Antivaccine nonsense Medicine

Mixing unvaccinated children with vaccinated children: Whose rights prevail?

Last night was a late night at work, and I didn’t have time to apply my usual annoyingly long-winded analysis to a study that I found interesting and had intended to look at today. It’ll keep. In the meantime, there are always the brief “link-and-comment” (or in my case “link-and-snark”) posts. Also, there was an article a couple of days ago that I have been meaning to bring up since I saw it but somehow allowed myself to get distracted. With the impending resurgence of measles and other previously controlled or even vanquished infectious diseases, courtesy of Jenny McCarthy, Generation Rescue, and their supporters and enablers, the issue described in this story is going to become more and more contentious:

Karey Williams never thought a parenting decision would come between her and a good friend. The two had known one another for a decade, supported each other through infertility treatment and had their first babies around the same time. But when she told the friend that she had stopped vaccinating her daughter at age 1, the relationship abruptly ended.

“She said, ‘Well then, your child can’t come into my house,'” recalls Williams, 47, who lives in the Chicago area.

That’s not the only time Williams has encountered conflict because of the decision she made for her daughter, now 7. “I’ve had people voice their opposition to me, that I’m ruining the herd immunity … that my child would put their child at risk,” she says.

The people voicing those sentiments are exactly right. Parents like Karey Williams are contributing to exactly that, and it is good to see that many parents actually understand this:

Jennifer Collado, 37, of Glen Rock, N.J., says members of her son’s toddler play group were “stunned” when one mother mentioned that her child wasn’t vaccinated. The group didn’t kick them out though, and shortly after they moved out of state. But the group felt that information should have been mentioned upfront. “Someone pointed out to her that it was her choice to do that but that she was putting everyone’s kids in jeopardy by not having her kids vaccinated,” Collado says.


Many parents who choose not to vaccinate will argue that it is no one else’s business but their own, that they’re not hurting anyone. Poppycock. (I had intended to use another word, but I’m trying to clean up my language after a few recent lapses.) By their decision not to vaccinate, antivaccinationists make their child a potential nidus of infection for their community, something they either cannot understand or refuse to understand:

This is the part I’ll never understand…if the parents who vaccinate their children have such confidence in the vaccines themselves, then an unvaccinated child could never harm their protected child. Which one is it? Do they believe that vaccines work with all kids 100% of the time or don’t they?

Here’s the simple answer: Vaccines are not 100% effective. Nothing in medicine is. They may be 99% effective, 95% effective, 90% effective, or even less. By medical standards, any intervention that’s over 90% effective is a pretty darned good intervention, and most vaccines are at least pretty darned good, especially given how rare serious reactions are. But they are not 100% effective, and it is almost as foolish for parents who vaccinate their children to believe that vaccines will be 100% effective in protecting their children as it is for antivaccinationists to believe that vaccines do more harm than good. At the very least, it’s naive. Also, there are children who for health reasons cannot be vaccinated and who thus rely on herd immunity. The larger the population of unvaccinated children, the weaker the herd immunity, and if the percentage of vaccinated children falls below a certain point herd immunity basically collapses. Indeed, one of the parents in the article doesn’t seem to understand that:

Angela Corry, 33, of Shirley, N.Y., has faith that vaccinations are going to protect both of her girls, no matter who they encounter.

“I have no problem welcoming unvaccinated children into a play group, and I have no problem with them attending school,” she says. “Simply put, my children are vaccinated, the risk is minimal. I may not agree with [other] parents’ choices, but there’s no reason to hold that against the child.”

Actually, I would argue that it is the parent of the unvaccinated child who is responsible for any ostracism that child suffers due to their decision not to vaccinate. It is not incumbent on parents of vaccinated children to bend over backwards to accommodate non-vaccinators. Also, if herd immunity collapses, the risk will no longer be minimal, and, make no mistake about it, the antivaccine movement is a dagger aimed at the heart of herd immunity.

One thing that I find heartening this article is that the social norm is still to vaccinate and that most parents still support vaccination even in light of the contininuous antivaccine propaganda pumped out by Jenny McCarthy and her fellow travellers. Antivaccinationists may be tolerated in the abstract, but when the rubber hits the road and it’s one’s own children potentially at risk due to them suddenly that tolerance is severely strained:

But parents who don’t know who’s vaccinated and who isn’t have their own concerns, highlighted by the measles outbreak in San Diego earlier this year that resulted when an unvaccinated 7-year-old boy traveling to Switzerland contracted measles. The virus spread to 11 other unvaccinated children at both his school and his pediatrician’s office — including a few babies who were too young to receive the measles, mumps and rubella (MMR) vaccine.

