Keeping vaccination rates up: Doctors must keep up the pressure

Childhood vaccines are a victim of their own success, and doctors find themselves spending more time convincing parents of the shots' necessity.

Editorial. Sept. 8, 2003.

Back-to-school time is also the time to bring many children up to date on vaccination. But these days, more and more parents are reluctant or refuse to get their kids immunized.

So doctors find themselves spending precious office hours educating parents on the necessity and safety of vaccines. Nevertheless, it is essential that they keep up this work.

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Ironically, vaccines are victims of their own success. Before mass vaccinations, for example, each year measles infected 4 million children and killed 3,000, while polio paralyzed 10,000, according to the Children's Hospital of Philadelphia Vaccine Education Center. Last year, there were 37 confirmed cases of measles and none of polio in the United States, government figures show.

In the eyes of some parents, these diseases seem like illnesses of the past that couldn't possibly hurt their children. To them, the shots appear unnecessary and more threatening than the diseases they prevent.

They worry that multiple vaccines given at once will weaken their children's immune systems or that the measles-mumps-rubella shot will give their children autism. These parents are blind to or unaware of studies that disprove both concerns.

The reality is that in today's world of global travel, many childhood illnesses are just a plane ride away. All of last year's measles cases are believed to have been imported into the country. According to news reports, this summer some Arkansas residents may have been exposed to measles on their trip to the Marshall Islands, and a Japanese student visiting Oregon State University was diagnosed with measles.

All it would take to start an outbreak of one of the extremely contagious childhood diseases is one case in an area where enough parents have skipped their kids' shots.

The risk of not vaccinating has become clear in England, where concern about the MMR shot and autism grabbed hold of many parents. Vaccination rates dropped to less than 80% of children. The result: More frequent and larger measles outbreaks. If current trends continue, measles could again become endemic in the United Kingdom, researchers reported last month in Science.

To be sure, no vaccine is 100% safe. The shots can cause negative, but seldom dire, reactions in children. Doctors should and do discuss the risks with parents. Physician reporting of adverse reactions to immunizations is essential to keeping tabs on any problems that arise and to prevent future vaccine injuries.

But too much of doctors' time and the nation's public health resources are spent allaying groundless fears about vaccinations and convincing parents of the shots' necessities.

The growth of state laws allowing parents to obtain philosophical exemptions from getting their children vaccinated will make physicians' job even harder. Doctors no longer will have the full force of state vaccination requirements behind them when they counsel fearful parents in these states.

The most recent law of this kind went into effect in Texas Sept. 1 -- one month after government data were released showing that the state already ranks 44th in vaccination rates for children ages 19 months to 35 months. The Texas rate is 68%, compared with the national average of 75% in this age group.

The medical community must fight these philosophical exemption initiatives. The American Medical Association is doing its part by opposing such laws, which now number 19.

The Association has done much to support the nation's immunization efforts. It is actively involved with government agencies on addressing the safety of, access to and shortages of vaccines. The AMA also is working on a continuing medical education booklet aimed at helping physicians reduce the racial disparities that persist in both childhood and adult immunization.

Despite the small backlash against vaccines, amazing progress has been made. School entry surveys show immunization rates among 5- and 6-year-old children are usually greater than 95%. It would be a tragedy if this number were allowed to fall.

The nation could not have made the strides it has in fighting childhood diseases without physicians' hard work. And only with their continued effort will vaccines continue to safeguard the health of millions of children.