What about this measles scare? To date, we haven’t seen any cases of measles, or measles-like illness, at any of our three health centers, nor have we heard of any cases in West Marin. According to the Marin County health department, two cases have been documented in Marin, but their location has not been made public.
Well before the current measles outbreaks—in fact, over the past generation—there has been pretty heated debate in our communities about the benefits versus the risks of vaccines. The Coastal Health Alliance is one of very few primary care medical sites in Marin that will even accept for regular care kids whose parents refuse immunizations, select immunizations, or delay and select them.
Rural Marin and Sonoma Counties have large numbers of community members who have grown up with a deeply held skepticism of government-sponsored research in general. This particularly relates to conclusions derived from pharmaceutical, industry-funded and government-vetted and approved research about medical care. There are several instances in which these companies have been charged and found guilty of lying in drug studies to get some questionable drugs to market. Worse, some of these drugs have been shown to be dangerous, and have been withdrawn. Of course it is that very industry that ostensibly profits from the production and distribution of vaccines.
With this perspective in full view, it is not difficult to see how the fear of hidden dangers in vaccines might prompt many caring parents to avoid exposing their babies and children to both the trauma of a painful injection (or several!) and the perceived risk of toxins, like mercury or aluminum. Then there is the vaccine itself: Will it make my baby sick? Will my baby get heavy metals injected into her that will stay in her for life and threaten her health later? Do the vaccines really work? Isn’t it better to let him be exposed to the diseases and develop his own natural immunity? Aren’t homeopathic versions of vaccines much safer?
Dive into this debate at your own peril. It is well-nigh impossible to corral the many ideas on the drum. That drum now beats loudly online and on cable TV. Backed by celebrities, politicians and many alternative health providers, the dangers of vaccines have seemed to many to outweigh the very real unlikelihood of danger from these remote and uncommon diseases.
How can we prove that vaccines are safe with so much information stating the opposite? Maybe we can’t. And maybe absolute vaccine safety is not the point. My conversations with parents are always about risk versus benefit. Every decision we make as parents is based on this principle: As guardians of our kids’ futures, we are constantly having to measure the risk versus benefit of learning to swim, eating that food, going to that school and going to that party, playing that sport, hanging out with that friend, taking that medicine.
There have been excellent articles, including two of the very best I’ve read in our own local papers, on the measles scare and the heightened vaccine debate. The recurring, and I think very correct, theme has to do with learning from history. Vaccines, even the first, much less safe ones, have made an amazing, measurable and well-documented difference in the presence of many life-threatening diseases: small-pox, polio, tetanus, whooping cough and, yes, measles, among many others. The irony is that they “worked too well.” They have removed their dangers from our communities to the extent that we take their absence, and their too often lethal consequences, for granted.
There is a groundswell of support for legislation to make vaccine refusal much more difficult. I get this. But legislation is not going to keep people who are sure of the inappropriateness or dangers of vaccines from finding ways to avoid them.
I feel strongly that our job as health care professionals, and as a society, is to find much better ways to communicate the risk-benefit reward of vaccines.
Dr. Douglas Diekema, a pediatrician from the University of Washington, wrote an important piece in 2012 in the New England Journal of Medicine called “Improving Childhood Vaccination Rates.”
“… Parents will be most receptive to considering vaccination if they believe their provider is primarily motivated by the welfare of the individual child rather than an abstract public health goal. Demonstrating a willingness to listen respectfully, encouraging questions, and acknowledging parental concerns are essential elements of this strategy. Providing accurate information about both risks and benefits is crucial to maintaining trust; interactions should include discussion of risks associated with both remaining unvaccinated and delaying certain vaccines and a reminder that vaccinations are important in part because effective treatments do not exist for most vaccine-preventable diseases…”
Amen.
Mike Witte is the medical director of the Coastal Health Alliance. He is board certified in both pediatrics and family practice, and has been a practicing physician in West Marin since 1975.