Darwin and Vaccines

(Note: this post is written partly to avoid exacerbating Flea's burgeoning comment trail, and partly to address an issue that got buried in it; but mainly to offer my support to the noble Flea.)

Flea is in the process of writing a wonderful series of posts about vaccine-preventable diseases, and of course in the process has been subjected to the attack of the wingnuts. Now at 121 comments and counting, there were a few along the lines of "Just let them die" (ie, let natural selection kill off the anti-vaxers by allowing them to contract the diseases in lieu of receiving the vaccines to which they so object.) Although I know (or sincerely hope) that these comments were tongue-in-cheek, I would like to address the question -- perhaps unasked in precisely this form -- "Why bother fighting them if it's only their children they're putting at risk?"

First of all, I am not agreeing with the second part of that statement. Herd immunity is real but fragile. Nevertheless, it must be agreed that unvaccinated children are at much more immediate risk from their status than are their innoculated peers.

So what's the harm? They may be whack jobs, but it's a free country. And in America, the most treasured right is the right to be stupid. Why should we waste our time and effort trying to convince delusional science-illiterates?

The answer is similar to that given by the senior OB resident during my third year med school rotation during the particularly hectic treatment of a drug addict in labor. I forget who raised the issue, but the question was asked, essentially, "Why are we bothering?" If the mother didn't care enough to take even the slightest care of herself all through the pregnancy (as I recall, she kept getting herself pregnant so she could shoot up in the dilated veins of her breasts) why should we be putting in all this effort to care for her now? The answer -- which I know comes as no surprise to any pediatrician or ethical OB reading this -- was that it wasn't the baby's fault its mother was a drug addict. Whatever your belief in "original sin" from a theological standpoint, it is never medically appropriate to punish one patient -- the baby -- for the sins of another.

The same issue holds in pediatrics. By and large, the ideal of the "best interests of the child" is seen similarly by loving parents, who want to do everything that can be done to keep their children as healthy as possible, and physicians with our armamentarium of vaccines.

Conflict arises when parents object to standard medical treatment -- whether they be paranoid, anti-vax wingnuts, or thoughtful, religious Christian Scientists. We may question the intellectual stands they take, but I don't think it's fair to impugn their feelings for their children. Still, we are left with the conundrum that has led to court orders overriding parental wishes in life-threatening medical matters. Although we cannot draw the line directly enough from "refusing to vaccinate" to "immediate threat of death" to justify that degree of intervention, it is still the innocent children whose interests we must keep striving to represent, even if it means dealing with irrational people.

That is why these discussions -- futile as they may seem -- deserve to continue.

There's also another side to this.

A few months ago, I saw a new patient in my office. This lovely, intelligent 14-year-old had received no immunizations at all. Having now done the research for himself, this boy was requesting all age-appropriate vaccinations. To his parents' credit, although they disagreed with his decision, they respected his wishes and brought him to see me. We (he and I) sat down together and set up an appropriate schedule. I administered the first set of vaccinations; he returned as requested, and all went well.

I have another family in my practice who just had their first child. They had "concerns" about the vaccines and came to see me before the birth to discuss these issues. They ended up deciding to forego Hepatitis B, but so far their 2-month-old is otherwise "on schedule." They don't want her to get MMR or Chickenpox vaccine, but every time I see them we discuss it some more. I try to provide more information and address their concerns with respect. I'm optimistic that when the time comes, the kid will end up fully vaccinated. And even if she doesn't, there's always the possiblity that she, like the young man above, will transcend her parents' limitations and eventually choose vaccine protection for herself.

So hang in there, Flea. Even though the crazies may come out of the woodwork, you never know who else is listening.