I noticed that Parmalee put in her ideas about the flu vaccine in last week’s newsletter, so I thought I’d write up some of my thoughts here.
Unlike a lot of parents I know in Santa Cruz, I am not anti-vaccine. Having read a fair amount about the devastating effects of many of the illnesses that we routinely vaccinate for, I was all for making sure my children didn’t get those. Frankly, there’s just no reason for polio to exist anymore. The WHO has been chasing it around India and Africa to try to suppress it once and for all, and until they do, I personally think that all children should be vaccinated against it.
I am, however, anti-vaccine-just-because-it’s-there. What I mean by that is that I know that the medical establishment has to make decisions more in terms of public health goals than in terms of individual health concerns. Public health decisions can be weird things: On the one hand, they are made for the general good. If a disease will kill tens of thousands, and the vaccine might sicken a hundred, the vaccine looks to be the better choice overall. If they crunch the numbers and find out that more people will be likely to get a particular vaccine in one form than in another, or at one time of life than another, they make public health policy decisions that don’t always make sense on an individual basis.
Case in point was the development of a hepatitis B vaccine. This was a great medical advance. I don’t know anyone personally (as far as I know) suffering from hepatitis B, but I do know someone who has hepatitis C, and it has been awful. It’s a slow, ugly disease. But it is one of those diseases that people largely don’t think about, the way they might worry about cancer or heart disease.
Hepatitis B is also a “lifestyle” disease. You can’t catch it walking down the street. You get it by exchanging bodily fluids with another human being, which generally happens either by sharing needles or sex.
Reasonably speaking, no child is likely to get hepatitis B. And speaking on the personal level, my own children’s personal risk of getting hepatitis B anytime soon is functionally zero. As is most kids’.
So why do they recommend hepatitis B vaccines for babies? Simply because when they crunched those public health numbers, they found that the only time in an average American’s life that s/he goes to the doctor in the right sequence of months to get the vaccine is, you guessed it, when they’re a baby. And from a public health point of view, that justifies giving babies a vaccine against something they have a functionally zero chance of getting.
This is why I’m not anti-vaccine, but I’m not vaccine-happy, either. I give my kids vaccines when I think there is a good reason to do it. Because of that, I held off on the hepatitis B till they were older, because I knew that as a responsible parent, I could handle bringing my kids in for multiple shots, and because I didn’t see any reason to stress out their little baby immune systems with another vaccine.
Every year we also get them flu shots. My son has asthma, and the flu is a major problem for asthma sufferers. Most people don’t realize that in a “good” flu year, 36,000 people die on average. The public health perspective is clear: a flu shot usually has no side effects; sometimes it causes pain, low fever. If a person has an undetected allergy to eggs, there can be severe symptoms. But for all others, the side effects are negligible. The side effects to getting influenza, however, are not negligible. People die from this disease.
Personally, I’ve never had influenza (note that “stomach flu” has no relationship to influenza, which does not cause vomiting). But when our son was small, our doctor recommended that I get the vaccine so that I couldn’t unwittingly bring the virus into his environment, even if I didn’t suffer symptoms. So I did. But lately, I have to admit that I’ve been more lax about it.
The H1N1 “swine” flu is causing a lot of us to think about our stance on vaccines, because it’s apparently much more virulent in children. (Flu is usually more deadly for the elderly.) So on the one hand, this virus is an unknown. It could just peter out and pose little threat to public health.
But I have to say that I agree with the government’s stance on this one. They are figuring that it’s worth the risk to vaccinate just in case this virus gets lethal. Just think if our government had a vaccine back in 1918, when fifty MILLION people died worldwide of a single flu virus. Consider how you would have felt burying members of your family, knowing that the government had chosen not to advise flu shots. Of course, this is all hypothetical because they had no such thing in 1918.
But here we are in 2009. We have such a thing. Our vaccines aren’t perfect, but they are a whole lot better than sitting back and watching fifty million, or even one million, people die. I know that a lot of people in Santa Cruz will choose not to vaccinate their children against this new flu. But the way I see it is this: the vaccine will not hurt the child. The flu might kill them.
That makes a pretty easy decision for me. I’m opting for a few aches and pains, and a lot of bellyaching on the part of my shot-hating daughter. I’ll go for the vaccine, and if this flu turns out to be nothing, well, as they say, “better safe than sorry.”
