The vaccine debate — Could compassion and nuance be an antidote?

I’ve been thinking a lot about vaccines. As a learner, an observer of humans and our nature, a worshiper of the scientific method, a doctor, a new grandfather, and a member of society, few debates could be more compelling. The kerfuffle over vaccines has it all. It’s the Lance Armstrong story on steroids. (Grin.)

The spark for writing on this matter came from reading a mother’s impassioned call for reason. (Link at the end.) The author is a young lawyer who writes (skillfully) about being married to a young doctor. Her vaccine post went viral, garnering 483 comments—which, for a blogger, is akin to nirvana.

In what follows, I promise two things: brevity and candor. I’m just a cardiologist, so I claim no special knowledge on the biochemistry and immunology aspects of vaccines. I am, however, more than just an observer. I work in a healthcare setting, taking care of the vulnerable elderly. Other relevant facts: it’s flu season; I don’t like shots; I like the post-vaccine immune reaction even less; and, as an American, I hate being forced to do something. The latter fact should not be taken lightly when considering this debate.

Chapter one of the vaccine saga must start with efficacy. Here, let’s consider the childhood vaccines. It’s simply not credible to look at the resurgence of infectious diseases like whooping-cough and measles and then say vaccines do not provide protection. Smallpox was eliminated with vaccines, and in western countries, so was polio. These vaccines work.

But like all effective therapies in medicine, there are tradeoffs. Adverse effects from vaccines occur. This is where the story gets very interesting. Sparked by fraudulent science and downright maleficence, the notion that vaccines were overtly dangerous grew and grew and grew. Social media and the Internet provided the runaway train of misinformation monster tailwinds. Now, almost a decade later, the fraud exposed, vaccine doubters remain strong and united.

We must learn from this phenomenon. Taking the view that the millions of freethinking humans who doubt the “net clinical benefit” of vaccines are stupid or selfish is not productive. We need to look at why so many have these concerns.

Let me make an analogy to a clinical situation that I see nearly every week in the treatment of atrial fibrillation—my primary disease. In AF, the anticoagulant (‘blood thinner’) warfarin has been shown in clinical trials of thousands of patients to be effective in preventing stroke and lowering mortality. The data are crystal clear. Arguably, stroke and death are the worst possible outcomes of a disease. But yet, many AF patients are overcome with fear about taking warfarin.

The key, I believe, in both cases (warfarin and vaccines), is the issue of fear. Inherent in the definition of fear is unknowing. Lack of knowledge creates and fertilizes fear. Make no mistake, I’m not going to argue that overcoming the knowledge gap of vaccines is as easy as explaining the net benefits of an anticoagulant drug, but I believe we must continue to try. I’m optimistic that the message of “net clinical benefit” can be made. Maybe not tomorrow, but over time, reason will get traction.

Vaccines are especially important because unlike heart drugs, there is the matter of others’ health. When my daughter takes my granddaughter to play group, I’m hoping that other human beings have been considerate enough to have vaccinated their children against disease. The role of the social contract cannot be ignored. We expect things from fellow humankind. We expect people to not text (or drink) while driving; we expect etiquette with cellphones, and it’s expected that we not infect each other with infectious disease. Basic things.

The final point I’ll add is a word of caution to the medical world. The dynamic of the patient-doctor interaction has changed—for the better. Paternalism and hubris no longer work well in adult medicine, and such an approach likely won’t work in Pediatrics. We can’t say: take this… because I said so and I am a doctor. Good riddance with that BS.

Call me naïve, but I believe the most effective means to move the vaccine needle in the right direction is to do it gently and with compassion for others. Let’s see the fear in the doubters. Let’s see them as fellow humans trying to do what’s best for their children. They are like the AF patient frightened of a blood thinner. Acknowledging that taking a therapy does indeed expose one to risk is quite important. Dr Harlan Krumholz taught me that removing fear and ignorance is the way to better medical decisions. He’s right.

I will continue to watch this debate. How it goes will tell us a lot about us as a society and as a medical profession. I hope the needle moves in the right direction before major infectious diseases make a comeback.

JMM

The link to the viral post. Vaccination: A Layperson’s Perspective