I feel that I am a very open-minded provider, letting patients make empowered decisions regarding their health and choose interventions based on their comfort levels after a thorough discussion of the risks/benefits and informed consent (with thorough documentation on my part). While I think that patients who decline age-appropriate cancer screening, or parents who decline vitamin K shots for their newborns, are making poor individual choices, their actions have individual and not epidemiological consequences. In contrast, I feel very strongly about the importance of vaccines (which some misguided parents withhold from children too young to decide) and have compiled a series of articles that argue in favor of vaccination, which is, as one author wrote simply but eloquently, "one of the most unambiguously helpful interventions in the history of modern medicine."
Here is the text of a recent article by Stephen Luntz posted yesterday by a friend on facebook, which prompted me to blog here, in order to put my articles in one place (and which made me want to move immediately from my hippie county, which has a high number of non-vaccinators, to Croatia).
"Croatia's
Constitutional Court has upheld compulsory vaccination laws against
nine infectious diseases. The court's statement has been translated as
reading, "The child's right to health is more important that the rights of the parents to the (wrong) choice."
Croatia and its neighbor Slovenia have been at the forefront of
universal vaccination. While most governments advocate in favor of
vaccination, and in some cases provide financial incentives, only a few
make childhood vaccination compulsory.
According to a study
of 29 European countries, “15 countries do not have any mandatory
vaccinations; the remaining 14 countries have at least one mandatory
vaccination included in their program”. Moreover, most of these do not
enforce the laws, provide extensive opt-out clauses, or make vaccination universal only against a small number of diseases.
Since Croatia made vaccinations universal in 1999 diphtheria, whooping
cough and measles have disappeared entirely and tuberculosis has
decreased by 93%, tetanus by 97% and hepatitis B by 65%.
Possibly because of this success, however, Croatia has experienced
substantial resistance to what was once an uncontroversial policy.
Having achieved universal vaccination for a decade (presumably excluding
cases where there was a valid medical reason) 28 children went
unvaccinated in 2012, according to official records, and in 2013 this
climbed to 143. While these numbers are not enough to generate the sorts
of outbreaks seen in the US and UK as a result of campaigns by anti-vax lobbyists, the direction is clear.
The potential scale of the revolt is indicated by 10,000 people signing
a petition claiming, "the vaccination of healthy children poses a
threat to their health." Inevitably the law was challenged in court, but
the highest court in the land has now endorsed it. The decision has
been hailed by the Croatian Medical Association and the Croatian
Institute for Public Health.
The implications of a let up in vaccination regimes can be seen in
Syria where the war has interrupted the childhood immunization program.
As a result polio, recently confined to just three countries, is now spiraling out of control in Syria. Children, including those who make it to refugee camps in surrounding countries, are being sentenced to lifelong paralysis.
Failing to vaccinate a child against a transmissible disease is
analogous to strapping a bomb to their chest and sending them out in
public – if something triggers an explosion they are the most likely one
to die, but there is a substantial risk everyone close to them will get
hurt as well."
YES.
Here's a really thought-provoking article which really hit home for me-- which includes a discussion of the ethics of declining to accept children to your practice whose parents don't vaccinate, and asks "If you won’t trust your doctors on vaccinating your kids, will you ever really trust them at all?"
Here is a great article debunking common vaccine myths (especially the one that the MMR vaccine causes autism [thank you, Jenny McCarthy], which is not only based on a completely falsified [and retracted] study, but which has unfortunately created so much public panic that the safety of other vaccines has been called into question by paranoid parents). This panic is why we are now having measles exposures and outbreaks in this country including in Oakland from an infected BART-rider, Orange County, and in New York.
Here are some visual maps showing the trend in recent years of the spread of vaccine-preventable illnesses across the world. If some of these parents could just witness firsthand some of the devastating cases of tetanus, polio, pertussis, diphtheria, and the like across the globe (or really talk to their grandparents), they may be awoken from complacency and change their minds. They need also to understand that outbreaks are happening because we are losing the "herd immunity" benefit of vaccination (that the more immune people there are, the less likely an infectious disease is to spread, even among unvaccinated/susceptible people).
