I wouldn’t normally do this. This part feels too deep, too personal, too hard to share. But we’ve been having a terrible flu season (with the second peak still coming), there are measles outbreaks where this disease had previously been eliminated, and we’re having to think about pertussis and mumps again. Over 900 people have just died from measles in Madagascar alone, most of them children, and the news is leaving every cell of my body screaming for the devastation these parents are facing.
So we need to talk, and today I’m bringing Jude. Not the brown-eyed, strawberry-blonde-haired pictures I normally share. Not the big smiles or the puppy boots or the lion hat or the dandelions or Superman jammies or Everest the penguin or little yellow pentagon or any of the things that made him so wonderful.
His things are in a box now.
So is he.
This is Jude. This is all that’s left of our child. We donated his big brown eyes – the only part they told us they’d be able to use after his death – and we later received a shitty letter that they weren’t able to use them after all, so they were thrown in the garbage.
Jude died from influenza B. The flu. That doesn’t sound so bad, right? Just an ordinary illness that everyone gets, like a cold. If it gets really bad you go to the doctor and you get better. Except sometimes you don’t. In fact, ~3500 Canadians and ~36,000 Americans die from the flu every year. Every. Single. Year. We don’t think of the flu as something to worry about unless we’re at higher risk, but the reality is that it can be incredibly dangerous for perfectly healthy people, too.
All of these diseases can be deadly, or otherwise cause serious health issues. We aren’t vaccinating our population because chicken pox and diphtheria or any of these illnesses are inconvenient, though even a mild case of any of them is miserable. We vaccinate because they can kill people, and before we had vaccines for them they killed a lot of people. A lot of families buried their children. A lot of families buried multiple children.
This isn’t the reality that most of us are familiar with. Those of us who are now making vaccination choices didn’t grow up watching our siblings and classmates die from measles or paralyzed by polio. We don’t understand the devastation of these diseases because we’ve never seen their full strength in a population. We don’t understand how dangerous these diseases are because we’ve grown up protected from them by vaccination.
Instead, we’ve come of age and become parents in the wake of fraudulent, self-serving claims that the MMR vaccine causes autism, with celebrities and alternative health gurus fueling these doubts. That single fraudulent study with 12 kids that led to its author losing his medical license has been shown to be false over and over, but the doubt lingers and vaccines are blamed for everything from allergies to… car accidents.
As parents we don’t want to make mistakes. We want to make sure we’re making the right choice. I remember the first time my daughter fell off her tricycle and scraped her knee. It’s going to happen and scraped knees are part of childhood, but I felt so guilty, wishing I could have better protected her. We don’t want anything bad to happen to our kids, ever. So when it’s time to make choices about their health, we worry that we’ll make the wrong one and cause them harm.
I get it. I hear you, and I feel your stress about these decisions. Our doctors are telling us to vaccinate, but when you start googling you find all kinds of websites telling you vaccines are bad, and you’re worried that you’ll hurt your kids by choosing to vaccinate. And those voices are LOUD and it might feel like a safer choice not to vaccinate because we don’t hear much about measles and mumps and rubella and pertussis and diphtheria these days.
Here’s the thing. We don’t hear about them as much because of herd immunity. We don’t hear about them because when enough of a population is vaccinated against a disease, it makes it hard for the disease to get a foothold and circulate from one person to the next, and so the population (the ‘herd’) is protected as a whole because of prevention through vaccination. A lot of people don’t like the term ‘herd immunity’. That’s okay, and I prefer ‘community immunity’. It’s the protection we give and get from living within our communities. It’s how we look after each other.
Diseases that are very contagious, like measles, need ~95% of the population to be vaccinated to establish community immunity. Less contagious diseases, like polio, need 80-85% of the population to be vaccinated. So if a high enough percentage of your community is vaccinated, you’re unlikely to be exposed.
Here are the problems.
Vaccination hesitancy is growing, so community immunity is failing. If 95% of your community is vaccinated, your family will probably* be protected. But we’re seeing those numbers fall. Take Manitoba as an example. Only 75% of kids are getting both doses of MMR by age 7 (you need both to develop immunity). That’s not enough. And only 62% of kids there have received all recommended vaccines by age 7. Each vaccination puts up a wall that prevents disease from spreading from one person to the next. Some people are medically unable to get vaccinated, some are too young, and some will fail to develop immunity, but overall with a high enough number participating, all those walls protect everyone. The numbers in places like Manitoba don’t provide enough walls to prevent the spread of the disease, leaving people who haven’t been immunized exposed and vulnerable. If you live in a place with low participation and you haven’t been vaccinated, you are at risk if someone with a vaccine-preventable disease comes into your community.
