Immunity should be seen and also herd

The alarming rise in measles cases has finally reached Pittsburgh, with four cases confirmed after exposure to an unvaccinated adult with measles. These people visited the airport, grocery stores, a thrift store, a car rental agency and untold other venues, exposing untold other people. This has fueled reactions in the general public from righteous anger (how dare these idiots remain unvaccinated and endanger my vulnerable loved ones with a preventable serious disease?) to outright fear (I can’t take my infant/immunocompromised relative out of the house now!).

When I learned as a child that vaccines keep us safe from viral scourges via herd immunity, the cynic in me thought that somewhere, there would always be an evildoer who would work to reintroduce the virus as a form of bioterrorism when the immunity of the populace was waning. Ah, but there are boosters to prevent the latter, I was told, and so I stopped worrying. I never thought that there would arise a movement to prevent or damage herd immunity outright and return us to the dark ages of disease.

Prevention of disease through mass vaccination is completely dependent on a social contract between us as humans so that the weakest, who cannot be immunized, will still be protected because the rest of us will not carry or transmit the virus due to our vaccinations. In other words, it relies entirely on the goodness and unselfishness of humans toward other humans. This in turn relies on human nature being essentially good, which is certainly debatable. As Stephen Hawking pointed out: “We have certainly not become less greedy or less stupid … I fear evolution has inbuilt greed and aggression to the human genome. There is no sign of conflict lessening, and the development of militarised technology and weapons of mass destruction could make that disastrous.” Together with George Santayana’s observation: “Those who cannot remember the past are condemned to repeat it,” it certainly speaks to the events of today.

We’ve become remarkably complacent as a populace about viral diseases, because we don’t see terrifying visual reminders like children trapped in iron lungs by polio. We live in the luxury of a world where these diseases have either been eradicated or confined to the far corners of the earth. There are children today who have never seen the Indiana Jones trilogy or a pay phone; how would they know about polio? Even Ebola is an exotic rarity to us, the stuff of a good thriller novel — but not an everyday threat. We have the immense luxury of forgetting the horrors of the past, because our parents and their parents upheld this social contract of vaccination. Our forebears upheld this social contract because unlike us, they all knew someone whose child had been afflicted or maimed or killed. They also were well-educated by government media campaigns ranging from newsreels to posters to mass vaccination programs. They vaccinated us out of love and fear of a real and present danger.

So how did we get so selfish in this regard? We’ve been lulled into a false sense of security regarding these diseases; we instead face the very real threat of school shootings, terrorism and the like. These threats are real because we see them tragically nearly every day along with the suffering they bring. The closest thing to a government media campaign we have is “See something, say something.”

We have cheated Darwinian evolution; we have created a utopian society through medical progress where those who might never have survived now can do so, via vaccines, prenatal care, NICU care, surgery, oncology treatments, gene therapy and transplants, among many advances. We have created a world where those who might not have even been born are born, via in vitro fertilization. Humans who might never have existed, let alone survived, now have the chance to procreate and pass on their genes. We as a world, as a society, are richer for having these individuals in existence — emotionally, intellectually, physically. Think of how much grief has been spared for parents who would have lost children to viral disease. Think of how much joy, creativity and benefit their healthy children have brought them and the world.

But this loving anti-Darwinian utopia we’ve created also has created an immense sense of entitlement. Every medical ailment can be met with “Oh, can’t they fix that? No big deal.” “Hacking,” “disrupting” and over-commercializing medicine also is symptomatic of this problem to some extent. It is easy to buy the patent on a decades-old drug and raise its price from $40 to $40,000 and claim you are being responsible in increasing shareholder value, because after all, it’s a drug to treat a rare disease, and you’re not the one suffering from it. As for the people who are, “Oh well.” Suffering is abstract when it happens to someone else, and when you are not in imminent fear of death, it is easy to be cavalier. As all of us learned in anatomy lab, death is unfortunately the great equalizer of heads of state and paupers alike.

