Vaccination and the Challenges of Success
Growing up in the 1940s was a dangerous venture: In America, thousands of children died every year from diseases we rarely hear about today. Diphtheria took the lives of nearly 2,000 — the same number that succumbed to paralysis from polio.
That changed with widespread vaccination. The effect has been so dramatic that the impact is still evident in our day-to-day lives. When was the last time you knew someone diagnosed with diphtheria? Or polio? Or tetanus? These diseases are now so uncommon, most young American doctors have never seen a case.
This success should be celebrated. Yet, when I speak to parents about vaccination, the response I hear is often less than enthusiastic. I hear concerns about safety and questions about necessity. Vaccination rates in some communities have fallen to dangerously low levels. In 2014, the U.S. experienced 23 outbreaks of measles, mumps cases doubled from the previous year, and the California pertussis epidemic claimed the lives of three infants.
How do we explain this discrepancy?
First, vaccine success is quiet — it doesn’t make headlines when people don’t get sick. We forget that nearly one in five childhood deaths worldwide is due to vaccine-preventable diseases that are just an airplane flight away. Measles alone kills more than 16 children every hour around the globe.
Second, although success is quiet, side effects are not. Like any medication, vaccines are not 100 percent effective, and side effects do occur, albeit rarely. However, we must keep our perception of risk within context. When a disease is common and an effective vaccine is 99.99 percent safe, vaccination feels safe to people. Yet, when the disease becomes less common, any risk of vaccination (even 0.01 percent) feels unsafe. The problem is that the risk of disease is still present. It just doesn’t feel that way because the disease itself has grown so rare in our society.
Finally, we have been inundated with a false balance of information. The media often cover scientific issues in the same format as political debates — both sides of an argument get equal time. This neglects the tremendous balance of rigorous scientific evidence showing that vaccines are safe and effective.
This issue is too important to be swayed by misinformation and fear. A recent Centers for Disease Control and Prevention analysis reports that vaccinating each child born in the U.S. every year would prevent approximately 42,000 deaths and 20 million cases of disease. By maximizing vaccination rates, we also protect those who cannot get vaccinated for medical reasons or who don’t have the immune system needed for vaccines to work.
It’s time for the misleading “debate” over vaccination to end and for meaningful dialogue to start among caregivers and skeptical parents. We will likely never see a more effective disease-prevention measure. It’s time to wield and affirm the success and power of vaccination.
Jonathan Grein, MD, is associate director of the Department of Hospital Epidemiology at Cedars-Sinai. He is board-certified in Internal Medicine and Infectious Diseases.