Vaccinations: A Shot in the Dark?

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The most recent outbreak of measles in the U.S. has reignited the vaccine debate, especially around the issue of whether medical decisions, historically left to parental consent, should be mandatory. Like most parents, my awareness peaked in the months before my first child was born. Because we were planning a home birth, outside of the conventional medical support network, we had to make those decisions ourselves. Because we were disinclined to take the advice of any single person, doctor, or government entity when it comes to important family decisions, my wife and I dug in and spent some long nights researching our options, reading a variety of books, and finally interviewing three potential pediatricians.  Like many big life decisions, research didn’t necessarily make our choices any easier. I came away with one belief I hold to this day. Once fear, parental insecurity, peer pressure, and bureaucratic inertia were peeled away, the answers I was seeking were somewhere in the middle of the current extremes that frame the contemporary debate.

It’s easy to make the argument that vaccines halt the spread of the targeted diseases and there is plenty of research to support this. Yet they are not without risk. In fact, in order to provide legal immunity to the pharmaceutical industry and doctors that administer vaccines, Congress passed the National Childhood Vaccine Injury Act of 1986. Since its inception it has paid out over $4 billion to parents of children that have suffered permanent disability and death as a result of reactions to vaccines. In the end, a better understanding of the state of public health policy, research, and finding a pediatrician willing to discuss a plan suited to my child’s individual health needs, lifestyle, geographic location, and exposure risk led us to a more balanced approach. A small portion of the insights important to our decision include:

Public Health Policy.  By nature public health policy will always gravitate towards a “one size fits all” proposition. The reason the recommended vaccine schedule starts with newborns in the hospital is not because it’s medically imperative at that stage, but rather due to policy formulators’ knowledge that if a child leaves the hospital without vaccines, the odds of a parent following up and getting them later tapers off. And our economic reality is such that many uninsured or low-income parents don’t take their children to well-baby checkups, which is another lost opportunity. However, “one size fits all” policy does not take into consideration any variables of health, place, or circumstance unique to any one child. At one extreme, is it the case that a child headed to infant daycare a few weeks after birth and living in an inner city requires the same vaccination plan as a home-schooled Inuit child living north of the Arctic Circle?

Research. There is still plenty of ongoing research and more needed. Unfortunately, one study linking vaccines to autism that was shown to be flawed has sucked up most of the public awareness and media attention on this issue. It has further overshadowed both the industry-acknowledged risks and data, as well as a variety of other research demonstrating possible damage to DNA, immune suppression, and associations with the increases in ADD and ADHD and Allergic Disease in children, to name a few. Additionally, the bulk of research on vaccines has been on efficacy, rather than safety. The research is compelling and continues to raise a lot of questions. However, current regulatory agencies consider the benefit-to-risk ratio to favor many vaccines and public opinion and policy reflects this.

Policy Arena. Studies have shown that in many cases around the world, low vaccine rates are the result from a lack of faith in governments that implement them. There is no known vaccination against this piece of human nature. Because the way our political system works in the U.S., public health policy is heavily influenced, and in some cases, directed by corporate lobbying. There are countless cases where the interests of industry supersede public welfare in our food and medical policy arenas.  Given that vaccine manufacturing is a $30 billion a year industry and our current Supreme Court believes that corporations have the same rights in our political arena as people, that’s not likely to change. It’s only exacerbated by the reality that heads of regulatory agencies, such as the CDC and FDA, are political appointments and often recruited from the industries they regulate. The fact that the CDC now recommends that children today receive three times more vaccines than they did in 1983 is not entirely the result of new diseases posing a threat to public safety. Also, consider the  “Half-life of Truth” study. Interestingly, a group of cardiology researchers looked back at medical research in 20-year intervals. What they found was that every 20 years you go back, 50% of the research, and policy it influenced, is no longer valid. Much of the popular research cited today about vaccine safety and efficacy is much older. Clearly this dialogue is not over. Nor should it ever be. Knowledge is not static. But public opinion and policy can be.

Public Opinion/Peer Pressure.As you can see in the contemporary debates on border security, terrorism and immigration, fear, often irrational, is a big driver of public discourse. This debate is not immune. Because we charted our own path, the hackles were raised among a few of our friends and family. Some dug in their heels holding strictly to their pediatrician’s words or CDC recommendations as gospel. Others supported our decisions once they took the time to listen. Yet the fact remains that as parents, we all live in fear of making the wrong decision when it comes to our kids. No one likes to be second-guessed and many even feel threatened when another parent makes a decision different from their own.  That’s just human nature. This, I believe, leads to some of the more entrenched opinions and shrill commentary one can experience on social media or in social circles.

In the end, my journey brought me to a place where I felt much more in control and informed. The chosen pediatrician agreed with us that current public policy did not consider the benefit-to-risk ratio of our particular situation. We discovered we had the option to save some for later, or that some might only be needed before overseas travel, and a few were not needed at all. These were all decisions unique to my child that I, and our pediatrician, were in the best position to make. And throughout, we never lost sight of reality that circumstances change. Had we decided to put our child in daycare, our plan would have adjusted, as it did when our home-schooled child entered public school at 3rd grade. International travel resulted in another re-assessment. And when our first child went off to college, more decisions were made and vaccines received. We don’t pretend to have made the best or most informed choices. We simply chose not to hand those decisions over to solely the CDC or the pharmaceutical industry, or let public opinion, peer pressure, or sensationalist media carry the day. We didn’t take a shot in the dark and a little light went a long way. In the end, it’s our decision as parents. And it should be yours, too.

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