Vaccines have become a cornerstone of modern public health and have greatly reduced the burden of infectious disease across the globe. They are also the center of major debate in America. Conjuring furious arguments with divided opinion, where vaccine safety gets more attention than vaccine effectiveness. In the era of Facebook, Twitter and every imaginable social media outlet, opinions and facts flood computer screens, distorting truth and instilling doubt. To support an argument, it is not difficult to find an article or group that agrees with you. Medical professionals constantly find themselves concerned and restrained by an apathetic response to reason and science.
For students, medical education offers little to no training on vaccinations — even many students themselves lack immunity to certain vaccine-preventable diseases. Arguably, if medical schools are deficient in this training, it is assumed residencies will fill the gap. However, many pediatric residency programs do not include formal training on vaccine safety, despite the fact that residency program directors support it as a priority.
Thus, it becomes an individual responsibility to equip oneself for this conversation. Not only must we become authorities on vaccination, we must also become proficient in communicating the safety and necessity of vaccines, while not abandoning our empathy for parental concerns. No matter if you intend to train in family medicine, neurology or plastic surgery, you will be a physician that is sought out. Medical schools and residencies may not be educating us on this issue, but it is our responsibility as the next generation of physicians to prepare for a querying public.
If we step back from all the rhetoric, the issue at hand — and the basis by which this conversation should always be grounded — is the safety and well-being of children. As physicians, this will be our top priority. Likewise, for parents, their children are their life. However, for most who did not pursue 12 to 16 years of education, fact and opinion are difficult to differentiate in this age of infinite misinformation.
Who can blame parents for being fearful and uncertain? Vaccines, like any medication, are not devoid of risks. Though the side effects are minuscule, fractions of fractions, they are risks none the less. And parents — not the physician — are left with the burden of weighing that decision for their children. To make matters more challenging, stories often surface like the one of a doctor using dirty needles and consequently spreading HIV in Cambodia. Anti-vaxxers and television stars campaign that vaccines cause autism, despite abundant evidence proving otherwise. Even presidential candidates, one of them a famed pediatric neurosurgeon, misuse their pulpit and further complicate the matter.
It is critical that we respectfully scrutinize the arguments of all parties in order to offer valid reason to our patients and their families. For instance, the argument exists that, up until this year, no children have died in America from measles in almost 12 years. This is absolutely true. However, the statement alone is deceiving and can be used to argue for or against vaccination depending on the use, or exclusion of, historical context.
Before a vaccine became available in 1963, nearly all American children got measles by the time they were fifteen. Every year, because of measles, 400 to 500 people died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain). This disease was not a simple rash, it was detrimental and potentially lethal to those infected. And yet, statements like the aforementioned are frequently used to justify withholding vaccinations because the disease is “no longer lethal.”
Meanwhile, for the rest of the world, vaccine-preventable diseases are not so benign. In 2014, there were almost 115,000 deaths from measles — that’s almost 315 deaths every day. Globally, this disease is real and it is dangerous. Many Americans are unaware of this reality or may believe that they are safe behind their castle walls. But we must caution them that globalization threatens to siege their kingdom.
Since 1975, America has welcomed over 3 million refugees from across the globe. It takes only 16 hours to fly from South Africa to Washington D.C., and only nine hours to fly from London to New York. War continues to displace people and disrupts their access to basic health care. Currently, America has admitted around 2,000 Syrian refugees and intends to admit at least 10,000 more in the next fiscal year — current politics pending. And, though polio has been eradicated in United States since 1979, countries like Syria and Iraq still have active spread of disease despite a global initiative to aggressively vaccinate in those regions.
Fortunately — excluding select pockets of unvaccinated communities — recent studies have shown that the majority of American children are indeed vaccinated. In fact, 94 percent of children have had two doses of the MMR (Measles, Mumps and Rubella) and DTaP (Diphtheria, Tetanus and Pertussis) vaccines, just shy of Healthy People 2020’s goal of 95 percent. Combined, this with state of the art medicine and adequate nutrition, it is easy to understand why American children are not as susceptible to the perils of these viruses. However, vaccination, state by state, continues to decline, foreshadowing a detrimental tragedy that an unvaccinated population could suffer.
Doctors in-training have a unique responsibility before them. We are entering medicine at a time when scientific discovery is exploding, but when public trust in our profession is declining. How do we gain back the confidence of our patients? Likely, the answer begins with genuine respect and empathy. When a parent comes into the office and states that they are concerned about vaccines, condemnation should not be our first response. We should instead congratulate them. Commend them for being good parents that actually care about their children. Applaud them for wanting to protect them from danger. Is this not exactly what we as physicians will be trying to do? This mutual aspiration is central in reminding them that we are in fact partners in the health and welfare of their children.
We can have all the education in the world, an MD, a PhD, fellowships and certifications abound. But if we fail to gain the trust and respect of our patients, or their families, then we will fail as physicians. Facts, truth and knowledge are all useless if no one is listening. Rather than flexing our credentials, we must render our integrity. We must remind ourselves, and the parents of our patients, that our commitment is to them.
Children, their innocence and their heartbeats, become our concern. We must do everything in our power to assure that those hearts will continue to beat long into the future. We can ill afford to wait for the system to change or for our egos to determine the outcome of these conversations. We, rather, must be the catalysts of change for the future of our society.
Photo credit: Photograph by Grook Da Oger.