Putting a Lens on Vaccinations

. July 31, 2015.

A favorite story told by my 92 year-old grandmother is the day that electricity was turned on at her parent’s home.  She was eight years old at the time and every neighbor of their farm had come out with a bucket in hand to see the house burn down. Everyone was convinced that when the electricity was turned on the house would ignite. It didn’t and soon everyone’s home was electrified.

Although the fear of electricity has faded, there is another fear of that time that has not. Unlike buckets of water to put out a fire, my great-grandparents and their contemporaries could only fear polio. Vaccines available in the 1920’s and 1930’s were limited to smallpox. Although studies were under way for the development of diphtheria, tetanus, pertussis, and polio vaccines, the actual shots were still years away. Influenza, an epidemic just four years before my grandmother’s birth, would have a vaccine in the early 1940’s. Diphtheria, tetanus, and pertussis would have regular vaccinations by the late 1940’s.

My grandmother sees the vaccine debate through the eyes of a child who grew up in the 1920’s and 1930’s. She knew the effects of whooping cough, children and adults with polio, others who died of influenza and her own experience with measles and mumps. When she was a mother and sent my mom to school in 1951 she made sure the available and necessary vaccines were obtained. When a polio vaccine was made available just a few years later she was in line and made sure her two daughters were vaccinated.

In 1972, when I started kindergarten, my mother did exactly what the doctor instructed on vaccinations. By then the list of vaccines had grown to ten shots and seven different diseases had vaccinations to prevent them. This list had actually shrunk the year before I was vaccinated with the elimination of the smallpox vaccine because the disease had been eradicated.

A generation of difference 

Fast-forward to the vaccinations of my own children and the world seems to have changed dramatically. My daughter began school in the fall of 2011 and when we submitted her vaccination record, she had received approximately 28 different shots for 10 different diseases, more than double what I had received in 1972. Although we had adopted an alternate schedule, spacing out the shots with fewer shots at a time and even sought out a doctor who separated the MMR vaccination, we still had hit most of the vaccines except Hepatitis B.

When I spoke to my mother about our vaccination process she wondered why we would even question the doctor and the CDC schedule. Although she was shocked to learn about the number of shots administered at one time, she still questioned our stance. My grandmother was less diplomatic. She thought it was downright stupid not to get a vaccine for a disease that could be avoided.

My story is similar to a small but growing number of families in the United States. To my grandmother they were miracles. To my mother they were required. To me they were questioned.

There is more material than any one person could ever adequately review about the safety and benefits of vaccines. The CDC website (www.cdc.gov) is filled with facts, figures and scientific support for the safety of vaccines. Scientific journals and research have revealed no link between vaccines and Autism or other neurological disorders. In spite of these assurances there are minimal risks as with any procedure. The scientific community and CDC acknowledge these risks.

Taking a shot at the risk

Most people in the United States do vaccinate. CDC information indicates that the vaccination rate in the United States in general is 95%, mostly because every state requires vaccination to enter public schools. The CDC reported in its 2012–2013 report on Vaccination Coverage Among Children in Kindergarten that of 49 states (Wyoming provided no information) and the District of Columbia, there was a median vaccination coverage of 94.7% for two doses of measles, mumps and rubella vaccine (MMR) and 95% for varying local requirements for diphtheria, tetanus, and  pertussis (DTaP).

In spite of the national statistic showing high rates of vaccination, there are variations in that information based on the type of vaccination and location surveyed. The more serious the disease (i.e. polio) the higher the vaccination rate and the lower the perceived danger, the lower the vaccination rate (i.e. chickenpox). There are also locations throughout the United States where pockets of low vaccination rates occur. For example the PBS news program Frontline recently featured Ashland, Oregon, the community with the lowest rate of vaccinations in the United States. All of these variations add texture to the landscape of vaccinations. To go into all them would be more than could be covered in this article. But a visit to the CDC website would reveal those vast differences and explain how statistics in this area can rarely be generalized.