*While 95% community vaccination is enough to provide herd immunity those who aren’t vaccinated and those who fail to develop immunity from their own shots will still be vulnerable if they come in contact with someone who is infected. A cousin, a neighbour, or even someone in line next to you at the store could be enough to put you at risk.
Diseases aren’t static because people aren’t static. You may not be worried about measles because outbreaks rarely happen in North America. Serious occurrences happen more often in places without widespread access to vaccines, and now we’re seeing a great increase in cases across Europe as participation declines. But outbreaks in North America are small and rare, right? The answer is yes – but. They’re only rare as long as we maintain high enough levels of vaccination in our communities *and* disease isn’t introduced. But that’s not realistic in today’s world. Measles and whooping cough are only a plane ride away. You’re planning a trip – are you and everyone in your family caught up on all your shots? Have all the adults had boosters? Maybe you don’t travel so you don’t worry about what’s happening in Europe or Asia. But what about your neighbours, or coworkers, or the kids your kids go to school with? The outbreak they’re currently dealing with in Vancouver didn’t just erupt. It happened because a parent took his three sons to Vietnam, none of whom had received the MMR vaccine as kids because Andrew Wakefield’s fraudulent paper had made him and his wife afraid. This family contracted measles and brought it home to their community. Measles is a plane ride away. Disease is as close and as far as anyone around you can travel, and we can travel anywhere.
If your kids haven’t been vaccinated against these preventable diseases, they may be at risk due to factors you’d never considered. Our communities are not isolated. We aren’t only affected by our own choices and actions, but also by the actions and choices of everyone we come in contact with, and vice versa. Your choice not to vaccinate could put others at risk. Other people’s choice not to vaccinate increases your risk. Growing up we could rely on community immunity, but with decreasing participation many don’t realize that they’re carrying a false sense of security.
We never thought we’d lose our child to a vaccine-preventable disease. It happened to us. It happens to many people every single year. It can happen to anyone.
‘But aren’t these just childhood diseases? People used to get measles/ chicken pox/mumps/etc. all the time. People get the flu all the time.’ Yes. People used to get these diseases all the time, and often they’d be horribly sick and then they’d get better. But not everyone got better then, and not everyone gets better now. Even today, with all the advances we’ve made in medicine, we can’t always save someone who gets measles or chicken pox or whooping cough. About a half million people die from the flu every year, tens of thousands in North America, and in many cases it’s too late before anyone realizes it’s serious. Jude had a low-grade fever and then died hours later from cardiac arrest caused by influenza B. We’re vaccinating against these diseases because they kill people when we don’t. It’s hard for us to understand the devastation that can be caused by these illnesses because we’ve been fortunate enough to grow up without them, but we’re only a couple generations removed from them, and there are places in the world without the same access to vaccines who are still struggling.
Let’s return to the outbreak in Madagascar, where more than 900 people have died. Access to vaccination is poor. Most were children. I think of our own tiny wood box and I can hardly breathe. More than 900 people. This is measles unchecked, and measles is an incredibly contagious disease:
- A room where an infected person has been will remain contagious for up to two hours after that person has left.
- One infected person will spread it to an average of 18 unimmunized people, which is why it’s so dangerous in populations with lower vaccination rates.
- It is airborne, and an infected person can be contagious for up to four days before symptoms appear.
‘What about the ingredients?’ There’s been a lot of doubt planted about the safety of vaccines because of the ingredients. I get it. Formaldehyde and mercury and aluminum sound unappealing, and for me always conjure up memories of high school science classes. But the dose makes the poison and I was surprised to learn that these substances are already found not only in our food, but also naturally in our own bodies. There’s more formaldehyde already circulating in your own body. There’s more in a single pear than in a lifetime of vaccines. The mercury in a flu shot is the kind that metabolizes quickly, unlike the kind found in fish and breast milk, which builds up in your system. Thimerosal (ethyl mercury, not methyl mercury) is only now found in multi-dose flu vaccine vials, and no other vaccines. It wasn’t removed from others because of safety concerns, but because people were refusing vaccinations because someone told them it would cause autism. Aluminum? There’s more in a cup of tea. We have a post about ingredients, but I’d really recommend chatting with your doctor about your concerns. It’s okay – that’s what they’re there for. When we’re talking about vaccines we’re talking about trace elements, but I know that it’s easy to feel concerned when there’s so much rhetoric. Talk to someone reputable. Talk to someone whose job it is to keep you healthy.
