Vaccines: The best way to persuade parents is the worst for kids

February 4, 2015
Lauren Durbin is given an MMR injection at the Paediatric Outpatient department at Morriston Hospital in Swansea

Lauren Durbin, aged 10 months, is given an MMR injection by Sister Sian Owen at the Paediatric Outpatients department at Morriston Hospital in Swansea, south Wales, April 6, 2013. REUTERS/Rebecca Naden

The United States has vanquished measles before. But it was a different era.

In 2000, the Centers for Disease Control and Prevention proclaimed victory over measles. The virus, which routinely infected millions and killed hundreds of Americans, was beaten, thanks to a vaccine and a public that understood community health was an essential foundation for personal health.

The vaccine remains — the rest is just a memory. The Centers for Disease Control and Prevention just brought the total number of individuals infected with the measles virus this year to 102. Ninety-four cases resulted from exposure to one person at Disneyland.

Measles is one of the most contagious infectious diseases known to man. If 100 people are standing in a room and just one has the measles, within the next three weeks, 90 of those exposed — if not already vaccinated — will come down with the disease. And the infected person doesn’t even have to be in the room for others to catch it. The virus can linger in the air for hours. So it is possible to catch it just by walking into a room where an infected person had recently spent time.

lisa -- measles case!

A child with a 4-day measles rash. WIKIPEDIA/Commons

The Disneyland epidemic is only possible because of a drop in immunization rates in the United States. One in 12 children born in the United States is not being vaccinated as recommended, according to the Centers for Disease Control and Prevention. Many of the anti-vaccine parents cite persistent concerns about what is now a widely discredited link between the vaccine and autism. Some of these parents are now at home caring for children who are feeling miserable because they have measles.

Though the infected children may well feel miserable, however, they are not the ones at the greatest risk from measles. The well-fed, healthy offspring of anti-vaccination middle-class or wealthy parents are at the lowest possible risk of dying or developing other complications of the disease. The centers’ studies suggest that, for every 1,000 cases of measles, we can expect one to two deaths. The risk of any of these kids developing any of the other complications of the virus — pneumonia, encephalitis, hearing loss, mental retardation — is only slightly higher. When a healthy, school-age child catches the measles, most will, like me and many of my childhood friends back in the 1960s, have a week or so of feeling rotten. That’s all.

Those really at risk of catching and dying from measles are the babies (like the unnamed infant in Orange County, California, too young to be vaccinated). Because of transmitted maternal immunity, the first measles vaccine won’t be fully effective if given before a child is 1 year old. Also in danger are children (like 6-year-old Rhett Krawett of Marin County, California) and adults whose immune systems are compromised because of cancer or some other illness. Those are the people most at risk of getting and dying from the virus.

I’m an internist and try to practice evidence-based medicine. Let me apply those principles here: What does the evidence suggest will restore our sagging vaccination rates? How can we persuade these frightened parents of what we all knew a generation ago — that community health is essential for personal health.

We certainly know what hasn’t worked. Scolding hasn’t done much — though Lord knows people keep trying. No real surprise there. Has scolding ever worked?

A doctor prepares an MMR injection in the Paediatric Outpatient department at Morriston Hospital in Swansea

A doctor prepares an MMR injection in the Paediatric Outpatients department at Morriston Hospital in Swansea, south Wales, April 6, 2013. REUTERS/Rebecca Naden

It turns out that education doesn’t do much, either. A recent study done by Brendan Nyhan, who teaches government at Dartmouth, looked at how education about a vaccine — in this case the flu vaccine — affected understanding and behavior. Educational materials about the vaccine were provided to a representative sample of 900 Americans who had concerns about its safety.

Many believed that getting the vaccine would give them the flu. After seeing the materials, the number of participants who believed that dropped dramatically. But, strangely, so did the number who intended to get the flu shot.

Strange and yet haven’t we seen something similar in the natural experiment of our own current vaccine debate? Over the past decade, layer after layer of data has disproved that supposed link between autism and vaccination.

The single research study that started this whole mess was published in the Lancet, a respected medical journal, in 1998. That study has been fully discredited — and retracted by the journal. The study’s findings, on a small number of children, had been falsified to give the desired result. The author was also revealed to have a financial stake in eliminating the combined vaccine — the conclusion he drew from the tampered-with data — so that people would buy his company’s single vaccines.

Yet these oft-repeated findings have done nothing to slow the small but persistent anti-vaccination tide.

So what does work? Experience — the one kind of education that we know works — might be having an effect. The rising number of cases of measles, from 100 cases a year in 2000 when the Centers for Disease Control and Prevention declared victory, to the 644 cases reported last year and the 100 plus reported last month, may have revealed some of the health benefits of vaccination.

Many of those who have opted out of vaccines for their children grew up when measles was at its historic low. Experience is an excellent teacher.

Indeed, in Marin County, the heart of the anti-vaccination movement, vaccination rates increased 20 percent from 2012 to 2014.

Child looks as paramedic injects measles vaccine at Playen district in Gunung Kidul, near Yogyakarta

A child looks as a paramedic injects measles vaccine into her arm in Gunung Kidul, near the earthquake-hit Indonesian city of Yogyakarta, June 7, 2006.

