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Sue Lani Madsen: Risk, benefit and vaccine mandates

Hundreds of people, including families, attend a rally at the Oregon State Capitol protesting a proposal to tighten school vaccine requirements on Thursday, March, 7, 2019, in Salem, Ore. (Sarah Zimmerman / AP)
Hundreds of people, including families, attend a rally at the Oregon State Capitol protesting a proposal to tighten school vaccine requirements on Thursday, March, 7, 2019, in Salem, Ore. (Sarah Zimmerman / AP)

When the Spanish flu went viral in 1918, it didn’t mean trending on Twitter. Before vaccines, antibiotics, better sanitation and clean water, the leading cause of death was infectious disease. In 1918, the leading cause was influenza-induced lung infections.

But the Spanish flu wasn’t really Spanish. It most likely originated in Kansas, shipping out with U.S. troops to Europe. Public officials and newspapers suppressed information to avoid deflating morale among the Western allies. Spain was on the sidelines during World War I and the first to report openly. The formal and informal censorship contributed to suspicion, fear and lack of preparedness as influenza spread.

Several social media sites recently announced plans to suppress sources questioning vaccination practices. Censorship actively feeds into conspiracy theories as surely in 2019 as it did in 1918. Labeling all vaccine-questioning sources as misinformation is like calling all mainstream media fake news. The challenge is sorting out the bias from the science.

Vaccines have miraculous benefits for public health, but avoiding discussion of risks and benefits is one factor driving some parents to resist vaccination. Mark Springer of the Spokane Regional Health District called them the vaccine hesitant. When too many people hesitate, the community has the conditions for many infectious diseases to go viral.

“With measles, for example, we need a community immunization level of 95 percent or higher to maintain good herd immunity,” Springer said. It’s a hard concept to think about, taking a drug to prevent disease not just for you but for neighbors and strangers.

Parents with questions about contraindications for their children need to approach their pediatrician for advice, according to Spokane pediatrician Dr. Deb Harper.

Dr. Harper said most pediatricians in Spokane are open to discussing alternative vaccination schedules and answering family-specific concerns. When parents have more questions than she can answer in a standard well-child visit, she invites them to email her with whatever they’re reading. Dr. Harper noted that nationally, only about 20 percent of pediatricians refuse to work with parents who are vaccine hesitant.

“If your pediatrician won’t talk to you, find another pediatrician,” Harper advised.

Some individuals do have adverse reactions. Harper said she’s reported a few incidents to the Vaccine Adverse Event Reporting System, although it’s hard to tell from any one incident if there was a connection or just a coincidence. There is no drug or treatment that is 100 percent safe and one size fits all government mandates contribute to vaccination resistance. Recent hearings on HB 1638 and SB 5841 strengthening Washington’s mandates drew overflow crowds to Olympia from all over the state to object.

One young mother from Deer Park who attended the hearings acknowledges there are community benefits to vaccines, but her oldest child seems to have had an adverse reaction. Now she’s concerned about vaccinating his younger sibling. Brittany F. asked that her last name be withheld because of the flak she’s received over her hesitance. She understands the risk is low, but “where there is risk, there must be choice. Informed consent, not coerced consent, is necessary in a free society.”

The diseases controlled by vaccines are distant in both time and place. We conquered smallpox. We forget we have not done the same for polio, measles, mumps, rubella, whooping cough and a host of others. The last generation of home-grown American polio victims and those who grew up with them is aging out of the culture and taking their memories of the very real side effects of disease with them.

Shortly after Dr. Harper had admitted a young child to the ICU with whooping cough, she met the only vaccine resistant parent she ever walked away from. The highly educated woman announced she didn’t vaccinate because her children could rely on herd immunity. Let others take the risk, she’d take the benefit.

Dr. Harper’s patient in the ICU recovered, but with a lifetime of lung problems. “Most of us survived riding in the back of the pickup, most of us survived riding a bike without a helmet, most of us survived riding in a car without seat belts … but not everyone did,” Dr. Harper said.

All drugs have potential side effects. So does every disease. The question is which side effects are worse, and for whom. Where there is risk, there must be choice. And it’s not an easy one.