In the decade before 1963 when a vaccine became available, nearly all children got measles by the time they were 15 years of age. It is estimated 3 to 4 million people in the United States were infected each year. Also each year an estimated 400 to 500 people died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain) from measles. (CDC)
Imagine if the vaccine hadn’t been implemented in 1963. Given that the population of the United States has more than doubled since then we might have been experiencing 8 million contracting measles and 100,000 hospitalized annually. Maybe disability and mortality would not have expanded at the same rate because our supportive care has improved, but that would still be a lot of people with serious illness and a large burden on the health care system.
According to the CDC:
Among the 49 states and DC that reported 2013–14 school vaccination coverage, median 2-dose MMR vaccination coverage was 94.7% (range = 81.7% in Colorado to ≥99.7% in Mississippi); 23 reported coverage ≥95%, and eight reported coverage <90%…Among the 46 states plus DC reporting 2013–14 school vaccination exemption data, the percentage of kindergartners with an exemption was <1% for eight states and ≥4% for 11 states (range = <0.1% in Mississippi to 7.1% in Oregon), with a median of 1.8% (MMWR)
While this would suggest that nationally maybe only about 5% of school age children aren’t adequately vaccinated, low vaccination rates/high exemption rates often appear in clusters, leaving groups of unvaccinated children at risk, contributing to the outbreaks of measles we have seen in the past few weeks.
Vaccination protects not only those who receive the vaccination, but it also helps protect those in a community who cannot receive such vaccinations or for whom vaccination did not provide adequate immunity. This gives us the concept of “herd” or community immunity: when more people who are vaccinated against a disease, there are less people to potentially become infected and outbreaks of infections diseases like measles, which spread from person to person, will be less likely to occur. When there are clusters of people in a community who aren’t immune through vaccination or previous infection, it is more likely that outbreaks of infections will occur, decreasing the effectiveness of community immunity.
Currently, all states have some requirements that children receive certain vaccinations before entering school. However, some people feel that governments should not be able to mandate vaccinations. They feel it is a violation of their personal right to make their own decisions about vaccinations, a violation of their autonomy. People should, by and large, make medical decisions based on what is best for them formed from an understanding of the risks and benefits. In most areas of health care, patient’s autonomy, their ability to make their own choices, is and should be the guiding principle.
However, in areas that affect public health, the physical health of the community as a whole must be the deciding factor. Public health laws, such as mandatory vaccination, were not made to dictate medical care. They were established to protect the overall health of all of a community’s citizens, helping to ensure their happiness and well-being and, indirectly, their productivity and the community’s prosperity. Vaccinated or unvaccinated, everybody in a community where people do receive vaccination receives the benefit of their actions. People who are able to receive vaccination should do so; this act of beneficence protects those who cannot. Community immunity is a public good from which all benefit. 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.
Vaccinating our children is the right thing to do. It protects our own children and families from the effects of devastating illnesses and by doing so, protects our larger community as well. Vaccinations have been proven to have very low risks of serious potential side effects and the benefits to both the individual and the community outweigh those rare risks.
Measles History. CDC: Measles. Retrieved from http://www.cdc.gov/measles/about/history.html (02/05/2014)
Seither, R. Masalovich, S. Knighton, C. Mellerson, J. Singleton, J. Greby, SM. (2014) Vaccination Coverage Among Children in Kindergarten – United States 2013-14 School Year. MMWR. 63(41); 913-920. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6341a1.htm
Dawson, A. (2011) The Moral Case For The Routine Vaccination of Children in Developed and Developing Countries. Health Affairs. 30(6). 2011. doi 10.1377/hlthaff.2011.0301 Retrieved from: http://content.healthaffairs.org/content/30/6/1029.full.html