I have concerns about the modern American vaccine schedule, and I am persuaded by some of the evidence launched against the scientific and medical communities. Because of this, I am willing to become a belligerent in the modern American vaccine debate, but not one who lines up on one side or the other. I dismiss the all-or-nothing approach to vaccines that both extremes push on me. As a parent and a scholar who has examined the claims made by the parties in the debate, I hold that all parents need a new way to think about their children’s vaccinations.
I do not accept much of what I hear advocated by the alternative health community, the libertarian critics of vaccine policy, or the anti-vaccinators in general. It is foolish to hold up notions of “natural” as being inherently superior to man-made alternatives. I will tell anyone who wants to adopt what they naively imagine to be a holistically natural lifestyle that (thankfully) technology and culture make it impossible to return to the state of nature that was known to our Paleolithic ancestors. We can, at best, justify choices about how we want to live based on a combination of scientific, moral, theological, economic, and political aspirations. I categorically reject as egotistically libertarian any claim that no one has a right to compel us to do anything with our bodies. We live in an interconnected community and are intensely reliant on one another, a situation that forces us to submit to a multitude of concessions as we balance the pragmatic demands of sharing the earth with the rest of humankind. Finally, I reject anti-vaccinators’ core assertion that vaccines represent a dangerous insult to our bodies and that we would be better off without them. I believe, as public health authorities claim, that vaccines represent one of the most effective tools in advancing both individuals’ health and the public’s health.
All that being said, I agree with many of the claims made by critics of the modern vaccine schedule. First, I accept the primacy of an individual’s responsibility as a parent in making medical decisions for his or her children. In weighing the benefits and risks associated with vaccines, parents’ primary responsibility is to the health and well-being of their children, rather than to the common good. The public and individual benefits cannot be disentangled from one another, of course. But as exemplified by Sybil Carlson, the woman who told the New York Times that she refused vaccination because “I refuse to sacrifice my children for the greater good,” they are not interchangeable.
I appreciate the willingness of vaccine critics to question the wisdom of blindly following the advice of the priests of modern science and technology. Countless examples of wrong-headed therapies and dangerous drugs should temper our confidence in the current state of medical knowledge and practice. Science and technology allow us tremendous power to improve the human condition, but they alone cannot make us happy, healthy, or good. Science and technology—and their practitioners—necessarily operate within a complex set of social, cultural, political, and economic systems. The claims offered by scientists and physicians must be weighed against a myriad of other, sometimes competing, claims and values. Indeed, science is not enough.
Finally, I see in much of the rhetoric attacking the modern vaccine schedule an underlying frustration with the condition of medical care in the United States today. Overburdened doctors and nurses, crowded waiting rooms, tremendously expensive insurance, massive profits made by pharmaceutical companies, and an elaborate maze of bureaucracy separating ill patients from the people who are expected to help them all have combined to alienate many parents from the medical establishment. Moreover, although medicine is cloaked in altruistic language, it is a business. One need not be a behavioral economist to understand that we can expect certain problems to accompany any profit-making enterprise.
Within this context, we have to admit that the debates over mandatory vaccines and parents’ anxieties about them are only partially about science and medicine. Much like recent debates over global climate change, stem cell research, and the teaching of evolution in public schools, the modern American vaccine controversy is a cultural and a political debate. No scientific finding and no agreement among physicians and scientists can possibly bring it to a close. Scientific findings alone cannot end this debate, because the central questions in the debate are inherently political: Who should be vaccinated? Against which diseases? When and why? Who is financially responsible for these preventive measures? How and why should we compensate the unfortunate few who experience adverse effects? Who should make personal medical decisions for individuals not capable of making them for themselves? What responsibility do individuals have for one another when it comes to issues of public health?
Several of the concerns parents express about the modern vaccine schedule are rooted in decisions that health authorities have made both in crafting vaccine policy and in communicating their recommendations to the public. One example is the all-or-nothing approach common in the public health community’s rhetoric about vaccines. Some problems are inherent to the institutional structures that are involved in vaccinating children, such as the economic losses pediatricians face with vaccines because reimbursement rates are simply too low. Other parental concerns are fundamentally beyond the scope of decisions that health authorities, insurance companies, and politicians have made and are instead rooted in the nature of vaccines themselves. Whether we consciously acknowledge it or not, vaccines are increasingly used for medical enhancement. As we add more vaccines to the schedule, these concerns will become a greater burden on our efforts to maintain high levels of vaccine uptake. Regardless of their origins, each of these concerns needs attention from people who can think reasonably and critically about them, people who can clearly articulate the problems and offer potential solutions with all the vigor employed in the rhetoric of the most ardent anti-vaccinators and vaccine proponents.
