Editor’s note: This commentary is by Peter Reed, who is a third-year resident in pediatrics at the University of Vermont Children’s Hospital. The opinions here are his own and do not necessarily represent those of the Children’s Hospital or the University of Vermont.
[W]hen my daughter started daycare at five months old, I was excited that she would get to play and learn with other children. But I was worried that she could be exposed to dangerous, vaccine-preventable illnesses such as pertussis (whooping cough), varicella (chicken pox), influenza, or measles because of unvaccinated or undervaccinated children at her daycare. At five months old, she had had the two rounds of vaccines recommended by the Centers for Disease Control (CDC). She had not yet been immunized against measles and chicken pox, which can be done earliest at 12 months of age. She was not yet fully immunized against pertussis. If a child infected with measles or pertussis came to my daughter’s daycare, she would be at risk.
We Americans are extremely privileged to have a low burden of infectious disease. Thanks to concerted, long-term investments in drinking water and sewage treatment, infection surveillance and control, food safety systems, and — yes – vaccination, most of us are at very low risk of contracting or dying of cholera, tuberculosis or polio. This freedom from infectious diseases is a public good. It is being degraded by self interest and violation of the social contract.
A public good is available for use, for free, by anyone; no one can be denied a public good. A public good also does not diminish with additional users. A common example is a streetlight. Anyone can walk under its light for free; and it will light the sidewalk for two people — or 10 — just as well as it will for one. A streetlight is usually powered and maintained by a government, which levies taxes to do the job. If we stop paying taxes, the lights go out.
Similarly, out-of-state visitors to Vermont can drink our tap water, eat at our restaurants, and visit our ski resorts with a reasonable expectation that they will not get sick with a serious infectious disease. We should do everything we can to maintain this public good: the freedom from infectious diseases. Specifically, we should fully vaccinate every child who can be vaccinated using the most up-to-date recommendations from the CDC.
It is worth taking a brief look at the history of success of vaccination programs in the United States. According to the CDC, before the pertussis vaccine was given to infants routinely, there were about 8,000 deaths per year due to whooping cough. Now there are fewer than 40 deaths per year. Before the varicella vaccine program was started in 1996 there were more than 100 deaths and 10,000 hospitalizations due to chicken pox. Now there are fewer than 20 deaths and 1,700 hospitalizations. In the early 1950s, there were more than 25,000 cases of polio each year. The vaccine was introduced in 1955 and now polio has been eliminated from the U.S.
If enough people are free riders and do not get vaccinated, then the public good is lost. This has happened already in Vermont with pertussis and is happening nationally with measles.
We are undoing this success. Take measles. Before the measles vaccination program began in 1963 there were 3 million to 4 million cases, 48,000 hospitalizations, and 400 to 500 deaths per year due to measles. In the year 2000, thanks to the vaccination program, measles was eliminated — eliminated! — from the U.S. In 2014, there were 644 cases of measles in the U.S., mostly in unvaccinated individuals. The current measles outbreak has reached 121 cases in 17 states and Washington, D.C. (as of Feb. 9, 2015). Its spread is made possible through pockets of unvaccinated individuals. We can stop this debilitating and deadly disease. But we all have to pitch in.
An effective vaccination program, and the public good it creates, relies on herd immunity. First, vaccines are not 100 percent effective. For every 100 people who are vaccinated against measles, for example, three will not be immune. Second, not everyone can be vaccinated. When my daughter entered daycare at five months, she was too young to be vaccinated against measles. Indeed, the current measles outbreak has affected eight babies at a single Chicago daycare, most or all of whom are too young to be vaccinated against measles. For some, health conditions that affect the immune system, such as pregnancy or leukemia, prevent them from being vaccinated. We need to protect these groups — the very young, the unvaccinated for health reasons, and those who are vaccinated but not immune. We can do this by surrounding them with vaccinated individuals. This is herd immunity and it takes all of us.
Every parent worries about vaccines. As a pediatrician I answer parents’ questions about vaccines. I advise parents about common vaccine side effects, such as sore arms and low-grade fever. I see parents trying to appear brave in front of their children in spite of their own fear of needles. And despite my daily exposure to vaccines, I still wince when my daughter gets her shots. Why do it? The science is absolutely clear. Vaccines are safe. Vaccines are effective. Vaccines save lives. I encourage Vermont parents to talk to your child’s pediatrician about vaccines. Discuss your fears, ask questions, get information, and get your child up-to-date on immunizations.
I believe all Vermont parents, like me, want their kids to be protected from vaccine-preventable diseases. The vast majority of us choose to have our children vaccinated because we understand that the benefits to our children and to society — the public good of herd immunity — outweigh the exceedingly small risk of a serious adverse reaction. A minority of parents have made a different calculation. They look around and see that vaccine-preventable diseases are rare (see above, “history of success of vaccination programs”) and they are surrounded by vaccinated kids, so why put their child through the “risk” of vaccination? Economists call this the free rider problem: people benefiting from a public good — herd immunity — without paying for it — getting vaccinated. If enough people are free riders and do not get vaccinated, then the public good is lost. This has happened already in Vermont with pertussis and is happening nationally with measles.
The primary solution to the free rider problem is regulation. For example, we restrict industrial pollution to protect the public goods of clean air and clean water; we levy taxes to maintain the public goods of streetlights and parks. Similarly, we should use regulation to protect our freedom from vaccine-preventable diseases. I urge Gov. Peter Shumlin and Health Commissioner Harry Chen to follow Lt. Gov. Phil Scott’s lead and call for repeal of the philosophical exemption to vaccination.
