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Should you be able to refuse a vaccine? Where does your personal autonomy outweigh the community’s right to a safer environment?
Witness the dramatic rise of measles in the US and abroad. While the majority of people who contract measles will survive and recover without permanent deficit, up to 30% will see some complication and something between 1-2/1000 will develop an encephalitis. How serious is that? Well, those are the kids more likely to succumb to measles in the short run. If they survive, those are the kids more likely to have permanent deficits. A febrile encephalitis (albeit infectious cause unknown) left a previously healthy and normal Alabama toddler deaf and blind. The world would come to know her as Helen Keller.
Measles is horrendously contagious. 90% of non-immune individuals become infected after casual exposure. If you’re sitting in your healthcare providers waiting room with your 4 month old for say a well child visit, and some with measles is in the same waiting room, your child’s risk is 90% for contracting the disease. “But wait,” you say, “I’m vaccinating my infant.” Unfortunately, MMR isn’t given till 12 months of age. Oh, and by the way, the virus has been documented to linger in the air as long as two hours after the infected person was present.
There are children who cannot be vaccinated for measles. Mostly, they’re rare, but not unheard of. Children with cancers, congenital immune deficiencies, but kids 12 months and up who can’t take the vaccine are few and far between. These kids, as well as infants too young for MMR, and the rare child in which the vaccine doesn’t take, get their protection from the benefit of herd immunity. When 95% or more of a population is immune, an infectious disease has a difficult time getting established in that community. Fall below that level and all bets are off.
As a physician, I have sympathy for my colleagues who are faced with identifying victims of a disease they’ve never seen. Honestly, parents of people now in the mid 50s and older, are more likely to recognize measles that MDs currently in practice. Those people in their 70-90s are more likely to have actually seen it. I can tell you 20 years ago, the first time I saw a patient with whooping cough (a man then in his 50s), I didn’t recognize it. A colleague 20 years my senior did.
So, knowing this now, how comfortable are you with parents who choose not to vaccinate? Should they be allowed to send their kids to public school? To the playground? To the movies? To your kid’s sleepover? To the sleepover your kid is going to? Did you check with all the other parents first?
How comfortable are you if I, as a medical provider decide for whatever reason to decline the pneumonia vaccine? Or the flu vaccine? (I haven’t by the way. I haven’t missed a flu shot in 43 years, nor will I. While that vaccine isn’t as effective as many others, I cannot bare the thought that I might personally infect someone because I refused the jab.). So, why is it I had to twist arms every year to get people to take the flu vaccine? It was easiest when that person had someone they cared for that stood to be devastated if they got sick with the flu. Do you know that the woman directly in front of you in line at the market isn’t 12 weeks along? Or has a husband on chemo? Or a child in systemic steroids? Might the guy behind you be on dialysis? Or have HIV? Should you be allowed to go shopping unvaccinated?
Communities of color continue to suffer larger burden of health consequences when nimbyism successfully deflects pollutants and the institutions that produce them out of wealthier communities into poorer ones. Public health workers have clearly documented there’s significantly higher incidence of pulmonary disease, both asthma, as well as other infectious lung diseases in kids in these poorer communities, and yet this appears to be acceptable to both the elected powers that be, like as it’s acceptable to the larger electorate. Clearly, as a society we find this completely acceptable, at least we do as long as we tacitly accept it and do nothing as a society to change it. Should we empower out public health community to enforce health regulations to protect our public health? We do give them the authority to quarantine in the face of infectious disease that create a community health risk. Why not move further?
Witness the dramatic rise of measles in the US and abroad. While the majority of people who contract measles will survive and recover without permanent deficit, up to 30% will see some complication and something between 1-2/1000 will develop an encephalitis. How serious is that? Well, those are the kids more likely to succumb to measles in the short run. If they survive, those are the kids more likely to have permanent deficits. A febrile encephalitis (albeit infectious cause unknown) left a previously healthy and normal Alabama toddler deaf and blind. The world would come to know her as Helen Keller.
Measles is horrendously contagious. 90% of non-immune individuals become infected after casual exposure. If you’re sitting in your healthcare providers waiting room with your 4 month old for say a well child visit, and some with measles is in the same waiting room, your child’s risk is 90% for contracting the disease. “But wait,” you say, “I’m vaccinating my infant.” Unfortunately, MMR isn’t given till 12 months of age. Oh, and by the way, the virus has been documented to linger in the air as long as two hours after the infected person was present.
There are children who cannot be vaccinated for measles. Mostly, they’re rare, but not unheard of. Children with cancers, congenital immune deficiencies, but kids 12 months and up who can’t take the vaccine are few and far between. These kids, as well as infants too young for MMR, and the rare child in which the vaccine doesn’t take, get their protection from the benefit of herd immunity. When 95% or more of a population is immune, an infectious disease has a difficult time getting established in that community. Fall below that level and all bets are off.
As a physician, I have sympathy for my colleagues who are faced with identifying victims of a disease they’ve never seen. Honestly, parents of people now in the mid 50s and older, are more likely to recognize measles that MDs currently in practice. Those people in their 70-90s are more likely to have actually seen it. I can tell you 20 years ago, the first time I saw a patient with whooping cough (a man then in his 50s), I didn’t recognize it. A colleague 20 years my senior did.
So, knowing this now, how comfortable are you with parents who choose not to vaccinate? Should they be allowed to send their kids to public school? To the playground? To the movies? To your kid’s sleepover? To the sleepover your kid is going to? Did you check with all the other parents first?
How comfortable are you if I, as a medical provider decide for whatever reason to decline the pneumonia vaccine? Or the flu vaccine? (I haven’t by the way. I haven’t missed a flu shot in 43 years, nor will I. While that vaccine isn’t as effective as many others, I cannot bare the thought that I might personally infect someone because I refused the jab.). So, why is it I had to twist arms every year to get people to take the flu vaccine? It was easiest when that person had someone they cared for that stood to be devastated if they got sick with the flu. Do you know that the woman directly in front of you in line at the market isn’t 12 weeks along? Or has a husband on chemo? Or a child in systemic steroids? Might the guy behind you be on dialysis? Or have HIV? Should you be allowed to go shopping unvaccinated?
Communities of color continue to suffer larger burden of health consequences when nimbyism successfully deflects pollutants and the institutions that produce them out of wealthier communities into poorer ones. Public health workers have clearly documented there’s significantly higher incidence of pulmonary disease, both asthma, as well as other infectious lung diseases in kids in these poorer communities, and yet this appears to be acceptable to both the elected powers that be, like as it’s acceptable to the larger electorate. Clearly, as a society we find this completely acceptable, at least we do as long as we tacitly accept it and do nothing as a society to change it. Should we empower out public health community to enforce health regulations to protect our public health? We do give them the authority to quarantine in the face of infectious disease that create a community health risk. Why not move further?
