by Craig Klugman, Ph.D.
By now, you have most likely been inundated with news about the measles outbreak tied to Disneyland in California. According to the Centers for Disease Control & Prevention, there have been 102 cases of the measles linked to Disneyland through either primary exposure (they were exposed directly) or secondary exposure (they were exposed to someone who had primary exposure) in 15 states. The state of Arizona alone is monitoring over 1,000 people at risk.
The latest turn in this continuing debate is parents of immune-comprised children begging their neighbors to immunize their children. For valid medical reasons—whether a child is too young, the child has an allergy to components of the vaccine, or whether the child has an immunity issue—a percent of children are unable to take the measles (technically MMR-Measles, Mumps & Rubella) vaccine. These children depend on everyone else in public being immunized to prevent the spread of the infection. This notion is called herd immunity, if a certain percent of the population is immunized, then the microorganism does not have enough hosts to cause a problem. If all of the people around a person are immunized, then the risk of infection is severely reduced. In other words, they are protected by everyone else being immunized.
Parents in California and another in Arizona have explained how both their children have leukemia and as a result of treatment have weakened immune systems. The vaccine response that causes most of us to develop antibodies to the infectious agent would overwhelm these children and cause them to have severe sickness if not death. These kids have a medical reason not to be immunized and they depend on herd immunity for survival. If children with measles or children whose parents elect not to immunize on philosophical grounds enter schools or other public places then the sick children have their lives put at risk. A voluntary non-immunizer poses a harm to those who cannot be immunized. Thus, these parents have asked other parents to vaccinate their children, or to not allow the voluntary non-vaccinators into schools. Because if the non-immunized go into the schools, then their kids—who medically cannot be immunized—can’t go to the school.
Yes, there is freedom to make choices. Yes, there is freedom to decide medical treatment for you and your children. But your freedom ends when you pose a harm to others. If you tell your mental health counselor that you have a specific plan to cause bodily harm to a specific person, then the counselor is obligated to report you to authorities and to inform the intended victim (i.e. the Tarasoff ruling). While measles may not be as messy as a gun or a knife, and a person wielding measles may not have an intent to harm, but the person with measles is just as deadly to the immune compromised child.
This outbreak has been viewed in the media and in bioethics as many things. For some people, this is a political opportunity as shown by some contenders for the Republican Presidential nomination who are in favor of measles vaccines but are more in favor of parents having the right to refuse the vaccine. On the other end of the U.S. political spectrum, President Obama is urging everyone to recognize the science and Hilary Clinton has tweeted in support of vaccines. The reason that there is a resistance to the measles vaccine has two sources. One is celebrities who espouse their personal beliefs that vaccines are dangerous by causing autism and other health conditions (absent any scientific proof of their assertions). The other is a now debunked study from 1998 that claimed a link between autism and vaccines. Not only has that paper been withdrawn from the journal BMJ, but the study was found to be an “elaborate fraud.” But in the new America, scientific facts rarely get in the way of political and religious beliefs.
From 1900-1909, measles was the sixth leading cause of death in the United States, at 13.3 deaths per 100,000 people. In 1920, 469,924 people had the measles and 7,575 people died of it. In 1968, the modern measles vaccine was developed and distributed. In 2011, 222 measles cases were reported and no one died. For all of 2014, there were 644 cases in the U.S.. Today, 91% of children receive the measles vaccine. That is below the 92-94 percent required for herd immunity. In the U.S., some counties have immunization rates among kindergartners that are below 75%. The trends are real—lower immunization rates and higher infection rates.
While all 50 states require the MMR (measles-mumps-rubella) vaccination, 19 of those states allow parents to use a religious or doctor’s exemption to avoid inoculations. 22 states do not require college students to prove measles vaccination.
The sum of this message is, immunize your child. Over 47 years of experience with the measles vaccine shows that it is safe for most children. If you have a medical reason not to immunize, then you depend on herd immunity for your health and safety.
If you have a religious or philosophical reason to not immunize, then I am sorry but your beliefs end where protecting others from the threat of harm you pose begins. If you do not want to vaccinate your children, then keep them away from other kids and homeschool them. Your electively non-immunized child poses a direct threat to rest of society, especially those who are medically vulnerable. Children who are electively not immunized should be banned from public spaces—schools, daycare, movie theaters, playgrounds, shopping malls and Disneyland. This may come across as Draconian but consider this—how would you have felt if we did not quarantine Ebola patients and let them go to the school where your children are in class? Does that sound scary? Measles is much more contagious than Ebola. Now you know how the parents of children who have a medical reason not to be immunized feel everyday. If your response is that perhaps these vulnerable children should be kept at home instead of yours who are electively non-immunized, consider that elective non-immunization is a choice. Medical non-immunization is not a choice. And all choices come with consequences. As long as you are the only one who is hurt, you get to make your choices with few limits. But once your choice harms someone else, then action must be taken to mitigate the harm.
It’s all very simply. If you want to be in public and you do not have a medical reason for avoiding it, then you should be required to immunize. The science is clear and the public policy should be as well.