Why should our children receive immunizations? This question is heard in the media, in some of our state legislatures and in federal hearings. The answer is clear: Immunizations improve health and save lives.
Thanks to the development and widespread use of modern vaccines, we have entered a new era of child health. Immunizations have reduced by more than 95 percent to 99 percent the vaccine-preventable infectious diseases in this country.
No longer do parents live in fear that their children will develop life-threatening paralysis from polio when they are at a swimming pool or movie theater. From 1951 to 1954, four years before the polio vaccine was licensed, there were 16,316 reported cases of polio each year. In 1998, because of polio immunizations, there were no reported cases of wild-type polio in the United States.
No longer do parents have to worry that a child with a high fever who is attending a child care center has developed Haemophilus influenzae bacterial meningitis and will suffer seizures, deafness or mental retardation. Before the licensure of Haemophilus influenzae type B vaccine in 1985, more than 20,000 serious cases were diagnosed each year. In 1998, only 54 cases were reported.
No longer do parents worry about large epidemics of whooping cough, a horrible disease in which a child chokes on his or her own phlegm. In the 1920s, before pertussis vaccine was available, more than 147,000 cases of whooping cough per year were reported in the United States, compared with 6,000 cases reported in 1998.
Immunizations are effective preventive medicine, and they have been used extensively, immunizing large numbers of children. These high immunization rates reflect the importance that most parents and doctors lace on protecting children from dangerous diseases that are easily prevented with vaccines.
Among parents of young children, support for immunization is strong. When asked on a recent survey to rank -- on a scale from 0 to 10 -- the importance of immunization for protecting a child's health, 87 percent of parents ranked immunization a "10," or extremely important. Focus group research supports these findings, and the vast majority of participants expressed positive feelings about immunizations.
However, the level of childhood protection that we have established is fragile and depends on what we refer to as "community immunity." Modern childhood vaccines are 90 to 95 percent effective. If sufficient numbers of children in a community are immunized, the vaccinated ones protect the unprotected by stopping the chain of transmission and drastically lowering the probability that a susceptible child will encounter the bacteria or virus. As long as the great majority of children receive their vaccines, we will be able to maintain our current level of disease control. However, should the level of community protection drop to a point where viruses and bacteria travel unimpeded, we will return to the era when deadly epidemics were an accepted part of life.
It is important to balance the public health and safety of our children and community with the principle of personal freedom of choice. An individual's "freedom" to choose not to immunize puts the child and society at risk. Failure to immunize a child not only puts that child at risk of illness but also increases the potential for harm to other children who are either not able to be vaccinated because they are too young or too ill, or to those in which the vaccine did not provide the expected protection.
Our experience with measles vaccine illustrates this point. In the late 1960s and early 1970s, despite the availability of a safe and effective measles vaccine, we experienced regular epidemics of measles. At that time, schools did not mandate vaccination, and most communities had vaccination rates of 60 to 70 percent. This coverage rate for measles did not and will not provide sufficient "community immunity" to prevent an outbreak.
A recent study published in the Journal of the American Medical Association found that on average, those who were not immunized were 35 times more likely to contract measles than those who had been immunized.
Despite all that vaccines have done to improve the health of individuals and communities in the United States and around the world, we, as pediatricians, recognize that vaccines are not perfect.
However, the benefits of immunization far outweigh the very small risks. I feel great sympathy for those unfortunate few who may have been harmed as a consequence of immunization. Though such reactions are rare, when a pediatrician advises a patient on the benefits of vaccines in preventing disease, it is important to acknowledge the very remote chance of an adverse reaction to the vaccine. It is equally important that we protest sensational and unproved reports about adverse effects of vaccines and that we fight to maintain and improve the level of immunization among our children.
Why should our children receive immunizations? The real question is, why would we deny our children society's greatest health care achievement? We won't, as long as we have all the facts.
