First Do No Harm: The Measles Controversy

Over thirty years ago a sign in our pediatrician’s office in Wellesley, Massachusetts made me chuckle. “Follow the herd and end up a lamb chop,” it warned, with a cartoon drawing of a flock of impossibly dull looking sheep beneath the caption. I loved the fact that the poster championed nonconformity and individuality, giving the Harvard Community Health Plan stamp of approval to those of us trying to raise critical thinking, independent kids. However, I am absolutely sure that my doctor was in no way repudiating herd immunity, the topic du jour on parenting sites, alternative a.k.a. “natural” advice blogs, autism listservs and the so-called mainstream media.

Both of my children were vaccinated by HCHP in Massachusetts and, later, by Kaiser Permanente once we moved to Virginia. It would never have occurred to me to withhold this vital medical care to my offspring. I don’t recall there being a “conversation” about whether to do it. My children received the measles mumps rubella vaccine (MMR), the diphtheria, tetanus, pertussis (DTP vaccine) and the oral polio vaccine. Yes, the kids were sometimes a bit grumpy or feverish afterwards, but that seemed a small price to pay to avoid potentially life-threatening diseases. (The varicella vaccine had not yet been perfected, and both girls got chicken pox, enduring two miserable weeks of itches, oatmeal baths and missed school, but luckily, no serious scarring).

I am old enough to have received only two childhood vaccinations –the Sabin injected polio vaccine and the smallpox vaccine–all that was available in the 1950s. I don’t remember getting the measles or the mumps, but I did have rubella, also known as German measles, while in high school. I very much recall the chicken pox, and, more ominously, I also will never forget having the non-paralytic form of polio at the age of about five or six — before the vaccine was available.

Not all polio results in paralysis; it can, at first, resemble the flu. I still recall lying in a pool of sweat on my Wamsutta sheets with the tiny multi-colored flowers, feeling the walls breathe in syncopation with my own inhalations and exhalations as I experienced vivid and terrifying fever dreams that became recurring nightmares in my later years. Every part of my body ached, but especially my legs, which seemed to weigh at least fifty pounds each and which weren’t always cooperating when I tried to rearrange them.

Back then, summer meant not just playing outside until dusk, catching fireflies, hunting for four leafed clovers, wishing while blowing on dandelions gone to seed, or trading baseball cards that came with packs of bubblegum. It also meant pool and park and camp closings when there were polio outbreaks, since contaminated water, close contact with others and heat and humidity raised the risk of an epidemic. Here is the Mayo Clinic’s description:

“The poliovirus resides only in humans and enters the environment in the feces of someone who’s infected. Poliovirus spreads primarily through the fecal-oral route, especially in areas where sanitation is inadequate. Poliovirus can be transmitted through contaminated water and food or through direct contact with someone infected with the virus. Polio is so contagious that anyone living with a recently infected person is likely to become infected, too. People carrying the poliovirus can spread the virus for weeks in their feces.”

Luckily, my mild case of polio, despite being a lengthy painful ordeal, did not progress to the paralytic form. Nor did any of my siblings contract the disease due to my stepmother’s diligence in isolating my laundry, my bodily products and me. My parents were plenty worried, but there really wasn’t anything to be done but to give comfort and hope for the best.

When the Sabin vaccine came onto the market in 1957, my physician father high-tailed us all to his office, lined us up by age, oldest to youngest, and made a game of it, taunting us a bit with what seemed like horse needles and having each one scream after the shot while the others cowered anxiously in the waiting room, fearing the worst. It was a bit over the top I know, but then again we felt lucky that our Dad could be the one to take care of us, and lucky that this disease could henceforth be prevented.

My father, now closing in on 95, has often said that he became a doctor at a magical time in medical history. Penicillin first became widely used during his years in medical school and World War II in the 1940s. Specialties like cardiology were just being born and technical breakthroughs like manufactured insulin, birth control pills and most importantly, vaccines, later allowed doctors to do more than give palliative care to the sick. Prevention, if not of disease of its most dire consequences, was now a real possibility.

