Walk around any old graveyard and notice all the small headstones of infants and young children. In a modern graveyard, infant headstones are rare.
These days, infants and young children in developed countries rarely die from vaccine-preventable diseases like diphtheria, tetanus, pertussis, polio, and measles. In most parts of the United States, vaccine coverage is so complete that these diseases are almost nonexistent. Because these diseases are no longer seen as a threat to the health of their child, some families opt to delay or forgo childhood vaccinations. Understanding vaccines helps us realize why delaying or skipping vaccines is dangerous.
Before clean water, antibiotics, and routine vaccinations many children died. In fact, in 1800, roughly 50% of all children died before reaching age 5. In 1900, about 24% of all children died before age 5.
Worldwide, the World Health Organization (WHO) estimates that vaccines have saved 154 million lives in the past 50 years, the vast majority of those being children. Do note: these data present deaths only, not disability, and most of these diseases are capable of causing both death and severe disability.
As a board-certified emergency medicine doctor, I encourage everyone who can be vaccinated to be vaccinated. Across the board, with no exceptions.
Unvaccinated children are at increased risk of serious disease from vaccine-preventable illnesses. Without the majority of the population being vaccinated, herd immunity is decreased and older people whose immunity has waned, and immune-compromised people, are at risk for death or severe disability.
Sadly, media sources agree that the USA’s official stance on vaccines may change with the incoming administration. Robert Francis Kennedy Jr, president-elect Trump’s proposed nominee for director of the Department of Health and Human Services, has strongly voiced long-standing opinions that vaccines are unhealthy or dangerous. There is no scientific basis for the claim that vaccines are unsafe. Most commonly, a vaccine might cause a short-lived, mild reaction, but the diseases vaccines prevent can cause death or disability. Severe, dangerous or serious vaccine reactions are very rare. It is possible that if RFK Jr is confirmed into this role by the senate, vaccines would no longer be officially advised, would not be required by schools, or worse yet, could be excluded from insurance coverage.
Any of these scenarios would be catastrophic to the health of our country, and likely widen the socioeconomic health equity gap between wealthier, more educated individuals, and less educated, poorer people. Understanding vaccines is key for preventing serious disease or death.
Unfortunately, vaccines and the science behind vaccines have been made into a political issue. All sorts of conspiracy theories began surrounding vaccines. The Covid-19 vaccine, which was the most politicized vaccine in history, brought this issue to a head. From that politicization, a massive surge of general distrust and hesitancy around vaccines has sprung up.
I’m not old enough to have been a physician before the days of routine childhood vaccines, but in my career, I’ve seen near elimination of sepsis, epiglottitis and meningitis (which used to be fatal or near-fatal) associated with Haemophilus Influenza, a vaccine against meningitis (often fatal), and the advent of the Gardasil vaccine for cervical cancer (and throat, mouth, and anal cancers), all of which have changed my practice of medicine in dramatic ways.
All of these diseases are called vaccine-preventable diseases. Due to growing vaccine hesitancy, we are seeing a resurgence of diseases like measles that were previously rare or eradicated. Many of these diseases can be deadly for children under 5 years old. Understanding vaccines means being able to compare the minuscule risk of receiving a vaccine with the real and deadly risk of disease.
When I see people doubting the value of vaccines, I am reminded of the infants I have seen die of tetanus in underserved countries. It is horrifying and gruesome, their little bodies twisted in contraction, and no treatment available. They get tetanus infection from their umbilical stump and their lack of immunity. The bacteria that causes tetanus is found everywhere. Any wound is a tetanus-prone wound- you don’t have to step on a rusty nail. The reason you don’t know anyone with tetanus is that we are all vaccinated against it as part of our childhood vaccines series, and then receive booster vaccines every 10 years throughout our lives.
Much of RFK’s anti-vaccine stance is surrounding infant and childhood vaccines which he thinks are poisoning our children and causing all sorts of chronic diseases and autism. Again, there is absolutely no data to support this. Doctors don’t recommend vaccines because they are getting paid by big pharma to recommend vaccines. They recommend vaccines because vaccines save lives. Until you have seen people dying of vaccine-preventable diseases, and have really delved into the scientific data around vaccines, you are not qualified to make decisions about vaccine safety and efficacy.
