Vaccination is an essential social contract

By Dr. William Foege

For The Beachcomber

We all want to protect our children. How to be knowledgeable as the science continues to expand is a daunting task.

A century ago, smallpox vaccine was the extent of our vaccine toolbox, at least for routine childhood immunizations. Then came DTP (Diphtheria-Tetanus-Pertussis) and 55 years ago the Salk polio vaccine. Now we have so many protective vaccines that we face the problem of how many can be given on a single visit without causing trauma to a child. A challenge is to provide more vaccines by mouth or by skin patches to avoid yet another needle stick.

The public health community has been very aware of adverse reactions due to vaccines and the need to weigh the adverse reactions of the vaccine against the adverse reactions of the disease itself.

No vaccine has had as many negative reactions as smallpox vaccine, and studies in the 1960s disclosed an annual toll in this country that included about seven deaths due to the vaccine itself. There was no smallpox in the United States at the time, but the fear of smallpox was so great that the country continued to pay that price, year after year.

In the early 1970s the Public Health Service recommended stopping the routine use of smallpox vaccine in this country because calculations showed vaccine was a bigger risk than importation of the disease itself.

With no other disease has the risk of importation fallen to the point that cessation of the vaccine is possible. But then in 1998 a frightening article appeared in the medical journal Lancet, authored by Dr. Andrew Wakefield. He reported on a dozen children with developmental problems and said that eight of them had received Measles-Mumps-Rubella (MMR) vaccine. He thought MMR was the reason for their problems.

It was not a rigorous study; it included no control group and yet it caused great concern. The good news was that it might provide a clue to the origins of autism. The bad news is that it provided major challenges to immunization. If true, it meant finding the cause and attempting to produce a vaccine free of the problem. No public health tool has been as far-reaching in preventing diseases and no tool has been so cost-effective. This was no small problem. It was also confusing news since most autism researchers assumed the causes of autism were generally prenatal in origin rather than exposures after birth.

Immunization programs were thrown into turmoil by parent activists, celebrities and even U.S. Rep. Dan Burton (R-Indiana), who assumed the link was true and influenced many parents to avoid immunizations.

Reductions in immunization levels and the increase in susceptible children inevitably led to outbreaks, in some cases causing the deaths of the very children parents were trying to protect. One measles outbreak in the United States involved 50,000 cases with 200 deaths. Those children had no second chance to examine the evidence.

In February 2010, the Lancet withdrew the article citing scientific problems with the original article and a series of studies comparing children receiving vaccines or not receiving vaccines showing no difference in autism rates. It was also revealed that Dr. Wakefield had received money from a lawyer who was suing vaccine companies and therefore had a vested interest in the results of his article.

This reversal is good news for vaccines, bad news for autism as the 12-year effort has shed no new light on causation and indeed funneled resources away from productive research that could have been done. It has also left confusion in the minds of parents who question what to believe.

Parents have so many things to worry about that they don’t need to worry about something that isn’t true. Multiple studies have shown no link between vaccines and autism, and Wakefield’s legacy is to unfairly leave children unprotected and at higher risk of disease if they ever wish to travel to other parts of the world. It is a disaster for children, a cruel hoax on parents wanting to do the right thing and an embarrassment to scientists who would like to believe other scientists have the well-being of the public as a higher priority than their personal bank account.

It is not too late for the young people on the Island. But we must unite as a community to make the science available to parents. And we must teach the lessons of personal responsibility and the need for a social contract if we are to protect the community.

— Dr. William Foege, an Island resident, is the former director of the Centers for Disease Control.

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