We now have at our disposal a large arsenal of effective and safe vaccines. Unfortunately, getting families who could benefit from these immunizations to accept them continues to be a challenge. I recently read a short news story that got me thinking about where the stumbling blocks to vaccine acceptance lie ("Move to Get Bin Laden Hurt Polio Push", Wall Street Journal online, Dec. 3, 2011).
In what seems to me to be a despicable and ill-conceived effort to capture Osama bin Laden, our own Central Intelligence Agency – through a local doctor in Pakistan – set up a fake hepatitis B immunization program near where bin Laden was suspected to be hiding. According to sources, the CIA hoped that DNA samples could be collected from bin Laden’s family members that would confirm the agency’s suspicions. Inevitably, the mock program became public knowledge. Some families have cited this deception as one of their reasons for refusing the ongoing polio eradication program in that region of Pakistan.
This seems to be a tragic example of the end not justifying the means. When it comes to immunization programs, credibility is the currency for those of us whose job it is to administer the vaccines. I suspect that it will be many years and several generations before this deception is forgotten in this part of Pakistan.
By Dr. William G. Wilkoff
Here in the United States, vaccine refusers seem to cluster into three categories. By far, the smallest includes those parents who have severe needle phobia. Although nobody enjoys watching a child receive an injection, the fear in some parents is so intense that they will go to extremes to avoid bringing their child in for a shot. If I am lucky to discover the underlying phobia, I can usually structure the visit so that the parent can be shielded from the sight and sounds of the procedure.
Also by far, the largest group of vaccine rejecters includes parents who are either sadly misinformed (the MMR-autism tragedy is too painful for me to revisit) or – more likely – uninformed about the need for immunization. It is hard to know exactly where to point a finger for this educational deficit. In some cases, serious complications of a disease may occur so infrequently that it is easy to understand why a parent may not have even third- or fourth-hand experience to motivate them; even a 70-year-old pediatrician might retire without ever having seen a varicella-related fatality.
It may be that when history is taught in school, too little emphasis is given to the role that disease has played in the unfolding of our national heritage. In addition to seeing the monuments, perhaps students who visit the nation’s capital should be taken on a stroll through an 18th-century cemetery. My own children have heard nothing about the fear my parents experienced during the polio outbreaks of the 1950s. And has anyone told students the incredible success story of smallpox eradication? It’s science, and it’s history, and it’s information parents need to make informed decisions about their children’s health. We pediatricians need to update it for them, but we rely on schools to provide the basic knowledge foundation.
The third group of immunization decliners includes the parents whom I consider the most frustrating. They often accept the tenet that immunizations are effective, but – although they are happy to reap the benefits of herd immunity – they don’t want to take even the miniscule risk that comes with any immunization. Some believe that by living a "healthy lifestyle" on the periphery of the herd they can avoid the diseases that the rest of us less-virtuous folks are vulnerable to.
Finally, let’s not forget that the government must maintain its credibility when it comes to vaccines – because it’s not just the Pakistanis who are skeptical about immunizations.
Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.