like pertussis (whooping cough) are foreign to most people; they think it’s just a bad cough and that’s it. However, as one pediatrician I worked with put it, “Any parent that doesn’t believe in vaccinating their child should be forced to watch a child die of whooping cough. Seeing a child literally cough themselves to death will change your mind real fast.”

It was this statement that really got me thinking more about the whole vaccination debate. I can understand that people who have never seen what these diseases look like might underestimate them. I can also understand how the average person wouldn’t have looked at the historical death rates, incidence rates, and prevalence rates for these diseases. Where I differ from most people who don’t understand the anti-vaccine movement is that I really do get it. These people aren’t evil, they aren’t abusing or neglecting their child; they view it as protecting their child. Most people object to vaccination on the grounds that it might cause autism, febrile seizures, and other developmental problems.

First, there is no evidence that vaccines cause autism. The study that everyone loves to cite was fraudulent, and the lead researcher admitted so in public. And yes, some children will experience adverse reactions to an immunization. But what people don’t understand is that every drug has potentially adverse effects for a small percentage of the population. Every single drug on the market will produce an adverse, deadly reaction in a small fraction of the population. Even the aspirin on the shelf at the drug store. The problem is that if you’ve never taken a medication before, there’s no way to know how you’ll react. The same logic goes for immunizations; if you’ve never been immunized before, there’s no way to determine how your body will react.

But let’s grant, just for a moment, that everything anti-vaccine people think and advocate really is true. That indeed vaccines do cause autism and other developmental abnormalities. Logically, there’s still no reason to refuse the vaccine. It’s a simple cost/benefit analysis. Does the cost of developing autism outweigh the benefit of not dying from polio? I’d probably argue that it doesn’t, and if parents were given the hypothetical choice of whether or not they’d want their child to develop autism or die a slow painful death, I’d be willing to bet most parents wouldn’t choose the latter option.

It’s the same logic that the patient with cancer uses. Is radiation and chemotherapy dangerous? You bet the hell it is. Both radiation and chemo are caustic and cause extensive damage to healthy tissue as well as cancerous tissues. But what’s the alternative? Dying a slow death from cancer? Given the choice of possible death or possible life, who amongst us wouldn’t choose possible life? But perhaps what I find the most ironic is that the same parents who don’t want to vaccinate their children for fear of the adverse effects will give dose after dose of Tylenol to their children when they get a simple cold. Tylenol, of course, contains acetaminophen, which is particularly harsh on the liver and in fact is the leading cause of acute liver failure and the second leading cause of liver transplants in the United States.

In reality, people hear anecdotal stories about children who have a bad reaction to a vaccine and think, “Aha! Vaccines are bad!” What they fail to realize, though, is that there would be a small percentage of children who would have a bad reaction no matter what anyway. Perhaps the increase in autism rates is due to a better understanding of it and a different classification system (after all, we do have an entire spectrum now). Perhaps there’s another environmental cause for autism (something in the food or water, perhaps?). What the public really needs is a new campaign about vaccinations in general. Time for public health to step up to the plate.

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6 thoughts on “The vaccination conundrum

  1. I always enjoy the compassionate point of view in which you write Ryan.

    “I can understand that people who have never seen what these diseases look like might underestimate them”

    I liked this statement. I also wondered if this is a little bit how perhaps war is more favorably looked upon for those who do not know the horror of it. Is that we can never truly learn the lessons of history and thus are condemned to repeat it. Since many of the diseases that vaccinations protect us from have nearly vanished from our consciousness people allow themselves to be swayed by misinformation. Could such anti-vaccination sentiment have developed even 50 years ago when so many diseases were still in the memories of people?

    1. The analogy to war is rather excellent and thought provoking.

      I’d like to think that this modern backlash is due to an overabundance of information–the more that’s put out there into the ether the more of it is likely to be distorted or bad information. 50 years ago the average person couldn’t google the works of some researcher they’d never heard of. Then again, 50 years ago people still knew people who had personally been affected by polio.

      1. It’s true that the immediate and vast access to information we now have is a new variable that changes how and what people believe in. Perhaps such misinformation always existed, but it just never got much of a chance to be showcased.

  2. It’s interesting that you suggest that there’s too much info out there. I’d think more information would be helpful, but I see your point. I’m not sure what the answer is. Seeing real situations in a hospital may be helpful, but I wouldn’t make it mandatory. There’s a lot of emotions involved, so perhaps appealing to our emotions could lead to some progress.

    1. I always have mixed feelings about what should and shouldn’t be mandatory when it comes to children. Obviously it’s the parent making the decision, but it’s the child who could be negatively impacted in the future. On the same token, though, obviously an infant or small child doesn’t have the capacity to make their own healthcare decisions. It’s a murky situation for me because I don’t want to see children needlessly impacted by the ignorance of their parents, but there really isn’t another solution besides making it mandatory, which isn’t going to fly in this country.

      I think that the point of the video is to make a lot of these diseases less abstract to people who have never experienced them. At least that was my interpretation. I agree that people need more information. But in the internet age, what passes for “information” can be at times dubious at best.

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