Furthering the conversation on vaccination

03/03/2016

Michelle Veneziano’s thought-provoking piece on immunizations in the Feb. 11 issue of the Light raises important issues worthy of careful consideration and discussion. As she notes, local health care providers such as myself and others at the Coastal Health Alliance have been keenly focused on helping families navigate decisions in the wake of the passage of California S.B. 277. Like Michelle, I am also a mother and a family physician, and have experienced my own complex thoughts and feelings on this topic.

The unfortunate reality is that immunizations are not perfect. They do not always yield 100 percent protection against the disease we hope they’ll prevent. They contain “adjuvant” materials, such as aluminum, which stimulate the immune system to respond to the injection, thus increasing the immune response and protection from illness. They contain preservatives to prevent the material from becoming contaminated. In the past, thimerosol (mercury) was used, though it has been phased out of the vast majority of immunization stock. 

A second unfortunate reality is that our medical literature is all too often biased. Michelle is right to point to evidence that the Centers for Disease Control suppressed and destroyed important information regarding potential risks associated with immunization. This is a matter of public record following 2014 testimony in Congress by a whistleblower. Regardless of whether the “end” of improved public health through immunizations was felt to justify the “means” of data suppression, it is clear that an open dialogue regarding the risks versus the benefits was not served. Clearly more high-quality, unbiased research is needed.

When making decisions regarding medical treatments, we always consider the “risks versus the benefits.” This framework is essential in navigating immunization decisions. As our society becomes distanced from the risks of immunization-preventable illness—for example, my great uncle died of pertussis at two weeks of age after an infected neighbor boy sneezed on him—the benefit of immunizations may be harder to see. When looking at rates of disease, however, we see that immunizations have significantly reduced morbidity and mortality from illnesses like whooping cough, measles, mumps and rubella. This is important.

Yet as a mother who diligently protected her unborn children from toxins, I intuitively balked at the idea of giving my babies all the immunizations recommended by the C.D.C. starting at birth. While not wanting to expose my children to undue risk of illness circulating through our community (like pertussis, pneumococcus and haemophilus influenza B), I decided to delay polio and hepatitis B immunizations at the time. My children are being “caught up” now. I understand the questions raised by concerned parents, and routinely work with concerned parents toward a slower schedule to minimize potential risks associated with a large challenge to the immune system.

The vast majority of immunized children experience only the beneficial effects of immunization: protection against serious illness. This intervention is not without risk, however. While published science seems to discredit the concerns regarding serious injury, a deeper look calls many assumptions into question. I’d like to trust the guidance and science performed by the C.D.C. I’d like to have my medical recommendations informed by the highest-quality, population-level research. I sincerely hope that those unbiased studies are being done now, and that we can have a truly informed dialogue.

For now, we are left with an imperfect law and the somewhat reassuring reality that immunizations rarely cause harm, and definitely have lowered the prevalence of serious illness and the very real risks associated therewith. I am very glad immunizations exist and I wholeheartedly support their use. Like many providers at Coastal Health, I believe that a slowed immunization schedule is a reasonable and safe approach toward minimizing theoretical risk. Furthermore, we do our best to stock immunizations with the lowest levels of aluminum and preservatives. We strive to provide collaborative, non-judgmental guidance within the context of the primary care relationship.

We will keep the conversation open.

 

Anna O’Malley practices integrative family medicine with the Coastal Health Alliance. She is a Bolinas resident and mother to two delightful daughters.