Avoiding Risk at Your Own Risk

In a world with seemingly more health information than we can process, making important medical decisions can be difficult at times. The latest challenge — deciding whether or not to vaccinate children.

“It’s like swimming in murky waters,” said Patricia Klein, a resident of New York City and mother of two young children. “Your job as a parent is to protect your children, but there’s so much information out there. You’re never 100 percent certain.”

Klein is one of millions of parents in the United States who face the decision on childhood vaccinations every year. Compelled by a “fear of the unknown,” she is concerned that the high number of vaccinations recommended for children might strain their underdeveloped immune systems.

The number of vaccinations recommended by the Center for Disease Control and Prevention, or CDC, is indeed at an all-time high. In 1983, only 10 vaccine injections were recommended for children 0 to 6 years old. Today, that number has risen to 36.

Childhood vaccines help to keep preventable diseases like measles and mumps in check, but there is rising doubt about the safety of the high number of shots administered to children. While it is possible to alter the shot schedule for one’s child, some parents choose to have their children skip the shots altogether, getting exemptions from immunization laws that allow their kids to go to school without being vaccinated.

Because immunization laws vary state-to-state, exemption options vary. Every state offers medical exemptions, provided to children with medical conditions that are likely to cause a bad reaction to the vaccine. In 48 states, religious exemptions are also awarded to those with religious opposition, while in 21 states, philosophical exemptions are offered for those who simply have personal beliefs against vaccination.

Perhaps not coincidentally, the rate of exemptions has also increased over the years. A 2006 study published in the Journal of the American Medical Association showed that the average rate of personal-belief exemptions increased from 0.99 percent in 1991, to 2.51 percent in 2004.

But while more people get their free pass in fear of the apparent risks of vaccination, few people seem to ponder the risk of not getting vaccinated. Unfortunately, recent studies show that the risks of skipping vaccinations could prove more costly than we think.

“There is a large perceived risk about vaccinations, and it is encouraging people to refuse them,” said Dr. Neal Halsey, a professor at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD and co-author of a review of vaccine studies that was published in the May 2009 issue of New England Journal of Medicine. “There are indeed some risks involved [with vaccinations], but people need to understand that those risks are minor, and occur much less often than those associated with the disease itself.”

Indeed, exemptions can come with serious repercussions. A study published in the June 2009 issue of Pediatrics shows that children whose parents refuse vaccination for pertussis, also known as whooping cough, are at higher risk of infection than vaccinated children. While most adults and teenagers who get pertussis avoid severe complications, the disease can cause serious respiratory problems in infants that can lead to pneumonia, seizures, brain damage, and in some cases, death.

The Pediatrics study also showed that herd immunity — the idea that one will be “immune” to a disease because everyone else is vaccinated — does not efficiently protect unvaccinated children.

In addition, a 2008 study published in the American Journal of Epidemiology showed a major overlap between populations in the U.S. with high rates of exemptions and populations with high rates of pertussis cases—areas with the most exemptions were 2.7 times more likely to have an outbreak. Though there is no exact evidence of a direct link to the increase in exemptions, a 2005 report by the CDC stated that pertussis cases increased from a historic low of 1,010 in 1976, to 11,647 cases in 2003.

Halsey understands why parents are confused about vaccinations. Public health officials continue to ensure the safety of vaccines, while groups like Generation Rescue, an autism awareness organization run by former Playboy model Jenny McCarthy, provide anecdotes about healthy children who seem to develop autism suddenly after getting vaccinated.

Dawn Richardson, president of Parents Requesting Open Vaccine Education, or PROVE, a vaccine information group located in Austin, Texas, explains that most people use exemptions because they know someone who had an adverse reaction to a vaccine. “When it comes to vaccines, one size does not fit all,” she said. “The time has come to begin questioning the necessity of vaccinating for every disease possible. Parents need to be able to choose.”

The truth is, however, that there is some choice. First, parents can choose to live in a state where they can get the exemptions they prefer. In addition, the CDC immunization schedule is only recommended — parents can alter the timing and frequency of shots as long as their children complete the schedule prior to school enrollment. Before making any changes to the schedule, however, it is recommended that parents consult their family pediatrician to ensure they have a suitable and safe plan for their children.

Although some parental control is important, the ease of getting exemptions may still be a growing concern. For religious and philosophical exemptions, states generally only require a doctor’s signature, and sometimes even just the parent’s signature is sufficient.

Lance Rodewald, director of the immunization division at CDC, explained that eventually people begin to get exemptions out of convenience because in some cases it’s easier to get the exemption than to go through the process of getting the vaccine itself.

Despite the potential threat of disease, as long as getting exemptions remains easy, it seems people will continue to use them. David Oshinsky, a professor of history at the University of Texas in Austin and Pulitzer-Prize winning author of the book Polio: An American Story, believes that is because we are dealing with a public who has never seen the severity of an epidemic. “Vaccines have worked so well that people think they aren’t worth the risk anymore,” he said.

Patricia Klein, then, may have had the right balance of concern for her children. Aware that vaccines are, in fact, important in maintaining children’s health, she knew she needed to get her kids vaccinated. But she was also concerned about the high number of shots given during each doctor’s visit, so she opted out of the official CDC immunization schedule and made one that she felt more comfortable with. The shots were spaced out over a longer period of time, and in the end, her kids got the vaccinations they needed to stay healthy.

Of course, Klein’s approach is just one of many ways to handle the vaccination issue. Though there are other options, Paul Offit, a physician at Children’s Hospital in Philadelphia, points out that not all of them are right: “Should parents be able to choose whether or not their kids get vaccines? Absolutely. But if you’re choosing to skip vaccines, you’ve got bad information.”