Rates of vaccination also seem to depend on the ease with which parents can avoid the regulations requiring the shots. Studies have shown that states that allow personal preference and easy access to exemptions from vaccine requirements have a higher rate of unvaccinated children — and a subsequent increase in vaccine-preventable diseases. Can reversing that trend make a difference?

California is betting on it. Recently, the state legislature made it more difficult for concerned caregivers to opt out of vaccination requirements. Previously, parents could have a “personal belief exemption” just by signing a form. As of January 2014, parents were required to get a signature from their doctor as well.

Did this little legislative intervention play a role in the increased vaccination rate in Marin County? Time will tell.

It is possible that we will never again hit that sweet spot of mastery over measles that the Centers for Disease Control and Prevention declared in 2000. The United States was unique in the world in its willingness to unite in the fight against communicable childhood diseases. It was a remarkable — a historic achievement.

Nowhere else on the planet has even come close. In Western Europe, there were 31,000 cases of measles reported last year. More than 7,000 of them were in France. There were 145,000 deaths from measles worldwide, largely children under 5. Will we ever be able to eradicate measles in our country when all these other countries could not?

We did it once. But perhaps it’s just another bit of American exceptionalism come to an end.

8 comments

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This went from a disease that “routinely infected millions and killed hundreds of Americans,” to something that has infected a total of 102 people in the this year. Moreover, 91/102 of the patients that presented with the disease had their infection traced back to once incident. “Another bit of American exceptionalism come to an end…” C’mon Lisa, you can come up with a better “fear mongering” article than this!!! ;)

Posted by Greggyyy | Report as abusive

I read a lenghthy blog yesterday written by an anti-vax mother who was unable cite the extensive research she had previously done but was emphatic in its pursuasivness that vaccines are far more harmful than good. Furthermore, she espoused that the pro-vaccine “scientific” evidence provided by the scientific community was fabricated to promote the government and pharmacutical industries agenda. After multiple lenghty paragraphs she then stated that as the mother of her child, only she is in charge of making decisions regarding her child’s care and nobody was going to dictate anything to her. Furthermore, she stated bluntly that it is not her responsibility to contribute to the welfare of others through the support and/or participation in programs that endeavor to irradicate horrible childhood diseases for all citizens. She basically stated that it was someone elses problem. The saddest part for me were all the comments contributed from other mothers praising her heart, sensitivity and love in expressing her conviction in such a bold and courageous way. They showed up like mindless moths fluttering around a light bulb. Welcome to our era of “its all about me”. The phrase “united we stand, divided we fall” appears to have no relevance today. National pride, civic duty and indivudual humanity are null and void. It is every person for themselves. We have reached such a point of self-absorption and selfishness that even mother’s are willing to push the children of others into the volcano. But be sure to take a selfie so you can post it!

Posted by Bartruns | Report as abusive

Part of the blame has to rest on the unrelenting negative misinformation of all things government coming out of right-wing media for the last decade or so. Why would people believe vaccination is the best thing for their baby when they’re told daily to distrust the government and all it does?

Of course scientists and other highly educated people are also not to be believed because they’re Liberals and/or atheists.

The author is right, scared gullible people must not be given the choice when it comes to life and death public health issues.

Posted by distancematters | Report as abusive

Bureaucrats care about public heatlh. Parents care about their children’s health. If you have a healthy child with a good immune system, the measels vaccine presents a greater risk to your child than the measels itself. That’s why “education” and scolding doesn’t work. Parents aren’t stupid. The government doesn’t care if my child dies. The government only cares if thouands of children die.

Posted by DanG | Report as abusive

Witness DanG’s comment to see why reason, logic, reality will not work to educate anti-vaxxer reality deniers.

Posted by Wizardling | Report as abusive

The article should have shown the statistics on side effects from vaccinations and the statistics on measles and its side effects. No one wants to hear opinions, from doctors, drug companies, bureaucrats or conspiracy theorists. “Just the facts, Mam. Just the facts.”

Posted by aeci | Report as abusive

“Nowhere else on the planet has even come close.” American exceptionalism indeed.

In 2002 WHO declared that the americas region, consisting of north, south and central america had all eliminated measles.

The western pacific region is also getting close to elimination, Mongolia, the Republic of Korea, Macao and Australia were all declared to have eliminated measles in 2014.

In fact in 2014 there were less cases in the european region than in the Americas, (Your 30,000 figure is from 2010, it has since improved greatly.) There were also less cases in the eastern mediteranian and south east asian regions.

The issues around vaccine rejection are important to explore but provably false statements about other countries doesn’t seem to be useful. Particularly as other countries are grappling with the same issues and there exists the potential to learn from each other.

Posted by lod | Report as abusive

Vaccinations are a powerful, proven tool in our fight to prevent childhood infections. Because of the widespread use of vaccines in the United States, there has been a dramatic decline in the number of children who suffer from deadly diseases such as polio, chickenpox, hepatitis B and whooping cough. A child who isn’t vaccinated is at risk for infections that physicians in the United States may have never seen. A likely example is polio, which still flourishes in developing countries that lack a strong vaccine program. It only takes a plane ride for an infection to migrate to this country and infect an unvaccinated child. If we stop vaccinating against these diseases, other people, not only children, may become infected. I believe vaccinating children with all the recommended vaccines, on schedule, is one of the safest and most advanced means of preventing infection.

Posted by DBrown21 | Report as abusive