The Vaccination Conundrum



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.)


No Longer the Killers of Yesteryear


Disneyland is in the news, and not because it is the most magical place on earth.   It also is the origin of the most recent rubeola measles outbreak, now spread to seven states and Mexico with over eighty cases diagnosed so far.  Unvaccinated children are being kept home from school in some California districts and vaccination requirements once again have become a battleground between  public health agencies and the “right to not vaccinate” community.

It’s been almost sixty years since vaccinations became routine for the childhood killers like polio, measles, mumps and whooping cough.  People my age and older had no choice but to suffer through childhood infectious diseases given how effectively and quickly they spread through a community.   Yes, most of us survived, subsequently blessed with life long natural immunity.  A significant number did not survive or suffered life-long complications from the effects of those diseases.

People living in wealthy and privileged first world countries have forgotten that harsh reality, and many have turned their backs on vaccinations, considering them “too risky” for themselves and their children when these diseases become less common in a mostly vaccinated society.  In contrast, millions of people without easy and affordable access to vaccines in third world countries have not forgotten what the devastation of these infections and gladly walk miles to get their children vaccinated to give them a better chance at a long life.

When measles or mumps or pertussis reemerges within our borders,  we act surprised when it becomes a major media event — but we shouldn’t be.  Diseases that were almost nonexistent are occurring with greater frequency again in modern societies due to misguided and misinformed anti-vaccination campaigns.

As a college health physician, I help enforce vaccination requirements for a state university.  A week doesn’t go by without my having a discussion with a prospective student (or more likely the student’s parent) about the necessity for our requirement for proof of mumps, measles, rubella vaccination immunity.  I have been accused of being a pawn of the pharmaceutical industry because I happen to believe in the evidence of the efficacy of modern vaccines to help keep a community free of infectious disease outbreaks that will kill people.  I also helped coordinate a public health response at our university in 1995 when we had a rubeola outbreak of eleven confirmed cases over a three week period, necessitating the mass vaccinations of over 8000 students and staff over three days in order to keep our institution open and safe.   I’ve experienced first hand what it takes to respond to a potentially lethal contagious disease outbreak.   Never again, if I can do whatever I must to prevent that from happening another time or place.

We have forgotten these vaccine-preventable bacterial and viral illnesses are honest to goodness killers of healthy human beings.   I’ve had caring loving parents of faith request a religious exemption as God will provide the needed immunity if their child gets sick so taking the risk of a vaccine is unnecessary.    I’ve had caring loving parents with no religious objection but who refuse vaccine on a personal basis, considering it a foreign substance that they do not want injected into their child and would rather “take their chances” by eating a healthy diet and other alternative prevention measures.

Actually they are banking that everyone else will be vaccinated.  The problem is:   guess again.  There are now too many deciding that they are the ones who can remain vaccine-free, so scenarios like Disneyland will happen again and again.  We’ve seen repeated pertussis outbreaks tragically causing infant deaths in several states over recent years.

I tell the doubting anti-vaccination families that indeed there is an alternate way to immunity – after suffering through a potentially lethal infection which threatens others who are unfortunately exposed.  I prefer the modern option of immunity in the form of a vial of vaccine, a needle and syringe.  I don’t think any one of these parents would deny the life saving miracle of injectable insulin for their child diagnosed with diabetes, nor would they fail to strap their child into a car seat for the rare but real possibility of a life-threatening collision on even the shortest car ride.

Vaccines are miracles and instruments of prevention too, but the rub is that we have to give them to healthy youngsters in order to keep them healthy.

I’m an old enough physician to have seen deaths from these diseases as well as the ravages of post polio paralysis, the sterility from mumps and deafness from congenital rubella.   My father nearly died from the mumps that I brought home from school when I was eight and he was in his early forties.   My sister-in-law almost didn’t pull through when she was an infant and contracted pertussis.  I’ve seen healthy people develop  encephalitis and pneumonia from chicken pox.    I’ve seen a healthy college student die of influenza within a week of getting ill despite everything modern medicine could offer him.

There is an epidemic of fear in our society that is unwarranted: as Seth Mnookin, a journalist covering science topics wrote in his book “The Panic Virus”,
“If only there were a shot for irrational fears.”  When I’ve written about my stance on vaccinations in various on-line forums, I’m astonished at the vehemence of the many responses from individuals who have no trust whatsoever in the advances of modern medicine to prevent the killers that have devastated mankind for centuries.

Sure, I wish vaccines were perfect with no side effects and conferring 100% immunity but as yet they aren’t.   I wish medications that are developed for treatment of some of these illnesses were perfect but we can’t depend on a 100% guarantee of cure once sickened.   I wish our immune systems were perfectly able to respond to infectious diseases, but they too fail and people do die.

There will always be a new plague – history has demonstrated that over and over with the appearance of  HIV, SARS, Avian flu, Ebola or multidrug resistant tuberculosis.   There is plenty to keep our immune systems at the ready because we don’t yet or may never have effective vaccines widely available.

But there is simply no good reason to invite the old plagues back into our homes, our schools,  our blood streams, and onto our death certificates.   They deserve to be considered the killers of yesteryear that are now overcome by modern medicine and resigned to be merely a footnote in the epidemiology history books.