Tue April 8, 2014
Vaccinating Children: Who Gets To Decide?
Originally published on Tue April 8, 2014 12:49 pm
MICHEL MARTIN, HOST:
I'm Michel Martin and this is TELL ME MORE from NPR News. They say it takes a village to raise a child, but maybe you just need a few moms and dads in your corner. Every week, we check in with a diverse group of parents for their common sense and savvy advice.
Today, we're talking about something you might think is a settled issue, but it is not. We're talking about childhood vaccinations. Researchers at the Centers for Disease Control - that's an agency that tracks health issues and keeps numbers - estimate that 95 percent of American kindergartners are fully vaccinated. But we want to talk about that 5 percent. California and New York have seen measles outbreaks, and health officials partly blame parents who did not vaccinate their children.
And in Colorado, whooping cough is a growing concern, and some lawmakers want to make it harder for parents to opt out of vaccinations. We wanted to talk more about all this, so we're joined now by Dr. Marilyn McPherson-Corder. She is a pediatrician, she is a professor of pediatrics at Howard University and the University of Maryland and a mom of two. Welcome back.
MARILYN MCPHERSON-CORDER: Thank you.
MARTIN: Seth Mnookin is author of the book "The Panic Virus: A True Story of Medicine Science and Fear." And he's also a dad of two. Seth Mnookin, thank you for joining us as well.
SETH MNOOKIN: Thank you so much for having me.
MARTIN: And Krista Kafer is a columnist who's been writing about this issue for The Denver Post. Krista, thank you for coming as well.
KRISTA KAFER: Great to be here.
MARTIN: And so, Dr. McPherson-Corder, I'm going to start with you 'cause, as I mentioned, you've been practicing for more than 30 years now, and you're also - I also want to mention -you're the director of pediatrics at a local health institution here.
And I wanted to ask if more parents are raising concerns about vaccinations, and are they things that you think - you're surprised that they're raising?
MCPHERSON-CORDER: Yes, they are raising concerns, and I would say they are raising more in the past five years. And I feel that lots of that is due to stories they hear on the social media and relatives, as well as just friends, you know. And what I tend to do, I tell them every question is a legit question. I sit them down, and I educate them.
MARTIN: What are some of the kinds of questions that they're asking? I mean, though - saying that - what - that they've heard that - what - that there are toxic substance in the vaccines? Or what are some of the things that they're saying to you?
MCPHERSON-CORDER: Well, that my child will be brain damaged if they receive certain vaccinations. And we're still hearing - unfortunately we're still hearing the relationship with autism, even though that report has already been proven to be fraudulent. But they still hear it. We're still getting backlash from it.
MARTIN: And Seth, you spoke to a lot of parents who are not vaccinating children for your book. So talk about this - you actually tried to trace this down and figure out why it is that these stories, rumors, opinions about vaccinations have kind of spread. Tell us what you found out, as briefly as you can.
MNOOKIN: Well, I think there are a couple of reasons - one is there have been these fraudulent reports that have been published. But I think the larger reason is that we're very uncomfortable just as people with introducing something into our body to protect us against a disease that we haven't had yet.
And so you combine that with the fact that because of the way our health care system is set up, there's not a lot of time for parents to discuss these issues with their doctors. And so they do end up either learning about it on social media and getting misinformation or, you know, talking about it at the playground or with other parents.
And I think one thing we really need to do is think about how we can bring this conversation, initiate this conversation, in a medical setting so the first exposure parents have to it is one where they're getting accurate information.
MARTIN: We're going to talk about that in a minute. In fact, it's interesting 'cause before we went on the air, Dr. McPherson-Corder was actually talking to us about that very thing. So I'm going to ask you both to hold that thought.
But, Seth, I'm just going to ask you just - one of the things that fascinated me, though, about your reporting is a lot of the parents that you reported on were well-educated.
MARTIN: I mean, these are not people who did not have access to health practitioners, but they were still getting information from, like, people who weren't doctors.
MARTIN: Or they heard about it from the supermarket or something like that. And I just - I was just fascinated by that.
KAFER: Yeah, I think that that stems from a couple of different things - one, I did find that a lot of the parents I spoke with tended to be better educated, better off, more likely to self-identify as politically liberal or environmentally conscious.
That's by no means true across the board, but I think that some of what you see is sort of typified by what this one doctor in California has suggested that his patients do if they're anxious about vaccines and that is, quote, hide in the herd. And essentially take advantage of the fact that most people around you are vaccinated and rely on them to protect your child. And that to me is such an incredibly entitled attitude to have.
And I think unlike some different issues where you see people ignoring science, this is not one that falls among neat political or class or religious lines.
MARTIN: Krista, in Colorado, where lawmakers are trying to address this issue in the way that we're going to talk about in a minute, the CDC finds that 15 percent of kids don't have documented vaccinations and, as we mentioned, that's a lot higher in the country on the whole.
Before you were a columnist, you were an education policy analyst. And you don't oppose vaccination yourself, but I was curious if you can tell us why you think in Colorado that that number is as high as it is.