In this book, I have described a confusing and contentious environment. And yet I feel strongly that, even within this environment, parents must personally accept responsibility to decide deliberately on their children’s vaccines—to decide the best course of action for themselves and their children. Over the last twenty years, just as modern vaccine anxieties have emerged, state legislators have loosened requirements related to childhood vaccinations and attendance at schools and daycares. Today, over half of all Americans live in states that allow for philosophical exemptions to mandatory vaccinations—often requiring little more than a parent’s signature on an exemption form. Outside of those states, parents with concerns about vaccines should seek out medical providers who can work with them to find alternatives to the routine vaccination schedule or who can allow them access to the medical exemption offered in every state. Like all children’s health care decisions, decisions about vaccines are every parent’s duty. In my view, ceding that responsibility to someone else—be it a highly qualified healthcare provider or a rabid anti-vaccinator—is an abdication of that duty.
Responsibly engaging in the process of deciding whether or not, how, and when to vaccinate your child requires continuous self-education on the subject, and an earnest search for a variety of trusted resources. Parents should take advantage of the tremendous amount of information available to them from their pediatricians, in bookstores and libraries, and on the Internet from reliable sources. Unfortunately, too many parents feel compelled to seek information about critical health matters only after their children develop symptoms. There is also danger in yielding to what appears to be an innate compulsion to find authoritative sources that confirm your prejudices and desires. To avoid this trap, parents need to draw on their critical abilities to weigh and judge various aspects of controversial issues by reading widely and not settling on only the material that confirms what they may already think. In every such contentious dispute, elements of truth are to be found on both sides of the debate. It is not a matter of deciding which side you want to subscribe to; rather, it is a matter of gleaning whatever you can from all of the belligerents in the vaccination debate and making decisions for yourself.
Throughout the first couple years of childhood, vaccinations are a routine part of almost every encounter a child will have with medical personnel. They begin almost immediately after birth, with the hepatitis B vaccine, and continue through almost every well-baby visit during a child’s first two years of life. Unfortunately, doctor’s visits are often rushed affairs. Aides, nurses, nurse practitioners, physician assistants, and pediatricians all perform different tasks. Their time is limited because they are under such tight financial constraints. Parents must prepare themselves for the visits and know what specific questions they will ask about the vaccines. For example, which vaccines does the pediatrician’s practice recommend? Which particular formulations do they use? What adjutants, preservatives, and other ingredients are in the vaccines? Most practices adhere closely to the routine vaccination schedule, which is easy to find on the CDC’s website. Parents can examine the schedule, think about their child’s situation, and consider their options. That way, when they decide in favor of or against a vaccine, they are actually making a conscious choice, rather than simply drifting into a decision that has been made by someone else.
Once they have decided the best course of action, parents will probably find that they will have to defend their decisions. Anyone—parent or otherwise—who has confronted the bureaucratic system of health care providers and insurance companies is well aware of the tremendous coercion they wield over the average layperson. A parent who opts for something different than the recommended vaccine schedule is likely to feel at least some of the system’s coercive power. For example, at Annabelle’s fourth-year well-child checkup, our pediatrician recommended both the seasonal influenza vaccine and the supplementary vaccine against H1N1 (also known as swine flu). I told him that earlier that year both Annabelle and I had physician-confirmed cases of H1N1 and that I had come to the opinion that that particular year’s seasonal flu vaccine was of little value given our particular situation. So, I had decided against allowing them to administer either of the flu shots to her. I simply said, “No, I have decided against it.” Over the course of the half-hour visit, three health care professionals pressed the vaccines on us, argued with my claim that because we had both had confirmed cases of H1N1 she should not get the vaccine, and made me repeat, “No, I have decided against it” three separate times. These well-meaning professionals were doing their jobs. And I was doing mine as a thoughtful and informed parent.
Standing up for yourself does not mean staking a position and stubbornly sticking to it. Rather, it means thoughtfully considering the evidence and choosing a course of action. If, in conversations with health care providers or others, additional information emerges, parents ought to take time to reconsider their decisions. But they should not make these decisions in the doctor’s office. A friend once told me the advice he had given to his children about sex. In deciding when it was time to lose their virginity, he said, “Don’t make the decision in the back seat of a car. Think about it beforehand and decide on a plan.” I offer the same advice to parents about their children’s vaccinations. Do not make the decision in a rushed moment in the doctor’s examination room. Take the time before you see a doctor to think about it and make a decision. Then, do not change your mind the moment you are pressured. Later, away from the coercive pressures that plague our relationships with medical providers, reconsider your decision in light of the information that your pediatrician provided you. You may change your mind. Or you may not.