By Raquel Weinstein ’21

Flu season is over, and it hit Crystal pretty hard this year. Pertussis (commonly known as whooping cough) even broke out among some of the underclassmen. Not to worry; there are ways to fight these terrible illnesses. One way is to take preventative action. The most common preventative action is vaccination. There are two common types of vaccines: live and inactivated, which are typically given via injection. Live vaccines are weakened forms of a pathogen, which the immune system can counteract easily, but are still viable. Inactivated vaccines administer an inactivated (“killed”) form of the pathogen. The body mounts an immune response to these vaccines, forming antibodies. These antibodies stay in your body and can help to fight off the disease if or when it arrives. The inactivated vaccine most commonly used  is the annual influenza vaccination. It is estimated that vaccines save around 2 to 3 million lives a year worldwide through protecting the individual and preventing spread to others.

It is estimated that vaccines save around 2 to 3 million lives a year worldwide through protecting the individual and preventing spread to others.

However, not everyone believes that vaccines are the answer. More than 3 million people die each year from vaccine-preventable diseases worldwide, and some of these 3 million people have access to the vaccines but choose not to have them administered. Although there is a large amount of evidence in support of vaccines, there are a rising number of parents who are choosing not to vaccinate their children. They are influenced by the counter-intuitive idea that putting the disease in you prevents you from getting it in the future and the idea of herd immunity; ideas which are explored below.

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Vaccines are not a cure. They work by lowering the probability of contracting a deadly disease or minimizing the symptoms and lowering the severity of the disease. Despite this, vaccines do protect the body and prevent fatal diseases from spreading. While many parents are upset by side effects from the injections, others believe that these symptoms outweigh the risk of getting a disease that has the potential to be deadly. Even if a vaccinated individual contracts the disease, symptoms will be milder since vaccination mitigates symptoms of a disease. Scientists study all vaccinations before they are released to the public in order to protect the largest portion of the population possible and ensure the safety of the patients. For example, the influenza vaccine varies from year to year as doctors attempt to predict the specific type of flu that will be most common for that year. Another leading reason for under-vaccination is accessibility to the vaccines. For some, vaccines are not very affordable or accessible. Therefore, it would be an extra effort to be vaccinated and if one already believes them to be unnecessary, it is easy to avoid vaccinations and stand against them.

The World Health Organization has declared vaccine hesitancy (the refusal to be vaccinated or have one’s kids vaccinated) to be one of the top ten global health threats of 2019.

A note before we begin: This article is in no way intended to offend anyone who is for or against vaccines. My goal is to explore all opinions held by both sides backed up by scientific data, facts and research that has been done regarding vaccines. Although I do explore the pro-vax vs anti-vax debate, I in no way intend to assign labels and call this debate two-sided because as you will read, there is a lot to consider. In addition, I want to be clear that non-vaccinated children do not automatically have deadly diseases they can transmit, they simply have not been vaccinated against them. At the heart of the argument is the fact that all parents just want what is best for their kids.

Toxic “things” in our vaccines?

Throughout history, there has always been controversy surrounding vaccines because people have different ideas on how to remain disease-free and healthy. However, more recently, vaccine hesitancy has become more prevalent for various reasons. Firstly, a common misconception is that vaccines can give you the disease they are to protect you against because they are the disease itself. It takes one or two weeks for the vaccination to begin working and some people do get the flu after getting the flu shot, but it is simply bad luck that they contracted the flu during this window.  The vaccine did not give them the flu, they just had bad timing. In fact, the vaccine may have decreased the symptoms and made them less severe.

The vaccine did not give them the flu, they just had bad timing. In fact, the vaccine may have decreased the symptoms and made them less severe.

Now that we have clarified this, let’s move on to more of the science and parental thinking behind vaccine hesitancy. Many parents worry about the side effects their children may experience from these vaccines. Many vaccines contain a preservative called thimerosal which is mercury-based. Although our instinct is to believe that this substance is harmful because it is mercury-based, when further researched, thimerosal actually contains a harmless type of mercury called ethylmercury which the human body quickly gets rid of naturally when it enters the body. Perhaps people often confuse nontoxic ethylmercury and toxic methylmercury (a poisonous mercury found in fish). The most common side effect that thimerosal may have is a small irritation or redness at the site of injection in the minority of people. A very small percentage of people can have a true allergy to it, as is true for any medication. The chemical is necessary when preserving vaccines and preventing any bacterial contamination before it is given to the patient. Although it was not in common use to begin with, it has now been removed from the majority of childhood vaccines. Today, thimerosal is only commonly encountered in the multi-dose vials of the influenza vaccine.

A link between autism and vaccines?

Another interesting argument against vaccines is that they cause autism. This was based on an article written by a British doctor (now discredited) by the name of  Andrew Wakefield, who claimed there to be a connection between autism and the measles-mumps-rubella (MMR) vaccine. In 1989, he released an article in the journal Lancet claiming that receiving the MMR vaccine would boost the probability that the child would develop autism. However, very quickly after the study was released, several studies were done proving the science behind Wakefield’s claims to be incorrect. Further investigation proved that he had been dishonest the Lancet ultimately pulled Wakefield’s paper from their works in February 2010 on the grounds of ethical misconduct and scientific inaccuracy. In short, the investigations and claims he made were completely false and were in fact, funded by anti-vaccination organizations. His claims may have been believable because the MMR vaccine is administered to children 12-15 months of age which is around the same time when signs of autism may first begin to appear in a child. While this still may concern some parents today, it is most likely not the principal reason behind parents refusing to vaccinate their kids but it is an interesting case to examine when discussing the movement towards anti-vaccination.

