Dad Next Door: A pox on all our houses
The outbreak of measles in Washington state has prompted heated public debate over vaccine exemptions. The facts as Dr. Lee sees them:
A little encouragement from across the fence
PHOTO: JOSHUA HUSTON
I don’t get a lot of hate mail — almost none, in fact. After all, this is a parenting magazine; I’m more likely to write about potty training than abortion or a Mexican border wall. Still, I haven’t avoided controversy altogether. Over the years, when the evening news has collided with my role as a parent, I’ve written about gun control, sexual assault, climate change, gender fluidity, race relations, and a handful of other topics that seemed guaranteed to raise a few hackles. Yet, after almost every one of those columns, the comments were civil and polite. Almost.
A couple of years ago, I wrote a column about the importance of vaccinating our kids. It was the only time my inbox ever caught on fire. Okay, that’s an exaggeration — there were only a few negative letters. But boy, we’re talking name-calling, flame-throwing, parentage-questioning, where-the-hell-did-you-get-your-medical-degree letters.
So you’d think I’d know better than to poke a stick at that particular hornets’ nest again, but this winter there’s been an outbreak of measles in Washington state. I felt compelled to say something. I know; I’m a glutton for punishment.
There are many reasons why people have strong feelings about vaccination. My Somali patients worry about the pork gelatin used in vaccine manufacturing, and that it’s prohibited by their religion. Some people worry about a 1998 British study (that has since been refuted and retracted) linking the measles/mump/rubella vaccine (MMR) to autism. Some people are suspicious of big pharmaceutical companies, or the government, or both. And some just don’t want someone telling them what to do — especially if it involves injecting foreign substances into their infant children.
For all of those people, what fuels their fear is a profound wish to do what’s best for their children. Even if you disagree with them, it’s a mistake to label them as neglectful or irresponsible. In truth, they’re exactly the opposite. They’re just trying to do the right thing.
My job here isn’t to question anyone’s motives — it’s to provide the best information I can find and add it to the discussion. These days, there’s a lot of information to digest. Any blogger with an ax to grind has the same size internet megaphone as the World Health Organization. It’s up to each of us to figure out what’s credible and what’s not, and I’ve tried to do that. Here are the facts as I see them.
- Measles is a dangerous disease. It’s extremely contagious, infecting 90 percent of the people who contract it. Worldwide, it infects about 20 million people a year. It is the largest cause of vaccine-preventable deaths in the world, usually killing the weak and the very young. And while we’re at it, mumps and rubella (the other diseases the MMR vaccine prevents) can also kill, as well as causing infertility, serious birth defects, and other long-term disabilities.
- MMR is very effective. In 1980, 2.6 million people died of measles worldwide. Widespread vaccination reduced that death toll to 73,000 by 2014. Most deaths now occur in Asian and African countries with little or no access to vaccines.
- MMR is extremely safe. Notice that I didn’t say 100 percent safe — that’s a claim no one can prove. Everyone has heard a story of some child coming down with a horrendous medical condition shortly after being vaccinated. But when you look at those incidents, they are no more common after vaccination than when no vaccination was given. If serious vaccine-related reactions do occur, they’re extremely rare. How rare? Much rarer than the 240,000 people who are struck by lightning each year. Significantly rarer than the 4,000 children who are hospitalized for near drowning in backyard pools. Probably less than the 19 Americans who are attacked by sharks each year. We have to balance the small, finite risk against the millions of lives vaccines save every year.
- When a community is not well-vaccinated, it’s at risk. Measles outbreaks occur in pockets of population where vaccination rates are low. By “low,” I mean less than 90 percent. It only takes about 10 percent of a community without immunity to allow the disease to spread. And who dies in an outbreak? Infant children who are too young to be vaccinated. People with weakened immune systems, like cancer and HIV patients. People who don’t have a choice.
This is not just an intellectual debate for me — I have skin in the game. I looked hard at the pros and cons before I started recommending vaccination to the families I care for. I vaccinated my own daughters as soon as the guidelines would let me, and when they have children of their own, I hope they do the same.
In the end, this is a decision that every family has to make for themselves. I chose to vaccinate my kids because all the credible evidence I know leads to one conclusion: by doing so, I made them and the people around them safer.
Now it’s your turn. Good luck. Choose well.
Jeff Lee graduated from Harvard Medical School and trained in Family Medicine at the University of Washington. He has practiced in Seattle’s Rainier Beach neighborhood for 30 years