Arguments Surrounding the Vaccination of Children

Measles. Smallpox. Polio. Three of the deadliest diseases known to man that, together, have resulted in the deaths of hundreds of millions of people. Once upon a time, catching any one of these diseases was considered a death sentence as there was no known cure.

Today however, smallpox and polio have become a distant memory, while measles outbreaks are a rare occurrence. How did this happen? How did three of the deadliest, most infectious diseases in history simply disappear? The answer to that can be traced back to creation of the first vaccine in 1798. Ever since their creation, vaccines have reshaped the landscape of human health and medicine and are considered by many scientists among the greatest successes in public health. With that in mind, there should be no question that mandatory vaccination for children is a logical solution to ensure that they lead healthy lives.

A vaccine is a biological preparation that improves immunity to a particular disease. When a virus or bacteria infect the human body, the bodies immune system immediately recognizes it as an intruder and produces molecules called antibodies to hunt down and kill the disease. After the virus is gone, the immune system will memorize what it looked like, so that if the same virus attacks the body again, the body will be able to form more effective antibodies at a faster rate. Vaccines can help in this process by teaching the body to recognize a pathogen that is has not encountered yet. All vaccines contain a sample of a specific disease such as smallpox or measles, but in a dead or weakened state so that the body can learn what the pathogen looks like and produce antibodies in advance.

That way, when the body encounters the real disease, it has antibodies prepared to deal with it before it can do any real damage. Today, there are five main types of vaccines: live vaccines fight viruses and contain a weakened version of the living virus. Inactivated vaccines fight viruses and contain the killed virus. Toxoid vaccines prevent diseases caused by bacteria that produce toxins in the body and contain weakened toxins. Subunit vaccines include only the important antigens of the virus or bacteria.

Finally, there are conjugate vaccines, which are especially important in protecting children. These vaccines fight a different type of bacteria which have antigens with an outer coating of sugar-like substances called a polysaccharide that “hide” the antigen from a child’s immature immune system; the vaccine connects the polysaccharide to the antigens, so the immune system can react (Watts, 2016).

It has been proven through multiple studies that vaccines help save children’s lives. Multiple organizations, such as The Centers for Disease Control (CDC), the Food and Drug Administration (FDA), and the American Academy of Pediatrics have spoken in favor of vaccines and vouched for their effectiveness in preventing child deaths. In particular, Robert Scullin, a professor at John Hopkins University, writes that “between 2000 and 2015, Hib (Haemophilus influenzae type b) vaccines prevented the deaths of 1.2 million children and PC (pneumococcal conjugate) vaccines prevented about 250,000 deaths” (Scullin, 2018). Before the creation of these vaccines, Hib was responsible for 299,000 child deaths, while PC was responsible for 600,000 child deaths. He further writes that between “1994 and 2014, an estimated 732,000 American children were saved from death and 322 million cases of childhood illnesses were prevented” (2018).

Vaccines not only save the lives of children already born but are also important in ensuring future generations are protected from disease. Vaccinated mothers protect their unborn children from viruses that could potentially cause birth defects, and vaccinated communities can help eradicate diseases for future generations. Mahesh Vidula, a professor of Biological Engineering at MIT, writes that “before the rubella vaccine was licensed in 1969, a global rubella (German measles) outbreak caused the deaths of 11,000 babies, and birth defects in 20,000 babies between 1963 and 1965 in the United States” (Vidula, 2011). Further studies have shown that women who were vaccinated as children against rubella have greatly decreased the chance of passing the virus to their unborn or newborn children, eliminating the birth defects, such as heart problems, hearing and vision loss, congenital cataracts, liver and spleen damage, and mental disabilities, associated with the disease.

