It’s a box in the top right hand side of the emergency chart, just beside the patient’s weight. I fill it in routinely, every time I’m seeing a patient in the pediat
ric emergency department. I systematically check the vital signs typed in at the triage desk, ask “Any allergies to medications?” and then “Are immunizations up to date?” I abbreviate it “ImmU2D” to save time. And each time I ask, my heart rate jumps for just a second, a guttural butterfly-in-stomach wave shoots through me, and I hold my breath while I await a response. “Yes, of course” most parents say, and I exhale, moving on to the next question.
Most parents. Not all. There’s a few, and I emphasize a few, who launch into a confident and slick diatribe when “Oh, we choose not to immunize” would do. It’s often dramatic, confrontational, and seems to have been practiced in the mirror over and over and over again. Of all the people I judge, I judge them the most: he who doth protest too much. I try not to show it, the actor in me rising to Oscar-worthy performances that say “I don’t hate you, but I don’t in the least agree with you, but I’m trying to hit my quota of 16 kids this shift, so let’s just assume you’ve already been made aware of how stupid you are and have elected to be stupid regardless.” I move on.
And that was it, I thought, until last night.
Now this isn’t a post about why vaccines are good. For the sake of completeness, the save lives, they don’t cause autism, and their utility in stamping out disease is based entirely on the concept of “herd immunity” – the idea that if two cows out of a hundred are susceptible to a disease, they can’t catch it from the 98 who are immune (since immune people don’t get the disease). It’s worth noting that some people – like babies and immunocompromised people – aren’t able to be immunized and thus depend on herd immunity for survival. If you like, Penn and Teller explain 
it better than I.
All of you have surely heard of the tragic death of Ezekiel Stephan, a 19-month old who died of bacterial meningitis after his parents, who are against vaccines, spent weeks caring for him with hot peppers, garlic, horseradish, and positive vibes, none of which kill Neisseria meningitidis.
This week, his parents were found guilty of “failing to provide the necessities of life,” a cop-out used by a Crown painfully aware that no jury would find well-intentioned (though stupid) parents guilty of murder. The maximum jail time is 5 years. This verdict, while better than an acquittal, angered me and, I suppose, made me extra-sensitive last night, 15 hours into my work day and still 3 hours from the end of my shift when I grabbed the next chart in the to-be-seen rack.
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NOT IMMUNIZED, I wrote in large letters, circling it twice (out of anger, not emphasis) along the entire top of the chart. I started taking a history, and immediately felt my eyes rolling as the parent recalled a years-long-battle with an “assumed” diagnosis of a rare, transient disease. I could feel the sarcasm broadcasting from my body. I performed a cursory exam, and reported to the consulting pediatrician that this patient could be discharged and follow up with their unfortunate immunologist. I could not hide my contempt, and my boss went in to discharge the patient. She came out with a signed consent to administer blood products. To save you the medical jargon, I had missed something serious that required immediate (and significant) treatment.
Eight hours earlier I sat in a lecture about being compassionate. I made a comment about trying to be compassionate towards people I dislike. And yet, primed by the tragedy in Alberta and tired of the vindication antivaxxers wear on their smug faces, I let my own judgments of a parent affect the care of my patient – a child – who was an innocent bystander in this massacre of my clinical integrity.
I’ll spare you the root-cause-analysis and discussion of cognitive biases. Suffice to say, I could have performed better. I let my “negative countertransference” towards her affect my ability to care for her child.
I’m no where near being able to throw compassion towards antivaxxers. But I’m more aware of my own reactions to these idiots, and (I hope) more capable of helping their extra-vulnerable children, lest a kid like Ezekiel be fortunate enough to end up in the to-be-seen rack before it’s too late.
Blair, thanks for posting and for your honesty.
Thanks Susan! Hope all is well.
Unfortunately for you and your ability to be compassionate, parents have medical legal rights to choose. Unfortunately (again) for you and your ability to be compassionate, this post is a slap in the face to any parent who has witnessed their child have an adverse reaction to their shots. Because as much as you want to say on the matter, the only fact that should ever be presented as REAL is that vaccines are not 100% safe and not 100% effective. That is like saying Xanax is 100% safe and 100% effective. No, Xanax is a drug. As are vaccines. Otherwise things like VAERS wouldn’t exist. We cannot keep having this argument and missing the fact that these are drugs sold and manufactured by pharmaceutical companies that are being administered to newborn and week old babies! Why is it okay to ignore that and have 0 compassion for any parent who worries about that? I guess because you assume that if a parent is worried about that, they automatically don’t worry about their child getting a disease. It isn’t one or the other. If you cannot show compassion for a parent who is worried for their child’s well being on all levels (one being injecting heavy metals and known neurotoxins into their bloodstream various times) then perhaps you’ve entered the wrong profession and maybe you should get a job selling pharmaceuticals! I think that would be a much better fit!
