My Turn: Vaccines – the best prevention money can buy
October 7, 2011
TRUCKEE, Calif. – I am astounded by the resistance to the greatest achievement in the history of health care. Over the years I’ve trumpeted the scientific facts to an increasingly skeptical crowd. Although I wish to touch on the medical highlights, I am increasingly interested in views based on financial and public matters.For present day parents, history seems irrelevant. The epidemics, less than a century old, that inspired little known pioneers such as Salk and Hilleman to create vaccines that have saved millions of live have been forgotten. Even though more recently vaccines against meningitis and invasive bacterial diseases have been very successful, they receive little recognition. Worldwide (and travel shrinks the world) epidemics continue, which we ignore, and poor nations beg for the vaccines we shun.Skepticism on vaccination began in the ’80s with an anti-DPT (diphtheria/pertussis or whooping cough/ tetanus) movement based on fever-induced seizures and the assumption of brain damage. Though still far safer than the alternative, the vaccine was purified to the current DTaP which should have eased minds. Then in the ’90s came the thoroughly discredited, but seemingly unforgettable, study by Wakefield from England postulating an association between the MMR vaccine and autism. In the last 10 years, mercury (which was eliminated and made no difference) and trace amounts of aluminum become bad guys, with no science to back up the claims.Subsequently, parents are falling victim to fear of rare side effects courtesy of Internet and journalistic irresponsibility, not to mention Playboy bunnies who claim intellectual superiority over respected scientists. Also courtesy of the diminishing “herd immunity” effect, friends may have unvaccinated children who “get away with it.” Herd immunity is the protection immunized people afford those who are not. It requires approximately 80 percent vaccination rate to achieve this, and currently in Nevada county, for example, our 2-year-olds are less than 75 percent fully vaccinated (even less for whites). In the last two years, scientifically unsurprising, pertussis outbreaks as well as measles outbreaks have occurred.For those concerned about too many vaccines given too young, I point you to copious and reliable information available at responsible websites such as aap.org and cdc.gov. Simply put, from birth on humans are challenged daily by hundreds of microbes through breathing, eating, and skin irritation without overwhelming the immune system. Even markedly premature and small babies are immunized multiple times with no increase in risk and great benefit, as they are more susceptible to the ravages of serious illness.For an interesting and novel twist, look at the common good. A recent California law was passed to assure Tdap (older child and adult DTaP) boosters for 11-12 year olds due to the pertussis outbreak. California, however, allows “philosophical” exemptions to vaccines unlike our neighbors Nevada and Oregon (and half the country). Others, therefore, achieve higher vaccination rate. The result is herd immunity to those who really need it, such as children with cancer, HIV, and other immune deficiencies who cannot be vaccinated. Note Gov. Rick Perry’s tapdance around a short-lived law in Texas he initially supported, which mandated the HPV (human papilloma virus)/anti-cervical cancer vaccine for early teenage girls. I don’t like his politics but admire the thought.All of us are severely challenged to create a healthy population at a reasonable cost. Vaccines have clearly shown their cost effectiveness, not only in savings in lives, great bodily harm, and overall hospital and medical costs, but in lost school and work time. Appreciate how much savings there is in medical costs, including antibiotics, with vaccines that prevent seriously sick children with the temptation to treat. Consider current issues with antibiotic resistant bacteria from overuse.Are we denying individual rights when adequate studies demonstrate a clear path? We have public safety laws governing water and air purity, smoking, and other health hazards. At the very least, should we not consider differential insurance rates for the unvaccinated. They are not only overutilizers of precious health care dollars, but threaten the most vulnerable around them. Should we copy hospital policy and require the wearing of masks for non-flu/pertussis vaccinators when in public during flu season? Are you legally liable if your unvaccinated child infects one who cannot be protected?My point is that this is a problem that affects us all. Encourage yourself and those you know to be truly educated and take the right steps to cost effective protection individually and globally. The only other choices may be epidemics or the unpredictability of governmental mandates.Chris Arth, M.D., has practiced pediatrics in Truckee for 31 years. He is board certified and an associate clinical professor at UCD teaching medical students through its rural prime program.