In addition, vaccines are responsible for the near eradication of multiple deadly diseases. As mentioned before, children today are no longer vaccinated against smallpox because the disease no longer exists due to vaccination. The last case of smallpox in the United States was in 1948; the last case in the world was 1977 in Somalia. In the twentieth century, there were 16,316 deaths from polio and 29,004 deaths from smallpox yearly in the United States; in 2012 there were no reported cases of polio or smallpox (Bhandari, 2018). Though polio still exists in countries such as Afghanistan, Nigeria, and Pakistan, there were only 500 reported cases in 2014, a sharp decrease from the 350,000 cases that were found in 1988. Other cases of dangerous diseases, such as diphtheria, measles, mumps, and rubella have decreased by 99% thanks to vaccines (2018).

Mandatory vaccinations not only protect the immunized but can also reduce disease among unimmunized individuals in the community through “indirect effects” or “herd protection”. Herd protection occurs when a large percent of a community is vaccinated to an extent that an outbreak is unlikely to occur. This protects both children and adults who cannot be vaccinated due to either age or poor health, as well as lowers the risk that the disease could spread. An example of this occurred in 2005, when an 18-month-old Amish girl contracted polio and spread the disease to four other unvaccinated children, but because the community met the herd immunity threshold for the disease, there was no polio outbreak (Watts, 2018).

Without herd protection however, those unvaccinated are at higher risk of infection in the event that an outbreak occurs. Just to give an example of what happens when herd protection is too low, in 2008 48 children in San Diego had to be quarantined during a measles outbreak because they were too young to be vaccinated and could not rely on herd immunity to keep them safe. Another example occurred in 2012 as a result 49 US states not meeting the 92-94% herd immunity threshold for whooping cough. This resulted in an outbreak that sickened 42,000 people and was the biggest outbreak since 1955 (2018).

A concept closely related to herd protection is source drying. Source drying involves identifying a particular group as the source of an infectious outbreak and targeting them for vaccination to decrease the spread of disease. For example, in North Queensland, Australia, there was a high incidence of hepatitis A in the indigenous population. By targeting the infants of that particular population for vaccination, the disease was eliminated before it could spread to other indigenous peoples who weren’t vaccinated (Watts, 2018). The proven success of source drying is often used as justification for vaccinating special occupational groups in most countries, such as food handlers and people who spend large amounts of time around children.

In addition to health benefits, vaccines also provide economic benefits to both parents and to society as a whole. According to research done by Mahesh Vidula, “children vaccinated between 1994 and 2014 have yielded net savings of $1.38 trillion in 'societal costs,' including money saved by preventing lost productivity due to disability and early death. $6.2 billion more could be saved in treatment costs if vaccines were more prominent in the world’s poorest countries” (Vidula, 2011). Further studies have shown that parents would actually save money by vaccinating their children as it would mean less missed wages for time off needed to take care a sick child, potential long-term disability care, and medical costs.

According to a study conducted by Michael Kinch, an associate vice chancellor at Washington University in St. Louis and director of the Center for Drug Discovery, children under five with the flu are contagious for about eight days which costs their parents an average of 11 to 73 hours of wages (about $222 to $1,456) and $300 to $4,000 in medical expenses” (Kinch, 2018, pg. 14). Furthermore, under the Patient Protection and Affordable Care Act (PPACA, or Obamacare) many vaccines are available to children and adults without copay.

However, despite the obvious benefits of vaccines, some people remain skeptical of both their effectiveness and safety. In fact, these people go as far as to actively campaign against vaccinating children. Today, these anti-vaxxers as they are commonly called include parents, politicians, and religious leaders, all of whom oppose vaccinations for a variety of reasons. Among the most popular arguments within the anti-vaccination movement is that vaccines cause autism, a serious developmental disorder that impairs the ability to communicate and interact.

This argument was popularized by a British surgeon named Andrew Wakefield, who is often credited as “the father of the anti-vaccine movement”. In a 1998 article that he wrote, he claimed that there was a link between autism and the measles, mumps and rubella vaccine. In the article, he described a study of twelve children who had begun exhibiting symptoms of autism, as well as gastrointestinal issues, shortly after receiving the rubella vaccine. This article and Wakefield’s findings are often used as a rallying cry for anti-vaxxers for why vaccines are dangerous and should be banned.