When news of the outbreak hit, Dr. Ari Brown says her office in Austin, Texas, received a spate of questions from worried mothers wondering if there were any nonvaccinating families in her practice, which there aren’t. “Parents were outraged,” she says.

“From the vaccinating parent perspective, it’s a little infuriating because you don’t know who these kids are,” says Brown, a vaccine proponent and co-author of the book “Baby 411.”

Yes, it is, hence the question being asked of parents whose children are going to play with other children. Naturally, antivaccinationists are outraged:

“Do I think it’s inappropriate to put a mark on people and kick them out from being able to participate in society, yeah I think it’s inappropriate — it’s inappropriate and it’s dangerous,” says Barbara Loe Fisher, cofounder and president of the National Vaccine Information Center, a group in Vienna, Va., that describes itself as “America’s Vaccine Safety Watchdog” and opposes forced vaccinations.

Fisher, “Libertarian” that she is who so forcefully opposes “forced” vaccination or anything that “tells her what to do about her child’s health” seems to think that she should be able to make her decision not to vaccinate and face zero consequences, that she shouldn’t face societal displeasure at her decision. In other words, for all her piously hypocritical appeals to “freedom,” she clearly thinks her rights trump everyone else’s. But what about parents who do the right thing by having their children vaccinated and do not want to put their children at risk from children whose parents are less responsible? This has nothing to do with government telling Fisher what to do and everything with shared values of society, where a parent wants to know if she’s putting her child at risk by letting that child play with another child. As part of assessing that risk it’s perfectly reasonable to want to know the vaccination status of the playmate. True, that doesn’t eliminate the risk of being exposed to disease thanks to the unvaccinated in various public areas, but children playing together often involve close contact with the typical spitty and snotty hands that children in their lack of concern for hygeine often have, a far more effective means of transmitting the various infectious diseases that we vaccinate against than any random encounter with a stranger in a public place.

Now don’t get me wrong. I understand that health information is private and that no parent is required to reveal her child’s vaccination status to another parent. However, the flip side of that is that it is not wrong for a parent to ask about the vaccination status of potential playmates for her child. With that in mind, I’ll make three points.

First, society is always a balance between competing interests of personal freedom and the good of society as a whole. In the U.S. we tend to value individual freedom over society, which has for many issues (freedom of speech, freedom of religion, etc.) served us very well indeed, although arguably not as well in others. Unfortunately, all too often advocates for “personal freedom” forget or don’t care that the corollary of this balance is that one person’s rights do not allow him or her to infringe on the rights of another. It’s that whole “balance” thing, admittedly a cause of contention since the republic was founded. Given that schools and day care centers, with their large concentration of children in relatively small spaces, represent perfect incubators for children to pass viruses and bacteria between each other, it makes scientific, medical, public health, and legal sense to require full vaccination according to the currently recommended schedule before a child is permitted to enter school or day care, with the only exceptions being children who for medical reasons cannot be safely vaccinated. Indeed, the push for “religious” and “philosophical” exemptions undermines that protection and is intentionally being exploited by antivaccinationists to get their children into school to endanger the other children there.

Second, a parent has every right to ask about the vaccination status of potential playmates for her child. Parents of said potential playmate, whether they vaccinate or not, have every right to refuse to answer. However, the parent asking also has the right to judge for themselves whether they will accept that answer. Personally, I would not accept a refusal to answer and recommend to pro-vaccination parents out there that they refuse to accept a nonanswer as well.

Finally, and most importantly, what this conflict shows is that antivaccinationists seem to think they have some God-given right to inflict their pseudoscience on society as a whole. They don’t want to vaccinate their child because of fears of autism or various other “complications” of vaccines based on fearmongering, pseudoscience, or religion? Fine, but there will be consequences, and I don’t care if they don’t like those consequences. Their choice based on fear is endangering the rest of society by making the resurgence of vaccine-preventable diseases more likely. If a parent makes the choice not to vaccinate, that parent should not whine when parents of vaccinated children decide that they do not want to risk their children’s health by letting them play with unvaccinated children.

After all, if antivaccinationists claim have the right not to vaccinate, they should not be disturbed if the parents of vaccinated children also claim the right to take action to protect their child from the risks introduced into society by antivaccinationists “exercising their rights.”

ADDENDUM: Apparently there is a poll at MSNBC on this issue.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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