The Vaccination Conundrum

cacti4

 

It is proof of MMR immunity season again.  Students entering school this fall are being asked to prove they have been fully vaccinated against Mump, Measles (rubeola) and Rubella infection as well as other routine immunizations in order to be allowed to enroll.  A small but significant and vehement minority insist they should be allowed a personal exemption from the requirement that the majority willingly comply with.

Concerned, caring parents make the decision every day to forego life-saving immunity by refusing to vaccinate their children, truly believing they are doing the right thing. They do not perceive an imminent risk to their child from the older contagious diseases despite their resurgence in developed countries like the U.S., focusing instead on the low—or often non-existent but ballyhooed—risks of vaccinations.

These are parents—most of them well-educated and on both ends of the political spectrum—who refuse to vaccinate their children, thereby denying a consensus of scientific evidence and increasing the risk for further outbreaks. “Oh my God. Wealthy, white, liberal enclaves are at risk!” declares Daily Show correspondent Samantha Bee, mocking the anti-vaccine bloggers and activists. So too at risk are some conservative Christian church communities where vaccination rates are low.

As clever the satire may be, I can’t bring myself to laugh or crack a smile. Now in my 60s, I remember the illnesses brought on by these diseases before vaccines. As a physician, I’ve seen cases of them coming back with fatal consequences.

Maybe some of us have forgotten or are too young to realize the severity of these conditions. Healthcare providers who haven’t had firsthand experience with these contagious diseases don’t always think of them when confronted with classic signs and symptoms. But it’s only been a little over 50 years since vaccinations became routine for childhood killers like tetanus, diphtheria, polio, measles, mumps, and pertussis, or whooping cough. Americans growing up before then had no choice but to suffer through childhood infectious diseases as they quickly spread through a community.

Most of us survived our illnesses, rewarded for our affliction with permanent natural immunity. Others suffered lifelong consequences: paralysis from polio, deafness from rubella, sterility from mumps. Some did not survive at all. My father nearly died at age 41 from a case of the mumps I brought home from school. As an infant, my sister-in-law almost didn’t pull through when she turned blue from pertussis infection.

Today, I’ve seen healthy people develop encephalitis and pneumonia from chicken pox. A fit college student in my practice died of influenza within a week of the start of his symptoms. Our university clinic just diagnosed a case of mumps during a local outbreak.  Our herd-immunity for many vaccine-preventable conditions has been waning, as reports of pertussis, measles, mumps, and chicken pox reemerge, in affluent countries with robust health care systems.

Parents who opt to leave their children unvaccinated contribute to the recent outbreaks. Well-meaning American parents are convinced they are doing the best thing by protecting their children from potentially rare and often unproven vaccine side effects. Some Christian parents claim vaccine risks are unwarranted, since God will provide the needed immunity if their children gets sick.

Most cases originate overseas, so it’s especially critical that Americans be vaccinated when traveling outside the U.S., even to Europe. (Those who serve in mission fields are particularly vulnerable, and I’ve found it interesting that previously unvaccinated Christians are more than willing to accept immunizations when they know for certain they will be exposed.)

As a physician of faith, I tell parents God indeed provides immunity. But as we’ve seen over millennia, it comes by very real suffering through a potentially fatal disease. In our modern society, God grants us everyday miracles, both pharmacologic and surgical, including the potential of long-lasting immunity in the form of a vial of vaccine. I don’t think these parents would deny insulin for their child newly diagnosed with diabetes, nor would they fail to strap their child into a car seat before starting the ignition. Vaccines are instruments of prevention, too, given to our healthy youngsters in order to keep them (and others) healthy.

“I’m concerned that so many people seem willing to let others carry the supposed burden of vaccination so that they don’t have to,” wrote Rachel Marie Stone in a Her.meneutics post several years ago. “To me, that’s a failure of the commandment to love our neighbors: our infant neighbors, our elderly neighbors, and our immune-compromised neighbors.”

When I was vaccinated for diphtheria, pertussis, and tetanus (DPT) at the age of 4 months in 1954, my mother wrote in my baby book: Up most of the night with fever 104.5 degrees, a good “take” for the vaccine. She was relieved that it had made me sick, as it meant that my stimulated immune system would keep me safe if exposed to those killer diseases that were so common in the 1950s. Our society doesn’t think about immunizations as we did back then and thankfully a febrile reaction like that would be unusual due to significant changes in how today’s more effective vaccines are formulated.

