“Crunchy,” “granola,” “hippie.” I wear these labels proudly. I am a home-birthing, extended breastfeeding, babyfood-making, co-sleeping, cloth-diapering, sling-wearing mom. I am also an infectious disease scientist and a public health professional that believes in evidence-based health practices. I know what happens when kids get preventable infectious diseases.
Prior to the licensing and widespread use of the measles vaccine in 1968, it was not unusual to have more than 85,000 cases of measles in Texas alone. Despite an outbreak of measles among college students in the early 1990s, which had a variety of causes, overall rates of measles declined drastically since the late 1960s.
In 1998, the World Health Organization declared that measles would be eradicated worldwide by 2007. In 2000, public health officials declared measles to be eliminated from the US. But instead of being eliminated, it returned with a vengeance: the CDC reported 11 outbreaks in the US in 2013.
In 2014 it’s been even worse, with Texas and California hit particularly hard. When one looks at the numbers, they tend to say “Ah, only a couple of hundred cases, that’s not much.” But what they’re forgetting is this: Measles kills. Like most vaccine-preventable diseases, it doesn’t always kill, but once we reach a critical number of cases, the likelihood that one of those children will die becomes much greater. For measles, that’s 500 cases.
It’s been many years since we’ve seen more than 500 cases in the US. But this year, as of May 14, there have been 216 cases in the US. Ever closer, we inch towards that critical threshold.
And it’s not just measles. The second M in MMR stands for Mumps. By May 27, 2014, there have been 464 cases of mumps in the U.S., most linked to outbreaks at Ohio State University and Fordham University in New York City.
And then Congenital Rubella (the “R” in MMR) rears its ugly head. For most of us, rubella is a mild illness, often not even noticed. But for pregnant women, it often results in the death of their fetus. If the baby survives, then there’s a high likelihood the baby will be born with severe abnormalities, all due to a preventable disease.
Pertussis is probably the most widespread vaccine preventable illness we see today. In 2000, if we’d seen more than 2,218 cases we saw in 2012, DSHS would have declared an epidemic. Today, this is the endemic level – the “new normal.”
“What’s pertussis?” you say, “Just a cough.”
For adults, that’s true. For tiny babies, it can be deadly. Babies can’t start the vaccine series until they’re two months old. My first case as an epidemiologist was a seven-week-old baby with pertussis. The child was too young for the first shot, and got sick: very, very sick, a difficult and tragic outcome for this family. There’s a good chance the baby had been in contact with an infected adult. There’s a vaccine available for adults. How many of us get it? Very, very few. Nationwide, adult vaccination for pertussis is around 16 percent.
In Bexar County, 65.7 percent children under the age of three have received all the required vaccinations.
That sounds pretty good, except when you learn that the US National Goal is 80 percent, and for some diseases, we need at least 90 percent of all kids vaccinated to fully protect the entire population.
Why? Why would anyone not prevent a disease when it’s so easily preventable?
Fear. Misinformation. Distrust.
Any one who is a parent knows that “mama bear” instinct. We all want to protect our child. An epidemiologist friend, a strong believer in vaccination, said she wanted to grab her child and run when the nurse brought out the needles at her baby’s two-month doctor’s visit. But she knew the greater protection came with vaccination.
It’s hard to see our kids suffer. It’s even harder to see them suffer when we don’t understand the cause. Dr. Peter Hotez, Director of the Sabin Vaccine Institute, has a child with profound autism. If any one knows first hand the challenges of an autistic child, it’s him. Yet, he leads the world’s experts in vaccine development and research while another one of his children studies the developmental psychology of autism.
It’s easy to call upon the Andrew Wakefields and Jenny McCarthys of the world when asking why people choose not to vaccinate. Yet, the public health community is also responsible. We failed to communicate the importance of vaccines. We failed to present the science in such a way that people would understand – really understand how important these vaccines are. Despite all the scientific evidence to the contrary, it’s hard to convince people once they’ve been scared into believing something, and now we have an uphill battle.
But we are also victims of our own success. In public health we often say that if we do our jobs well, no one knows about it. That’s what happened. We did our jobs so well that the rate of these vaccine preventable diseases declined. Cases declined so much that people in the U.S. felt they were no longer at risk. Except, in a world of global travel, every communicable disease is a risk. You don’t even have to travel, you just need to come into contact with someone who did; or someone who came into contact with someone who did.
Herd Immunity. Community Immunity.
A herd is a community. That would be us. Your child goes to school. He has a friend whose parents chose not to vaccinate. That friend becomes sick and he passes the infection on to anyone susceptible. No vaccine is perfect, most range form 80-90 percent effective, some less. Some kids, even though they’ve been vaccinated, may not be protected. Then there are the kids who can’t be vaccinated because they have immune disorders that make them ill if they’re vaccinated.
To prevent those kids from getting sick, we have Community Immunity. That’s a trick we play on the infections. If 90 percent of us are vaccinated against measles, the virus can not persist in the community. This is how small pox was eradicated and why it was believed that measles could be eradicated Measles, especially measles, should be very easy to eradicate – it’s a single strain, we mount a significant and what appears to be life long immune response.
The virus isn’t smart enough to play tricks on us. All we have to do is vaccinate 90 percent of the population. Instead, in the U.S., one of the most developed nations, our rates hover around 60 percent.
Do we really want a return to the 1950s, when 85,000 kids had measles and a death rate of 20-30 percent? Given improvements in overall health, we might be able to decrease that fatality rate to 5-10 percent, but even that is too high for something that is entirely preventable.
I am a believer in questioning – that’s why I’m a scientist. I ask questions. Ask your health care providers to explain those vaccinations. Ask them to reassure you of their safety. Ask them to give you the scientific data to support them. Most providers welcome the opportunity to discuss the importance of vaccines with their patients and they have the answers you seek. They understand our “mama bear” instincts, and they want to protect our kids as much as we do.
Now, I must offer a disclaimer. My life’s work has been in preventing infectious disease. Currently I work for an organization, The Immunization Partnership, which seeks to improve vaccination rates in our community. But, if successful, I’m ultimately out of a job. If we had 80-90 percent coverage, there’d be no need for such an organization. And that would be a good thing.