Whooping cough might sound like a disease from your great-grandmother’s era. But cases of pertussis have tripled since last year and the Center for Disease Control and Prevention (CDC) has declared an epidemic of the disease in Washington state, whose vaccination rate is the lowest in the US. Indeed, other infectious diseases that we’ve grown to consider relics of the past — measles — have resurfaced in the US.
What puzzles public health officials is why, despite stepped-up public health campaigns to raise awareness about the need for vaccination, more parents are choosing not to vaccinate their children as a study published on September 20 in The New England Journal of Medicine (NEJM) reports.
The Rise and Fall of Andrew Wakefield and a Very Misguided Theory
When my son Charlie was born in 1997, getting him immunized seemed a matter of protocol. I still remember the yearly check-ups with Dr. Lee; “shots” were always last and the part I hated the most. My parents had both worked in hospitals and I rigorously followed the schedule of vaccinations, feeling those tugs at the heartstrings when Charlie wriggled, wailed and was pinned down to get his shots.
Then Charlie was diagnosed with autism in 1999 and my husband Jim found ourselves inundated with information (mostly from the internet) about one particular theory of autism associated with a British doctor, Andrew Wakefield, who claimed that the MMR was linked to autism. We dug into our memories to recall Charlie’s reactions to the vaccines he’d been given. Though there was nothing very dramatic — no “overnight” loss of language as some parents have ardently described — we chose not to have Charlie have his scheduled vaccines when he was 5. We sought religious exemptions for a few years before concluding what we had long thought, that Charlie was born autistic and that no external environmental agent had “triggered” autism in him.
Charlie is 15 now. Wakefield’s 1998 study linking the MMR to autism has been retracted by the British medical journal, The Lancet, that published it and he is no longer able to practice medicine in the UK. Scientific studies refuting a vaccine-autism link have accrued.
Fear and Uncertainty About Vaccines Remain
Yet parents are as wary, if not distrustful and downright scared, of vaccines as ever and no matter how much doctors and public health officials explain how immunizations not only protect your child but an entire community due to the creation of herd immunity (when a high-enough percentage of people in a community are vaccinated, those who are not vaccinated such as babies are protected).
Washington State Has Lowest Vaccine Rate in the US
Accordingly, states are starting to take action to address low vaccination rates. Last year, Washington state adopted a law making it harder for parents to opt out of vaccinating a child in order for him or her to attend public school. In the decade ending in 2008, the number of parents seeking exemptions from immunizing their children more than doubled in the state of Washington. In the 2008-2009 school year, the parents of 7.6 percent of kindergartners sought exemptions.
But already under the new law, the opt-out rate in Washington has fallen by a quarter, the New York Times notes.
Other states may well follow Washington’s leads and pass similar legislation to make it harder to secure an exemption. Currently, 48 states allow parents to request religious exemptions for vaccinations (the exceptions are Mississippi and West Virginia) and 20 allow parents to request such on philosophical grounds.
Vaccines: A Matter of the Heart?
Children need to be vaccinated and parents who opt out must keep in mind that infectious diseases can be deadly. But I wonder if the medical and scientific establishment, in their concerted efforts to exhort parents to immunize children, have not taken sufficiently into account the emotions affecting parents’ choices. These are so strong, and run so deep, as to make a person give a nod to “the science” and then go look for answers of her own (which the internet has, of course, made amply available). The whole business of getting a child immunized — the long needles, the syringes, even the word “shot” (or “jab” in the UK) — smacks of harm and hurt and gives rise to a parent’s instincts to protect, rational thinking be damned.
I think Wakefield understood all this and it is extremely unfortunate, if not tragic, that he used this understanding to promote an incorrect notion, that vaccines or something in vaccines could be linked to autism. This idea, in all its wrongheadedness, lives a stubborn half-life.
While legislation like Washington state’s is crucial for our public health, I suspect such laws may only increase distrust and defiance in those doubtful about vaccines. Perhaps the message we need to send out is not “vaccinate your child because, studies show this will protect their health” but rather “you love your child — vaccinate!”
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Photo by Dave Hargarth