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US county bars unvaccinated children from public spaces amid measles emergency

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1481 (Published 28 March 2019) Cite this as: BMJ 2019;364:l1481

Linked opinion

Measles in America—what’s playing out in New York State is nightmarish

Re: US county bars unvaccinated children from public spaces amid measles emergency

Response 2 to Dr Anand

Anand writes: “Dear all interested in immunisation against a particular disease - by full, free, informed consent of the person at risk of that particular disease.”

Anand continues to ignore that we live in communities, which means rights as well as responsibilities. As I wrote earlier, there are children who can’t be vaccinated, e.g., autoimmune diseases, chemotherapy for cancer, or other genetic disorders that reduce immune system’s response to vaccines. Many children are alive today who only a generation or two ago would not be, e.g., low birthweight, very low birthweight, who have problems; but can live reasonably healthy long lives. How do we protect these kids? Should their parents home school them, not take them to parks, schools, shopping, Disneyland, even doctor’s offices? No visitors to the home? Do their lives not matter? Don’t they deserve a quality of life? As I wrote previously, besides just a sense of community, what if the shoe were on the other foot, i.e., there but for the Grace of G-d go I? (Harrison, 2019)

Perhaps Anand was a supporter of Margaret Thatcher who said: “there is no such thing as society. There are individual men and women, and there are families. . . people must look to themselves first. It’s our duty to look after ourselves and then, also to look after our neighbour (Thatcher, 1987). Not to go too far afield; after Brits had gone through the Great Depression and World War II together, they established the National Health Service, among the best in the world; but Thatcher almost destroyed it. Despite claims to the contrary, health care doesn’t fit into a market model, it is a “public good” [community, society] (Arrow, 1963; Harrison, 2018; Rice, 2015). But even Thatcher’s quote says after we have looked after ourselves, we should look after our neighbors. Or how about Rabbi Hillel from 2000 years ago: ““If I am not for myself, who will be for me? If I am not for others, what am I? And if not now, when?”

Anand writes: “It is stated that the “hesitants" are mostly well-educated.
Might I suggest that cultural anthropologists be kept out of it? Margaret Mead is sometimes invoked. But it is forgotten that she did not write about Samoa by reading about Samoans, nor did she pay flying visits only. Could it be that the well-educated parents take umbrage at being bullied? Being told that they are enemies of “

The studies weren’t conducted by cultural anthropologists (e.g., Hornsey, 2018; Khazan, 2014; LaVito, 2019; Oracknows, 2015; Warner, 2017; Yang). A number of studies have found that one major group of antivaccinationists is comprised of well-educated, middle-class whites, but not all studies agree; but who cares? I actually in younger years read Margaret Mead, Ruth Benedict, and Franz Boas, plus other anthropologists, so what? Is it bullying to outlaw storage of large amounts of combustibles in one's garage? Is it bullying to quarantine those returning from, for instance, countries with Ebola outbreaks? Is it bullying to deny people the right to drink and drive? After all, there are those who can hold their liquor??? Since many vaccine-preventable diseases are contagious long before they become symptomatic, should we quarantine anyone not vaccinated who travels abroad? How would this work with those traveling to and from Mexico and Canada? Again, in communities, we have rights and responsibilities. The overwhelming evidence supports that vaccines confer exponentially more benefit compared to minuscule serious risks, autism not one of them. As part of a community, should individual parents be allowed to rely on others vaccinating their kids? As long as vaccine rates remain high, they are still no guarantee that an innocent child who can’t be vaccinated won’t become infected by someone who voluntarily refused vaccination. The recent outbreak of measles at Disneyland was attributed to a non-vaccinated kid (Zipprich, 2015). What if parents brought their child who had just successfully been treated for cancer to Disneyland and he/she became infected? The consequences may have been dire. Whether low vaccination rates cluster among white, educated, well-off suburbanites or elsewhere, they put everyone at risk ! ! !

Anand writes: “I have it from an unimpeachable source that in Germany, there is licensed, a monovalent MEASLES Vaccine. But it is not available. Why, I wonder. It may be costly. But might I suggest that the vaccine may be made available to those who are willing to pay?”

It is not available in the US because the companies decided it wasn’t cost-effective to produce (Kimberlin, 2009). And in the US it is illegal to import any drug not approved by the FDA, so companies producing monovalent measles vaccine abroad would have to spend a fortune to get it through the FDA approval process (Congressional Research Service, 2018). As I’ve written before, the safety profile for the MMR is the same as for the monovalent measles vaccine. And what happens if parents only get their kids the measles vaccine? Then they risk mumps and rubella, both, though often, not always, benign, could have serious sequelae for the kids who can’t be vaccinated because of compromised immune systems.

Anand writes: “The WHO knows full well that in India it quite happily supports MEASLES - RUBELLA vaccination. Yet , in Europe, it has to be MMR.”

Actually, India is in the process of adopting the MMR.(Bhatnagar, 2014; Bandyopadhyay, 2017; Gomber, 2011; Shah, 2017). And I guess if currently India only vaccinated for measles, then Anand would question why add Rubella.

References

Arrow KJ (1963 Dec). Uncertainty and the Welfare Economics of Medical Care. The American Economic Review; 53(5): 141-149. Available at: https://www.who.int/bulletin/volumes/82/2/PHCBP.pdf

Bandyopadhyay B (2017 Feb 19). All you wanted to know about MMR vaccine but never asked. Bangalore Mirror. Available at: https://bangaloremirror.indiatimes.com/news/state/all-you-wanted-to-…-mmr-vaccine-but-never-asked/articleshowprint/57070816.cms?prtpage=1

Bhatnagar N, Kaur R, Gupta M, Sharma D (2014 Jun 15). Introducing Combined Measles, Mumps and Rubella Vaccine in Chandigarh, India: Issues and Concerns! Indian Pediatrics; 51: 441-443. Available at: http://medind.nic.in/ibv/t14/i6/ibvt14i6p441.pdf

Congressional Research Service (2018 Dec 21). Prescription Drug Importation. Available at: https://fas.org/sgp/crs/misc/IF11056.pdf

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Harrison JA (2018 Aug 10). The Case for A Non-Profit Single-Payer Healthcare System. Physicians for a National Health Program. Available at: http://pnhp.org/news/the-case-for-a-non-profit-single-payer-healthcare-s...

Harrison JA (2019 Mar 31). Response to John Stone. BMJ Rapid Response. Available at: https://www.bmj.com/content/364/bmj.l1481/rr-3

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Khazan O (2014 Sep 16). Wealthy L.A. Schools' Vaccination Rates Are as Low as South Sudan’s: Hollywood parents say not vaccinating makes "instinctive" sense. Now their kids have whooping cough. The Atlantic. Available at: https://www.theatlantic.com/health/archive/2014/09/wealthy-la-schools-va...

Kimberlin DW, Bocchini JA (2009 Dec). Monovalent vaccines no longer available for measles, mumps, rubella. AAP News. Available at: http://www.aappublications.org/content/30/12/9.1

LaVito A (2019 Mar 19). Hereʼs where parents are refusing to get their children vaccinated. CNBC. Available at: https://www.cnbc.com/2019/03/28/heres-where-parents-are-refusing-to-get-...

Oracknows (2015 Jun 4). The faces of antivaccine parents: Overwhelmingly a!uent, white, and suburban. Science Blogs. Available at: https://scienceblogs.com/insolence/2015/06/04/antivaccine-parents-overwh...

Rabbi Hillel. Available at: https://www.goodreads.com/quotes/556948-if-i-am-not-for-myself-who-will-...

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Shah N, Parikh R, Casabona G, Kolhapure S (2017). A New Combined Vaccine Against Measles, Mumps, Rubella and Varicella in India. Indian Pediatrics; 54: 1041-1046. Available at: https://www.indianpediatrics.net/dec2017/dec-1041-1046.htm

Thatcher M (1987 Oct 31). Epitaph for the eighties? “there is no such thing as society”. Sunday Times. Available at: https://briandeer.com/social/thatcher-society.htm

Warner EL, Ding Q, Pappas LM et al. (2017). White, affluent, educated parents are least likely to choose HPV vaccination for their children: a cross-sectional study of the national Immunization Study – teen. BMC Pediatrics; 17. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710112/pdf/12887_2017_Arti...

Yang YT, Delamater PL, Leslie TF, Mello MM (2016). Sociodemographic Predictors of Vaccination Exemptions on the Basis of Personal Belief in California. American Journal of Public Health: 106: 172-177. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695929/pdf/AJPH.2015.30292...

Zipprich J, Winter K, Hacker J et a. (2015 Feb 20). Measles Outbreak — California, December 2014–February 2015. Morbidity and Mortality Weekly Report (MMWR); 64(06): 153-154. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm

Competing interests: No competing interests

15 May 2019
Joel A Harrison
Long-Retired Epidemiologist
None
I have NEVER worked for the FDA, NIH, CDC, any pharmaceutical company, nor ever purchased pharmaceutical stocks