Parents’ Fear and a bit of psychology

Most vaccine hesitancy develops from parents’ fear of introducing a foreign substance into their children’s bodies, especially in newborns, who are the most vulnerable. Most new parents are extremely protective of their children and believe that they know what is best for them, even if it is against a professional’s opinion. Regardless, both sides, pro-vax or anti-vax, share one concrete idea: they both want what is best for their children. The psychology leading some parents to disregard vaccinations is quite interesting. A term largely used by psychologists is “availability heuristic.” Availability heurism is the human habit of allowing the things we see and experience in our day to day lives to affect our decisions. It is our way of making mental shortcuts and keeping the things most prevalent and recent in our lives at the forefront of our minds. Another important concept is “confirmation bias,” which is the action of seeking out information that supports your beliefs, regardless of whether it is true or not. As we all know, not all information on the internet is accurate because the internet provides people with a platform to publish their own opinions, regardless of whether they are factually correct or not. Therefore, many parents have access to negative stories about vaccines, which promotes ideas that there are alternatives to keeping their children healthy. Technology is the platform through which ideas spread and new movements can form, such as vaccine hesitancy. Parents argue and pledge to find a more “natural” way to protect their children, or believe the illness itself is less harmful than the vaccine. Moreover, humans are very poor at risk assessment and are unable to recognize that the risk of contracting the disease poses more of a threat to the child than any side effects of the vaccine. If we were to take confirmation bias a step further, it would be known as “motivated reasoning,” a term defined as an emotionally driven rejection of facts due to one’s own beliefs (and the idea that one’s beliefs are correct). Most parents, therefore, choose to look for and believe only the information that supports their beliefs. Those opposed to vaccines deny the notion that any of these diseases are present and pose a threat because they do not hear of many cases where a child suffers or dies due to these infections. Again, the foundational motivator for parents is to protect their children. All families handle this differently and some children ultimately make decisions contrary to their parents’ beliefs and choose to be vaccinated. 

Ethical reasons + stigma

As in any heated debate, there can be a lot of stigma and a lack of compassion due to a lack of understanding for either side. For example, it is common for many parents who choose to not vaccinate their children to be ostracized. In the past generations, it would have been thought of as ridiculous or absurd to not vaccinate one’s kids and it was only up until a few years ago that this movement towards anti-vaccination began to gain momentum. Vaccine hesitancy and this rejection of government standards of safety could be due to a deflection of the stress and fear parents have for their children. It is true that some vaccines are required by the government in order to attend school. There is no federal law that requires children to get vaccinated but there are varying state laws that require children to be vaccinated to enter certain grades. If we look at the numbers, all 50 states (and DC) allow for medical exemption, 47 states (and DC) allow for religious exemption and 17 states (and DC) allow for philosophical exemption. After the 2014 measles outbreak in California, the California Senate Bill 277 passed in 2015, eliminating personal-belief exemption from vaccines for school attendance. Out of those affected, there were 37 vaccine-eligible patients (because the vaccine is given around 12-15 months of age) but 67% of them were intentionally not vaccinated. However, other states still allow for religious or philosophical reasons as valid justification for exemption. 

If we look at the numbers, all 50 states (and DC) allow for medical exemption, 47 states (and DC) allow for religious exemption and 17 states (and DC) allow for philosophical exemption.

Herd immunity + Vaccines individually + Recent times

While vaccines do in fact protect the individual themselves, they also give us herd immunity: the idea of indirect protection when the majority of the people in the community are vaccinated and immune to the disease, limiting spread and protecting those who have not been vaccinated. Herd immunity is especially important for those who are medically fragile, such as people who are immune compromised or are too young to receive the vaccine. Many parents against vaccinations believe that herd immunity will protect their children. However, with the growing number of participants in this anti-vax movement, there have been outbreaks of diseases, formerly thought to be controlled or eliminated. For example, our current measles outbreak has been caused by under-vaccination. Unfortunately, this is not uncommon as many diseases that have not been seen for a long time are returning due to vaccine hesitancy.

Above is a graph provided by the Center for Disease Control and Prevention, the CDC. (Note: The data for 2019 was last recorded June 20, 2019, as the number of cases for this year continue to rise.)

Conclusion

As you are now well aware, there are many reasons parents have for not wanting to vaccinate their kids, whether it is due to religious, ethical, or personal beliefs. However, as the rate of vaccine hesitancy increases, the rate of serious and deadly diseases increases as well. Unfortunately, this has led to the resurgence of “eradicated” diseases. Regardless of the abundance of scientific studies supporting vaccination, our society still supports personal choice. The question remains whether personal liberty trumps societal health and wellness.

“In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.” -Benjamin Franklin