Those routine shots only really work when the whole community takes part, says this doctor and professor of public health
The measles epidemic in the western United States earlier this year provides a good reminder that it is time to end the religious exemption for vaccination. It may also be time for physicians to change the way they educate their patients about vaccines.
First, we need to understand that government requires vaccination not to protect the individual, but to protect the community. Vaccines have failure rates—that is, what gives me and my family protection is not that I was vaccinated, but that everybody was. Despite the failure rate, enough of the community is immune so the disease cannot find room to spread. Combine the failure rate with a high-enough refusal rate, however, and the disease can spread, and even those who are immunized are at risk.
We can only protect individuals by demanding they participate in protecting everyone.
Second, with all due respect to religion, we need to understand that a religious reason to refuse a vaccine is no reason at all. Imagine if I insisted that my child attend school with a fever during a flu epidemic, claiming religious belief. The school would rightly scoff and refuse my child access. The claim to a religious exemption for vaccines is no different. There is no rationale. It is based simply on belief, or a claim to a belief. Indeed, we do not accept refusals based on seeing the science differently, or an extreme libertarian point of view, or distrust of government, or a fear of technology we don’t understand.
Religious objections count precisely because they come without any reason except a statement of belief, perhaps endorsed by a religious “authority,” which also has no reason but “belief.” In other words, the objection arises for no reason at all. Right now, according to our laws, it’s the only excuse good enough. And for this we put the community at risk.
While it is not possible here to address all the religious arguments made against vaccines, two are common enough that they deserve comment. One is that vaccine mandates interfere with the sanctity of the parent/child bond and the “religious” right that parents have to make decisions on behalf of their children. This argument can only hold if one is in ignorance of the community-protection reason for vaccines. The vaccine requirement is made not on behalf of the child, but for the community, and no religion should give parents the right to endanger others.
The second argument is that vaccines interfere with the natural healing power of prayer. Setting aside for a moment the overwhelming scientific evidence that prayer does not reduce the spread of measles, it’s important to point out how selectively this kind of argument is made. Do those who hold this belief in prayer also refuse the help of a rescue squad during a flood? I think not.
The solution is simple and clear. If you want to refuse vaccines, then home-school your children. Don’t send them where they place my family and community at risk.
As for government officials who endorse such exemptions and would extend them, this suggests a failure to understand the basics of civics and the reasons for vaccine laws in the first place. To understand how irresponsible such statements are, imagine these same politicians urging drivers to treat traffic lights as optional! Like vaccines, traffic lights are imposed by government for public benefit.
Vaccines may impose on us in a small way, but they also make us safer and enhance our greater freedom by allowing us to live our lives free of the risk of preventable illness. This has long been settled science—and, until recently, settled policy. It needs to be settled policy once again, free from attacks by religion or ideology.
How should the medical profession address vaccine deniers? We need to start in our offices, with our patients, and make sure that parents understand the true rationale for vaccines. We are accustomed to being an advocate for our patients, and not an agent of the state, but in the case of vaccines, the two roles are inseparable. We can only protect individuals by demanding they participate in protecting everyone. We need to remind our patients that we are all in this together.
This article first appeared in Spring 2015 issue of Tufts Medicine magazine.
Anthony Schlaff is a professor of public health and community medicine and director of public health programs at the Tufts School of Medicine.
