Vaccines, preventable disease, and the nature of risk

This is an article I wrote that was published on Kevin Pho's blog: http://www.kevinmd.com

The Nature of Risk: Vaccines and Preventable Disease

Two nights ago, I was watching, with my family, an old episode of Dr. Quinn, Medicine Woman, in which a young woman is bitten by a rabid wolf, develops rabies, and dies. That same night, I read a post on Facebook decrying the dangers of immunizations, with a link to an online “news” article blaming immunizations for everything from spreading cancer to HIV.

My mother, as a girl, was bitten by a rabid dog. She was treated immediately with a series of injections of anti-rabies vaccine to prevent her from developing the disease. Rabies, once symptoms develop, is nearly 100% fatal. In Dr. Quinn’s time, there was no vaccine. In my mother’s time, the vaccine she received saved her life (and thus my own).

While most children are not immunized against rabies, they are routinely immunized against an increasing number of diseases. Some of these used to be called “usual diseases” of childhood, such as measles, an acute viral illness which can lead to permanent brain damage, pneumonia, and death, and which can be prevented by immunization. However, when people stop getting immunized, measles returns. According to the Center for Disease Control (CDC) website, we could expect 2.7 million deaths from measles if immunization were stopped.

For every disease that is preventable using vaccines, there is a similar story. I remember, as a child, knowing that parents all over the country were terrified of polio, which could cause severe paralysis and death. I remember putting dimes in slots on a card for the March of Dimes, a nationwide effort to fund research into preventing polio. Polio vaccine came as a miracle, and people rushed to receive it.

Other vaccine-preventable diseases, such as pertussis (whooping cough), can be found closer to home. It is most dangerous to young infants under 1 year old. According to the CDC, 1 in 5 infants get pneumonia, 1 in 100 have seizures, half stop breathing, 1 in 300 have encephalopathy (inflammation of the brain), and 1 in 100 will die.

There are people who do not immunize their children. They believe that immunizations are dangerous, and do not want to take the chance that their children could be harmed. They believe that it is too great a risk.

All of us live with risk. We do not know with certainty what will happen. Every day, we choose what risks we are willing to take. Most of the time, we do so without really thinking about it. Many of our choices are automatic and habitual. We simply do not recognize much of the risk we navigate daily.

As parents, it is in our biology to protect our children from risk, and we must decide how to protect them. Our decisions are based on what we learned from our own parents, friends, reading, research, feelings and emotions.

Frequently lacking, however, in our decision-making, is the study and understanding of history. Edmund Burke said “Those who don’t know history are destined to repeat it.” He could have been talking about vaccine-preventable diseases.

Today’s parents of young children grew up themselves in a time when many of these diseases were rare by virtue of the fact that their generation was immunized. Unlike me, they do not remember polio, measles, or diphtheria. These parents do not understand the risk that they are accepting on behalf of their children.

In truth, vaccines, like everything, are not without risk themselves. However, the risks of the vaccines that we use today are proven to be very small.

Vaccine-preventable diseases all carry much greater risk of serious illness and death, than vaccines. And if we stop immunizing, they will be back to threaten our families.

It is also important to consider risk to the community. As people travel all over the world, they carry illness as unseen baggage. And at home, your non-immunized child can give pertussis to the infant next door. Your child, who is now a teen, could get very ill, but your neighbor’s baby could die.

The community is protected by something called herd immunity. If enough people in the community are immunized, there is less chance for disease to take hold and spread. It is contained by all those people who don’t become ill, but only if most people have been immunized. Ultimately, this is how smallpox became eradicated all around the world.

To make decisions about risk in the present, we must learn the events of the past. We must understand and consider risk vs. benefit, and that we choose risk for others besides those in our own families. In planning for the present and the future, it is vitally important that we choose risk in a way that benefits people around us in addition to ourselves and our children.