Web edition: October 31, 2009
PHILADELPHIA - For the folks who promote vaccination, these are trying times. Recently, CNN hosted a segment titled: “Virus or Vaccine: Which is Worse?”
It’s enough to set Paul Offit to ranting, which he did this week at a meeting of the Infectious Diseases Society of America. Offit, a physician who heads the infectious disease division at Children’s Hospital of Philadelphia, has devoted a career to fighting illness. In his job, vaccines are often the most reliable weapon available, and cost-effective to boot. And although it’s astonishingly more dangerous to contract a disease than it is to get vaccinated for it, that message seems to have gotten lost somewhere along the way.
Offit traces this detour back to 1982, when DPT — the shot that prevents diphtheria, tetanus and pertussis – was (wrongly) linked to brain damage. “Three people believed their kids were harmed by the vaccine,” he says.
Offit has compassion for families who have a child who has suffered, whatever the cause may be, known or unknown. But since 1982, it’s been one accusation after another against vaccines. People tried to link the HIB vaccine to diabetes (no evidence), the hepatitis B vaccine to multiple sclerosis (all but one study found no link), and other vaccines to SIDS or autism. Recently, the HPV vaccine — which prevents cervical cancer – got linked to heart attacks and strokes (no proof).
And now the seasonal flu vaccine and H1N1 flu vaccine are being skipped by millions of people who somehow distrust the science that went into making them, even though the illnesses they cause can be fatal.
But hey, it’s a free country. Paul Offit just throws up his hands: “Is it your right to catch and transmit a potentially fatal infection? The answer is ‘yes,’” he says.
Mary Ann Jackson, a physician who heads the infectious disease section at Children’s Mercy Hospitals and Clinics in Kansas City, Mo., investigates vaccination rates among specific groups. She says that the new generation of people dodging vaccines includes many white, college-educated women, often young mothers who get their information from the Internet. The odd part, Jackson says, is that these same women are also health-conscious, seat-belt-buckling folks. “They are trying to choose what’s best for their children. They want it to be their own decision,” she says.
Unfortunately, avoiding vaccination has consequences beyond one household. It turns people into pathogen carriers and provides viruses with convenient hiding places. “Herd immunity is eroding to the point that we’re now seeing outbreaks of preventable diseases,” says Offit. In 2004, for example, the United States experienced its worst outbreak of whooping cough (pertussis) in years. Mumps has also cropped up. Daycares have become high-risk areas because they’ve got a population of children who are relatively under-vaccinated, he says. “Doctors are worried about their waiting rooms being dangerous places.”
William Schaffner, a physician who chairs the Department of Preventive Medicine at Vanderbilt University, cited a recent round of focus groups held to discuss vaccines. Some people voiced doubts about vaccine safety. But Schaffner was impressed by one group of participants who were adamantly in favor of vaccination: immigrants from developing countries. “They knew about these diseases,” he says.
Meanwhile, infectious disease experts have little use for “natural exposure” adherents, which include parents who have been known to host chickenpox parties or who otherwise intentionally expose their children to a disease rather than get the kids vaccinated. Chickenpox is far from harmless. While most cases in young children are indeed benign, older children and adults can get terrible illnesses. And getting chickenpox as a child puts a person at risk of getting shingles when older, whereas there is no evidence that a chickenpox vaccination does.
It’s easy to see why these scientists get frustrated. But sometimes not even a barrage of facts helps their cause. Ronald Reagan famously said, “Facts are stupid things.” Maybe so, maybe no.
For example, the vaccine for H1N1 flu is now being distributed nationwide. But among pregnant women, who can go to the front of that line, three-fourths aren’t getting vaccinated, even though H1N1 is particularly lethal for them and — as if that weren’t enough — it poses risks to theirs fetuses. Facts are scary things.
Health-care workers, another bunch who should know better, also don’t necessarily get vaccinated. Jackson was shocked to find flu vaccination rates of only 50 percent among hospital workers she studied.
So despite vaccines’ overwhelming safety profile when compared to the risks run by exposure to the diseases they prevent, and despite the exhortations of the CDC and World Health Organization, some people just gravitate toward other sources of information they deem more reliable.
"There’s a post-modernist notion that all levels of belief are acceptable,” Offit says.
The vaccine disconnect brings to mind a bumper sticker seen a few years ago, when some school boards and even the state of Kansas were openly advocating the teaching of an alternative explanation to counter Darwin’s theory of evolution.
The bumper sticker read: “What’s next — gravity?”