My favorite libertarian quote -
"The right to swing my fist ends where the other man's nose begins." - attributed to Oliver Wendell Holmes, Jr.
We unfortunately have a growing anti-vaccine movement in this country. Last night I participated in a heated discussion with a group of medical students. The expressed outrage at parents who refused to vaccinate their children.
For the first 30 years of my medical career I never saw or heard of a patient having pertussis. Today pertussis represents a serious problem in our society and is the only vaccine preventable disease showing an increasing mortality in the US. Pertussis mortality is increasing because we are losing "herd immunity".
Vaccination nihilists disbelieve scientific data. They have accepted a superstitious belief that vaccinations endanger their children, despite all the data proving vaccination safety and effectiveness.
This stance leaves us with a most challenging ethical dilemma. The decision to refuse treatment as an adult represents autonomy, but what about the children. Children cannot decide for themselves. Do parents have the right to endanger their children?
Even worse, we must ask whether they have the right to endanger others.
We do not let patients with TB have the freedom to infect others. We try to isolate many infectious diseases.
So now imagine a pediatrician's office. Some of the patients have received vaccination, while some have not. Some have not yet had their vaccination, and some have had their vaccination immunity become inactive (immunity only lasts for 5-10 years after vaccination, and some have argued that it may only last 3-6 years).
When a parent's decision puts their child at risk, and others at risk, how do we handle that decision.
Our students expressed great angst over their problem. What do you think?
{ 4 comments… read them below or add one }
Back in the early 80's, prior to having children of my own…I worked in a small community hospital ER. A nurse ran across the parking lot from the office complex carrying a limp appearing six month old child. Resuscitation was attempted and MedFlight transported to a large tertiary hospital.
The infant died of menigitis as the Hib vaccine was not yet available.
I promised myself that my future children would receive all vaccines on schedule and that I would keep my immunization status up to date at all times as well.
Came over from a tweet from @movinmeat.
I wonder if you have seen Dr. Diekema's excellent essay, "Improving Childhood Vaccination Rates".
http://www.nejm.org/doi/full/10.1056/NEJMp1113008
Pediatrician-mom who blogs at My Two Hats has also written an excellent post, "Why I Do Not Fire Vaccine-Hesitant Families".
Over the last year, there have been a number of excellent posts by blogging physicians in pediatrics and in family practice addressing just this issue.
The problem as I see it is this:
There are a number of organizations (the mis-named National Vaccine Information Center, NVIC, is probably the most effective) who are, in your terms, "vaccine nihilists". The purpose of these organizations is to spread fear, uncertainty and doubt (FUD) about the safety and efficacy of vaccines. The medical establishment has done very little to effectively counter their misleading propaganda.
On the other hand, there are parents of infants and toddlers, many of whom don't have the background information to understand what NVIC & fellow travelers are spreading is false propaganda. So those parents become vaccine hesitant or vaccine refusers.
My sense is that it is counter-productive to be angry with vaccine-refusing parents.
Forgot the link for "Why I Won't Fire…."
http://mytwohats.wordpress.com/2012/02/29/why-i-wont-fire-vaccine-hesitant-families/
Physicians and other supporters of public health and high vaccine uptake should be aware of the true vaccine nihilists, the organizations and people who are actively working to spread fear, uncertainty and doubt about vaccine safety and efficacy. The following list is not complete, nor is it rank ordered. I do not link to these organizations' websites, but they easy to find through any search engine:
Generation Rescue and its website, Age of Autism
Barbara Loe Fisher and her organization, National Vaccine Information Center (NVIC)
Joe Mercola (Mercola regularly publishes anti-vaccine screeds full of misinformation. He also supports NVIC financially)
Mike Adams (The Health Ranger, Natural News)
Sherri Tenpenny
Chiropractic industrialist Tedd Koren
Chiropractic cult Maximized Living
VaxTruth.org
The Refusers
As I said, this is just a partial list.