Monday, March 24, 2008

The Crusade Against Vaccines

A recent NYTimes article nicely portrays the stealthy rise of parents withholding vaccinations from their children for non-religious personal beliefs. These "vaccine skeptics" believe they are taking some kind of enlightened view of vaccines as dangerous tools of pseudoscience. As the article notes, the parents are falling prey to a form of information asymmetry:
“The very success of immunizations has turned out to be an Achilles’ heel,” said Dr. Mark Sawyer, a pediatrician and infectious disease specialist at Rady Children’s Hospital in San Diego. “Most of these parents have never seen measles, and don’t realize it could be a bad disease so they turn their concerns to unfounded risks. They do not perceive risk of the disease but perceive risk of the vaccine.”
This misperception of risk leads to comments from parents like this:
“I refuse to sacrifice my children for the greater good,” said Sybil Carlson, whose 6-year-old son goes to school with several of the children hit by the measles outbreak here. The boy is immunized against some diseases but not measles, Ms. Carlson said, while his 3-year-old brother has had just one shot, protecting him against meningitis.

“When I began to read about vaccines and how they work,” she said, “I saw medical studies, not given to use by the mainstream media, connecting them with neurological disorders, asthma and immunology.”

Ms. Carlson said she understood what was at stake. “I cannot deny that my child can put someone else at risk,” she said.

I can see how reading random misleading websites about the link between vaccines and autism can lead to confusion and skepticism, but what is sad is that these parents are not typically poorly educated. They have the means and intellect to seek out proper information and discuss the choice. Instead, they seem to buy into the fear and paranoia to the detriment of not only their own children, but other people's children as well.

As a public health issue, this is quite alarming. Vaccines work not only due to immunologic principles but also social ones. The social aspect is due to the herd effect, where increasing immunization rates help protect those who are not immunized yet or have poor immunity. If parents do not vaccinate their children, the effect is potentially much larger than merely having their own child get sick.

Stories like this lead me to believe more and more that, in addition to lamaze classes, new parents should be required to take classes about how to care for their impending bundle of joy. The classes would not only teach basic parenting skills (simple things like... babies should drink milk, not water), but also important ideas like the value of vaccinations. If the parents-to-be do not take the class and do not pass a basic test, then a relative who has previously passed the test or Child Protective Services should take custody of their children until they do pass the test.

Radical? Maybe, but think about it: we require such testing before people adopt children. The state also requires testing before one is allowed to drive. The idea in both cases is that these activities can potentially harm other people, so the state wants to ensure that people are capable before entrusting them with the responsibility. Why should parents of natural-born children be any different? As the issue with vaccines and many other cases of poor parenting show (ahem, Britney Spears?), there is a role for the state to play here.

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