Face reality: vaccines should be treated as any other drug are treated, risks should be acknowledged and you have absolutely no right to belittle any parent for practicing their parental rights!
Hi Deidre, thanks for your comment. You are very right, nothing is risk-free, and vaccines are not risk free. Vaccines do cause reactions; fever, rash, and flu-like symptoms. This is evidence of an inflammatory response the body produces to vaccines, and in fact demonstrates their function. I understand that they can be scary and they can appear to be bad reactions. The incidence of lifethreatening reactions to vaccines is extraordinarily low, much lower than the risk of a lifethreatening reaction to an antibiotic, or instance. Also, I should correct you as newborn babies and week-old infants are not given vaccines. They get their first vaccines at age 2 months, and in fact are very much benefited when everyone around them is vaccinated during that vulnerable period. Also, there are no heavy metals or neurotoxins in vaccines these days. Thimerosal, which contains mercury, is no longer used. Also, heavy metals are not necessarily bad for you (in fact, some are required for life function) and no study has ever shown that thimerosal is harmful when used as a preservative in vaccines. Next, I don’t think my post belittled parents for practicing their parental rights, but rather belittled parents who do NOT live up to their parental responsibilities. It takes a village to raise a child, and sometimes the villagers must stand in judgement. Thanks again for engaging in this important conversation.
For those of you who are asking for evidence that vaccines do not cause autism, please see this summary I’ve prepared.
Evidence that Vaccines Cause Autism:
In 1998, Wakefield published a study of 12 children in the Lancet. He demonstrated that 8 of the 12 began to have autism symptoms and gastrointestinal histological changes shortly after being vaccinated.
This paper was fully retracted when it was shown data and histological slides were falsified.
There is no other scientific evidence that vaccines cause autism.
Evidence that Vaccines do Not Cause Autism:
2013: A Centre for Disease Control study finds that immunized children with autism have equivalent antigen levels to immunized children without autism.
2012: A large study showed that thimerosal (a mercury-containing preservative no longer used in vaccines) does not cause neuropsychological problems in children.
2011: An Institute of Medicine report finds that 8 commonly used vaccines do not cause autism and extraordinarily safe
2010: A large study found that exposure in the womb to vaccines does not cause autism.
2009: An Italian study found no connection between vaccines and autism.
2008: This American study found that flu vaccines were not associated with autism.
2007: This study found no connection between thimerosal and neuropsychological sequellae.
2004: A scientific review finds that thimerosal (a mercury-containing preservative no longer used in vaccines) does not cause autism.
2003: A comparative analysis between California, Denmark and Sweden showed no evidence that vaccines cause autism.
Source: http://www.cdc.gov/vaccinesafety/pdf/cdcstudiesonvaccinesandautism.pdf
Autism rates jumped when vaccine rates jumped:
Autism rates jumped in the 1990’s as diagnostic changes came into effect. In addition to autism rates rising, vaccine rates also rose as governments realized the health benefits from funded immunization programs. Air travel, the price of crude oil, and the % of power generated by solar panels also increased during the 1990’s, but like vaccines, these are not related to the rise in autism.
Vaccines Cause Allergic Reactions:
All medications can cause an allergic reaction. Vaccines in particular cause extremely few, much less than the 3:100,000 anaphylaxis reactions that lead to death after antibiotic exposure. What vaccines do cause is a generalized inflammatory response which may include rash and fever. This is often interpreted as harmful adverse event, when in fact it is an appropriate immune response by the body to the vaccine.
Are vaccines risk-free?
No. Nothing is risk free. But the risk is extraordinarily small.
This risk is offset by the incredible benefit to human health since vaccines were introduced. For example, before-and-after vaccine introduction for:
1) Paralytic poliomyelitis: 24:100,000 / 0:100,000
2) Invasive pneumococcal disease: 88:100,000 / 9:100,000
3) Measles: 250,000/year. Jan-Apr 2016: 4.
4) Diptheria: 77,000 in 1934 (UK). 2 between 2004-2015 (US).