Monday, March 24, 2014

A Debate over Childhood Vaccinations? The View From the Mudroom

As if there simply hasn't been enough drama, opinion or celebrity-mom tweet-hating over vaccines in the last decade, The New York Times has thrown vaccines up for debate once more, this time in their Room for Debate feature. No not that debate. Technically this debate is not over the efficacy or safety of childhood immunizations.  Thank goodness. Fortunately the venerable news source didn't slog through that quackmire but instead turned their considerable platform to the issue of religious and personal exemptions, specifically the question of whether vaccination should be mandatory.

Oh there's room for debate over vaccine exemptions but it's not cavernous, it's more mudroom than ballroom. With vaccination rates above 90% the New York Times or their peers can still debate this issue or at least entertain such debates. This particular discussion though wouldn't be possible without the success of childhood vaccinations.

As for the actual debate, the content, well, you can probably guess most of it. You could have written the arguments. So in lieu of actually reading the article, why not try to match these opinions with the right expert(s)?

A. No Exemptions for Anybody

B. Exemptions for Anybody

C. Religious Exemptions Only (out of respect to the religious folk)

D. Exemptions Are Okay for Now Because We Don't Want to Upset/Coerce Anyone (unless we inadvertently export more childhood diseases)


1. The infectious disease physician at Children's Hospital of Philadelphia (Paul Offit's stomping grounds).

2. The anti-Big Formula/anti-Big Pharma/anti-Big Medicine/anti-Consumerism journalist.

3. The former US Surgeon General (i.e. a political appointment).  

4. Two British pediatric professionals.

You probably could match 1A and 2B pretty easily.                

The last two are probably the hardest. C3 and D4 (yes I made it very challenging). I don't completely buy the Brits' argument that mandatory vax might backfire and create more anti-vaccine sentiment and hence reduced vaccination rates. It is interesting though. Even as a somewhat rebellious type, I can't endorse this without some more evidence. Is there any evidence axing exemptions would reduce vaccination rates? I'm trying to think of any public health legal measures that have backfired.*

Seat belts. Are there drivers out there who stopped wearing seat belts because of mandatory seat belt laws? Motor cycle helmets, probably yes but all my evidences comes from Sons of Anarchy (Season One - seriously how many times let alone seasons can Jax not get killed?)

Child car seats. Any parents not strapping their kids in a booster out of some rebellious, government-go-to hell attitude?

True the risks of non-compliance are hefty in those above legally mandated examples. The risks of not using a car seat appear plentiful even if we discount the possible exaggeration of safety features on today's models.

I suspect mandatory vaccination might also deter some of the parents who might be tempted to turn down vaccines. I know these adults comprise a small but ardent and vocal group but it's possible some might just go ahead and endur the MMR and others just as some who seem to embrace vaccines then might fall into the anti-vax camp.

How about other public health recommendations that could possibly result in oppositional defiance?

The Back To Sleep Campaign. I haven't noticed a backlash, no pun intended.  Pediatric occupational therapists and others have pointed towards its adverse effect on motor development and thus, given us Tummy Time but I've yet to encounter any complaints about parental freedom vis a vis infant sleep position. True mothers have been known to let their kids sleep on their stomachs (guilty) but it's not out of defiance but the simple fact some infants prefer sleeping sunny side up.

Breastfeeding? The latter recommendations aren't mandated by law not yet anyhow but somehow nobody seems particularly worried that strong recommendations might encourage rebellious non-compliance.

Why don't we worry about the blowback from these campaigns?