However, what many people do not realize is that Wakefield’s study was debunked not long after he published it. Other scientists conducted similar tests to the one Wakefield conducted and failed to corroborate his findings. From 1999 to 2005, scientists in countries such as the UK, Finland, Denmark, and Japan all performed similar tests, and none of them were able replicate the results that Wakefield boasted of. Most recently, studies performed by Australia and the U.S. analyzed the combined results of ten prior studies — collectively involving over 1.2 million children — and similarly found no relationship between vaccines and autism (Chau, 2014).

Questions began to arise about the legitimacy of Wakefield’s findings until 2004, when an investigative journalist named Brian Deer presented evidence that Wakefield may have falsified data in his publication. This evidence, as well as years of studies that failed to verify Wakefield’s findings, eventually led to the General Medical Council ruling Wakefield guilty of serious misconduct in 2010 retracting his original article. A few months later Wakefield was removed from the UK medical register and barred from practicing medicine in the UK.

Another common argument that anti-vaxxers use is that vaccines contain ingredients that can lead to adverse, sometimes fatal reactions in certain people. For example, some vaccines contain aluminum, and excess aluminum in human bodies can cause neurological harm. Other vaccines contain formaldehyde, a carcinogen that can cause side effects such as cardiac impairment, central nervous system depression, changes in higher cognitive functions, coma, convulsions, and even death. Some vaccines for the flu contain chicken egg protein, which can be harmful to children who are allergic to eggs. Even the CDC notes that all vaccines carry a risk of a life-threatening allergic reaction in about one per million children (Chou, 2016).

There is some merit to the anti-vaxxers concern. Some vaccines do contain harmful ingredients such as aluminum, formaldehyde, and other dangerous compounds that can be life-threatening when taken in large doses. However, the amount found in vaccines is so miniscule, that they are essentially harmless. Children are exposed to more aluminum in breast milk and infant formula than they are exposed to in vaccines. While an adverse reaction is certainly a possibility, according to Vivian Chou, a Biology professor at Harvard University, 'you are 100 times more likely to be struck by lightning than to have a serious allergic reaction to the vaccine that protects you against measles“ (Chou, 2016). In addition, the FDA requires up to 10 or more years of testing for all vaccines before they are licensed, and then they are monitored by the CDC and the FDA to make sure the vaccines and the ingredients used in the vaccines are safe (2016).

A third argument often employed by anti-vaxxers is that mandatory vaccinations is an infringement on a person’s individual rights. They argue that medical decisions for children should be left to that child’s the parents or caregivers. Many anti-vaxxers fear that this could lead to a slippery slope where the government slowly takes away the individual rights of its citizens. Barbara Low Fisher, Co-founder of National Vaccine Information Center, has stated that, 'If the State can tag, track down and force citizens against their will to be injected with biological products of known and unknown toxicity today, there will be no limit on which individual freedoms the State can take away in the name of the greater good tomorrow' (Chou, 2016). Anti-vaxxers argue that they should have the right to choose what medication their children should or should not take, and that taking that choice away from them is an infringement on their rights.

While an argument can be made about the government’s involvement in the lives of its people, at the end of the day, the issue of vaccination goes beyond individual personal choice. It concerns the public health of society as a whole. While parents may have the right what medical treatments their child receives, that right should not supersede the rights of another person to live a healthy life. Multiple studies have shown that vaccines not only save the lives of the vaccinated, but also prevent infections from spreading to those in the community who are not vaccinated. Tamara Bhandari, a biophysics professor at the University of California, stated succinctly: “When you choose not to get a vaccine, you're not just making a choice for yourself, you're making a choice for the person sitting next to you” (Bhandari, 2018).

It is understandable that some people would have a problem with mandatory vaccination of children. Vaccines, like all medical technologies, have advantages and pitfalls. However, research shows that the pros of vaccinations far outweigh the cons. While some vaccines can cause dangerous reactions, more often than not, vaccinating children saves not only their lives, but the lives of those around them as well. Vaccines have a long way to go before they can be considered fully safe, if such a thing is possible, but for now, they are the most effective weapons we have to protecting society from disease.