Mark, a six year-old leukemia patient, was unable to receive the measles vaccine due to his compromised immune system. Given his lack of immunization, he contracted the disease from an unvaccinated playmate and now is in critical condition from encephalitis, a serious, life-threatening complication which can occur with this highly infectious disease. Given the ongoing, indeed increasing, anti-vaccination movement in the United States and abroad, this illustrative scenario is likely to occur more and more frequently.
The year 2000 is frequently cited as the year in which measles was virtually eliminated in the US, with an incidence of less than 60 cases country-wide, cases most likely introduced by visitors from abroad given that, world-wide, there is still a high incidence of measles – some 20 million cases annually with 122,000 deaths. However, despite the virtual eradication of measles in the US, as pointed out in The New York Times, the Centers for Disease Control and Prevention reported recently “ … 644 cases … from 27 states last year, by far the largest number since 2000.” Indeed, in just the first month of this year, some 102 people have been diagnosed, largely from the outbreak in California’s Disneyland, an outbreak most likely caused by a visitor from abroad who spread it to unvaccinated US children. This is a highly contagious disease, many times more contagious than Ebola, given that the measles virus can become airborne, remaining in droplets sprayed into the air by coughing and sneezing infected individuals, able to infect others for some two hours after the measles carrier has left the area. Indeed, it has been reported that some 90% of exposed, unvaccinated individuals contract the disease.
What has gone wrong? Why are we still discussing a disease which some 15 years ago was virtually eliminated from the US, eliminated thanks to the development of a vaccine which has been shown to be 95 to 97% effective in preventing the disease? The problem is that an increasing number of parents are opting out of vaccinations for their children, vaccinations against such often life-threatening diseases as measles, mumps, whooping cough, polio, and many other preventable diseases. Unfortunately, laws governing vaccination requirements across our states vary widely, with some areas allowing only the rare medical- or religious-based exemption from vaccination, and other localities and states allowing frequent, easily-obtained exemptions based on ill-defined “philosophical” or “personal belief” grounds. As reported by The New York Times, while many areas of the country are tightening their exemption requirements, “pockets of resistance remain… In Orange County, California, some schools report that 20 to 40% of parents have sought a person belief exemption.”
Why should we be concerned that individuals are opting out of protecting their children from measles? Should not parents have the right to choose whether or not their child is immunized? I feel strongly that the answer to that question should be a resounding “No.” Except for the infrequent but legitimate medical reason or for well-substantiated religious beliefs, I do not feel that an individual has the right to endanger others through their insistence that they be allowed to choose not to vaccinate their children. The principles of a concept known as “herd immunity” apply … if the vaccination rate within a community is very high – for measles, some 94-95% - the vaccinated people act as a barrier and reduce the [likelihood of] infection for people who can’t be immunized, like the very young or those with compromised immune systems [like the fictionalized leukemia victim I described at the beginning of this Commentary] (see The New York Times, 2/2/15). Such individuals must rely on the immunization of others to avoid the disease. And, as pointed out by The New York Times Opinion Writer, Michael Gerson, parents who don’t vaccinate are free riders. Their children benefit from this herd immunity effect; but, their choice to opt out threatens the very lives of those most vulnerable in our community.
Some of these individuals cite as the reason for opting out the supposed risk of developing autism subsequent to vaccinations. Yet, this belief is based on a totally discredited report based on a single, fraudulent study – a study based on only 12 children and which has now been retracted by the journal which originally published it. Indeed, despite hundreds of studies, no link has ever been found between vaccination and autism. None. Other individuals insist on their rights as parents to opt out. As stated by Mr. Gerson, “What could be wrong with choice?” “A lot,” he said, “when you are endangering your neighbors” – a concept, we might remember, which led to anti-smoking legislation across the US and around the world based on the belief that second-hand smoke endangered others.
It has recently been estimated that vaccinations of children have prevented more than 100 million cases of serious contagious disease in the US since 1924, from polio to measles to pertussis or whooping cough, and on and on (The New England Journal of Medicine as reported in The New York Times, 11/27/13). The pain and suffering, even loss of life, prevented by such immunizations is incalculable. Being part of a community, or a herd, brings untold numbers of benefits and advantages to each member. However, there are responsibilities inherent in being a member of such a community. No one, in my opinion, has the right to endanger others through their actions. The health and well-being of others, I feel, trumps free choice every time. I strongly urge our policy makers and elected officials to find ways to ensure that diseases long since conquered do not re-emerge to threaten the weakest and most vulnerable among us.
Dr. Karen Hitchcock, Special Advisor in the consulting firm, Park Strategies, LLC, was President of the University at Albany, State University of New York, from 1996-2004, after which she went on to lead Queen’s University in Kingston, Ontario, Canada. Dr. Hitchcock has received honorary degrees from Albany Medical College and from her alma mater, St. Lawrence University. She has served on numerous regional and national committees and task forces dealing with issues in higher education, research and economic development. While at both the University at Albany and Queen’s University, she co-hosted the popular WAMC program, “The Best of our Knowledge”.
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