To “V” or not to “V”, that is the question……

After a lot of thought and consideration, the doctors at Our Family Doctor have finally decided it was time to officially and publicly share our views on the topic of vaccination. In the wake of the ongoing Measles outbreak in our country, and against the backdrop of increasing public awareness and discussion regarding the “anti-vax” community, we felt it was important for our patients to hear the OFD perspective on this controversial subject. While I (Dr. Michael Weizman) am the author of this blog post, I have shared this piece with Drs. Polansky, Preston, Schwab and Wilson, and we all stand behind the thoughts expressed in this column.

First off, allow me to share our philosophy or “policy” in dealing with parents who have alternative view points on vaccination. In keeping with our general approach to the doctor-patient relationship, OFD physicians enter into our patient encounters with universal respect and open-mindedness toward the parents and caregivers of our Pediatric patients. Even when parents make decisions about their families that we fundamentally disagree with (as is the case with those who choose not to vaccinate their children), we always try to minimize judgment, to offer informative and science-based counter points when appropriate, and to ultimately do all that we can to best support the children who we are charged with caring for. Whereas other pediatric practices refuse to see these families outright based on a parent’s anti-vaccination sensibility, we at OFD feel that all children deserve a caring physician – even when their parents have alternative viewpoints regarding vaccination. For a not-so-great analogy, consider our patients who habitually smoke cigarettes. We doctors universally think that this is a terrible idea, subjecting our patients to the extreme risks of heart disease, stroke and cancer, and yet we care for these patients even when they do not take our advice to quit smoking.

So just how many parents at OFD do not vaccinate their children? Admittedly, we have not kept careful data on this number (perhaps we need to start doing that), but our best guess would be that roughly 30% of our parents vaccinate their children fully, adhering closely to the CDC recommendations; about 60% vaccinate their children on a slower or delayed schedule with our guidance (usually having their children caught up by Kindergarten), and about 10% do not vaccinate their children at all against our medical advice. For the last group, we bring up vaccination at each well child visit, giving parents many opportunities to ask questions and hopefully reconsider their positions on the subject. This is where being non-judgmental really helps, as many parents do eventually come around to the decision (better late than never) to vaccinate their children in the safe space that we have created for them. All that said, and in accordance with our medical society’s legal advice, we do have these non-vaccinating parents sign a “refusal to vaccinate” waiver at each well visit, which provides us legal indemnity should their child succumb to a vaccine-preventable illness. Often just being asked (required) to sign this document gives parents pause and opens up further dialogue.

OK, now that you understand our philosophy of care regarding this subject, allow me to reflect on some of the controversy surrounding routine vaccination. At this point it should be made clear that OFD physicians recommend routine vaccinations for ALL children who do not have a medical contraindication (such as certain cancers or immune deficiencies). Period.

Consider that the three most important advances in medicine over the centuries as agreed upon by experts the world over have been (1) improved sanitation and hand washing, (2) the advent of antibiotics and (3) … wait for it… routine vaccinations. The Pediatric wards in our nation’s hospitals used to be filled with children suffering (and dying) from meningitis before the advent of the HIB vaccine. Since the Prevnar vaccine was introduced, the residual cases of meningitis caused by Pneumococcal disease have been all but wiped out. We don’t see Polio anymore in the U.S. due to universal vaccination against this dreadful disease, but sadly Polio is on the rise in developing war-torn countries where drops in national funding for vaccination programs have taken a toll. Believe it or not, I have actually been informed by a patient that “the Polio vaccine does not work”, and that “Polio was on its way out anyway, right around the time the vaccine was introduced”. Really? This is of course nonsense! While I am not trying to mock this obviously misinformed patient, I share this story to illustrate just how much bad information is out there. There should absolutely be no debate on whether or not vaccines work to prevent disease – they do. The proof is in the pudding as they say.

