Hysteria and threats to herd immunity

Among the problems we’ve encountered in primary care, vaccines weren’t at the top of the list. While anti-vaxxers, who boycott vaccinating their children, are a force to be reckoned with in the United States, those against vaccination in the Philippines were in the relative minority. Until recently it’s been more the norm rather than the exception that mothers bring children to their checkups and, when asked about their child’s vaccination status, still say proudly that they’re “complete” or “updated” for their age, while slightly more painstaking parents bring their baby books along with them and show their record of vaccination.

And that was good, because in a culture flooded with hokum news about health, vaccines and their importance should have been the least of our problems. As it is, we have people who won’t pay for or line up at the PCSO for antibiotics or chemotherapy, but who will shell out money for neutraceuticals. We’ve watched even highly intelligent colleagues pay extra for alkaline water, or supplements, or the latest “health benefit” trend, the search for a “magic” vegetable or an instant cure-all. It was bad enough.

The news that parents have been so alarmed about the Dengvaxia issue that some have refused to have their kids vaccinated is alarming. This is in a background of public mistrust of doctors and the rise of doctor-shaming—a phenomenon unique to the social media age, where doctors get publicly lambasted either personally or as a profession. When public trust in doctors and medicine is at an all-time low, trust in sound, evidence-based treatment follows suit.

Dr. Gerardo Legaspi of the UP-PGH has said it best—that if we want to stop the hysteria, we should stop talking. But when the fuss dies down, I can only imagine the efforts to be made by both the private and public health sectors to gain what trust has been lost, and with it, the security of herd immunity. In our haste to point fingers in the Dengvaxia fiasco we’ve lost sight of the fact that not every frightened parent will sit down, open Google Scholar and make a rational,
evidence-based decision about their child’s health and the need for vaccination. And this would not be the fault of the parents, whatever their level of education, but the fault of the government and its stakeholders who have conducted this affair without the appropriate sobriety or discretion, presenting facts which are incomplete or skewed but which make all the difference to those on the other end of the newspapers or TV news.

Because of this failure, the job has fallen to us, as healthcare professionals, to separate politics from science, so in this space I will need to reiterate that vaccines work. They work not only for individuals, by providing them with immunity for strains of prevalent diseases, but also for the community. The concept of herd immunity, by which a population develops resistance against a certain disease if a significant proportion of the group is already immune or vaccinated, is no small thing, and is the reason behind the eradication of smallpox and the decline in other communicable diseases. Due to herd immunity, even those individuals who are not vaccinated have a measure of protection.

The refusal of parents to have children inoculated, therefore, isn’t just a personal decision but also a public health concern, because the refusal of a few can affect the health of many. The Dengvaxia vaccine itself works, but because it is relatively new we can maybe allow for some questions about the best timing and candidates for inoculation, but we can’t allow doubt to fall on the safety and effectiveness of those vaccines which have been the workhorse of public health for decades. So we need to be calm, avoiding treating the Dengvaxia issue like another piece of sensational gossip, but maintaining a steady and vocal support for proven and necessary government health programs. In a time when fears range from nuclear threats to death at the hands of law enforcers, this would be the worst time for the resurgence of diseases we thought we had already left in the past.

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