‘Isn’t it better to develop natural immunity?’ No. You can develop immunity through a vaccine or you can develop it by having and surviving a disease, but not everyone survives these diseases and other complications can be devastating. This is a very short list and your doctor can talk with you more about the complications of every disease they vaccinate against. Death is a possible outcome of each one.
Measles: pneumonia, encephalitis, seizures
Mumps: meningitis, encephalitis, pancreatitis, infertility
HPV: genital warts, cancer
Pertussis: pneumonia, seizures, apnea, encephalopathy, rib fractures
Influenza A and B: pneumonia, encephalitis, organ and system failure
Chicken Pox: shingles, secondary bacterial infections, pneumonia, meningitis, encephalitis, seizures, Reye syndrome
‘But vaccines aren’t perfect.’ No, they’re not. They aren’t a guarantee, and if they were I wouldn’t be here having this conversation. Sometimes people like Jude will fail to develop immunity from their own vaccinations. Some people will have a reaction from their shots – most commonly a low-grade fever and some local discomfort. Serious reactions are exceptionally rare, but it’s okay to talk to your doctor if you’re feeling concerned. They aren’t a guarantee, but they are our best first defense, and a vaccinated population is healthier than an unvaccinated population – as long as the rates are high enough to protect everyone within our communities. In addition to vaccination, we’ve put together a page with tips to help protect you from the flu and other vaccine preventable diseases. No method alone is enough for full prevention, but added together these steps are an strategy to keep you well and protect those around you.
‘I just feel scared.’ Me too. I think that’s probably the natural state of parenthood, and I think that can be a good thing. It pushes us to protect our children, to think ahead, to plan, to make sure we’re making the best decisions we can for them. But sometimes a small amount of information can work against us, leading us to reject experts whose job it is to keep us safe and healthy and alive. There are a lot of ideas on the internet, and they are not all equal. You’re not wrong to have questions and you’re not wrong to want answers. It’s okay to ask for that information. Please do. But make sure you’re getting your information from credible sources. Please talk to your doctor with your questions and concerns. They’re there to help you protect your kids.
I don’t want to have this conversation.
I don’t want to know what it’s like to plan a funeral for your toddler. I wish I’d never had a reason to learn so much about the flu, about vaccines, about public health. This isn’t the soapbox I’d have chosen for myself, but almost three years ago my perfectly healthy little boy died. What if more people had been having *this* conversation a year or two earlier? What if more people in my community had understood how important it is to protect themselves, so they can also protect others? It’s too late for Jude. It isn’t too late for all the kids who are still here. It isn’t too late for your family.
We lost Jude, and we will live with that horror for the rest of our lives. The only peace we have is knowing we did everything we could to protect him. It wasn’t enough. As a community we failed him. As a global community we’re all failing. We don’t have to. Please. Do everything you can to protect yourselves, your children, and everyone you come in contact with. We are losing our community immunity and there will be more stories like ours if we don’t all do our part. I don’t want this for you. I don’t want this for anyone.
Vaccination isn’t a personal choice, it’s a public one. When we decide whether or not to vaccinate, we decide how much risk of contracting a disease we want to take on for ourselves, and also how much we want to pose on everyone we come in contact with. There are fewer people right now making the decision to protect themselves, and that means there are fewer people doing their part to protect your family. You can’t rely on your neighbours for immunity right now, but you can be part of the solution and do your part. And hopefully your friends, family, neighbours, and community as a whole will make the same choice.
Doctors – this part is for you. When you have a parent come in with concerns about vaccines, please, please take the time to talk them through their questions, and if you’re short on time during their appointment please direct them to reputable resources. There’s a lot of nonsense on the internet, and some of it is dressed up to appear credible. It’s easy to start looking and find something that looks official, but it might be misinformation. Every parent who comes through your door wants the best for their kids. What seems obvious and logical to you might not be so clear to someone without your medical background, especially if that person is hearing competing views from friends, family, neighbours, Google, online support groups, Facebook, Instagram, etc. And those sources? They have unlimited time and will speak to us in our language. They can have the facts wrong, but sound convincing because they’re explaining their position in a way that’s easy for the average person to understand.
You’ve seen the claims and you’ve heard it all. The facts are out there and available, but there’s an enthusiasm gap between people who are for or against vaccination. The parents coming into your office might not have many people speaking to them in favour of vaccination. You might be the only one. Your time is precious and you have a lot of families to see, but when you can take that time to have this conversation, when you hear someone’s concerns and work through them with them, when you give them real information that makes sense to people without a science background, you have the chance to break through the narrative. That makes a difference.
Thank you for all you do to keep us safe and healthy.