A Community Conversation About Health and Responsibility: Vaccines and Beyond

Fall is upon us. The school year has begun. Once again, we are subjected to a constant series of public health messages and editorials claiming that making an informed choice about your health care is immoral and selfish. If you want to be a good person, these sources claim, you must follow directions.
 
Okay, it usually isn’t phrased that way. It’s usually phrased as "the threat of vaccine refusers" or "the danger of vaccine free-riders." But the core message is still the same: the right to medical choice endangers public safety. This message is tiresome, it’s polarizing, and it’s false. But it’s also pretty pervasive. So, with a deep sigh, we address this issue again.
 
As is frequently quoted in alarmist articles, Washington state has one of the nation’s highest vaccine exemption rates: 4.5%. Is this a problem? Maybe not. The Pacific Northwest also has an unusually high rate of autoimmune diseases, some of which are a medical contraindication for certain vaccines. We also have an unusually high level of education and access to health care. The relatively high vaccine exemption rates may be a healthy indication of well-informed parents making careful decisions for their unusually vulnerable children.
 
Perspective is important. How is it that 95.5% vaccination rates could be considered a cause for alarm? After all, it indicates that we are successfully providing vaccines to all children, even those living in severe poverty. Given the state of our overall health care system, this is quite an accomplishment.
 
But what about those exemptors? Can’t they cause devastating epidemics of measles that endanger us all?
 
Sigh. No.
 
First, unvaccinated children do not compromise the immunity of children around them. Kids who are immune to measles will not lose that immunity by playing with children who are not immune to measles. Being unvaccinated is not contagious. If your vaccination worked and provided you with immunity, you are safe from infection.
 
To see evidence of this, look carefully at the statistics on all the recent US measles outbreaks. Measles is a highly contagious disease, yet all the outbreaks are small and localized. This pattern is revealed in a CDC document analyzing 9 outbreaks of measles in 2011, with a total of 118 cases. The median size of the outbreak was 4. The largest outbreak was 21. Everyone made a full recovery. This is not a devastating outbreak of disease. This is strong herd immunity. (For a link to the full document, see our blog.)
 
What about the babies? Well, one outbreak in Washington was started by a baby too young to be vaccinated. The baby traveled to a nation where measles is endemic, then returned home and shared measles with an unvaccinated child. All subsequent infections in that outbreak were unvaccinated children and teens who had accepted the risk of measles when they declined the vaccine. And once again, everyone made a full recovery. Even the baby who started the whole thing.
 
The current approach to measles vaccination is working, including the part where people are allowed to refuse. The simple fact is that people want safe and effective vaccines. There is no coercion required. Greater than 95% of our state’s population will happily and willingly choose any vaccine that is safe, effective, and offers a genuine health benefit. That is plenty to achieve herd immunity against measles...because the vaccine has a very high efficacy rate and longevity of protection.
 
Which brings us to pertussis. If herd immunity is working well for measles, why do we have epidemics of pertussis? After all, the vaccination rates are fairly similar.
 
The unfortunate reality is, the measles vaccine has an efficacy rate of over 98% and offers lifelong immunity. The pertussis vaccine has an efficacy rate of only 60-70% and wears off in 3-5 years. Because of these differences in the vaccine, we have achieved herd immunity for measles. We have not achieved herd immunity for pertussis...and we will never do so with the current vaccine.
 
Medical choice doesn’t endanger public safety. In truth, medical choice protects us all. When a safe, effective, appropriate vaccine is available, most parents choose it for themselves and their children. If significant percentages of people are refusing a vaccine, there’s a reason. Perhaps the vaccine isn’t very effective. Perhaps the complication rate is too high. Perhaps the rising rates of allergies have made certain vaccines contraindicated for too many people.
 
The important concept here is that when we accept a poor vaccine, vaccine manufacturers have no financial incentive to improve it. If everyone finds it acceptable, why should they waste their money making it better? When large numbers of people start refusing a vaccine, there’s suddenly a profit motive to put forth better research and offer a better vaccine.
 
Coercing people into vaccinating does not improve the safety or efficacy of vaccines. It doesn’t make concerns go away. If anything, coercion heightens anxiety and suspicion and feeds into conspiracy theories. Name-calling just distracts from the real questions about safety and efficacy.
 
We deserve access to safe, effective vaccines. We deserve the right to decline vaccines that do not meet our standards for safety and efficacy. How can we work together to make that happen?
 
Have ideas? Suggestions? Please visit our blog, and share your comments. Also, we invite all readers to review Part #3, Individual Power in Community Health Dynamics. As we start another school year, it is important to remember the many tools available which empower us to protect our own health and the health of others.