Is there a cure for the anti-vaxxers?

Headlines still appear about the vaccine “controversy.” However, there really isn’t one is there? Vaccines hold no controversy in the arenas of science, public health records, and medical schools across the country. In fact, the use of vaccines is considered standard of care. All mainstream religions uphold their immense value and even make them a part of their humanitarian relief programs. So, what is happening?

I am a physician and a very practical person who happens to accept that vaccines are very effective and safe. My youngest child is just five months old which leaves her vulnerable to outbreaks such as the recent California measles fiasco. I have an immunocompromised brother. I had a mother taking chemotherapy two years ago. I have elderly relatives. My family can be damaged from outbreaks of disease that had all but disappeared a bit over a decade ago. My interest in the issue is two-fold. I need to protect my family, and I need to protect my patients.

My gut reaction is hostility. I do believe that this anti-vaccine movement represents the worst of elitism. Many of the anti-vaxxers are well educated. But, at some point, the debunked “science” and concerns about “injecting chemicals” appealed to them and they committed to the idea of “protecting” their children from vaccines and probably began buying as many organic products from Whole Foods as possible. They are further misled by some medical professionals (I hear even a cardiologist?) and relative celebrities. The paranoia becomes entrenched. The reasoning becomes a passion.

But, it is really self-serving, isn’t it? These folks may discuss it and grow their own micro-communities of like-minded people. But, they don’t really want all comers. They don’t intend to save the world from these horrid vaccines. They are not marching on Washington, DC and asking for vaccines to be thrown off the shelves. They fully intend for their precious little ones to be protected by the concept of herd immunity. Let the lowly get their kids vaccinated. I’m not going to subject my kid to any vaccine-related risks.

I think many of them fully recognize why measles no longer infects millions a year in America (as it did in the early 1960s). I think many of them probably accept that vaccines are not likely to cause autism. I think many of them know that childhood vaccines don’t contain mercury. Their pediatrician has probably told them that the chance of a severe allergic reaction to a vaccine is 1 or 2 per million. They accept that trace amounts of aluminum salts are used in vaccines but are also found in water, food, and even air. They even took biochemistry and know about formaldehyde occurring naturally in the human body, and they may even know that it was used to help create the cushy interior of their luxury vehicle. But, they still have paranoia about the vaccine, and they are rabid about keeping their kids away from it.

And, now those anti-vaxxers are probably a lost cause. For years, research has demonstrated that people are enslaved by motivated reasoning, and it can include denial of science. Once someone becomes passionate about an idea, they defend it even against science. In fact, shoving more science down their throats may even create a deeper paranoia about your intentions. Conspiracy ideas about big pharma come in. Distrust in the physician delivering the information can happen. Some of the anti-vaxxers believe that their pediatrician is only in the vaccine business for the money (in reality, pediatricians sometimes just break even or lose money to offer their patients vaccines). The anti-vaccine propaganda has become so engrained that there must always be an ulterior motive or a puny mind behind the voice trying to offer reassurances about vaccines.

So, what should physicians do? Articles discuss addressing a family’s unfounded fears. But, in their minds, their fears are deeply founded. In fact, they usually believe that they have made the anti-vaccine choice from a totally rational place. And, maybe it started that way. But, now, it is a passionate ideal that they almost cannot let go of. If you insult them or show negative emotion, they will turn away.

We are probably left with the old “Keep calm and carry on” slogan. When approaching these patients, it is probably best to keep insults and emotion completely out of it and appeal only to simple reasoning. Most are lost, but physicians still need to try to spread the word in the most successful way. Plus, we need to try to recapture these unvaccinated kids as they age into adulthood. Many of them may not realize that the complications associated with some of these childhood diseases can be even worse for them in adulthood and that these illnesses could pose risks to their future pregnancies.

Pediatricians have the biggest quandary in regards to treating the children of the anti-vaxxers. Obviously, these kids still need care. You know, they need an occasional prescription for amoxicillin (which contains some preservatives, anti-vaxxers!) for a cold (sorry, I’m getting bratty). Administering vaccines is only a small (but very important) part of a child’s care. But, what should they do? Some infants in California are currently under a multi-week quarantine because of potential measles exposure in a pediatrician’s waiting room. Do you put your compliant patients at risk?

Anti-vaxxers feel embarrassed or marginalized in health care settings, but I feel like they have earned that. Some pediatricians have isolation areas for sick kids, and perhaps they already put their anti-vaxxers there (and probably should). Perhaps some of them only see those kids at the end of the day. These are definitely some ways of minimizing risks. But, I think if a pediatrician can’t feasibly protect the bulk of their practice from this problem, they should consider turning the anti-vaxxers away.

