Global Doc: Vaccination

Author: Dr. Vincent DeGennaro Jr. ’02

Measles is highly contagious and willful ignorance is reigniting its spread. While Ebola patients infect an average of two other people, measles patients can spread the virus to 18 others, presuming that they are not vaccinated. The virus is spread by respiratory droplets, coughs and sneezes or casual contact with contaminated surfaces, and in the past two months has infected more than 150 patients in the U.S., even though a vaccine has existed for 50 years.

Until 1980, before widespread vaccination, measles was a leading cause of death of children worldwide. In 2013, there were 145,700 measles deaths globally, a 75 percent decrease in 30 years, thanks to vaccination. Children with measles die of respiratory failure when a pneumonia caused by the virus shuts down their small lungs.

A vaccine completely eliminated smallpox from the face of the planet. Polio will soon follow suit. Even if the children of the United States are less likely to die from these illnesses because of access to adequate supportive medical care, the costs of treating sick children in an ICU are astronomical and an unnecessary strain on the medical system for preventable illnesses.

The fear of vaccines started in 1998 when Dr. Andrew Wakefield falsified data to demonstrate a link between autism and the Measles, Mumps, and Rubella vaccine. Although a fabrication, the research was published by The Lancet and became fodder for conspiracy theorists and paranoid parents concerned about the number of vaccines their children were receiving. The number of pediatric vaccinations went from five in 1995 to 10 by 2010 and parents were understandably upset at watching their children receive so many needle pricks. Rather than being grateful to science for saving their children from any number of fatal and debilitating diseases, some parents turned on modern science.

Those opting out of vaccinating their children have never watched children die of measles. In Uganda, Haiti and Rwanda, I’ve witnessed a dozen or so children die in this way. Weak and listless, their bodies burning up with fever, children with measles lose their appetite. In the poor countries where I work, they often come to the hospital so dehydrated that nurses have to place IVs in the veins along the sides of the head. They cough uncontrollably and breathe rapidly, over 40 times a minute, until the respiratory muscles give out and they die.

Those opting out of vaccinating their children have never seen a 24-year-old with liver cancer caused by hepatitis B, passed to them by their mother during pregnancy and birth, which could have been prevented with a vaccine. In Uganda, I cared for a young man who had no health problems until his belly started to slowly fill with water as did his legs. By the time he came to the hospital, his eyes and skin had turned yellow and the ultrasound of his liver showed a 10 centimeter tumor. He never knew that he had the hepatitis B virus in his body until he was on his death bed from liver cancer.

After the earthquake in Haiti, thousands of people lived in tent cities where a respiratory virus outbreak was a constant threat. One child contracted diphtheria, a bacteria spread through respiratory droplets, while living in the tent city where Sean Penn and his non-profit worked. Penn made heroic efforts to save the child but the odds stacked against him. The World Health Organization warehouse that stored the diphtheria anti-toxin was closed for the weekend. Project Medishare’s pediatric ICU had had a fire the night before and couldn’t put the boy on a breathing machine. Ultimately, he died and Penn took to the airwaves in outrage, ultimately lobbying to congress on the issue of prevention of communicable diseases among children. A simple vaccine would have prevented the child’s death and any scare of the illness spreading in the tent cities.

It is illegal in most states to forego a seatbelt while riding in a car or a helmet while riding on a motorcycle. In those cases society has deemed it a public good to enforce motor vehicle safety with legislation because of the economic cost to society for medical and long-term care costs associated with the seriously injured.

However, while foolish choices on the road may only affect the person thrown through the car windshield, vaccination affects everyone around them. The concept of herd immunity means that once the percent vaccinated in a population crosses a certain threshold, those who are not vaccinated have some protection simply from living amongst a vaccinated population. Once roughly 85 percent of a population is vaccinated, then there simply aren’t enough people to propagate an epidemic because one infected person becomes increasingly unlikely to contact another unvaccinated person. With increasing numbers of unvaccinated children in the school system, however, herd immunity may no longer offer protection. Even so, those who are vaccinated might still be susceptible to illness simply based on their biology or genetics. Opting out of vaccination for one child then can have serious repercussions for those children around them. The irony of herd immunity is that the choice of most parents to vaccinate their children is also what thankfully protects the children of the parents who opt out.

The perceived personal freedoms for one unvaccinated child encroach on the freedom of another child to remain healthy. The personal freedom of the unvaccinated child is not violated in mandatory vaccination, but the freedom of choice of the parents. My advice to parents wishing to opt out of vaccination is to travel the world a bit more and observe the death and destruction wrought on populations of unvaccinated children. If you’re still not convinced of the importance of vaccines, then homeschool them so that your decisions don’t affect the lives of the children around them.

Vincent DeGennaro is an internal medicine doctor and a global public health specialist at the University of Florida’s Division of Infectious Diseases and Global Medicine and works half time in Haiti with the nonprofit Project Medishare. See his An American Doctor in Haiti blogs.