The Key to Convincing Parents to Vaccinate Their
Children
By Drew
Harris in the Wall Street Journal
The recent measles outbreak linked
to Disneyland is drawing attention to the issue of families with unvaccinated
children and the public policies that allow them to opt out of
immunization mandates. More on that later. First, let me tell you a story.
Imagine you read about a horrific
car crash on the Internet. Bystanders pulled mom and dad from the wreck but the
infant trapped in the car seat behind them perished when the spilled gasoline
ignited. Hearing this, would you worry the next time you strapped your child
in?
We are wired to
learn through stories. Like my car-seat example, the ones that hit
closest to home resonate the most. There was a time when everyone knew of a
seemingly healthy child paralyzed days later by polio.
While fewer than 1% of the infected developed the paralysis, the fear loomed
large in every parent’s mind. The all-too-common reality of polio,
measles, mumps, pertussis and other childhood infections spurred the
quick adoption of each preventative vaccine when introduced. Even when a bad batch
of the polio vaccine actually infected hundreds and killed some of
the children, demand for the vaccine didn’t wane. Polio was
that fearsome.
While my story may make you think
twice before putting your baby in a car seat, you can’t because the law
won’t allow it. Every state
mandates their use and your newborn can’t leave the hospital without one. There
are no exemptions, no claims that your child is safer in your loving arms
or protected by your creator or that car-seat manufacturers are hiding their
failures from the public. Unlike immunizations, car-seat laws are applied
equally and without prejudice.
Collective memory is its
own inoculation against complacency. Stories of unrestrained children dying in
car crashes regularly remind us of what’s at stake. However,
like immunity, memories of past epidemics fade. The paradox of vaccines is
that they become victims of their own success. As we forget the disease,
concerns about vaccine side effects grow relatively larger. This effect is
exaggerated when fears about vaccine injuries are stoked by vaccine denialists
and so-called researchers selling debunked theories.
This chart illustrates
the phenomenon and shows that there is a point when your real individual
risk from the disease may drop below the very low risk
of serious vaccine-related injury—generally less than 1 in a
million people—because the disease is no longer circulating in
the community. Even then, fully vaccinated people help
protect those too young or too sick to take the shot or
whose own vaccination didn’t take. If enough people are immune to a disease
that only infects humans, then it is possible to eradicate it
completely, as we did with smallpox. We’ve been tantalizingly close with
polio. Measles was eliminated from the U.S. until the latest outbreak
linked to Disneyland revealed flaws in the invisible wall of community
immunity.
A chart documenting our concerns
about car seats would look very different. Unlike those mandates, concerns over
vaccine safety have resulted in a patchwork of exemption options. All but
two states grant religious exemptions and 20 allow
philosophic or personal belief exemptions. How these laws are implemented
matter because research shows that stronger state immunization exemption
requirements increase
the percentage of fully immunized children and lower the rate
of vaccine-preventable diseases like pertussis.
New Jersey is a great example of
what happens when the rules are weakened. In 2008, state policy was changed
to grant a religious exemption to any child whose parent submitted a piece of
paper with the word “religious” or “religion” on it. No substantiation
is required. Parents who pick and choose their shots or who immunize
their other children can opt out on religious grounds. After it became easier
to get an exemption than a shot, there was an over 4-fold increase (from
2,105 to 8,977) in the number of children with religious exemptions from
one or more mandated vaccines in the state’s schools and child care
centers.
The New Jersey Legislature is
considering a bill that would tighten the state’s lax exemption
requirement. The bill does not eliminate the religious exemption. It merely
places a few more speed bumps in the process, such as notarized written
statements and proof of counseling about the risks of not vaccinating
for both the child and the community.
Despite the bill’s focus on
validating the nature of religious belief, many of the opponents testified
about vaccine safety concerns, government and industry malfeasance, and the
belief that the risk of these diseases is not really as bad as the public
health authorities claim. Only the bill’s supporters (myself included)
recalled the largely forgotten horrors that come with vaccine-preventable disease.
In essence, we were telling two different stories because unlike car
crashes our experiences were different.
While a few people will never buy
into the narrative that vaccine-preventable disease is the greater threat,
there are many undecided parents who can be convinced to immunize their
children for their own sake and the sake of their friends and
neighbors. Laws requiring a rigorous exemption process will work when they
force the conversation, address parental concerns and remind us of these fearful
diseases.
Dr. Drew Harris (@drewaharris)
is director of health policy at Thomas Jefferson University’s School of
Population Health in Philadelphia, where he focuses on the complex interplay
between public health, medical care and public policy.
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