Two of the most important men in my young life bore witness to the toll that diseases could take on young, healthy people. My father contracted tuberculosis during the war and later spent two years convalescing in a sanitarium in Colorado, having 25% of his lungs removed in the process, the only intervention then available. As a result of his infection, and my birth soon after, I have had a positive tine test for tuberculosis for my entire life due to my exposure as an infant. My headmaster at George School was a burly man nicknamed Mr. Dick who rode around campus in a golf cart and spoke at Assembly a la FDR with leg braces and strong arms holding him up to the podium. As a young all-American lacrosse player at Johns Hopkins he contracted the paralytic form of polio, which paralyzed him as it did FDR from the waist down. Nonetheless, he like my father, was a model of optimism, “can do” spirit and determination.

My generation straddled the era of deadly epidemics and routine childhood vaccinations like the ones my children received. It is no surprise then, that support for vaccination is much higher among older people who remember the toll that so-called childhood illnesses could take. We also know that being healthy today doesn’t preclude becoming the host for a viral or bacterial infection tomorrow. I remember how pregnant neighbors feared contracting illnesses that would compromise their babies. I remember whispered stories about young adults becoming seriously ill, or in one case sterile, because of contracting mumps.

As a college student, I had a bad reaction to a vaccine. I was traveling to what were then very backward areas of Yugoslavia and Greece, and I needed immunization against typhoid and typhus. The school doctor gave me my shots, and within twenty-four hours I was delirious, febrile and scared to death. My roommates conferred with the clinic and kept me under twenty-four-hour watch for three days, making sure that I was still conscious and hydrated. It was awful. But that experience didn’t deter me from getting flu shots throughout my teaching career, or hepatitis A, B and C and typhoid inoculations this past year, or the shingles vaccine and TDaP booster a few years back. And I’ve never had another bad reaction.

Nothing we put into our bodies, whether “natural” or not, is guaranteed. Vaccines aren’t always one hundred per cent effective. Some small percentage of recipients will experience an untoward result, or fail to achieve immunity. People who swear by untested supplements or get tattoos covering large parts of their bodies or otherwise ingest “toxins” while refusing to allow their children to receive vaccinations confuse me. People who think only God can cure disease through grace and prayer rather than through the agency of the human beings who are his instruments perplex me. Asking “what would Jesus do” just strikes me as a rhetorical device.

As a left leaning liberal, a progressive, I have no more love for the profit-based U.S. healthcare system in the abstract than my anti-vaxxer friends. But as a member of my generation as well as a childhood community of the health professional friends and colleagues of my extended family I have a hard time buying into the conspiracy theory, anti-government, anti-modern medicine ethos I see on both the crunchy granola left and the Christian conservative right. I am rather shocked by the fact that these two groups, these right and left flanks of the herd, see themselves as the victims, condemning efforts to convince them of their responsibility to the herd as “hate speech.”

Reading the comment sections on my Facebook feed or in online articles in places like the New York Times fills me with disgust when I see intemperate people hurling epithets at one another. But most of all, I am just so disheartened by the attitude that one person’s child’s extremely small potential risk from a reaction to a vaccine is more important than risk to the entire herd, especially the most vulnerable members of that herd, immune compromised people of all ages, pregnant women and infants under the age of one.

Parents who refuse to vaccinate their children against a non-communicable disease like tetanus may in my book be foolish, but they are within their right as stewards of their children. However, parents who choose not to vaccinate their children against highly communicable diseases have potentially endangered not just their own kids, but also the herd, by, as Dr. Paul A. Offit characterized it, potentially martyring other people’s children to their own beliefs or ideology. In my view, they have broken the social contract that grants us all not just rights, but responsibilities to one another and to society at large. Not fully part of the herd, they are wolves in sheep’s clothing. In the end, with regard to vaccination at least, I guess I’d rather be a lamb chop.

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