Avoid Spots and Worse

How epidemics happen: first a vulnerable population. Then, bring into that population a highly contagious infection. Recently that’s measles. Unvaccinated kids are often in clusters where not vaccinating is culturally popular- like Washington State and southern New York. Then someone visits from another country with spotty vaccination, carrying measles. It’s highly contagious- carriers cough in a room, and mucus particles stay in the air for two hours. During that time, an unvaccinated kid enters, breathing in those particles. A week or two later, she starts coughing, has a high fever, pops out in a spotty rash all over. She’s already been shedding virus to other kids four days before breaking out herself! How do you keep the lid on a virus like that?

Of course, vaccines. When epidemics happen, the sheen is suddenly off having unvaccinated kids, and clinics cannot keep up with the demand. It’s hard for public health officers not to crow “I told you so!” We don’t advocate vaccinations because it’s cool and certainly not for secret payoffs from pharmaceutical companies; the companies couldn’t care less. Vaccines are such a financial dog for them that in the 1980s, Congress had to intervene so they wouldn’t stop making the stuff. They’d rather be making scads of money on Viagra and other drugs they advertise. When’s the last time you saw ads for vaccines?

Non-vaccinating is frustrating for pediatricians because to us, who “live the data” the benefits are so clear, the risks so minimal. Throughout our careers, we read the studies, debate the statistical design and see in practice how effective vaccines are. When non-vaccinators say “I did my research” they didn’t pull the data, do their own statistical analysis and find study design wanting. They read some cranks on the internet. Like climate scientists, we who know the actual numbers are reminded of Senator Daniel Patrick Moynahan’s words: “Everyone is entitled to his own opinions, but not his own facts.”

The consequences of this are life-and death. Doctors who counsel parents have been sued, even when warning parents on not vaccinating. If the child then contracts a fatal, vaccine-preventable illness, the parents argue in court, “But he didn’t tell us our child could die!” Your child could die.

Once at a party a mom came up to me and whispered, “So what’s the real truth about vaccines?” As if we kept quiet, I’d confess about the piles of money drug companies are paying us pediatricians to administer unnecessary vaccines. It was a little exciting- for the first time in my life someone thought I was part of a conspiracy! Cue the James Bond music!

Unfortunately for my income, the conspiracy theory about vaccines is a myth. As we mentioned last week, vaccines are the least favorite things for pharmaceutical companies to make. The profit margins are slim, the insurance burden is great and they make lots more on the medications you see advertised on TV. If they made so much money on vaccines, why aren’t they running ads for them?

And what about those corrupt researchers? I’ve met many and can attest that few do it for the bucks. They’re nerds and careerists who’d rather make associate professor than make money. They live for clean data, elegant study designs and the admiration of their colleagues when they publish a good paper. They’re nice folks who do good science to save kids’ lives. How can we get non-vaccinating parents to understand? For years the American Academy of Pediatrics (AAP) has advocated not kicking them out of practices. The strategy is to see the kids, gain the parents’ trust and teach them the importance of vaccination.

If the parents still don’t listen after some time, then the doctor can release the patient from care, since the parent-doctor trust is broken. A recent editorial in the AAP newsletter advocated a more aggressive approach. The author evokes the great Mohandas Gandhi, quoting that we should “cling to the truth” and in all ways stand up for it. This means pushing for stricter laws on vaccination and school participation and boycotting anti-vaccine businesses. Picketing, striking and even fasting are tools to show our seriousness. This includes keeping non-vaccinated children from practices, schools and extracurricular activities, where they could infect others. We don’t want to punish these kids for their parents’s folly, but we don’t want other kids to catch life-threatening illnesses either.