To reject the social contract by rejecting vaccination of a healthy child comes down to selfishness. Even if, for argument’s sake, there was any merit to a slightly increased risk of autism or other side effects with vaccination, refusing to take that risk for your own child and allowing the vulnerable children of your fellow man to die or be maimed by a preventable disease is just that: selfish. It is a violation of the social contract. We make an inherent contract with our government as citizens; we rely on our government to protect us, but we also agree to serve if called up in a draft. Every young man is required to register with Selective Service at the age of 18; vaccination is not so different. In the face of war, one can be a conscientious objector, but conscientious objectors do not provide material support and housing to the enemy by housing the enemy. In contrast, by refusing to vaccinate one’s healthy children, one provides preventable viral diseases with a host from which to conduct biological warfare. And one day, the enemies of our country may rely on exactly that unvaccinated host capability to wreak havoc upon our populace via true biological warfare. No one approaches the vaccine debate from a national security standpoint or a patriotic framework, because we are not yet facing an existential viral threat. Yet. It is only a matter of time before we do.

How did we get so selfish? It has been a long slide from the unselfish days of World War II where rationing, meatless Mondays, air-raid/blackout drills and conservation of resources were accepted because our survival potentially depended on these things. Government posters and media campaigns essentially advised Americans: “Don’t be that guy.” In the 1950s, there was a Red Scare, and the nuclear threat began; this continued until the Cold War ended. In between, we were all bound together with a sense of communal duty to each other and to our country. In the decades since, those bonds have loosened for many; they re-emerged briefly after 9/11. It should not take an existential threat to unite us, but sadly that is human nature. Since then, we have grown politically extreme as a nation in media, politics and rhetoric. The moderate struggles for a place to survive, let alone be heard. Everyone is convinced that they are special in our narcissistic culture of judging one’s worth by one’s Twitter following; everyone is convinced that they’re an expert, and rejects true education and expertise. We say in our field that a dangerous clinician is one who doesn’t know (or won’t admit) what he/she doesn’t know; most of the nation has seemingly lost that common-sense virtue, and has fallen prey to the Dunning-Kruger effect.

Supporters of the anti-vaccine movement rely on misinformation, the public’s gullibility, and fear tactics. They use an all-or-nothing approach to make their point, asserting that “vaccines are evil, physicians are evil, and every vaccine advocate is a pharmaceutical industry shill and suppresses ‘the truth’ about side effects.” This is the worst of human nature surfacing. It is like Salem, Mass., in the days of old, or the days of the Inquisition. How can you defend against accusations of witchcraft in the face of mass hysteria? When anti-vaccine activists damage the reputation of decent physicians and go so far as to encourage harm to their persons, families and practices for stating scientific fact, what can you do?

The side of medicine and science has understandably dug in equally hard in response. We restate our case over and over to anyone who will listen. We adhere to the studies and schedules that are already in existence. We dig in our heels and scream at them like they scream at us, because they are wrong, and we are right, and they act crazy. The result is like our modern politics, with each side entrenched, ultimately no cooperation across the aisle and therefore no progress.

Instead, what if we were to change the debate? As in, this is no longer about us as individuals. None of us is so special that we can risk harm to another’s life without a valid medical reason to be exempt. We all have to admit that we have value as individuals, but that individual value is useless when the health and security of our society is at risk in the age of bio-terrorism. After all, the military mandates vaccinations for our soldiers who defend our country to avoid losses. Reissue the social contract. How can we achieve the goal of public safety? Listen to the other side within reason. Don’t want multiple vaccines at once? Fine. Do an alternate dosing schedule, but get the vaccines in a timely fashion. Want more transparent research? Great. Let’s do it. But get your children immunized. Put out modern newsreels: “Don’t be that guy/gal.” Loose lips sink ships, and not vaccinating puts our national security at risk.

Let’s reframe vaccination not as a choice but as the patriotic duty of every American, as it has been in the past.