Summary: During a disease epidemic, people will do anything for a vaccine to prevent the disease. When the epidemic passes, we take vaccines for granted. We are enjoying periods of general good health now that routine vaccines prevent many diseases that were dreaded by our grandparents. In these good times, critics of vaccines oppose routine vaccination, believing that vaccines are harmful. All vaccines have side effects, some of which can be severe. All vaccines have the beneficial effects of preventing or reducing the severity of potentially deadly and disabling infections. The bottom line is this: Are the children of vaccine experts (those who know the most about vaccines) vaccinated? The answer is yes, because the benefits of the vaccines outweigh their risks.
Is there any doubt that vaccines (also known as immunizations) prevent illness? There is no doubt in my mind, but some believe otherwise. We are fortunate to live in a period when many feared diseases of the past are unheard of. In the past, many died from smallpox. Many were paralyzed from polio. Many suffered death and brain injury from pertussis (whooping cough). Many suffered pneumonia, brain injury, death and dehydration from measles. We hardly worry about these diseases now because we never hear about anyone with these illnesses any more. Do you know of anyone who has had diphtheria, tetanus (known as “lock jaw”), polio or measles? Probably not.
We worry about cancer, heart attack, stroke, car accidents, drugs, firearms, etc. What if a vaccine against cancer became available. Would you want it? I personally would be willing to pay a lot for such a vaccine. Notice that when a serious disease is frequent in the population, there is a known fear from this disease and a vaccine to prevent this disease is highly sought after. But when a disease is absent from the population (due to the success of a vaccine), there is little enthusiasm for a vaccine to prevent this illness. It's considered just another shot and parents are more concerned about the side effects of the vaccine rather than its benefits.
Such is the case for many of our vaccines today. Routine vaccination of all children has made nearly everyone immune to measles. This makes the measles virus hard to find in our community because, it must live inside the body of a non-immune person for the virus to survive.
Some vaccines are so effective that the disease has been wiped off the face of the earth. Smallpox no longer exists except in lab storage and polio no longer exists in the western hemisphere.
It is possible to remove a disease from a population or community if enough people are immune because the germ needs to infect a susceptible person for it to survive. If the germ cannot find a susceptible host, it can no longer survive. This is the concept of "herd immunity." This concept refers to a large herd of animals or people. For example, on an isolated island, a colony of 100,000 people live together. An immunization program against measles is successful at vaccinating 99,950 people. Only 50 people are susceptible. One day, a tourist brings measles onto the island, but unless this tourist exposes one of the 50 susceptible people on the island, his case of measles will die out and infect no one else. Most likely, the measles virus from this tourist will encounter only immune individuals so it is not possible to spread the infection very far. What if only 90,000 people on the island were vaccinated? This would leave 10,000 susceptible people on the island, making it very likely that a measles epidemic will result. For herd immunity to protect the susceptible individuals, the immunity rate in the herd must be very high. For highly contagious diseases, 90% immunity is often not high enough. It needs to be higher.
This concept of herd immunity is important because it is often used as a reason to avoid vaccinations. Let's use polio as an example. The immunization rate for polio is very high. In fact, it is currently felt that polio does not exist in the western hemisphere. It has been many years since a case of polio has been reported in the western hemisphere. If 10 people in the country decided not to receive polio vaccine, is very likely that they would be protected by herd immunity, since it would be nearly impossible to start a polio epidemic in this country. But we continue to recommend routine polio vaccination because, if routine immunization were stopped, there would be thousands of susceptible children and eventually millions of susceptible children. If one case of polio came to the western hemisphere in a visitor, it could easily cause an epidemic in the millions of susceptible children after years of non-vaccination. Herd immunity does not protect a community if there are too many susceptible persons in the community.
In the case of whooping cough (also called pertussis), the series of DPT vaccines protects children against pertussis. But in the past, the pertussis vaccine (the "P" in DPT) has been the vaccine associated with the most side effects. Pertussis vaccine has been improved since then, but these earlier side effects led many parents to decide against pertussis vaccine for their children. They believed that herd immunity would protect their children. They were wrong because although adults do not become very ill from pertussis, adults are still susceptible to the pertussis germ because the pertussis vaccine only protects against pertussis during childhood. Adults can get pertussis and spread it to unvaccinated susceptible children. Small epidemics of pertussis might occur frequently among adults but because they don't get very sick (it just seems like a bad cold to them), these epidemics are not noticed unless there are a lot of unvaccinated susceptible children who also become sick during the epidemic. Young children, especially infants, are noticeably ill when they get pertussis with severe cough and noisy breathing. Because of these noticeable symptoms, small epidemics of pertussis in infants and small children are easier to recognize. Because of adult susceptibility to pertussis and many young children who are poorly immunized, herd immunity fails to protect children from pertussis and small to medium sized epidemics of pertussis occur in most communities every 3 to 5 years.
New vaccines are frequently being introduced and current vaccines are frequently improved. New recommendations for existing vaccines add to the reasons that health care professionals must frequently change their vaccine administration schedules for their patients. How can parents determine which vaccines are safe for their children? All vaccines have some risk of side effects and bad reactions, but these risks are low. There is a small risk of death, brain damage and paralysis for some vaccines. The risk of other bad complications of vaccines may be less easy to determine. There is some uncertainty that parents must accept because any risk no matter how small, could happen to your child. By consenting to a vaccine, you must accept this uncertainty.
The scientific information about the risks and benefits of a vaccine are extensive. Most physicians cannot possibly know all there is to know about every vaccine. Fortunately, designated specialists (vaccine experts) have been thoroughly informed of all the risks and benefits of vaccines. These experts together as a committee will recommend vaccines based on how well they work compared with their risk of unwanted side effects. The bottom line is this: What do these vaccine experts recommend for their own children? If they give a vaccine to their own children, then you should be convinced that the best possible scientific information which is available, suggests that the benefits of this vaccine outweigh its risks. There is, of course, some uncertainty that must be accepted. Based on the best scientific information available, deciding AGAINST routine vaccines, is most likely harmful for your children. My children have received all the recommended vaccines.
One of the most common reasons for deciding against vaccination is INCOMPLETE information. The amount of scientific information available for each vaccination is substantial. Just getting some of the information about a vaccine would mean making a decision using incomplete information. This is unwise. Unfortunately, it is practically impossible for most parents and most physicians to know everything about every vaccine. With the understanding that there is always some uncertainty which must be accepted, my best suggestion is to follow the recommendation of the vaccine experts.