I have a higher and grander standard of principle than George Washington. He could not lie; I can, but I won’t.

Editor-In-Chief, Chester "Trip" Buckenmaier III, MD,  COL, MC, USA

Chester “Trip” Buckenmaier III, MD,

“I have a higher and grander standard of principle than George Washington. He could not lie; I can, but I won’t.” (Mark Twain – 1835-1910)

            It is with some dismay that I have watched the news reports concerning the re-emergence of measles, a viral illness within the paramyxovirus family that is highly contagious via casual contact or the air. Measles remains one of the leading causes of death among young children (145,700 people died from measles in 2013.)1 despite that an effective vaccine for the disease has been available since the 1970’s. Prior to the availability of routine vaccinations for measles, about 2.6 million deaths were attributed to the virus. Because of routine mass vaccination in the United States (the MMR — measles, mumps, rubella shot on your immunization record) for the past 50 years, many physicians, myself included, have never seen an actual case of measles.

Dr. John Franklin Enders is likely most responsible for the development of a working measles vaccine during the 1960s. The effectiveness of the measles vaccination is an empirical fact with decades of few measles outbreaks and countless families spared the emotional devastation of the loss of a child in the United States. This all comes at the bargain basement price of approximately $1 per dose of the vaccine. This is truly a public health win of epic proportion for the American public.

Like many vaccination programs, the effectiveness of the vaccine depends on “community immunity” (sometimes referred to as herd immunity). Put simply, the more individuals who are healthy and immunized within a population, the less chance for the disease to take hold and spread within that population. Those who, for various reasons, cannot be vaccinated — such as immunocompromised people, pregnant women and infants — receive protection from the large number of vaccinated people in the community. Obviously, for vaccination programs to be successful, a certain amount of collective public responsibility is needed to ensure that a large majority of community members are vaccinated in order to obtain the community immunity benefit that protects from outbreaks of this deadly disease and to avoid the community disruption that ensues from outbreaks.

Anything we do in medicine carries some amount of risk, and vaccination is no exception. Few patients have any problems with the vaccination itself, but for those who do have problems, the issues are usually mild, and the rare, serious problems (pneumonia, bowel inflammation, blood in the urine or stool, as examples) often are difficult to link directly to the vaccination. Compared to many other things we do to patients as providers in the name of “better health,” the risk/benefit ratio of vaccines is truly laudable. So why is this, for all intents and purposes, eradicated disease back on the public stage? Enter the villain of this editorial, Dr. (I am using the broadest definition here) Andrew Jeremy Wakefield, a former British surgeon and medical researcher.

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Comments (3)

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  1. COL [ret.] Dean E. Calcagni, M.D. says:

    As usual, Trip Buckenmaier, has superbly called attention to a medically related issue that affects our entire society. The best disinfectant of fear is sunlight.

  2. Karen Drexler, MD says:

    Thank you for this informative and most unfortunate history of the origin of the fear of measles vaccines.

    Sadly, I find that even some clinicians at my facility have a generalized fear of vaccines that keeps them from obtaining the flu shot, as recommended for healthcare workers- thus increasing the risk of transmitting the flu to our patients and their families.

    I will share this widely, in hopes it can change the culture.

  3. Maureen Huizinga says:

    Thoughtful article. I’d venture to say that given we have had our trustworthiness called deeply into question due to the behaviour of (I’m not certain I can bring myself to address him as “Dr.”) Wakefield, perhaps the best way to win back the trust isn’t a campaign of equal fear-mongering, name calling, and end run attempts on individual (particularly parents’) rights. As someone who personally had a severe reaction to a vaccination, believe me, I never tire of being told my stupidity, imagination of the whole minor “not breathing” thing, or that my sole source of information must just be Google. 🙁 My personal experience does not colour my professional approach, every patient is offered the vaccines as per outlined by the CDC or governing body of my facility. I do tho, treat them with every bit the respect I would any other drug. Respect and care, we’ll effectively reach our patients.

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