What about some of the myths which continue to stymie routine vaccination? As physicians we deal with these myths on a daily basis, trying our best to debunk them as they come up. Here are just a few of the top myths that we encounter.
1) Vaccines (particularly the MMR vaccine) cause Autism. This myth has been shown by dozens of scientific studies to be completely false. However, if one is skeptical of science in general, consider this simple fact: the incidence of autism is the same in vaccinated and unvaccinated children. Yep. Read that again to make sure you understand this.
2) Vaccines have mercury in them, and therefore are dangerous. False. There is no mercury in vaccines. In 1999 the FDA recommended the removal of thimersol (ethyl mercury) as a preservative from vaccines. They did this to calm public health concerns about the subject even though repeated studies had not (and have not) shown any link between ethyl mercury and neurological disease. This is in contrast to methyl mercury (which we find in top-of-the-food-chain fish that we eat) which has indeed been linked to neurological disease. Maybe that is where the confusion came from. But this point is of no consequence, since there is no thimersol in vaccines anymore!
3) Vaccines contain dangerous levels of Aluminum. This is false. In fact, there is more aluminum in breast milk than in vaccines. Aluminum is everywhere – it’s in our food, and in our water. The amount of additional aluminum in vaccines is utterly negligible.
4) We can’t trust the vaccine manufacturers or the government because all they care about is money. False. Yes, profits are important to corporations, but so is safety. We have one of the strictest FDA’s in the world, and when there is a question about safety, products are pulled from the market. Case in point: Years ago children were vaccinated with an oral polio vaccine. Unfortunately, since it was a live vaccine there was a very rare incidence of contracting polio (to the tune of about 1 in a million) after vaccination. This was not safe enough for the FDA so oral polio was pulled from the US market. There have been no cases of polio contracted from the injectable, inactivated form of the polio vaccine that we now use. Here is another case in point: A few years ago, during routine inspection, trace amounts of staph bacteria were found on the surface of one of the machines used to make the HIB vaccine. The FDA ordered a recall of some 40 million doses of HIB (creating a national shortage of this crucial vaccine) even though not a single child was sickened by Staph nor was a single dose of HIB found to have Staph contamination. This was a very expensive lesson for this drug manufacturer, further emphasizing the importance of maintaining strict sterility in vaccine manufacturing. I could go on with more examples of strict FDA oversight, but suffice it to say, there is no conspiracy here. Doctors, Scientists, and the people who work for both drug companies and the government all vaccinate their own kids with these very same products.
5) Vaccines have dangerous side effects. True (sort of) and False. Severe vaccine reactions are exceptionally rare. Common reactions like muscle soreness, fever and irritability of course happen often, but are not serious at all. Consider the numbers: 1 in 40,000 children who get the MMR vaccine will have a moderate reaction. 1 in 300 children who contract Measles will die. Just like with all other parenting decisions, parents need to consider the risks and benefits. For example: bike riding and driving in cars is inherently dangerous. In fact more children die in car accidents each year then from diseases. So how does the informed parent respond? Do we avoid cars and bikes altogether? Of course not! We insist that our children fasten their seatbelt and wear a bike helmet, two proven safety measures that will keep them safe from harm. Vaccines are the same. They are proven to keep our children safe from preventable disease.

So how did we get to this point? How is it that the wealthiest, most technologically advanced nation in the world has seen a decline in vaccination rates and an increase in “old-fashioned” diseases like Whooping Cough (Pertussis) and now Measles? Why do we live in a country where parents don’t trust the medical community and it has become fashionable for some to not vaccinate based on myths, fear and non-science? There is a great book that should be required reading for all new parents called “Autisms False Prophets” by Paul Offit, MD (2008). This book more than anything I have read explains in shocking detail how we got to the point where we are. If you have not yet read it, please read this book or buy it for your friends and family who are still not vaccinating their children.

Finally, let’s talk about the Disneyland Measles outbreak. The cause of the recent Measles outbreak in California and beyond is similar to the cause for the Pertussis outbreaks that doctors have been seeing in recent years. Due to reduced vaccination rates nationally, we are losing the protection gained from “Herd Immunity”. We have begun to dip below the 95% minimum threshold for vaccination that is needed to prevent disease outbreaks (within the herd). With the swelling of the ranks of those who have been labeled “anti-vaxxers”, the prospect for this new reality getting much worse is an accurate assessment and very scary. Without getting into the various public policy debates that are floating around state and federal government health departments, the mainstream media and of course social media outlets, we at least need to acknowledge that the loss of our herd immunity is real and serious. At some point new parents will need to consider the public health angle on this subject and figure that into their personal decisions. Parents simply can’t afford to hope that others will vaccinate so that they don’t have to. Those days are over. All of us who share this earth and this community have a responsibility to do right by it. This is why we don’t drive drunk, this is why we don’t send our children to daycare or school with high fevers, this is why we spend hours combing out our kids hair when they have lice, and this is why I teach my kids to pick up litter that others have thrown on the ground. This is our community and we all have to take care of it and of each other.

So back to the title question of this blog: “To V or not to V?” The simple answer is “V !!!”

If you already vaccinate your children, thank you for doing your part. If you are on the fence about vaccination, please keep learning and read Paul Offit’s book before you make your final decision. And if you have chosen not to vaccinate your children, in spite of all the science that has been presented and continues to be presented, please reconsider. Your child’s life and the life of the child living next door to you may literally depend on it.

MICHAEL WEIZMAN, MD