I do think that pediatricians and family practice doctors should start protecting themselves with documentation. If they continue to see anti-vaxxer families, they need to document the conversation about immunizations. If the patients refuse vaccines, then they should have them sign the equivalent of AMA (against medical advice) waivers. I think there will be civil suits in the future waged against wealthy anti-vaxxers if this problem worsens or incidents of illness can be tracked to people who knowingly exposed members of the public. It would be a pity to have pediatricians dragged into the muck.

In any event, the anti-vaccine movement should be prepared to pay for their choice. A 100 case outbreak of measles cost taxpayers and its state government about $5 million. If people can be fined for refusing to find health insurance under the Affordable Care Act, then they should be similarly fined for refusing vaccines. It is an important public health issue just like having massive numbers of uninsured.

School districts need some better protections in place, and state governments need to place limits on exemptions from vaccines. Religious exemptions seem to be on the menu but with the exception of some extremist sects and perhaps some groups of Christian Science, I do not know a religion that prohibits vaccines. Otherwise, the exemption is based on a philosophy if it isn’t a medical exemption. Do some parents get to place other people’s children at risk for their personal belief system that is scientifically bankrupt? But, one could also argue that the risk goes up if you force all of these children into private school systems because the herd immunity is lessened. The decision rests with the constituency of that state.

But, I do think that schools should have a waiver in addition to the exemption that could hopefully help displace legal blame onto the anti-vaxxer. Because there is danger of lawsuits looming. As I write, there is a family in California that is trying to keep their son who has leukemia safe from the non-vaccinated. They are asking the school to bar unvaccinated children. If a child in this situation contracts a disease from a non-vaccinated individual and suffers severe complications or dies, there will be a lawsuit.

Some Americans don’t like science, but they love and understand money. I think we will start to see this problem dwindle when it starts to create a void in the wallet. Personal beliefs may begin to waiver very quickly if this trendy anti-vaccination thing starts to get painful and has consequences.

And finally, what about some of our misguided comrades? If you are a physician, you are expected to give sound advice and practice commonly accepted science and medicine. That is what you call standard of care. So, if I thought very highly of an antibacterial holistic soap, I could offer it as an adjunctive, possibly helpful skin care to a patient with a cellulitis (skin and soft tissue infection). But, per the standard of care, I should also prescribe an antibiotic that is most likely to kill the suspected bacteria and clear the infection. If I did not do that, I could be reported to our state medical board and be investigated. This would then be followed by fines, a reprimand, undergoing several hours of continuing medical education in the area of infectious disease, and possibly some supervision of my practice. If substandard care continued, then I would lose my license to practice medicine.

If we have colleagues that are violating standard of care, then they should be reported to their respective medical boards. If they are part of this public health issue, they should be reprimanded and rehabilitated if possible. We should not allow medical doctors to become a vocal part of the anti-vaccine movement. They shouldn’t offer alternatives to vaccines, sell books, or otherwise benefit financially from this. Even though this is a tiny, fringe number of physicians, they have an inappropriate power and create confusion for the patients who are looking for answers from a trusted source.

I am a surgeon. I am not on the front lines of this issue. I am not trying to serve as an expert on vaccinations. I am merely a concerned physician and mother who feels that medical and legal action in the response to the anti-vaccine movement has not been definitive enough. There are plenty of hostile articles circulating that continue to espouse all the literature proving vaccines effective and safe with a lot of hair pulling about the idiocy of anti-vaxxers. But, there are not many articles talking about the next steps. The anti-vaxxers are here to stay. What do we do with them? How do we talk to them? How do we best treat their children? How do we protect the compliant and the vulnerable? What should the penalties be for the anti-vaxxers? How do we protect schools and doctors from lawsuits? How do we approach the doctors who are partly responsible for a significant public health issue?

I also have another compelling reason to think about this particularly in reference to the hot spots in California where the rates of under- immunization reach as high as 22 percent and some school exemption rates can be 10 percent. I practice and live in a Texas town that many a Californian seems to love and has relocated to. Even Andrew Wakefield (the doctor stripped of his British medical license after his research linking vaccines to autism was discredited) lives here. Most of the Texas children that are under-vaccinated are delinquent due to poverty or lack of access (another issue). I really don’t want a growing population of anti-vaxxers here. They seem to spread like a virus. It’s time for an effective social vaccine.

Lauren Crawford is a surgeon.

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