As an infectious diseases specialist married to a pediatrician, I am going to propose, in most unhumble fashion, that I have the ideal perspective to assess the worthiness of vaccines.
So when Robert F. Kennedy Jr., a notorious anti-vaccine crusader, announced this week that he was under consideration to head a government commission on vaccine safety and scientific integrity, and is planning to step away from his environmental job to take that post, I had several thoughts.
The first was to come up with a suitable analogy for this hair-raising prospect. Was it like asking Bernie Madoff to manage the Federal Reserve from his prison cell? Or maybe Lance Armstrong to head up a committee on doping in sports?
And then it occurred to me that we have seen something like this before, when Elvis Presley received an official Federal Narcotics Bureau badge from Richard Nixon, this just a few years before Presley died of a drug overdose. Priceless.
My second thought was a reflection on just why this possible appointment makes both of us so angry. And it’s hard to make infectious disease doctors and pediatricians angry — we’re the nicest bunch of doctors you’ll ever see, especially the pediatricians. They coo over everyone’s babies (even the ugly ones), and wear costumes to work on Halloween. They used to have small stuffed koalas clinging to their stethoscopes, but we no-fun ID doctors told them that practice might spread “germs.” Now, no more koalas.
But right now, we're not feeling nice, we're feeling horrified and furious. Because infectious disease doctors and pediatricians know firsthand about the miraculous reduction in serious infectious diseases from vaccines.
Boy, do we love vaccines. Let me list the ways, with a focus on simplicity, because this information doesn't seem to have gotten through to Kennedy:
● Vaccines prevent suffering and death. Here are a few numbers for the United States:
-- Paralytic polio — 16,000 cases per year pre-vaccine, 0 now.
-- Bacterial meningitis or other serious illness from Haemophilus influenzae type B — 20,000 cases per year pre-vaccine, fewer than 50 now.
-- Measles — 530,000 cases per year pre-vaccine, 100 now.
● Vaccines prevent suffering and death even in the people not vaccinated. What a bonus. Remember, most of the childhood diseases for which we recommend vaccination are highly contagious. In fact, I have never read a single review of measles transmission that does not include these very two words: 1) Highly. 2) Contagious. How does a 90 percent household transmission rate sound? See, I’m being very simple.
● Vaccines prevent illness in the most vulnerable populations. This is related to the previous point, but deserves emphasis, because it underscores the societal responsibility of getting vaccinated and highlights the selfishness of vaccine refusers. A major reason we want healthy people to get their pertussis vaccines and flu shots is that very little babies (pertussis) and frail old folk (flu) don’t respond well to the vaccines — but are the most likely to die from these diseases. This plea comes from our hearts: Protect them!
● Some vaccines prevent cancer. The hepatitis B and HPV vaccines are the stars here, preventing hepatocellular carcinoma and cervical, anal and some head and neck cancers, respectively. If enough of the population is vaccinated against HPV, the need for cervical pap smears will be greatly reduced, if not eliminated.
● They also prevent loss of family income. When the chickenpox vaccine was approved, some questioned the need for a vaccine for such a “mild” disease. To which I would ask in response: Mild to whom? To the child who is spotted and itchy and miserable for a week? To the kid’s parent who can’t work while Junior is out of school? Plus, a small percentage of kids with chickenpox got very sick, requiring hospitalization for pneumonia or secondary skin infections.
● And they save money. Childhood immunizations are one of the very few medical interventions that actually save society money. Even our most cost-effective, miraculous medicines — statins for heart disease, antiviral therapy for HIV, TNF-blockers for arthritis, tyrosine kinase inhibitors for leukemia — don’t save money. But if a cheap H. flu vaccine can prevent childhood meningitis and a lifetime of subsequent neurologic disability, everyone benefits — patients, caretakers, government, even insurance companies. And most of all, of course, the child.
● They elicit broad consensus among policymakers. The CDC’s Advisory Committee on Immunization Practices does not make vaccine recommendations in an offhand, casual manner. They review all the efficacy and safety data on a given vaccine, and then provide comprehensive, sensible and widely adopted recommendations. If you want evidence of your taxpayer dollars at work for the common good, here’s a great example.
● And finally, they are incredibly safe. If there’s a silver lining to the anti-vaccine cloud, it is that it has forced scientists and public health officials to rigorously scrutinize the safety of vaccines. And ever since the notorious Wakefield paper in Lancet suggested a “link” (intentionally put in quotation marks) between the MMR vaccine and autism, innumerable studies have disproved this association — and the paper has been retracted.
One of my colleagues, a vaccine researcher, says it's hard to be grateful about not having a problem you’ve never had, or have never even seen. By contrast, everyone knows a child with autism, a condition for which there is no single obvious cause. But that anti-vaccine activists like Kennedy attribute autism to vaccines is the kind of flawed scientific thinking that we must fight, regardless of political leanings.
If only, my wife and I have been wishing, there were a vaccine against the sort of flawed thinking that makes people oppose vaccines.
Dr. Paul E. Sax is clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital, and a professor at Harvard Medical School.