I wish vaccines were perfect in their protection and potential side effects, but they aren’t. I wish medications developed for treatment of some of these illnesses were perfectly effective, but we can’t depend on a guarantee of cure once sickened. I wish our immune systems were perfect in their response to exposure to pathogens, but they too fail and people do die. Even though there will never be perfect prevention or treatment, parents in third world countries who have watched their children suffer and die from completely preventable disease will walk miles, for days, to get their children vaccinated when they learn of a mobile health clinic setting up an immunization center. Undeterred by that harsh reality, some in our highly educated society choose to run, not walk, in the opposite direction from much more easily accessible free state-supplied vaccine.

There will always be a new plague to worry about. Even as we eradicated illnesses through vaccine, we watched HIV, SARS, avian flu, multidrug-resistant tuberculosis, and MERS infect us. Some countries have seen the return of polio, and we remain concerned over smallpox somehow finding its way out of its lockbox in laboratories.

Given these threats and the new pathogens on the horizon, it remains unwise to refuse safe and effective vaccination. By doing so, we invite the old plagues, these killers of yesteryear, back into our homes, our churches and schools, and inevitably, onto our death certificates.

We can and must do better for our next generation.

 

(an earlier version of this essay was published online three years ago with a significant negative reaction from Christian readers.  It bears repetition because anti-vaccination beliefs continue to be an issue in the midst of current rubeola measles and mumps outbreaks in the U.S.)

cacti9

And Grace Will Lead Him Home

amazing-grace

Nothing was helping.  Everything had been tried for a week of the most intensive critical care possible.  A twenty year old man, completely healthy only two weeks previously, was dying and nothing could stop it.

The battle against a sudden MRSA pneumonia precipitated by a routine seasonal influenza had been lost.   Despite aggressive hemodynamic, antibiotic and ventilator management, he was becoming more hypoxic and his renal function was deteriorating.   He had been unresponsive for most of the week.

The intensivist looked weary and defeated. The nurses were staring at their laps, unable to look up, their eyes tearing. The hospital chaplain reached out to hold this young man’s mother’s shaking hands.

After a week of heroic effort and treatment, there was now clarity about the next step.

Two hours later, a group gathered in the waiting room outside the ICU doors. The average age was about 21; they assisted each other in tying on the gowns over their clothing, distributed gloves and masks. Together, holding each other up, they waited for the signal to come in after the ventilator had been removed and he was breathing without assistance. They entered his room and gathered around his bed.

He was ravaged by this sudden illness, his strong body beaten and giving up. His breathing was now ragged and irregular, sedation preventing response but not necessarily preventing awareness. He was surrounded by silence as each individual who had known and loved him struggled with the knowledge that this was the final goodbye.

His father approached the head of the bed and put his hands on his boy’s forehead and cheek.  He held this young man’s face tenderly, bowing in silent prayer and then murmuring words of comfort. It was okay to let go. It was okay to leave us now. We will see you again. We’ll meet again.  We’ll know where you will be.

His mother stood alongside, rubbing her son’s arms, gazing into his face as he slowly slowly slipped away. His father began humming, indistinguishable notes initially, just low sounds coming from a deep well of anguish and loss.

As the son’s breaths spaced farther apart, his dad’s hummed song became recognizable as the hymn of praise by John Newton, Amazing Grace.  The words started to form around the notes. At first his dad was singing alone, giving this gift to his son as he passed, and then his mom joined in as well. His sisters wept. His friends didn’t know all the words but tried to sing through their tears. The chaplain helped when we stumbled, not knowing if we were getting it right, not ever having done anything like this before.

Amazing Grace, how sweet the sound,
That saved a wretch like me.
I once was lost but now am found,
Was blind, but now I see.

Through many dangers, toils and snares
I have already come;
‘Tis Grace that brought me safe thus far
and Grace will lead me home.

Yea, when this flesh and heart shall fail,
And mortal life shall cease,
I shall possess within the veil,
A life of joy and peace.

When we’ve been here ten thousand years
Bright shining as the sun.
We’ve no less days to sing God’s praise
Than when we’ve first begun.

And he left us.

His mom hugged each sobbing person there–the young friends, the nurses, the doctors humbled by a powerful pathogen. She thanked each one for being present for his death, for their vigil kept through the week in the hospital.

This young man, now lost to this life, had profoundly touched people in a way he could not have ever predicted or expected. His parents’ grief, so gracious and giving to the young people who had never confronted death before, remains unforgettable.

This was their sacred gift to their son so Grace can lead us home.