I am going to be a parent soon. One of the (many) big debates in parenting for the past decade or so has been whether or not vaccinate a child. There’s a lot of talking points, but there tends to be little in the realm of hard data and evidence in the discussions (at least from my experience of them). Fear not, however, for I am doing the research. I wish to divide this post into three parts: outlining the main positions, outlining the quality research I can find, and discussing the two groups of points. At the very least, I hope this remains a useful starting point for others’ research. While I do not expect everyone to accept my opinion, I would like to hear others’ arguments and evidence — perhaps I’ve missed something.
For the sake of simplicity, I am reducing the main positions to three: (1) standard vaccination, (2) delayed vaccination, and (3) withheld vaccination.
The standard vaccination programmes* (US, Canada, UK) are pretty intimidating. One interesting bit from looking at just these three programmes is that Canada apparently allows a few types of delayed vaccination in addition to the early infancy schedule. The UK’s recommendations are a bit accelerated (main vaccines done at months 2, 3, and 4 while the US and Canada do them at months 2, 4, and 6). The primary reason for vaccinating a child is the obvious one: to prevent diseases (the CDC’s answer repeats this five times — the same reason is repackaged). Considering that some countries are only just seeing the end of some of these diseases (in February 2012, India was able to claim that it hadn’t had a new case of polio in the wild for a year — the US crossed that threshold in 1979). The main criticism of this programme is that there are serious — sometimes fatal — reactions to the vaccinations. According to one post by John Snyder, the following are adverse reactions just to the measles vaccine (other vaccines have similar reactions):
One in 1000 cases of measles results in encephalitis, with a high rate of permanent neurological complications in those who survive.
Approximately five percent develop pneumonia.
The fatality rate is between one and three per 1000 cases…
[D]eath is most commonly seen in infants with measles.
Subacute sclerosing panencephalitis (SSPE) is a rare complication of measles infection that occurs years after the illness in approximately 10 of every 100,000 cases.
It causes fever and a mild rash in 5-15% of recipients.
0.03% will have a febrile seizure – likely not a result of the vaccine itself, but simply a child’s individual predisposition to febrile seizures.
One in 10,000 children will have a more serious event following the vaccine, such as a change in alertness, a drop in blood pressure, or a severe allergic reaction.
The argument to delay vaccination centres on the criticisms outlined above regarding the standard vaccination programme. Many people have heard that there was a link between the MMR vaccination and autism, and they have used this link to delay (or withhold) vaccines. The primary objection to delaying vaccinations hinge on the importance of vaccines: they prevent the spread of disease (see John Snyder’s post linked above). The criticism brings out a contradiction in the concept: the only way one can safely delay vaccines is if the majority of others follow the standard programme, but delaying vaccination decreases the number and subsequently increases the chance of the diseases for those who have delayed vaccinations.
Similar to the delayed vaccination position, the argument to withhold vaccinations focuses on the criticisms to the standard vaccination. However, this argument follows the delayed vaccination argument to its extreme: it is better to delay vaccination forever rather than risk the adverse reactions associated with vaccinations. Such an argument is especially true in some relatively rare situations. Because the argument for withholding vaccinations is similar to the argument to delay vaccines, it should be no surprise that the criticism is similar: withholding vaccinations increases the chance of diseases and, more importantly, the possibility of new strands and mutations to occur which would affect more than just those who have not been vaccinated.
The main question of concern should be clear: do the risks involved with vaccines outweigh the benefits and do the risks involved with withholding or delaying vaccines outweigh the benefits? To answer these questions, an investigation requires at least a risk assessment of individual children and a risk assessment of society.
To see where problematic side effects occurred, I used the VAERS database maintained by the CDC and ran a query for all serious (hospitalisation and above) events since 2000 reported for the recommended vaccines for children under the age of 2. There was a total of 43,000 reports.
The risks of not having vaccines varies by location. For example, Hepatitis B is recommended in the US, yet the number of cases is minimal (there are only 350 million worldwide, and 600,000 deaths per year worldwide). The primary manner of infection is as an STI or through shared needle use (i.e. in certain drugs). Of the adults who contract it, 95% have a full recovery, though children and newborns have a much lower recovery rate — and they generally contract it from their mother during birth. Diptheria is a more serious disease (the fatality rate is 5-10% and it is airborne), but widespread vaccination has reduced it to less than 5 cases in the US over the past decade (and Canada, Europe, and other industrialised nations have similar levels). Likewise, pertussis is a another serious disease (responsible for 17 deaths in 2001 alone) which has seen an increase in cases since 1980 largely because of parents not vaccinating their children against it. Tetanus is yet another serious disease (over 66% of cases tend to be fatal), but it is eliminated in many countries (especially Western and industrialised ones). The story continues similarly with other immunizations — especially those recommended in many countries.
Given that the birth rate has averaged at least 4 million per year since 2000, one can safely assume that a third of those born are vaccinated according to the standard programme. That gives a total of 16 million children vaccinated over the 12 years. To continue the conservative streak, even doubling the number of reported serious effects occurs in one out of 184 children vaccinated will have some degree of a serious reaction (a half of one percent). The main offenders (over 5% of or 1000 reports) are DTaP, the combo 5-in-1 [DTaP, Hep-B, IPV] (only during first 6 months), PCV-7 (but not PCV-13), MMR (before 6 months and after 12), IPV (before 6 months), Hep-A (after 12 months). The odds of having an adverse reaction from vaccines is 183 to 1 – one is more likely to commit suicide within one’s life than have an adverse reaction. It seems that the risks of immunisation are minimal.
Returning to the MMR-autism link mentioned above, the majority of those who have heard of it do not know that (1) the journal which published it has retracted it, (2) almost all of the thirteen authors have disowned it, (3) further studies have not corroborated the link, (4) the original study did not find evidence of such a link, and (5) the primary author (Andrew Wakefield) was barred from practising medicine. Attempts to find links between immunisations and other diseases/conditions (such as autism) simply do not pan out regardless of what celebrities and a very small minority of physicians (some who have questionable qualifications). Not only that, but studies have suggested that delaying (or withholding) vaccination does not improve mental faculties. As a result, I cannot find a strong argument against vaccinating children according to the recommended schedule; but this is not the end of the discussion. In fact, I have not yet found a strong argument for the recommended immunisation schedule — most, if not all, of those arguments work strictly against withholding vaccines. Why? They argue that there is a strong chance of an unwelcome (to say the least) outcome if one encounters one of the diseases in the wild. They also argue that it is necessary for the healthy well-being of human society for its members to be vaccinated. However, the two arguments do not imply that one must be vaccinated as early as possible after birth — especially in the context of a society which has nearly eradicated the virii in question. In other words, the anticipated risk of encountering a disease in a country like the US are rare, provided that the general population does vaccinate at some point.
To bring these strands together, there is enough research and educated medical opinions to accept that (1) immunisation does prevent some horrible diseases and (2) it is a good idea for society that individuals are vaccinated against at least some of the more serious diseases. This means that withholding vaccinations completely is a horrible gamble because it places a person at risk of contracting one of these diseases as well as weakens the communal protection of others. This leaves a parent’s choices to either the recommended schedule or a delayed schedule. Since I have not found a convincing argument to require one over the other, I will leave the issue open at that.
*NB: Basic data for recommended vaccinations is as follows for the first 18 months (all numbers represent age in months):
|Hep-B||0,2,6||4 (total of 3 after month 4)||(None)|
|DTaP (Diphtheria, Tetanus, and Pertussis)||2,4,6,15||2,4,6,18||2,3,4,15|
|Varicella (Chicken Pox)||12||12||(None)|