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In a recent “From the Director’s Desk” (Dignitas 19:2, Summer 2012, 2-3)Paige raised the question “Who is my neighbor?” in relation to the topic of vaccinations. This commentary initiated several comments, two of which we are including here. They have been edited for length, formatting, and citation style.
Paige Cunningham recently used the parable of the Good Samaritan to call us to action in the protection of our neighbor in the use of vaccinations to the benefit of the community. Her contention was that vaccinations provide benefit both to the person and to the plurality. As a practicing pediatrician, I not only echo the contention, but champion it on the basis of efficacy coupled with a favorable benefit-burden ratio. There is much information regarding this topic that is easily available, and in writing this piece I make use of both the more “standard” medical sites [1]in addition to the less-traditional options.
Why do people refuse to allow vaccinations for themselves, or for the people that they care for?
It is my experience that the greatest resistance to the use of vaccinations has come from young educated parents who have benefited the most from a vaccination program that was implemented many years prior to their birth. These parent’s grandparents welcomed the use of vaccinations because they had witnessed the scourge of illness, morbidity, and mortality that ravaged a pre-vaccination population; they had suffered through the use of the iron lung following polio; they had seen death following diphtheria and pertussis; they had even perhaps participated in a quarantine to help isolate infected children and adults to the greater benefit of the local community. These glimpses from recent history may not be relegated only to the past; Ms. Cunningham made reference to the current alarming increase in cases of whooping cough.[2]What she did not mention was the startling rise in the number of cases of acute measles infections in Europe[3]– not the relatively benign course of German Measles, but the substantial disease process of Rubeola which carries a definitive risk of neurologic impairment and mortality. It is astounding to me that the very recipients of the documented benefits of modern-day medical progress refuse to provide the same benefit for their own progeny.
Another reason often given by those refusing vaccinations is anecdotal information:information that is presented but neither adequately proved or studied. Many vaccinations are given during a time period of rapid change and development of the child; children are typically seen many times during this window (birth to3 years of age) by the medical practitioner, and particular attention is given to the issues of growth and development. In modern medicine, a temporal relationship of a vaccination and an unfortunate neurologic condition does not imply causality. Medical research studies of this venue would not only be difficult, but unethical, and would never be approved by a research guidance board. Which of us, as parents, would allow our unvaccinated child to be a member of the study group that is purposefully and willfully exposed to a child with active and contagious pertussis?
Also, some individuals continue to refer to poor medical studies that are either misleading or – in some cases – entirely discredited. Medical professionals often have an “air” about them and are frequently regarded as experts – even in a medical field that is not their particular area of expertise. And so, it is not surprising to come across medical information such as that provided by Dr.Andrew Wakefeld that was published in 1998.[4]His information alleged a medical causation between MMR (measles, mumps, rubella) vaccination and autism. The non-blinded research ‘study’ – not approved by the hospital ethics committee – included hand-picked children at a party (who were paid for their participation) who underwent painful procedures– such as spinal taps and colonoscopies – in the attempt to obtain serum and tissue culture samples for viral analysis. Following the publishing of the article, and spread of the “findings,” UK vaccination rates for MMR plummeted to 80 % in 2004 and there were reports of measles-related deaths – the first in fourteen years.[5] In2010, the UK Medical Council pronounced Dr. Wakefeld both dishonest and unethical, The Lancet retracted his article (in 2004, 10 of the co-authors issued a “retraction of interpretation”),and Dr. Wakefeld was erased from the medical register in the UK.
Another reason used by individuals opposed to vaccinations is the persistent accusation regarding autism and the use of mercury as a vaccine preservative.[6]Despite the remarkable implementation of ‘single-dose’ vaccinations (that have either miniscule or no amount of mercury, implying the discontinuation of the multiple-dose vaccine bottle), the immediately-expected decline in the number of cases of autism never occurred. Undoubtedly, much of this accounting is due to the difficulty in diagnosis of the condition as well as the present-day use of reclassification terminology such as “autism spectrum disorder.” The courts have ruled[7]regarding the alleged association, but many remain skeptical.
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The religious leaders of the day left the injured on the street, while the caring sojourner – with little to gain – provided care for the stranger. Vaccinations give us the same opportunity – to protect the least of these – among others: the very young, the very old, and the medically compromised.
I vaccinated my children, and my daughter has vaccinated my twin grandsons. For this, I am thankful.
FerdinandD. Yates, Jr., MD, MA (Bioethics)
Medical Director, Neighborhood HealthCenter, Buffalo, New York
Professor of Clinical Pediatrics,State University of New York at Buffalo
Co-Chair Healthcare Ethics Council, CBHD
[1] Center for Disease Control and Prevention, “Vaccines& Immunizations,” http://www.cdc.gov/vaccines/hcp.htm and American Academyof Pediatrics, http://aap.org (accessed March 19, 2013).
[2] Steven Reinberg, “Whooping Cough Cases ReachingRecord Highs: CDC,” HealthDay, July19, 2012, http://consumer.healthday.com/Article.asp?AID=666879 (accessed March 19, 2013).
[3] Makiko Kitamura, “Measles Surge in Europe RaisesRisks for Sports Fans,” Bloomberg, April 4, 2012, http://www.bloomberg.com/news/2012-04-03/measles-surge-in-europe-raises-risks-for-sports-fans.html (accessed March 19, 2013).
[4] AJ Wakefield, “Ileal-lymphoid-nodular Hyperplasia,Non-specific Colitis, and Pervasive Developmental Disorder in Children,” TheLancet 351, no. 9103, February 28, 1998, 637-641. (Retracted, 2010)
[5] Brian Deer, “Andrew Wakefieldand MMR: The Investigation,” http://briandeer.com/mmr-lancet.htm (accessed March 19, 2013).
[6] Cf. Lisa Jo Rudy, “Autism, Vaccines and Mercury,” About.com,http://autism.about.com/od/vaccinesandautism/a/mmrautism.htm (accessed March 19, 2013).
[7] Alex Newman, “Court Rules Against Autism-VaccineLink,” The New American, March 15, 2010. http://www.thenewamerican.com/usnews/health-care/item/1713-court-rules-against-autism-vaccine-link?tmpl=component (accessed March 18, 2013).
