“A one year-old just died. Paramedics were called but he was gone by the time they got there,” the resident spoke softly, obviously affected by the news. “What happened?” I asked. She told me that the child had been seen in the ER two days earlier, was diagnosed with measles and sent home. My heart sank. I had sent home a one year-old child with measles two days earlier. Was this the same child? It was. He had looked so good two days earlier, responsive, alert and in no distress. The careful follow up instructions that were given were not followed and the child developed complications and arrested. I will never forget how I felt when he died.
He died, needlessly, because his mother and aunt did not believe in immunizations. He was one of 7 cases of measles in the family, 4 of whom were hospitalized. I was so angry at his parents and his aunt. I held them responsible for the child’s death. Their decision to believe false information from vaccine fear-mongers over the advice of their doctor was to blame for his death. Arrogance and ignorance ended his life.
The year was 1990, the peak of the last epidemic of measles in the United States. It was a year of frustration for doctors as we were forced to deal with a disease that was close to disappearing just a few years earlier. Prior to the development of the measles vaccine, measles was an incredibly contagious scourge. The numbers from the late 1950’s are staggering. It is estimated that there were nearly 4 million cases a year, only a fraction of which were reported to health officials. The yearly averages were frightening, 150,000 pneumonia like complications, 48,000 hospitalizations, 4000 devastating brain infections and 450 deaths. Measles was a disease as unavoidable as it was harmful. Over 90% of the population was believed to be exposed in their lifetimes.
In 1988 the story was different. Cases were rare with the majority of cases occurring in non-immunized immigrants. Measles cases were estimated to be fewer than 10,000 a year. There was talk that we might accomplish with measles what had been miraculously accomplished with smallpox, complete eradication of the disease. Then something happened. From 1989-1991 measles made a comeback. The boy I saw die was one of 55,000 cases and 123 deaths during that time.
What happened was that some parents decided not to immunize their children. As it is extremely contagious, measles does not need much of an opportunity to regain a foothold. That opportunity was provided by a false belief in some parents that immunization was unnecessary or even harmful. Parents who were too young to have experienced the disease became more fearful of the vaccine than the disease and their unvaccinated children became innocent victims.
In response to the epidemic in 1989-1991 the medical community mounted a counteroffensive. Doctors aggressively educated their patients about the safety of vaccines and the dangers of the disease. Measles faded from the scene, returning to its status as a rare disease seen mostly in textbooks and rarely in medical practices. Measles remained rare and hidden for 20 years, with only about 60 children becoming infected annually in the United States.
This generation has seen a large cohort of parents, skeptical of the medical profession and supremely confident in their own knowledge and judgment, repeat the mistakes of the past and refuse to immunize their children. Immunization rates are dropping. The incidence of the disease increased 1000% from 2013 to 2014.
The recent outbreak traced to Disneyland illustrates the seriousness of the disease. At least 12 cases were traced back to visits to the theme park in mid December. 11 of the cases were in non-immunized individuals. Two of the children were too young to be immunized, the rest were unprotected due to a foolish parental decision. It is deeply troubling to consider how babies were put at risk by another person’s decision.
It is this Disneyland story that took me back the 25 years to the day I saw that child die. The feelings of anger and helplessness came rushing back. These feelings are intensified when I think of the increasing number of parents who are refusing to vaccinate their children. As someone who took an oath to help people I cannot comprehend the arrogance and foolishness that leads to these decisions.
As a doctor I have spent hours upon hours trying to convince such parents of the importance of protecting their children. The years have proven that such efforts by me are futile. As these are emotional and irrational decisions, rational arguments have no effect. I have reached a place where I don’t argue anymore. I tell parents that vaccines have been proven safe and that if they refuse to vaccinate their children that I will not provide care for their family. I will not stand by while they risk the health of their child and I do not want my other patients placed at risk. There is no negotiation. Their position need not be heard, tolerated or respected.
It is time that society take a similarly firm stance. There is no duty to respect a foolish position.
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Update- The Disneyland Data is evolving. The post reflects the data that was available at the time of writing. The post has been edited to clarify the reasons for parents not immunizing children in the late 1980s.