Adding to concerns about immunizations rates are recent outbreaks of Measles in California’s Disneyland and Ohio’s Amish community, which bring light to the difference between personal immunity and herd immunity revealing that the vaccination question is not merely one of personal choice but of responsibility to the community. Herd immunity protects those who are too young to be vaccinated for a particular disease and those with compromised immune systems who cannot be immunized because of the danger. But herd immunity only works when immunization rates exceed 90%. Some communities in American have much lower rates than that, Toledo included.

Making the personal political

Opposition to immunizations is nothing new. The first mandatory vaccination law was passed in Massachusetts in 1855. In response to this law and others like it in other states the Anti-Vaccination Society of America was founded in 1879. This organization was formed with the belief that it “is undignified” to mandate vaccines and that the “efficacy of vaccinations as a disease preventative is a matter of individual opinion.”

Arguments against vaccinations haven’t changed since the nineteenth century in many ways, but who makes those arguments has evolved. Although opposition revolves around faith matters in certain religions, the safety of vaccines, and the need for herd immunization, the ultimate decisions about vaccines seem to be more related to the generational scenario I presented above than any single oppositional argument. In a study by the Pew Research Center it was found that 41% of adults between 18 and 29 believe parents should make the decisions about vaccinations. Compare that figure with 20% of adults 65 and older and it is obvious that generation is the determining factor.        

Why age is such a determining factor seems to be simultaneously obvious and complex. It is obvious that parents in my generation – who have rarely, if ever, seen those with Whooping Cough, Measles, Mumps, and Polio – would not find them the threat my grandmother did. But more complex is the fact that my generation and those younger than me have access to more information than previous generations and we have been asked to have our children immunized against more and more diseases with an increasing numbers of shots. Because we have no memory of terrible diseases, we only see the risks of immunization and not the benefits as clearly.

Doctor’s orders 

Doctors have responded to this questioning generation in a manner also never experienced by my parents or grandparents. Doctors in some cases have abandoned patients who are unvaccinated. Currently more than 25% of doctors’ offices in the United States will refuse treatment to patients who do not follow the recommended CDC schedule of vaccinations. This approach by doctors and the practice of some parents to not allow non-vaccinated children to play with their vaccinated children could have the effect of ostracizing the anti-vaccination group and harden their resolve against vaccines. The Frontline documentary demonstrated how this had happened in Ashland, Oregon.

I talked to friends from all over the United States. I received responses from those in Ohio, New Hampshire, Connecticut, Minnesota, and Colorado.

What I found was that most of our friends do vaccinate but have thought seriously about the issue and researched it in a way that neither my grandmother nor my mother would have thought necessary. A friend from Minnesota, who has thoroughly researched vaccinations, said that her family does vaccinate because they “feel strongly that everyone should be vaccinated.”

I did find that although most friends did vaccinate for the standard diseases required for school, they did not vaccinate for perceived less serious diseases as chickenpox and the flu. One person told me that she did not get flu shots “mostly because I grew up without them and year after year, our family doesn’t get sick.”

Weighing the options, for our community

Over time people have trusted electricity in their homes, businesses and public places. People no longer stand around fearing a fire. Those in older homes may take precautions to improve their wiring but in general very few people are going without electricity because of fear of fire. That’s because the benefits far outweigh any relative danger.

I’ve found that the same is true of vaccinations. To my knowledge and in spite of the existing dangers, vaccines are safe and provide a protection against diseases we never want to know and, hopefully, will never know to the extent my grandmother did.

Obviously questions will continue to be asked by generations weighing the relative danger to benefit for their children.  Each year that a disease is absent means that the perceived danger is reduced. That may mean that doctors have to be more patient with newer generations who are more concerned with the safety of the vaccine as opposed to the danger of the disease. They may have to engage in a colloquy that ends with more than “because I said so”, but actually answers questions related to timing and number of shots at one time.

I understand the need for vaccinations, the benefits of herd immunity and the safety of such medical miracles. At the same time I am sympathetic to my generation’s need to question a doctor and make certain that parents make the important decisions in their child’s life in an informed and thoughtful manner.  That will be the tender line everyone will have to walk as we move into future generations where the cure is more common than the disease.

Matthew Reger is a local father and attorney. He contributes to Toledo Area Parent monthly with his Diary of a Dad column.