Does getting a vaccine challenge the immune system? Yes, yes indeed it does. Vaccines are designed to prepare the body to respond quickly with immune cells if exposed to disease. It’s like amassing the troops on the border in an area where war is about to break out. Would it be better if we didn’t need the troops? If there were no such thing as infectious diseases? If there was no such thing as war? Yes, yes it would.
But there are infectious diseases, and these vaccine-preventable infectious diseases used to kill or severely disable children regularly. They no longer do, thanks to vaccines.
I guarantee that these vaccine-preventable diseases still exist. They exist, and they are still deadly. They are just waiting in the wings to start killing susceptible, unprotected infants and children again if people stop vaccinating young children and if herd immunity wanes. (Herd immunity means that the vast majority of the population is protected so that infectious diseases don’t have the opportunity to spread from person to person as easily.)
Why is the infant vaccine schedule the way it is? Why can’t we space infant vaccines out so it’s not as hard on their little systems? Understanding vaccines is key to answering these questions.
It is uncomfortable, to say the least, to imagine giving an infant a vaccine. No one wants to hurt an infant. But the brief sting of a shot is nothing compared to what can happen if vaccinations are delayed or skipped.
Understanding vaccines requires us to learn just a bit about how the immune system works. The reason behind the current infant vaccination schedule is that infants are unable to create long-term immunity. They are also at the greatest risk of death from vaccine-preventable illnesses in their first year of life. Because of this, vaccines are given every two months to provide infants with temporary immunity, since that type of immunity is all they’re able to develop.
This vaccination schedule protects them from infantile diseases that are often fatal, such as pertussis (whooping cough), or Haemophilus influenza b (which causes meningitis, blood infections, bone infections, and epiglottis).
A delayed vaccine schedule is better than nothing but it leaves the infant completely unprotected for periods of time.
One of the reasons breastfeeding young infants is recommended is because it helps protect them by conveying the mother’s immunity. However, not all infants are capable of being breastfed, and not all mothers are capable of breastfeeding.
Many infants used to die in the first two years of life due to vaccine-preventable diseases that we have now eradicated. Infant mortality has plunged as vaccines have become available.
Another critical part of understanding vaccines is knowing that immunity is not lifelong. Most immunity wanes 20 to 30 years after exposure. Therefore, infants being vaccinated protects infants from disease, and also keeps diseases from spreading in the general population, and protects the elderly, whose immunity from vaccine or exposure may have waned. This is how herd immunity works.
Sadly, lots of people only look at the rare reactions related to vaccines and not at the overarching protection and common good that vaccines have created for us all. Because viruses and bacteria are invisible to the naked eye, it is easy to not recognize their threat. But let’s be clear, the threat is real.
Let me pose an example to you. Let’s say, you are out on a walk when suddenly a raccoon appears in the street. It sees you and immediately begins running toward you. You run away, but the raccoon is in hot pursuit. Soon, it is on you- you see the foam at its mouth and its wild eyes. It bites into your leg and latches on as you try to beat it off with a stick. Finally, you free yourself and go to the hospital for your wound. You are appropriately offered a rabies vaccination series to prevent the 100% fatal rabies infection.
Would you decline that rabies series?
I’ve never met anyone who would say they would decline this vaccine. Is that because you will die if you don’t get the vaccine? So, why would you not vaccinate a baby for something that, while potentially not fatal, is vastly more common, and fully preventable?
If you are one of the folks who is hesitant about childhood vaccines, please put aside your politicization of this issue and really delve into the science on this issue. Understanding vaccines is important. The science is clear. Vaccines are generally safe and save hundreds of millions of lives. This board-certified emergency medicine doctor is telling you what I have done for my children, what I have advised my patients, and what I do. I vaccinate.
If you don’t need to be convinced about vaccination and already believe in vaccinating yourself and your children, consider scheduling an appointment for before the new administration takes office to discuss with your healthcare provider what vaccines you might need in the upcoming several years, and if any of those vaccines can be administered early to ensure that they are available to you and covered by insurance. For example, we frequently start talking about giving the HPV vaccine at age 12, but it is approved for individuals aged 9-45 years. My advice, if you have a child who is in this age range, but has not yet been offered the vaccine, is to ask for it early, just in case access or coverage changes.
The science behind vaccines is solid and compelling. Understanding vaccines and following the recommended vaccination schedule brings us all one step closer to achieving better health.
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