KAFER: Well, I imagine that some of those kids are in fact vaccinated, but when they take a personal exemption - when their parents take a personal exception and sign that card, basically some of those kids don't have vaccinations. Some of them do, but the parents don't want to have to go look for the paperwork.
So the number might be a little bit high. It's very interesting - I find that it's the case of what Seth was talking about - some of the parents are very well off and liberal, some of the parents are conservatives. I mean, the group of people who are not vaccinated is - it's pretty diverse. And as I looked around, it seemed that they fell into two camps - conscientious objectors who were perhaps not vaccinating or not vaccinating - using all of the vaccinations.
And then there's another group of parents that were either misinformed, believing these, you know, so-called science reports linking autism, for example, and also parents that were simply too lazy to go look for the paperwork.
MARTIN: So there's the bill that's being considered in Colorado - would force parents to take an online education course before they opt out, if they want to opt out in what's called this personal exemption as opposed to, say, for example, there's an ingredient in the vaccine which they know their child is allergic to, you know, for example.
I mean, some - just like the flu vaccine, for some kids - if you're allergic to eggs, that's generally not indicated, although some kids can still sort tolerate it. So we're not talking about that. We're talking about people who personally opt out. Krista, you're saying - the reaction to this is what, has been what?
KAFER: Well, we've three exemptions - we've got medical, we've got religious and we've got personal. And the personal one is just very easy to take - all you have to do is sign the back of a card. And, you know, some of those parents have done due diligence. They've actually investigated.
They've made a conscientious choice, perhaps they're doing many of the vaccines, but not all of them. They're in contact with their physician. I would say they're doing due diligence. But the fact that it makes it so easy for parents who simply don't want to do due diligence or who are misinformed or who simply are either too lazy to vaccinate or too lazy to go look for the paperwork, it really does keep it wide open.
MARTIN: So what's been the reaction to this proposal, which as we said, would force parents to take an online education course if they want to take that personal exception? Presumably, if there's a medical exemption, then the doctor has certified that the child would be medically harmed by that particular vaccination. But what's been the response to this idea that, you know, you should, you know, force the parents to kind of take some education about - what are people saying about that?
KAFER: Well, the hearing was very boisterous. A lot of people testified on both sides. Again, it was not a homogenous group of people - there were people on the left and the right. And I spoke to the lead opponent before I wrote my column and I thought it was interesting - they're basically saying that it is discriminating against a group of people who conscientiously determined not to use vaccines.
And I - even though I am a hundred percent pro-vaccination - I ended up coming out against the bill because I was uncomfortable with the idea that we have to force people who are objecting from a particular medical practice from, you know - that we would force them to take an online government-generated course. That was what I was uncomfortable with.
I would rather see a robust private sector initiative to educate parents to really get to those misinformed parents or those parents who - I mean, I probably shouldn't call them lazy, but parents who either aren't looking for the paperwork or who are not doing the vaccinations.
MARTIN: If you're just joining us, we're talking about childhood vaccinations in our parenting roundtable. We're talking about the - what has become a surprisingly - perhaps surprising to some - perhaps persistent and robust debate about childhood vaccinations, at least among some parents.
I'm joined by columnist Krista Kafer. That's who was speaking just now. She wrote about the issue for The Denver Post. Also joining us, Seth Mnookin, author of "The Panic Virus." And Dr. Marilyn McPherson-Corder. She's a pediatrician and a professor of pediatrics. So, Dr. McPherson-Corder, what about that? I mean, do you think - what do you think about the approach being contemplated in Colorado?
MCPHERSON-CORDER: Well, you know, because we are spending less time because of the demand for access with our patients, I feel that it's important. I think it's a good idea to inform, to have that website or that training because that way, they'll know what they're saying no to. As a matter of fact, I even feel that when you're pregnant you need to see it because there's certain things that right - once you are - once you deliver, the vaccinations start so that they'll know what they're saying no to. Many a time, that's not the case. They just don't know.
MARTIN: So you're saying you actually - in your prenatal visits, when people are shopping for or looking around for a pediatrician - people often visit while they're pregnant. When you have those initial visits, what do you say?
MCPHERSON-CORDER: And I encourage that initial visit. And what I tell them, I tell them the practice of pediatrics and what we do and what's recommended with CDC, developmental milestones, etc.
And I hand out at that encounter, even before the baby is born, I hand out the immunization sheets, the CDC information so that they'll know because anticipatory guidance is very important in this case. And so they see that and they're like, wow, we may talk 15, 20 minutes, but we get that point across, and we begin the educational discussion that's necessary.
MARTIN: Seth Mnookin, what about that? I mean, do you think that these anti-vaccine parents that you spoke with might be persuaded by this? What's your take on it?
MNOOKIN: Well, I think there are a couple of distinctions. One, there is this very small but very fervent group of parents that I think really accurately can be described as anti-vaccine. They tend to get more attention than they probably deserve because they're very well-organized and very vocal. If all of those parents didn't vaccinate, that would not be an issue because it really is such a miniscule number.