*Another possibility: my anonymous friend at Public Health Rants (no it's not me, look at the cool graphics) suspects that "going DefCon" on parents who don't vaccinate actually turns people off vaccination. Now that's something to consider. In her post How Not To Not Get Autism: The Kristin Cavallari Story, she argues it's the public outcry against anti-vaccine sentiment that spawns anti-vaccine sentiment:
I know, I know, when people don’t vaccinate it doesn’t just affect them, it affects all the immunocompromised people and babies too young to be vaccinated.  I get it.  Which is why we need to stop going DefCon whatever on celebrities who don’t vax.  Because someone is listening and is choosing NOT to vax because of what they may perceive as unjustified personal attacks.  You don’t catch any flies by hurling acid.  Well maybe you do but you’d kill them.  Or something.  Just be nice is all I’m saying.  What kind of a person do you trust?  Someone who is hateful or someone who listens and doesn’t judge?  What kind of people do vaccine-hesitant parents trust?  So for the sake of the immunocompromised, please let’s not hurl acid.  If that approach worked than everybody would vaccinate.  But they don’t.  So we’re doing something wrong.
Okay PHR, this is me turning nice. Very nice. Stay tuned..


TIME OUT FOR ADVOCACY....

Can you imagine this debate in say Uganda, Nigeria and other countries where parents walk miles to health clinics? As if they're sitting in their mudrooms wondering about the possible negative repercussions of mandated vaccination. As long as I'm on the topic, the United Nations Foundation's Global Mom's Challenge is here again this spring. Here's how it works:


From International Women’s Day through Mothers’ Day–March 7 through May 11–a celebrity or community leader, from New York to Nairobi, will share a personal story of how a mom has changed his or her life, and then “pass the baton” to the next person. Read these inspiring posts and share them with friends through your social networks–each time you do, Johnson & Johnson will donate $1, up to $250,000, for each share on each network, to help moms and babies around the world stay healthy and happy. 


You can sign up to get the Global Mom's daily posts. The Queen of Jordan chimes in on March 26th, Melinda Gates, the 31st.

Of course you can also join the UNF's Shot At Life Campaign, a grass-roots movement to increase awareness, funding and access to life-saving childhood vaccines in the developing world.  It's not just the more economically depressed nations plagued by these diseases. Check out this map of vaccine-preventable diseases compiled by the Council on Foreign Relations and yes, it illustrates these illness are in the United States. The sizes of the circles/dots are not great, the graphics make it seem like entire states are engulfed by measles and whooping cough. Edward Tufte, the grand poobah of graphs would not approve but you can click on the individual circles for the exact # of cases and you can check by disease. NPR has a good description of the map too.

UPDATE: Check out this graphic analysis of the relative risk factors linked to autism. Love it, from Sam Wang at Princeton. 

3 comments:

PHR said...

Hey Momma Data!
Just want to explain a little as I feel my bumbling paragraph quoted didn't totally make sense... Just don't want us to fall into the trap of
Questioning vaccines = She's a witch! Burn her!
People question vaccines for different reasons and I fear we may be prematurely labeling people "anti-vaccine" and promptly feeding them to the wolves before we get a chance to really understand. Like Amy Baxter taught us, some people are hesitant bc they have a real, primal fear of needles and we can do some things to work with that and help them, but just telling them to cowboy up will have them running the other direction. True some people will never touch vaccines but many others will if you parse out how they really feel or what they're afraid of and meet them where they're at. I don't like this make up your own schedule thing (and why is Norway perceived as soon much better?!) but if it is the only thing that will convince a terrified parent who otherwise would skip then it's still a W.

Or we could just call them stupid blonde bimbos and laugh hysterically at them like everyone else does. Ick.

Polly Palumbo, Ph.D. said...

Hi PHR! Yikes, I should have made it clearer that you are in fact a vaccine supporter, I'd hate to give a misleading impression. What is this about Norway?

Public Health Rants said...

Yeah, 2B lady argued that we should replicate the vaccine schedule that Norway has, citing no evidence of how it's better, just the logical fallacy of well...Because Europe? Data please!

Anyway, I found an article I like that points out a celebrity misbehaving without the usual mudslinging and misogyny. I wish the media were more level headed like this Wired writer. http://www.wired.com/geekmom/2012/05/mayim-bialik-disappoints/