Risk benefit analyses for vaccinations

In Marin, a surprisingly large number of kids do not get vaccinated.  This is because a lot of the yuppies here have hippie inclinations.  They want everything natural.  They spend a fortune on organic foods, think raw is always good, and consider vaccinations to be an unnatural and therefore dangerous activity.  “Natural” is their God.  They are unresponsive to gentle sarcasm (“You know, arsenic is a naturally occurring substance.”).  I get that.  Not everyone is subtle.

The problem is that these same parents are also unresponsive to facts.  Point out to them that unpasteurized milk carries heinous bacteria of that type that once contributed to the pre-Pasteur 50% child mortality rate and they’ll earnestly explain that they get milk from “clean” cows.  That’s an interesting notion.  I’ve visited an organic dairy with those “clean” cows.  The cows’ udders trail in the muck beneath their feet, muck composed in equal parts of urine, feces, bugs and generic dirt.  The automatic milking machines aren’t always so friendly to the cows teats, which means that the milking process can be a mildly bloody experience.  When I visited the farm, the fact that the farm workers cursorily wipe the cows udders with a disinfectant before milking them didn’t really allay my concerns about bacteria.  Pasteurizing, however, does set those fears to rest.

The same “if I don’t see it, it doesn’t exist” mentality governs when it comes to vaccinating children.  The current generation of parents has never seen a polio epidemic.  They’ve never gotten reports that their school mates died, or seen them months later, dragging around in braces — or worse, visited them once they were confined in a giant iron lung for life.  These parents have never seen a child struggle to breath through diphtheria, or held that same child in their arms moments after it died.  And of course, they’ve never watched a child fade away slowly from the heart damage inflicted by scarlet or rheumatic fever.

I haven’t experienced these pre-vaccination tragedies either.  But unlike these Marin parents, I have a vast repository of historic knowledge ferreted away in my brain.  I know the statistics.  I’ve read the letters parents wrote in the wake of their children’s death.  Since I’m an older mom, and the child of older parents, my folks grew up in a mostly pre-vaccination era (worsened, in my dad’s case, by extreme poverty).  My mother almost died from diphtheria and my dad from scarlet fever.  I knew men rendered sterile by mumps and people who limped through life, permanently damaged by polio.

Yes, vaccinations have risks.  If your child is the one in ten thousand, or even one in one hundred thousand, who has a seriously bad response to a vaccination, resulting in death or permanent disability, that risk, in retrospect, was too high.  But for the the 9,999 kids or the 99,999 kids who responded just fine to the vaccination — well, you’ve saved them from death or permanent disability, and at much higher rates.  Polio, for example, was a terrible early- to mid-20th century scourge for both adults and children:

Spinal polio is rarely fatal.[33] Without respiratory support, consequences of poliomyelitis with respiratory involvement include suffocation or pneumonia from aspiration of secretions.[56] Overall, 5–10% of patients with paralytic polio die due to the paralysis of muscles used for breathing. The mortality rate varies by age: 2–5% of children and up to 15–30% of adults die.[4] Bulbar polio often causes death if respiratory support is not provided;[39] with support, its mortality rate ranges from 25 to 75%, depending on the age of the patient.[4][60] When positive pressure ventilators are available, the mortality can be reduced to 15%.[61]

In the Third World, the unvaccinated world, kids with  measles or diphtheria or polio die in horrible numbers.

And yet . . . .

Affluent Americans, blind to the world around them, still resist vaccinations.  So on a regular basis, scientific organizations, clinging to their threads of respectability (I think science squandered a lot of its reputation on global warming scares), issue reminders that vaccinations aren’t really so bad.  The latest comes from the National Academy of Sciences, which again reminds us that, in a risk benefit analysis, the risks of vaccinations are much, much lower than the benefit they confer.  In other words, stop worrying about polar bears, melting ice caps and rising seas.  Just vaccinate your children.