Ronald Dunlap, M.D. and John O'Reilly
---- — The state Department of Public Health, in its most recent (2010) Health of Massachusetts report, wrote that “Massachusetts has always had, and continues to have, one of the highest levels of infant immunization in the United States” and that “most vaccine-preventable diseases of childhood have been essentially eliminated” in the commonwealth.
This enviable record is now in jeopardy. The DPH’s Immunization Program has seen an increasing number of religious and medical exemptions to vaccinations among kindergarten students during 2012-2013.
The rate in Essex County is 1.3 percent, reflecting exemptions for 120 children, and that’s below the state average of 1.5 percent. But exemption rates are much higher elsewhere. Three counties in Western Massachusetts are three times above the state average: Berkshire County at 3.2 percent, Franklin County at 6 percent, and Hampshire County at 4.2 percent. In Barnstable, Dukes, and Nantucket counties, the rate of exemption is also three times the statewide average, at 4.5 percent.
The question we must ask is this: Is this a trend likely to continue throughout other areas of the state?
If we need any reason to remind ourselves about the value of vaccines, all we need to do is look around our country and the world. Diseases once thought to be under control, even eradicated, are reappearing with disturbing frequency.
In the U.S., outbreaks have occurred coast to coast. According to the Centers for Disease Control, 2012 was the worst year in six decades for whooping cough with nearly 42,000 cases. Washington state saw a 1,300 percent jump in whooping cough cases from 2011 to 2012. The number of measles cases in the U.S., recently highlighted by an outbreak centered in a Texas church whose ministers reportedly questioned the value of vaccines, is on track this year to be one of the highest in 17 years. Mumps is returning as well, as evidenced by more than 100 cases in Virginia.
Measles and mumps outbreaks have occurred in Canada, Europe, and the Middle East. Polio has shown a fierce stubbornness, resurfacing in Somalia after six years. The disease has reached Israel, which is vaccinating one million children, from Pakistan, one of three countries, along with Nigeria and Afghanistan, where it remains endemic.
Those countries may be far away, but distance no longer provides the protection it once did. A measles outbreak in Brooklyn earlier this year, brought back by an overseas traveler, is a stark reminder that an outbreak — or epidemic — can be just one plane ride away.
Too many people are losing sight of the importance of vaccines. More states are granting medical and philosophical exemptions from childhood vaccinations, and the medical-conspiracy theorists are still at it; despite mountains of scientific evidence on the safety of vaccines, scare tactics can still work with some people.
The irony and frustration of the current resurgence of these diseases is that as more diseases become drug-resistant, as new ones like MERS emerge, we continue to fight the old ones we can easily prevent.
Physicians must recognize the rights of parents to make what they believe are proper decisions about immunizations for their children, even if the physician and the scientific evidence do not support that decision. However, physicians, parents, and patients of all ages must recognize that immunization is a public health priority as well as a personal health issue.
Vaccines have an enviable safety record, they prevent diseases that once claimed millions of lives (and in some countries, still do), and high vaccination rates provide a collective, public health advantage, as even those who are not immunized benefit from “herd immunity” because so many others do get vaccinated.
Vaccines are considered one of medicine’s greatest advances and should be an indispensable part of primary care. With them, we can easily, inexpensively prevent suffering, illness, and death. Without them, our most vulnerable individuals are needlessly put at risk of disease, with the potential for future and lifelong complications. The choice should be clear.
Ronald Dunlap, M.D., a cardiologist at South Shore Hospital, is president of the Massachusetts Medical Society, and John O’Reilly, M.D., a pediatrician at Baystate Health, is president of the Massachusetts Chapter of the American Academy of Pediatrics.