To the Parents of My Unvaccinated Patients:
Let’s get a few things out of the way before we begin, so we have a better chance of understanding one another: I’m a pediatrician who works in a hospital. It’s true that sick kids pay my bills, but I would much rather that kids never got sick, even if it meant losing my job. (I’m adaptable. I’m sure I’d be OK.)
I’m also a person who thinks that when young people become seriously ill from diseases that might have otherwise been prevented, it’s a tragedy. Pertussis outbreaks in this country are on the rise; paralytic polio quickly returned to Syria after immunization rates dropped due to the war; the measles outbreak currently taking young lives in Europe may now do the same in Texas. When children die of these diseases, it’s unconscionable.
I am, as you might have guessed, pro-vaccine. I am amazingly grateful that my own children are growing up in an era in which it is highly unlikely that I will have to watch them die. One hundred years ago, it was ordinary to lose a child before they reached the age of five. Can you imagine? I don’t even want to.
That’s me, in a nutshell. What about you?
Statistically speaking, I know that you are smart and educated people. You love your children as much as I love mine. You want what’s best for them. You are not and do not want to be confused with the unhinged anti-vax bloggers who believe vaccines are part of a government conspiracy to intentionally injure children. You probably aren’t personally responsible for the sharp uptick of online anti-vaccine posts on Twitter, statements that are as far removed from reality as their wealthy authors are from the median income. A new study even suggests that these posts are coming from only very localized areas in California, Massachusetts, New York, Connecticut, and Pennsylvania. You’re normal and rational enough to know that while there is formaldehyde in some vaccines, it’s also present in pears, which your children have probably enjoyed in both puréed and solid forms. And you are not, no matter what I say, going to vaccinate your son or daughter just because I think you should.
Communicating effectively is something doctors are meant to do well, so it’s tempting for me to just try harder to convince you that vaccinations are not harmful. After all, the diseases that standard childhood immunizations protect against — pertussis, pneumococcus, meningococcus, etc. — aren’t in the same league as, say, the common cold. These are the sorts of bugs that kill. Paradoxically, though, it may be better if I don’t say anything at all. Research suggests that if you express concern about the measles, mumps, and rubella vaccine and I respond by teaching you about measles infections and their dangerous complications (pneumonia, encephalitis, death), you walk out of that room more convinced that MMR causes autism (it doesn’t) than you were when you went in. I never said the word autism. Neither did you. But I pushed back against your hesitation to vaccinate with information that sounded scary, and so you doubled down.
I understand. In the face of uncertainty, doing something can often feel more frightening than doing nothing. Saying yes to a vaccine may feel weightier than saying no.
Considering all this, one might conclude that we have no common ground at all, but there is one very important thing that we do agree on: we both want your children to be healthy. If you choose not to immunize your family, I can’t force you to. But that means to minimize your child’s risk of exposure to a potentially life-threatening infection, it is absolutely necessary that the children your own kids come into contact with (at school, on the playground, in the grocery store) be vaccinated themselves. The antibodies in those vaccinated children’s immune systems are what’s keeping your own family safe.
You know this. You understand that these are real and lethal illnesses. Roald Dahl was not lying when he described how his daughter Olivia, seemingly on the mend from measles, suddenly had trouble moving her hands and told him she felt “all sleepy.” Hours later, she was dead. Medicine has progressed in leaps and bounds since Olivia died in 1962, but even so, treatment for measles remains supportive — there are no medicines that can cure the virus itself, and the more severe cases will still result in death.
I know that you would never knowingly put your child at risk. You must believe it’s safe for your children to skip their vaccines because, being surrounded by other vaccinated individuals, it’s incredibly unlikely that being unvaccinated will kill them. But that math changes when someone online convinces a new mom — who has never watched an infant turn blue from pertussis — that vaccines aren’t worth the risk. That math changes when a celebrity — who has never seen a healthy toddler be placed on life support, only to die anyway from pneumococcus — goes on television and tells parents that vaccines will harm their children. It changes when candidates for public office — who have never watched a college-football quarterback seize and be killed by meningitis — waffle and cave to public opinion instead of asserting that the best evidence available says that vaccines are incredibly safe. The fact that vaccine refusal has turned into a movement is what makes it dangerous. But it’s not my children who are most in jeopardy. It’s yours.
Do what you believe is best for your family, but if that means not vaccinating, I’m imploring you to keep it to yourself. Otherwise, you are putting your children at increased risk. Steer clear of private schools where immunization rates are so low that infections would spread right through the entire community like wildfire. Don’t click on articles by anti-vax conspiracy theorists just so you can feel validated in your worldview. If someone tells you they’re an expert on vaccination because they Googled it, it’s all right to laugh. And when conversations at the office or the park turn to whether or not to immunize, just say that you feel lucky to live in an age when death from childhood infections is at an all-time low. Because of course you do. Who doesn’t?
My children don’t enjoy getting jabbed, but they get their shots with a normal degree of grumbling. Afterward, when their Band-Aids are in place and I have dried their tears, I remind them of how important it is to keep their friends and those around them safe and that doing their part should make them proud. I hope enough people in your community feel the same as I do and will create a protective bubble around your own children, even if you’re not willing to do so for theirs. Appreciate that gift for what it is. Don’t poke the bubble, or it might pop. Instead, consider saying thank you.
Meghan MacLean Weir, MD
Meghan MacLean Weir is a pediatrician and the author of Between Expectations: Lessons From a Pediatric Residency and the upcoming novel The Book of Essie.