Vaccine Hesitancy and Refusal
Vaccinations are arguably one of the most important public health successes in our history. Diseases that caused significant pain, disability, and death have been reduced or even eliminated as a threat to our population as a result of vaccines. This has led to better quality of life and increased longevity, especially in the most vulnerable: our children.
Unfortunately, vaccinations have become a victim of their own success. As the rates of the diseases they protect against have declined, the concern about the diseases have as well. When was the last time you heard of a child paralyzed from a Polio infection? Or requiring a breathing tube because of a throat infection with Haemophilus influenza B (Hib)? These infections, among others, are now rare in the United States, entirely because of vaccination. However, because they are so rare, many of today’s parents are not worried about their children becoming victims of these diseases and therefore believe the vaccinations against them are unnecessary. Moreover, there is a growing movement in the United States against vaccines completely, proclaiming they are unnecessary and harmful.
As a Pediatrician, the idea that children are vulnerable to preventable diseases is heartbreaking. My life’s work is focused on caring for children, preventing disease and injury when possible, and treating illnesses as we are capable. While I recognize that many of the vaccine-preventable diseases are now rare in our country, they still remain a threat outside of our borders. We live in a global, travel-oriented world. Assuming that a child will not come into contact with a disease such as Polio because it has been largely eradicated from our country is incorrect and dangerous.
Are they safe?
This is the main question, isn’t it? Are vaccinations safe to give to our children? Do they cause harm? The question is both easy and difficult to answer, because people have different definitions of what “safe” means to them. Vaccinations do come with risks of reactions – fevers, pain and swelling at the site of injection, or more severe reactions such as febrile seizures and anaphylaxis (severe allergic reactions). However, all activities and exposures we experience in life come with risks – riding in a car, walking down the street, riding a bicycle, eating foods, etc. We still interact with the world and decide if the risks associated with these activities is worth experiencing them.
The risks of side effects of vaccinations must be weighed against the risks of the diseases they prevent. Severe side effects to vaccines are rare, while the diseases they protect against have much higher rates of disability and death associated with them. Additionally, we do not have treatments for some vaccine preventable illnesses (measles, for example), so if a child does become infected there is nothing we can do other than to offer supportive care through the illness.
What ingredients are in vaccines?
So what, exactly, is in vaccines?
- Antigens – these are the particles of viruses or bacteria that stimulate an immune response in the body. These are the “active ingredients” of vaccines. These particles are not able to infect a person but stimulate the immune system in the same way as an actual infection to prepare the body for any future exposures with the actual bacteria or virus.
- Stabilizers – these are used to protect the antigens during transport and storages so they are still as effective once injected.
- Adjuvants – these are substances added to vaccines to make them more powerful at lower doses by stimulating the immune system along with the active particles, or antigens.
- Preservatives – these are necessary to prevent contamination, particularly from bacterial or fungal growth.
It is important that I say this here: there is no mercury present in vaccinations. A preservative called Thimerosol, which contains ethylmercury (a compound more easily processed by our bodies) has been used in vaccinations previously. However, now it is only found in multi-dose influenza vials.
For more detailed information about vaccine ingredients, please visit the Children’s Hospital of Philadelphia’s Vaccine Education Center (https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-ingredients).
Do vaccines cause autism?
Honestly, I could write an entire article about this question alone. So much damage has been done to the public’s trust in vaccinations as a direct result of a paper written by Andrew Wakefield in the UK – a paper that has since been retracted because it was found to be fraudulent and the data was misrepresented. On the other hand, there have been multiple scientific studies that have been done since then that have shown the risk of autism is the same in children who are vaccinated for MMR, and those who are not.
For more detailed information about vaccines and autism, please visit the Children’s Hospital of Philadelphia’s Vaccine Education Center (https://www.chop.edu/centers-programs/vaccine-education-center/vaccines-and-other-conditions/vaccines-autism).
But my Google search said…
Please keep in mind that anyone can write anything on the internet. They don’t have to prove that it is true. Google searches are scary places when it comes to medical issues, and vaccinations are no exception. This is one of the primary reasons I created as they grow, so my patients’ families would have a safe place with accurate information. I try to add links to outside sources and resources that will help families to gain more detailed information when needed. Many simple Google searches will result in anecdotes, personal stories, and rumor. This is not how medicine and medical advice works. Issues must be studied, information must be gathered in a controlled way in order to determine if the outcome can correctly be attributed to the factors being studied or if it was actually due to something else entirely.
Can I use an alternative schedule?
The Advisory Committee on Immunization Practices (ACIP) is part of the Center For Disease Control (CDC). The job of this committee is to provide a recommended schedule of vaccinations based on the available research and information. This committee is made up of both medical and public health experts. The purpose of a vaccination schedule is to ensure that infants and children are protected as early as is safely possible. It is also true that certain diseases affect particular age groups more than others – this is why children over age 5 years are not recommended to receive the Hib or pneumococcal vaccines.
In recent years, there has been the development of “alternative vaccination schedules” that are very different from the CDC’s recommendation. There are many rationals for this but the most common I hear in clinic is fear about “too many vaccines at one time.” My primary concern with these alternative schedules is that they leave children vulnerable to preventable diseases for longer than they need to be. Much research has been done to ensure the vaccines are given as early as possible to prevent disease, but not too early for young immune systems to handle.
In the end, if the parents of my patients want an alternative schedule, I will work with them on developing one. My primary goal is to protect my patients from preventable diseases, and if that has to be done at a slower pace in order to ease parental peace of mind, then I will do it.
Further Resources
One of your best resources if you have questions about vaccinations is your child’s Pediatrician. We are happy to have honest, evidence-based discussions with you. In addition, there is a lot of good, accurate, science-driven information online regarding vaccines. The problem is knowing where to look. Some of my favorite sites to send parents to are the following:
Children’s Hospital of Philadelphia’s Vaccine Education Center:
https://www.chop.edu/centers-programs/vaccine-education-center
Center for Disease Control:
https://www.cdc.gov/vaccines/index.html
Immunization Action Coalition:
