Declining vaccination rates

August 1, 2011

What does society do when one person's behavior puts the greater community at risk? We make them stop.

What does society do when one person's behavior puts the greater community at risk?

We make them stop.

We pass laws, or impose economic rules, or find other ways to discourage individual behaviors that threaten the greater common good.

Then what should we do about people who decline vaccination for themselves or their children and put the greater public at risk by fueling the resurgence of nearly eradicated diseases? Isn't this the same thing, one person's perception of risk producing behaviors that put others at risk?

Of course it is.

Isn't it time for society to say that in the greater public interest, we need to regulate the risk created by the fear of vaccines?

Yes. It is.

The evidence is overwhelming that declining vaccination rates are contributing to outbreaks of disease.

Take just one example: measles.

The European Center for Disease Control reports outbreaks in many countries where vaccination rates have gone down. As of June: France (12,699 cases in 2011, more than in all of 2010 already, including 6 deaths), Spain (2,261), Italy (1,500), Germany (1,193, 1 death), Switzerland (580), Romania, Belgium, Denmark, and Turkey.

There have already been 550 measles cases in England and Wales this year compared with 33 for all of last year.

The United States has seen 156 cases as of mid-June, compared to a total of 56 cases per year from 2001 to 2008.

The Centers for Disease Control and Prevention has an emergency health advisory out for measles, a disease officially declared eradicated in the United States in 2000.

The antivaccine folks argue: "If we're just putting ourselves at risk, why should society tell us what to do?"

Well, this is a risk to far more than just those who decline vaccination.

People who have been vaccinated are getting sick, but the vaccine either doesn't work or the immunity has weakened. (Of the 156 measles victims in the United States as of June, nearly 1 in 5 of them had been vaccinated.)

Infants too young to be vaccinated are getting sick, and some of them are dying when exposed to diseases in communities where "herd immunity" has fallen too low to keep the spread of the disease in check.

And unvaccinated people who get sick and seek treatment at doctors' offices and hospitals raise the risk to anyone sharing those facilities, cost the health care system millions of dollars in avoidable expense, and cost local and state government (that's taxpayer money, yours and mine) millions more as they try to chase down each outbreak and bring it under control, to protect the public's health.

Your health, and mine. (A recent economic analysis found that " . . . vaccination of each US birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and $69 billion in total societal costs.")