Last week, the New York Times published an article about Washington state’s efforts to increase vaccination rates, which include a new
law that would require parents to get a physician’s signature should they choose
to opt out. Interestingly, the article quoted a naturopathic physician who
supported vaccination and talked about some of the reasons parents avoid them,
rather than opposing vaccinations, as NDs are often accused of doing. It always
makes me happy to see NDs portrayed positively in the media, but on this topic
in particular I was glad that an ND got a voice.
Let me put it in simple terms right here at the beginning:
in a conversation dominated by loud voices at either end of the spectrum, the
naturopathic profession should promote a moderate point of view, one the
resonates with what the majority of parents and healthcare providers
understand, and that respects the needs of both the population as a whole and
individual children. Both the movement against vaccines, as well as physicians
who ‘fire’ patients for refusing vaccination have major failings. Rejecting
vaccines ignores the tremendous victories over infectious diseases that we’ve
seen in the past century, and allows for the re-emergence of diseases that are currently
well-controlled. On the other hand, firing patients who decline vaccination
alienates people from the healthcare system and is self-defeating in the effort
to increase vaccination rates.
As healthcare providers and as good scientists, NDs
understand the important role that vaccinations have played in the history of
disease. Smallpox, a disease which in the 20th century alone killed
over 300 million people worldwide, has been eradicated in the wild since 1979.
Polio, a disease that affected even the future President of the United States,
has been nearly eradicated, save for isolated regions in Nigeria, Afghanistan,
and Pakistan. Many potentially fatal diseases, such as pertussis and diphtheria
have been curbed, primarily due to vaccination. Clinical success of this
magnitude is undeniably important.
Vaccines are sometimes called victims of their own success –
their importance is easily forgotten because, when successful, nothing happens.
To draw modern analogies, imagine that we were able to completely eliminate
smoking, or Type II Diabetes, or Breast Cancer – the effect on public health
would be massive. To prevent these illnesses through a public health campaign
would save millions of lives and prevent suffering on an enormous scale. This
is the same type of effect that vaccinations have had. To be able to continue
to eradicate these infectious diseases, and prevent future epidemics, is a
great opportunity for our profession.
At the same time, because of our attention to individual
needs and individual cases, NDs understand that some patients have needs or
desires that must be respected. A growing number of physicians are ‘firing’ patients who decline vaccinations, and while this is not without reason, I
think there are serious problems behind this practice. Firing patients (or more
specifically parents) who refuse vaccinations alienates these families from the
healthcare system, and may result in these families seeking out providers who
agree with them regarding vaccination, but who may not be fully qualified to
deal with the ramifications of non-vaccination. Additionally, firing patients
loses the battle for vaccination – while parents may not be willing to have
their child fully vaccinated at 2 years old, they may be persuaded to do so a
few years later, with the birth of a second child, for example. Vaccination is
not an on-or-off switch, and catch-up schedules do exist for children who are
not vaccinated on the first pass. It’s important to keep these families in the
conversation, and at least under medical supervision.
I should note here that the American Academy of Pediatrics’
official position is that physicians should respect parents wishes, but
continue the conversation on vaccination. The American Association of
Naturopathic Physicians has a similar position. Of course, these moderate
points of view don’t make headlines, as it’s the loudest, most extreme voices
that make it into newspapers.
My last note today is simple: we need to understand more.
One of the primary concerns raised by vaccine objectors is the proposed link to
autism. I’m not going to make a comment on that proposed connection, but what I
will say is that we need to understand autism better than we currently do – we
can describe it quite well, and have diagnostic criteria for it, but still have
little understanding of why it occurs in the first place, and are still
scraping the surface of how to treat it. There are treatments and theories out
there, but nothing has really come to the fore as a unifying explanation of
autism. Autism can be a very scary disease for parents, and it’s not surprising
that parents are frustrated with physicians’ lack of answers; a better
understanding of the cause and treatment of this disease would almost certainly
take some pressure off vaccination.
Additionally, we need to understand more about vaccines and
adverse events. We know that they happen, we know the basics of preventing them,
but we haven’t fully eliminated them. Some are minor, like pain and redness
around the injection site. Some are more serious, including neurological
damage, high fevers, and other issues. Vaccines have improved over time, even
in the past few years, so that they are far more targeted, with less likelihood
of side effects – even so, though, their near universal use necessitates that
we understand why adverse events happen in isolated cases. Unfortunately, this
will take some time to determine, as these events are rare enough that it takes
significant amounts of time for enough cases to accumulate to make conclusions.
The system isn’t yet perfect, but efforts are being made. In
the interim, consumers should work with qualified healthcare providers who are
willing to have a conversation about vaccines and supply information. Likewise,
providers shouldn’t alienate skeptics, but rather keep them in the
conversation. A moderate course of action, based on advancing public health and
respecting individuals is currently the best solution to this slightly thorny
issue, and it’s no surprise that both the AAP and AANP have advocated for this
approach.
