The Price of Civilization

CHW LogoMatch up the number on the left with the fact on the right:

  1. 1400 A.  # of people demonstrated to suffer autism as a result of measles immunization
  2. 2.6 million B.  # of annual deaths from measles in 1950
  3. 0 C.  # of deaths per day from measles in 2014

(Correct answers: 1.C; 2.B, 3.A)

Despite the hysteria spread by several prominent but ill-informed celebrities, fueled at least in part by completely discredited “research,” vaccination remains one of the most important discoveries in the history of medicine, and along with sanitation one of the top advances in public health.  My first year of medical school we saw a movie celebrating the eradication of smallpox, which had been declared by the World Health Organization just a few years earlier in 1979 (the last naturally occurring case was in 1977).  It was moving to see this illness, which was responsible for up to half a billion deaths during the 20th century alone, and the disfigurement of many survivors, wiped from the planet through scientific discovery and international collaboration.  I, of course, have never seen a case of smallpox.  But I have seen plenty of children suffer – and in some cases, die – from diseases that are now vaccine-preventable.  Measles, Hemophilus influenzae, meningococcemia, etc.  As inspiring as the triumph over smallpox was, it was equally disheartening to arrive in Philadelphia for my fellowship on the heels of one of the largest US measles outbreaks in the vaccine era, with over 1000 cases and 9 children dead.  The epidemic was traced to members of two sects who opposed vaccination on religious grounds.

Today, people are at least as likely to reject vaccines (either completely or selectively) for philosophical or personal reasons.  Although every state requires evidence of immunization for school entry, with exemptions for medical contraindications, 48 allow parents to refuse on religious grounds, and 20 (including Wisconsin) allow refusal on personal or philosophical grounds.  This is what is behind the current national measles outbreak.  Ironically, two of the poorest “Bible Belt” states – Mississippi and West Virginia – which do not permit religious exemption, have much higher immunizations rates than affluent communities like Orange County and Santa Barbara, California, where up to 40% or more of children are unimmunized.

Many politicians are framing this as an issue of individual choice.  Those who claim not to be antivaccine support education to convince parents to have their children immunized, but insist that it is a parent’s right to choose.  I’m not convinced by that argument.  We don’t allow parents to choose to abuse their children, and we don’t allow parents to refuse treatment for life-threatening conditions.  I don’t believe they should be allowed to withhold life-saving preventive measures either.  More importantly, though, this isn’t just about parents making decisions for their own children.  These decisions affect other children, too.  Most vaccines are incompletely effective in an individual.  Much of the protective effect is from what is called “herd immunity”: if enough individuals in a population are rendered non-susceptible to a disease, then the disease cannot perpetuate in that population and everyone is spared.  For measles, which is one of the most contagious diseases known, the level of vaccination required to achieve herd immunity is quite high.  Jenny McCarthy choosing not to immunize her kids put mine at risk.  (Well, not literally, since my kids are unlikely to ever be in the same population as hers, but you get the point.)

At some level, infectious diseases like smallpox, tuberculosis, and measles are the product of civilization.  They arise and thrive when people come together in societies.  Oliver Wendell Holmes said “Taxes are what we pay for civilization.”  So are vaccines.  Like taxes, they shouldn’t be optional.

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