California's "personal belief exemption" is really scary, especially as I live in the state, and we see active whooping cough outbreaks (preventable by DTaP/TDaP). TDaP is recommended for all adults one-time, and all pregnant women between 27-36 weeks in each pregnancy (regardless of past vaccination history and regardless of pregnant women's hesitancy to be vaccinated) to mainly reduce the risk of newborn pertussis disease, which can be devastating and deadly and which you can read about here where two previously-indifferent or unaware moms talk about their personal experience with pertussis (diphtheria, also prevented by DTaP, is very rare in this age, due to vaccination, although devastating back in the day). I personally feel that children should, without question, be forced to be vaccinated in order to attend school (or any public place, really, in case everyone just decides to home-school, although the latter is not really enforceable).
In case people perceive that it's just doctors who favor and are pushing vaccines, here is a very well-written article by Lisa Murakami, a layperson, which every parent should read.
While I don't agree with Dr. Sears (nor do most medical professionals) and "alternative" vaccine schedules only delay needed immunity, it is better to do some vaccines than none, and I work with parents who, while reluctant, are trying to compromise with me (with me hoping that I can ultimately convince them of the *right* thing to do). I agree that the hepatitis B vaccine (in the absence of maternal exposure history) and perhaps polio (which was eradicated from the US thirty years ago because of vaccination, although a polio-like illness has been recently found to be affecting kids in California) are less immediately important than the "2, 4, and 6 month" HIB, pneumococcus, rotavirus, and DTaP (and influenza, in children older than 6 months) vaccines, for those infants who are not imminently leaving the country. However, if we have an effective and well-studied combination vaccine (like Pediarix-- DTaP/polio/Hep B) that includes them, it boggles my mind why a sane parent who loves their child would decline these, as the child would get the same number of "pokes" and no increase in adverse effects.
I routinely give all parents the following resources to review to encourage them to make the decision to vaccinate:
http://vaccinateyourbaby.org/
Http://www.cdc.gov/vaccines/parents/index.html
http://www.cdc.gov/vaccines/parents/parent-questions.html
http://www.cdc.gov/vaccines/vac-gen/additives.htm
http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/prevent-diseases/provider-resources-factsheets-infants.html
Http://www.cdc.gov/vaccines/parents/index.html
http://www.cdc.gov/vaccines/parents/parent-questions.html
http://www.cdc.gov/vaccines/vac-gen/additives.htm
http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/prevent-diseases/provider-resources-factsheets-infants.html
So yes, vaccines cause transient pain-- children cry for a few seconds when they get poked with needles, and it's not uncommon to have a mild local vaccine reaction or even a fever in the 24 hours after vaccines. And until their child has serious complications or dies from an illness that is preventable (or sees cases in other parts of the world where, unfortunately, access to vaccines is limited and mass-vaccination is not feasible), parents may feel comfortable assuming the risk of letting their children going unvaccinated. However, while perhaps deferring vaccines just (in a harsh, blunt way) allows natural selection to take its course for those children (but not actually the parents who made the poor choice), it is still not fair that some parents are putting others' children at risk who didn't make the choice or aren't eligible for vaccines due to immunosuppression or allergies, and that these misguided parents are creating a public health hazard.
Again, "Failing to vaccinate a child against a transmissible disease is
analogous to strapping a bomb to their chest and sending them out in
public – if something triggers an explosion they are the most likely one
to die, but there is a substantial risk everyone close to them will get
hurt as well."
If I had a child (as I tell my patients/parents), I would vaccinate him/her without hesitation for every disease for which we had an immunization, and would be tempted (especially where we live now!) to keep him/her away from playgrounds, churches, and even schools where the other disease-carriers are running around (although I believe in public education). Or move to Croatia where they seem to have gotten things right.
Croatia's
Constitutional Court has upheld compulsory vaccination laws against
nine infectious diseases. The court's statement has been translated as
reading, “The child’s right to health is more than the rights of parents to the (wrong) choice.”
Croatia and its neighbor Slovenia have been at the forefront of
universal vaccination. While most governments advocate in favor of
vaccination, and in some cases provide financial incentives, only a few
make childhood vaccination compulsory.
According to a study
of 29 European countries, “15 countries do not have any mandatory
vaccinations; the remaining 14 countries have at least one mandatory
vaccination included in their program”. Moreover, most of these do not
enforce the laws, provide extensive opt-out clauses, or make vaccination universal only against a small number of diseases.
Since Croatia made vaccinations universal in 1999 diphtheria, whooping
cough and measles have disappeared entirely and tuberculosis has
decreased by 93%, tetanus by 97% and hepatitis B by 65%.
Read more at http://www.iflscience.com/health-and-medicine/croatian-court-upholds-vaccine-mandate#zP8PfsKkWFW6vrfW.99
Croatia's
Constitutional Court has upheld compulsory vaccination laws against
nine infectious diseases. The court's statement has been translated as
reading, “The child’s right to health is more than the rights of parents to the (wrong) choice.”