The real issue is the much larger number of parents who are anxious and don't know what to think. And I'm very, very much in favor of prenatal intervention. In fact, it's one of the things that I wrote about a couple of years ago in the Washington Post. And the reason that I think that is such an important time to start delivering that information is because when I went to those first appointments after our son was born, I was barely standing up.
You know, our child wasn't sleeping. He was crying all the time, I was not in a position where I could take in information. For our prenatal visits, we had - my wife and I had our notebooks out, and had a list of questions and we're writing down answers. I think that's a much better time to initiate that conversation.
MARTIN: Do you think, Seth, that part of it is that kind of, we're in an antiauthority age - is that if some authority figure tells you something, you're kind of more likely to not want to hear it? And I'm just wondering if you think that that's part of it
MNOOKIN: Well, it certainly seems that it is - that is tapping into some of that. What you tend to find in surveys and studies is that even parents who have a negative view of the health care system, more of the medical system overall, tend to view their own doctors positively.
So I think it's a little bit hard to tease out how that actually affects their decisions, but certainly there is an enormous difference between our relationship with doctors and all sorts of people in authority today than there was 20 or 30 years ago, when I think as a society, we were much more likely to go along with what we were essentially told to do. So yeah, I think that is one current that's going on here.
MARTIN: Krista, can ask you to refer to something that Seth mentioned earlier, which is that there's now kind of a backlash against vaccines, which is that there are parents who are now becoming very annoyed and saying that these, you know, kids who are not getting their vaccinations are either free riders or they are jeopardizing their kids with, you know, diseases that should have been eliminated by now.
And I'm just wondering if there has been some discussion about that. How do you mediate that? Or how is that being discussed?
KAFER: Well, you know, I'm glad that these parents are speaking out. There's a website - I think it was Voices For Vaccines - that I looked at where it has some very poignant stories because there are kids that are either too young to be vaccinated or who have been vaccinated but the vaccine didn't take, and they are at risk of getting these diseases once they've made an entry into the population.
And keeping that herd immunity high is essential. We really want to have as many kids vaccinated as possible. And so I'm glad that parents are hearing these other voices 'cause I think the scare tactics are out there and we need voices to combat them.
MARTIN: Dr. McPherson-Corder, final thought from you on this because we're talking mainly about childhood vaccinations, which are generally delivered in early childhood, but now there's another debate over Gardasil - I believe is the trade name - which is given to older girls. Now some people are starting to object to that.
They feel it hasn't been sufficiently tested or other people feel that it's either kind of - they feel like it's kind of stigmatizing, it's almost like implying that their girls are going to be sexually active and they are annoyed about that. And so I just wanted to ask your thoughts about something - how should we be talking about this next wave?
MCPHERSON-CORDER: Right. Well, before I say that...
MARTIN: Go ahead.
MCPHERSON-CORDER: Before I go in - I want to also bring this out - that I've had two or three families that do not get their child vaccinated. And one of the problems we ended up having - one child had whooping cough, went to the emergency room and refused or did not tell the pediatrician that they were unvaccinated. When I spoke to the doctor - 'cause I always call and make sure that I know what's going on with my patient - I said this is an unvaccinated child. And that put everyone at risk in the ER as well, as well as elderly people, etc.
Going back to the Gardasil, yes, we have a direct correlation with cervical cancer and HPV, as well as throat cancer and HPV. So what I say to my parents who now, I feel, about 50 to 60 percent are accepting and requesting versus 20 percent maybe three or four years ago, that this is something that we can eradicate, we can prevent. And I would like to make sure that each and every one of my patients, male and female, are protected from cervical cancer, from throat cancer - their loved ones, etc.
So it's coming into a discussion that - we're not talking about sexual activity anymore - I mean, sure, down the road, but we're saying this will prevent them when they are. So we're not saying your child is precocious and having these activities and - we're talking about down the road.
MARTIN: Do you think five years ago - we only have a minute left, Dr. McPherson-Corder - do you think five years from now we'll still be talking about this or do you think that this is just one of those interim sort of infliction points in history, something we had to get over so that we started talking about vaccination again? What's your thought?
MCPHERSON-CORDER: I think we will be over it, especially now that we're seeing outbreaks of other conditions that should have been eradicated. So my hope is that we are - we will be past this.
MARTIN: Dr. Marilyn McPherson-Corder is a pediatrician, a professor pediatrics and a mom of two. She was kind enough to join us here in our Washington, D.C. studios. And she still has her white coat on, and she's actually going right back to her office. Krista Kafer is a columnist for The Denver Post.
She was with us from Denver. And Seth Mnookin is the author of "The Panic Virus," and a father of two. He's also associate director of the science writing program at MIT. And he joined us from there. Thank you all so much for joining us.
MCPHERSON-CORDER: Thank you.
KAFER: Thank you.
MNOOKIN: Thank you so much for having me.
MARTIN: And that's our program for today. I'm Michel Martin and you've been listening to TELL ME MORE from NPR News. Let's talk more tomorrow. Transcript provided by NPR, Copyright NPR.