The following was a speech I planned to deliver at last month’s CTA State Council in regards to State Senator Dr. Richard Pan’s SB 277 . Due to personal difficulties, I was unable to attend, but I wanted to share it as CTA has not yet taken a position on this issue:
I have a personal stake in this, but what I’m going to say is informed by what medical professionals and public health experts have to say. It is my assertion that the PBE for immunizations needs to be eliminated. While I’m loathe to impose on parents, this is a larger issue than individual beliefs and has now become a public safety issue. I wish that talking and reasoning would make a difference, as this would be a preferable way to go, but based on what we already seeing, and what human behavior studies tell us, this will not resolve this issue.
Why am I pro-vaccination? I like to start out saying that I’m part of a family with autism, but I’ve also had a very close family member who contracted measles in childhood, and has had to live with life-long complications from that illness. I know that the autism my brother and son have was not caused by immunizations they had. I also know that my relative who had measles (severe and degenerative hearing loss which required her to learn to lip read as a child) this has caused life-long problems in her ability to form relationships, hold employment, and had a very detrimental effect on her mental health. This was not and will never be a “harmless” childhood disease. Because we reduced the incidence of measles in the U.S. during my lifetime, folks are very focused on the complications from the vaccines, seeming to forget that the outcomes are worse when there’s a measles outbreak. Complications like the ones suffered by my relative (brain fever or encephalitis) occur in 1 in 1,000 measles cases, whereas the rate of cases of encephalitis occurring in people getting the MMR vaccine is 1 in 1,000,000. That’s an exponential difference in risk. Once again, this is NOT a harmless childhood illness.
Why not share facts like this with parents? While this would be ideal, this is an approach that has not worked as over the last decade, the rate of parents choosing not to immunize has grown. The following is from a report on NPR:
[A] study by Brendan Nyhan at Dartmouth…found that messages that tout the health benefits and the safety of vaccines are most effective when it comes to persuading people who already believe that vaccines are safe and effective. When it comes to parents who are worried about the safety of vaccines, the researchers found the messages were not only ineffective, but potentially counterproductive because worried parents became less likely to want to vaccinate their children after hearing these messages.
So vaccines and the concerns about vaccines are an example of this much larger phenomenon, which is once you believe in something, it’s very hard to debunk that belief. And when someone comes along and tries to debunk that belief, they get seen as being part of the conspiracy theory.
Some parents are merely “leaners” on this issue of vaccines and may not have fully embraced being anti-vaccine, but talking to them about “choice” results in a higher level of them exempting from vaccines.
Research by Dr. Doug Opel, a pediatrician at Seattle Children’s Hospital noted that doctors handled the conversation in one of two ways.
The first, Opel calls “presumptive.”
“The doctor,” he noticed, “just simply presumed that the parent was going to be fine with the vaccines that the doctor was going to recommend,”
Some other doctors, Opel observed, invited parents to discuss their feelings about vaccines — “sort of invoking a shared decision-making approach, inviting the parent to be part of this conversation.”
The study’s surprising results: When doctors assumed parents would be OK with vaccines, they were. More than 70 percent had their child vaccinated.
On the other hand, when physicians were more flexible and allowed for discussion, most of the parents — 83 percent — decided against vaccination.
We could say, “well, that’s their kids who are going to get sick,” except that’s not how vaccines work. Part of the effectiveness of vaccines in eradicating a disease is that a population gets herd immunity, so when a given percentage of folks in an area get immunized, enough people acquire immunity that it can’t get a foothold. That is a percentage that is usually pretty high. For measles, it’s estimated to be somewhere between 90-95%. So even if most people are vaccinating, if a small but sizeable percentage aren’t you lose that herd immunity. This is a problem because a small but very vulnerable part of the population will not be able to vaccinate (children under the age of vaccination, children and adults with immune conditions, and people who’ve had significant side-effects from the vaccines and cannot get boosters). If there isn’t herd immunity, not only will the children of naysayers be at risk, these folks will also. In addition, there will always be some folks for whom the vaccines do not take and without herd immunity, they are vulnerable.
Dean Vogel’s letter pointed out that the percentage of PBEs statewide is low (~3%) but it has been growing, and PBEs are clustered in geographic areas, some of which are horrifically high. The rate of PBEs at a public school in my district, Alice Birney Waldorf is 32%. There is a “hot spot” in parts of East Sacramento. This affects members and their families. I have a member with an infant who is scared that a trip to the park could expose her precious baby to risk. That is a risk that shouldn’t be there. Because of this clustering, there is no statewide herd immunity, and it’s allowed measles and other childhood diseases that are vaccinated for to get a foothold.
What I know about autism, both the science and living with a brother and a son with it, tells me that it is not caused by vaccinations. My brother had signs of autism well before he was one year old. I’m not going to go into scientific studies on this topic because the ONLY study claiming link between autism and MMR was a hoax and fabrication.
The concern about vaccines reflects a psychological bias that hurts my autistic family. First, it’s based on the idea that autism is the worst thing that you could “give” your child. Second it’s based on a form of guilt on and in families with autism that probably pre-dates the condition even being named.
There is a bias called “anticipated” regret that causes some parents to opt to not vaccinate since they project that they would feel more guilt if there were complications from the vaccine and this guilt would be greater than any bad feelings they’d have if the child suffered complications from not being immunized. Basically, many of us are looking for a “cause” when something like autism happens, and it’s easier to say “I should NOT have done that” and feel guilty than to accept that this is a complicated thing, because make no mistake, the way some vaccine deniers talk about autism is pretty unacceptable.
My brother was born and diagnosed when the vogue for the theory of “refrigerator moms” (blaming parents for making their children autistic) was on the descent, but there was still a lot of guilt being heaped on my parents. This is bad for families with autism, it’s bad for those with it, it’s bad for their parents. It does NOTHING to help that cause, and makes it worse. When people “blame” autism on vaccinations and when parents blame vaccines for their child’s autism, this in another form of shaming and blaming that is neither healthy or productive.
The time for the PBE to end has come. This is a potential public health crises. It’s about more than these families, it’s about our communities and keeping them safe and healthy.
Measles Complications such as bronchopneumonia and otitis media occur in about 10%. Encephalitis occurs in 1/1,000 cases (fatal in 15% and neurologic sequelae in 25%). Subacute sclerosing panencephalitis is a rare but fatal complication.
Measles vaccine is given in combination with mumps and rubella (MMR).
MMR vaccine: Malaise and fever, with or without a non-infectious rash in about 5%; up to 1% of recipients may develop parotitis, about 5% have swollen glands, stiff neck or joint pains. Transient arthralgias or arthritis may occur and are more common in postpubertal females.
About 1/30,000 develop transient thrombocytopenia, 1/1 million develop encephalitis.
The team also identified five clusters where all vaccines were refused for the babies and toddlers in the study:
10.2 percent of children in an area from El Cerrito to Alameda
7.4 percent in northeastern San Francisco
6.6 percent in Marin and southwest Sonoma counties
5.5 percent in northeastern Sacramento County and Roseville
13.5 percent of kids in a small area south of Sacramento
Altogether, nearly 9,000 young children lived in these clusters.
In nearly every case, vaccine-refusal clusters overlapped with large areas of under-immunization.