Croatia and its neighbor Slovenia have been at the forefront of
universal vaccination. While most governments advocate in favor of
vaccination, and in some cases provide financial incentives, only a few
make childhood vaccination compulsory.
According to a study
of 29 European countries, “15 countries do not have any mandatory
vaccinations; the remaining 14 countries have at least one mandatory
vaccination included in their program”. Moreover, most of these do not
enforce the laws, provide extensive opt-out clauses, or make vaccination universal only against a small number of diseases.
Since Croatia made vaccinations universal in 1999 diphtheria, whooping
cough and measles have disappeared entirely and tuberculosis has
decreased by 93%, tetanus by 97% and hepatitis B by 65%.
Possibly because of this success, however, Croatia has experienced
substantial resistance to what was once an uncontroversial policy.
Having achieved universal vaccination for a decade (presumably excluding
cases where there was a valid medical reason) 28 children went
unvaccinated in 2012, according to official records, and in 2013 this
climbed to 143. While these numbers are not enough to generate the sorts
of outbreaks seen in the US and UK as a result of campaigns by anti-vax lobbyists, the direction is clear.
The potential scale of the revolt is indicated by 10,000 people signing
a petition claiming, "the vaccination of healthy children poses a
threat to their health." Inevitably the law was challenged in court, but
the highest court in the land has now endorsed it. The decision has
been hailed by the Croatian Medical Association and the Croatian
Institute for Public Health.
The implications of a let up in vaccination regimes can be seen in
Syria where the war has interrupted the childhood immunization program.
As a result polio, recently confined to just three countries, is now spiraling out of control in Syria. Children, including those who make it to refugee camps in surrounding countries, are being sentenced to lifelong paralysis.
Failing to vaccinate a child against a transmissible disease is
analogous to strapping a bomb to their chest and sending them out in
public – if something triggers an explosion they are the most likely one
to die, but there is a substantial risk everyone close to them will get
hurt as well.
Read more at http://www.iflscience.com/health-and-medicine/croatian-court-upholds-vaccine-mandate#zP8PfsKkWFW6vrfW.99
Croatia's
Constitutional Court has upheld compulsory vaccination laws against
nine infectious diseases. The court's statement has been translated as
reading, “The child’s right to health is more than the rights of parents to the (wrong) choice.”
Croatia and its neighbor Slovenia have been at the forefront of
universal vaccination. While most governments advocate in favor of
vaccination, and in some cases provide financial incentives, only a few
make childhood vaccination compulsory.
According to a study
of 29 European countries, “15 countries do not have any mandatory
vaccinations; the remaining 14 countries have at least one mandatory
vaccination included in their program”. Moreover, most of these do not
enforce the laws, provide extensive opt-out clauses, or make vaccination universal only against a small number of diseases.
Since Croatia made vaccinations universal in 1999 diphtheria, whooping
cough and measles have disappeared entirely and tuberculosis has
decreased by 93%, tetanus by 97% and hepatitis B by 65%.
Possibly because of this success, however, Croatia has experienced
substantial resistance to what was once an uncontroversial policy.
Having achieved universal vaccination for a decade (presumably excluding
cases where there was a valid medical reason) 28 children went
unvaccinated in 2012, according to official records, and in 2013 this
climbed to 143. While these numbers are not enough to generate the sorts
of outbreaks seen in the US and UK as a result of campaigns by anti-vax lobbyists, the direction is clear.
The potential scale of the revolt is indicated by 10,000 people signing
a petition claiming, "the vaccination of healthy children poses a
threat to their health." Inevitably the law was challenged in court, but
the highest court in the land has now endorsed it. The decision has
been hailed by the Croatian Medical Association and the Croatian
Institute for Public Health.
The implications of a let up in vaccination regimes can be seen in
Syria where the war has interrupted the childhood immunization program.
As a result polio, recently confined to just three countries, is now spiraling out of control in Syria. Children, including those who make it to refugee camps in surrounding countries, are being sentenced to lifelong paralysis.
Failing to vaccinate a child against a transmissible disease is
analogous to strapping a bomb to their chest and sending them out in
public – if something triggers an explosion they are the most likely one
to die, but there is a substantial risk everyone close to them will get
hurt as well.
Read more at http://www.iflscience.com/health-and-medicine/croatian-court-upholds-vaccine-mandate#zP8PfsKkWFW6vrfW.99
