A letter to parents hesitant about vaccines

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Below is a letter I have written to parents who are hesitant about giving vaccinations to their children.  I don’t know how many it will convince, but I needed a respectful and informative way to follow up with parents who expressed concerns or declined vaccinations, and this is what I now share with them after such visits.  This is written not with the goal of exhaustively proving the case for vaccine safety and efficacy, which would require a longer treatise, but simply to address a few major points trying to address the sources of such parents’ fears and doubts about vaccines.

Dear concerned parent,

I understand that you have concerns, doubts and maybe fears about immunizations, and that you may have chosen not to immunize your child. This is an emotional topic, and I know it is sometimes hard to even articulate exactly what those fears are — you may just feel uncomfortable about them. I appreciate the opportunity to share my perspective with you, and I commit to discuss this with respect for your rights and responsibilities as a parent. But I would like to share my perspective with you in hopes that it will help you to think about immunizations.

Here in the 21st century, many of us have an inherent suspicion of anything synthetic or artificial and are trying to get back to what is naturally healthy. We know that processed foods are bad for us, and whole foods are much better. Even though I am a physician, I share those biases.

Further, while we may rely on the health care system for certain needs, we tend to have less than full trust that the health care system is really always oriented for our best interest. We also tend not to trust the government, and since immunizations are controlled and pushed by both government and giant companies, they are a natural object of suspicion for us. Plus, there is much written on the Internet, and it is hard to know who has the correct interpretation of the facts and often even what the facts are.

Regardless of the reasons, once fear or mistrust has developed, it is very hard to overcome. You may read a lot of positive information about vaccines and still feel uncomfortable. As you think about vaccines more, you may develop more specific questions that you need to be answered. But I want to tell some history behind the development of two particular vaccines.

The first known immunization was with smallpox in China in the 15th century. Smallpox was a disfiguring and frequently deadly disease present throughout human history. The Chinese developed methods where dried scabs from a smallpox patient would be applied to a patient who had not had smallpox; the inoculated patient would develop a much milder form of smallpox and would become immune to the disease. This type of immunization was later introduced into England and North America in the 1720s.

Later in the 1760s it was observed that dairy workers would never get smallpox, and it was postulated that they had immunity to smallpox because they had already had cowpox, a related disease that is much milder in humans than smallpox. In the 1790s, Edward Jenner developed a method to vaccinate humans with the cowpox virus to induce immunity against smallpox. During the 1800s, the virus used for immunization against smallpox was changed to vaccinia, another similar virus. Smallpox was eliminated from the United States by 1897, and worldwide eradication was finally accomplished by 1979. For most of us, smallpox is now simply a vague and distant historical fact, rather than the terrorizing disease it once was.

The reason I recounted this story is to remind us that immunization is not quite as new as we tend to think, and that horrible diseases can sometimes be completely eliminated through immunization. Every one of the vaccines we use today has an interesting story that could be helpful to understand, but there is one other story I’d like to tell in this letter, that of the MMR vaccine.

The MMR vaccine is a three-in-one immunization that provides protection for measles, mumps, and rubella, but I will focus on measles.

Measles in its current form has been present since about 1100 AD. Measles is one of the most contagious viruses known to man; nine out of ten nonimmune people in a room with a measles patient could be expected to get infected. Measles causes a high fever, a rash, and many possible complications including diarrhea, pneumonia, or brain infections. In the United States, measles may kill about 3 in 1000 people infected, but in developing countries it may kill 20 to 30 percent of those infected. The measles virus was first isolated in cell culture in 1954, and the first measles vaccine was licensed in 1963. There were several early versions of the vaccine including an inactivated (killed) virus and a live attenuated (i.e., weakened) vaccine. There were also several more weakened viruses studied, but by 1968, an even weaker live attenuated version was licensed, and this version has been used in the United States ever since. In 1978, the CDC announced a campaign with the goal of completely eliminating measles from the country, and by 1981 the number of cases annually had dropped 80 percent. New outbreaks of measles in 1989 prompted a recommendation for a second or “booster” dose of MMR to increase immunity to nearly 100 percent. Measles was virtually eliminated from the USA by 2000, but, unfortunately, that is not the end of this story.

In the case of vaccines, although there may have always been some level of fear about them, those fears were multiplied when, in 1998, Dr. Andrew Wakefield published in the Lancet, a prestigious British journal, a study proposing a link between the MMR vaccine and autism. The study had a huge effect on public opinion and has given a great deal of fuel to the fire of the ongoing fears and doubts of many about immunizations.

However, it turned out that Dr. Wakefield’s research was fraudulent, which ultimately resulted in the loss of his medical license and the retraction of his publication by the journal. Since then, multiple studies of millions of vaccinated vs. unvaccinated children have repeatedly failed to find any association between MMR and autism, but the fear lives on in spite of that. It turns out that doubt is even harder to eliminate than measles itself.

The Disneyland measles outbreak of 2015 has shown us that, when the number of children who are vaccinated drops below some threshold, some vaccine-preventable illnesses can resurge in the population. So in reality, every time a family chooses not to vaccinate a child, the risk of vaccine-preventable diseases actually rises for the entire community.

Can side-effects occur with immunizations? Absolutely, but serious side-effects are exceedingly rare. Some people have written their experiences on the Internet to discourage others from immunizing their children, but while those stories may foment our fears and doubts, those individual horror stories often contain many false assumptions and draw many inaccurate conclusions. It is very easy to stir up fear with even incomplete or inaccurate information, and very hard to eliminate fear once it exists.

Here are the facts as I see them about modern immunizations:

  • Immunizations have resulted in the elimination or dramatic reduction of many childhood diseases.
  • The illnesses that are preventable by vaccines range in severity from “major inconvenience and expense” to disfiguring and deadly, but are mostly forgotten because most of us have never seen cases of those diseases.
  • To maintain the benefits of immunizations, they have to continue in use by a certain percentage of the population as long as the virus continues to exist anywhere in the world. Once usage drops below some level, a vaccine-preventable disease can make a resurgence in the population.
  • Although doubt is very difficult to dispel, there is overwhelming evidence of the extremely high safety of vaccines, making their risks very low versus benefits that are very great.

I hope this is helpful to you as you consider whether to immunize your child. I believe that immunizations were perhaps the single greatest advance in health care in the 20th century, but we have to continue to use them to continue to reap their benefits.

Brian Elkins is a family physician and medical director, Legacy Health and Wellness. He blogs at brianelkinsmd.

Image credit: Shutterstock.com

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