Vaccines and public health: Can we have our cake and eat it too?

Physicians today are challenged with the unique task of navigating the fundamental incompatibility between patient autonomy and the goals of public health. A few months ago, I faced that challenge when my elderly patient declined to receive the recommended influenza vaccine.

“I respect my patients’ right to choose, but sometimes I’m concerned that they make choices based on fiction rather fact,” I reflected in a recent post. “It’s been quite a challenge learning how to debunk misconceptions, without seeming too pushy.”

Prompted by the recent conversations surrounding the anti-vaccination movement, I am here, once again, reflecting on a doctor’s responsibility to support the health of the community while simultaneously empowering their patients with the information needed to make informed choices.

Vaccinations work in part by exerting their protective effects via herd immunity. That is, when people are vaccinated, they not only build up their own immune systems, but also thwart the spread of disease to community members that are ineligible for certain vaccinations like immunocompromised patients, pregnant women and babies. By definition, most people must buy into the concept of vaccination for it to work.

Given the recent increase in outbreaks of vaccine-preventable diseases like measles and whooping cough, can we as doctors truly respect a patient’s wish to stray from evidence-based vaccination guidelines?

When it comes to vaccinations can we have our cake and eat it, too?

Los Angeles Times writer Michael Hiltzick doesn’t think it’s possible:

The lesson of all this is that vaccination is not an individual choice to be made by a parent for his or her own offspring. It’s a public health issue, because the diseases contracted by unvaccinated children are a threat to the community. That’s what public health is all about, and an overly tolerant approach to non-medical exemptions — and publicity given to anti-vaccination charlatans like Wakefield and McCarthy by heedless promoters like, sadly, Katie Couric, affect us all.

I’ve realized that sometimes, the medical community doesn’t care about being pushy in the name of public health. Sometimes we are the biggest bullies, using science and the letters behind our names as weapons to shame those who choose not to follow medical recommendations. Some medical professionals have flooded my twitter timeline with unkind tweets about celebrities that choose to opt out of vaccinations. A legitimate source citation in a tweet does not mitigate the meanness in the message.

Reality TV starlet, Kristin Cavallari recently revealed that she doesn’t believe in vaccinating her children. I instantly felt sad for her. Not sad because her misinformed beliefs based on shady Internet blogs will place her children and others in her community at an increased risk of preventable disease (this is an obvious tragedy), but because she was about to be massacred by the vaccine mafia for her parenting choices and medical decisions.

Celebrities do have the power to influence public opinion, but at the end of the day they are patients, too. By attacking celebrities for their medical choices, do patients fear that they will also be targeted for sharing the same views? How many patients are afraid of asking their physicians questions about vaccinations or exploring alternatives because they are afraid of being dismissed or labeled as an “anti-vaxxer”? By publicly shaming and bullying “anti-vaccination charlatans” are we inadvertently destroying opportunities for productive dialogue with our patients?

Dr. James Hamblin, an editor at The Atlanticreminds us of the dangers of misappropriating our energy to educate patients:

Exasperating as it can be for experts and journalists who hear about vaccine conspiracy theories and discredited research regularly, for years, concerns are still best addressed seriously. Dismissing concerned parents out of hand is dangerous to the culture on the whole. Go after the misinformation, not the misinformed. McCarthy is not an aberration, in that celebrities without medical expertise have and will continue to shape public health. Often for better, often not; either way it’s powerful and the effects are pervasive.

I think we can have our cake and eat it, too, by going after the misinformation, not the misinformed. At least we can make it easier for patients to make the right choices, instead of pushing them toward the wrong ones.

Jennifer Adaeze Anyaegbunam is a medical student who blogs at her self-titled site, Jennifer Adaeze AnyaegbunamShe can be reached on Twitter @JenniferAdaeze.  This article originally appeared in The American Resident Project.

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  • SarahJ89

    I’m not sure how old older woman not wanting one vaccine translates into across-the-board anti-vaccination. I don’t get flu vaccinations, partly for reasons that have nothing to do with vaccines. But I lived through the polio epidemic and am fervently in favour of polio vaccine so don’t leap to the erroneous conclusion I’m anti-vaccination just because I refuse one particular vaccine for myself for reasons you know nothing about because we only have fifteen minutes together.

    Does it not occur to people that not everyone is all one way or another? Some people actually access information on a case-by-case basis. When you fail to recognize that you throw away any chance at communication or resolution.

    • SarahJ89

      My apologies for that big, honking sentence in the first paragraph. Do *not* try to say it three times fast. You’ll hurt yourself.

  • safetygoal

    His practice, his choice. More than 3 million people die from vaccine-preventable diseases each year. Approximately 1.5 million of these deaths are in children less than 5 years old. Anaphylaxis from vaccines is extremely rare and death is even more rare. Responsible parents vaccinate their children.

  • W Joseph Ketcherside, MD

    Actually, I kinda like this anti-vaccination movement. It seems like a very good way to thin the herd of idiots.

    • CHDmom2007

      Sounds well and good however sadly majority of those it kills are the ones who cannot be vaccinated and who would be in a heartbeat. Which is why this statement is misleading and detrimental to those vaccinated. Also its sad to wish death on those who have no choice as its thier horribly misinformed parents making that decision for them.

    • Trish Browning

      Nice idea, but, like drunk drivers on the road, it is all too frequently the innocent that suffer and die. Too bad the anti-vaccers are also into organic food, drive Volvo station wagons, and professionally baby-proof every inch of their MacMansion. Poor ability to prioritize risk….these are good moves but rank below getting little Ava or Asher their shots.

  • CHDmom2007

    Well..since you have a child with such issues with vaccines, I would hope you tried to learn everything about them. Including the fact that for some, the vaccine isnt as effective and that people still have a chance of catching the disease. Its not foolproof. That is why we need everyone (who can) be vaccinated. Your example is extremely rare. I have never heard of that happening..however I have seen many of the diseases vaccines prevent. And have seen very recently a few infants dying from said diseases (pertussis). My daughter has a severe heart defect and we spend a very large amount of time in the cicu. Two babies have died from pertussis since the beginning of the year. There hasnt been a death from this in over twenty years in our area. I asked the staff. I have an obligation to shame those who choose not to vaccinate ..they are directly responsible for these babies dying. Majority of people are so far removed from seeing the devastating effects of these diseases that its not real anymore, of course its easy to say no when they dont see the ramifications of thier actions. Im tired of doctors and people treading lightly with those who dont vaccinate. Maybe we should resort to scare tactics, posts videos and hang photos of children who caught mmr or polio of pertussis etc. Show them legitimate peer reviewed studies and tell them that natural news is not an acceptable place to get medical information.

  • Trish Browning

    @guest….because amongst those in that waiting room are babies far too young to have recieved all of their vaccinations, and for younger babies, ANY of their vaccines!! THEY are at high risk for all of these vaccine preventable diseases, even if they have passive immunity from being breast fed. THAT is why so many docs are telling the un-educable parents out there to find another pediatrician.

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