V-Ticket to Ride

by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership

I haven’t been to Disneyland since my senior year in high school, and I’ve actually never visited one of the Disney World resorts. Frankly, I never really cared for the noise, the crowds and the artificiality of the Disney parks. The fact that one of these amusement parks is now the center of an infectious disease outbreak makes my aversion even more intense.

Public health officials in California recently confirmed that an outbreak of measles in that state has been linked to the Disneyland theme park in Anaheim. Over 90 new cases of measles have been reported in California and seven neighboring states during the past two weeks, with over 50 of those cases originating in the Magic Kingdom. Most of those cases occurred among unvaccinated kids.

To put this outbreak into context, consider that in 2000 the US Centers for Disease Control and Prevention (CDC) declared that measles had been eliminated from the United States due to vaccination programs and a strong system for detecting, reporting and responding to outbreaks. Only 37 confirmed cases of measles were reported that year, all of which were imported from other countries.

What a difference 15 years can make. In 2014, the United States experienced a record number of measles cases. 644 cases of measles were reported to the CDC, more than the total number of cases in the previous four years combined. If this year’s Disney outbreak is any predicator, we are likely to surpass the 2014 record.

The disease itself is still largely imported from overseas, but it spreads like wildfire among unvaccinated Americans. This is because measles is one of the most infectious diseases known to man. On average, a person with measles spreads it to 18 other people. By contrast, a person with Ebola (the deadly disease that caused widespread panic last year) is only likely to transmit that virus to one or two others, and only in places that lack a robust public health system. An outbreak of Ebola in the US is highly unlikely, whereas measles outbreaks will probably become commonplace.

The anti-vaccination movement is solely to blame for the re-emergence of measles as a public health threat. The easiest way to prevent the spread of measles is vaccination. If 95% of the people in a community are vaccinated against measles, outbreaks cannot occur. Unfortunately, rates of vaccination have fallen to their lowest levels since the start of widespread measles immunization programs in 1963. For example, over 40% of kindergarteners in Orange County, home to Disneyland and epicenter of the current outbreak, are not vaccinated against measles.

Those opposed to vaccination, including such public health luminaries as disgraced British researcher Andrew Wakefield and former Playboy Playmate Jenny McCarthy, have successfully convinced a large swath of the American public that vaccines are dangerous. Despite scientific evidence to the contrary, claims have been made that vaccines cause autism, cancer, asthma, allergies, and a host of other acute and chronic ailments. These so-called “anti-vax” claims have been largely accepted by a gullible populace. According to a recent survey, barely 51 percent of Americans believe that vaccines are safe and effective. About the same number of people also believe in astrology, creationism and ghosts.

Since the Disneyland outbreak began, a number of prominent anti-vaxxers have also argued publicly (including on the CBS Evening News) that measles is not a disease to be feared. Nothing could be further from the truth. Measles is a dangerous and deadly illness. Before the first effective vaccine was developed, approximately 4 million Americans contracted measles each year. Of those, 3 in 10 developed complications like pneumonia. Nearly 50,000 people were hospitalized, 1,000 were permanently disabled due to measles encephalitis, and 500 died.

When confronted with the lack of compelling data to support their claims, anti-vaccination activists often fall back on the most American of arguments: individual freedom and personal liberty. Specifically, many anti-vaxxers believe that the government cannot tell them what they should or should not put into their (or their child’s) body. But this position has limits, particularly when individual actions jeopardize the lives of others.

That is exactly the case here. When someone refuses to vaccinate themself or their kids, they put others at risk, including children who are too young to be vaccinated or elderly whose resistance to measles and other preventable diseases has waned.

It’s time for clinicians, public officials, and politicians to take a stand on vaccination, and take a stand against the claim that personal liberty trumps public safety. Pediatricians and other physicians should refuse to accept new patients who chose not to immunize themselves or their children. School officials should no longer allow unvaccinated children to attend public schools, except in rare cases where vaccination is contraindicated medically. Finally, local, state and national politicians should no longer make it easy for parents to obtain philosophical or “personal belief” exemptions from vaccination requirements and other public health statutes.

If you don’t like vaccines and refuse to get immunized, that is your right. But you shouldn’t expect to line up for Space Mountain or the Pirates of the Caribbean with the rest of us.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on January 29, 2015, and is available on the WAMC website. The contents of this post are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

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3 thoughts on “V-Ticket to Ride

  1. Maybe not vaccinating your kids isn’t a crime, but parents have been charged with reckless endangerment for offenses as minor as driving too fast with kids in the car. I would argue in favor of charging a parent with something similar if the parent’s decision not to vaccinate a child leads the child to become seriously ill with a perfectly preventable disease later on.

  2. People who are not immunized not only run the risk of becoming infected themselves, but of passing that infection on and causing illness in others in the community. People who are able to receive vaccination should do so; this act of beneficence protects those who cannot for medical reasons receive the vaccine or those for whom the vaccine offers inadequate protection. Community immunity is a public good from which all benefit.

    The public needs to recognize what a risk these preventable childhood illnesses can be. Sure, our ability to provide supportive care to children with serious illness has improved and maybe the rate of serious long term effects and mortality would be lower when infection occurs, but those risks would still exist. Another factor I would guess most parents wouldn’t realize is that because these childhood infections are so rare, there’s a good chance that their pediatrician or urgent care provider might initially miss the diagnosis and cause a delay in care. Although I admittedly haven’t worked with a pediatric population in years, as a physician assistant who completed training in 1995, I’ve never personally seen measles, rubella, and diphtheria, and I’m sure this is becoming a more and more common problem among providers.

    On the issue of public health as a whole, most people no longer have any idea of the risks from infectious diseases without the celebrity of something like HIV or Ebola. Seeing Senator Tillis suggest this week that requiring food services workers to wash their hands after using the bathroom is an unnecessary regulation further illustrates the complacency most people have about the importance of public health law. It is especially frightening to hear from a lawmaker, however.

  3. Reblogged this on Singular Meg and commented:
    The public needs to recognize what a risk these preventable childhood illnesses can be. Sure, our ability to provide supportive care to children with serious illness has improved and maybe the rate of serious long term effects and mortality would be lower when infection occurs, but those risks would still exist. Another factor I would guess most parents wouldn’t realize is that because these childhood infections are so rare, there’s a good chance that their pediatrician or urgent care provider might initially miss the diagnosis and cause a delay in care. Although I admittedly haven’t worked with a pediatric population in years, as a physician assistant who completed training in 1995, I’ve never personally seen measles, rubella, and diphtheria, and I’m sure this is becoming a more and more common problem among providers.

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