On the subject of vaccines, medical opinion is widespread and settled: They are among the triumphs of public-health medicine, preventing thousands of deaths every year -- not to mention millions in lost sick time and other productivity.
And yet, getting a fully vaccinated populace, from infants through senior citizens, remains an elusive goal for doctors and public health officials. They blame lack of access, inattention (on the part of both patients and doctors) and a small, but outspoken, cadre of vaccine objectors for the gap.
They say it’s an expensive one.
“Using published studies and data, we calculated there is, conservatively -- and I do mean conservatively -- $500 million a year in direct and indirect costs” from vaccine-preventable illnesses in the state, said Joe Fortuna, vice chairman of the Michigan Primary Care Consortium. That figure includes health care, missed work and other factors.
The consortium mainly concerns itself with adult vaccinations, Fortuna said, which “are more important in terms of public health.” Many adults may not be aware that not all childhood vaccinations provide lifelong immunity and require occasional boosters. Pertussis (whooping cough), for example, is a disease most adults survive, but if it is contracted by an infant before the child’s first vaccinations, it can be fatal.
Health-care and lost-productivity costs associated with vaccine-preventable illnesses have a "potential impact on the economy of the state," added Fortuna, and promoting more adult vaccinations "could very well improve our image in terms of the business community. People who run big companies, they count on lost time due to flu."
Some Republicans in the Michigan House, however, are looking to move the vaccination requirements in the other direction. They have filed a bill (HB 5605) to overturn the mandate for hospitals and clinics to ensure their employees are vaccinated for influenza. The Michigan State Medical Society, the advocacy group for doctors in Michigan, already has termed the bill "dangerous."
Rep. Rick Olson, R-Saline and a co-sponsor of the bill, said, "I'm not a strong believer in mandatory things. If it's against someone's religious beliefs or something like that, there are people who just don't believe in things like that."
The Michigan Health and Hospitals Association has not taken a formal position on the flu bill, but "would likely oppose," a spokesperson said, because the bill goes against guidelines for health workers from the federal Centers for Disease Control and Prevention.
While nearly all children are recommended to have a standard panel of immunizations, the recommended shots for adults vary from person to person. Those who aren’t seeing a primary-care physician regularly may not be aware they should get a pneumonia, shingles, TDaP (combined tetanus, diphtheria and pertussis) or even flu shot.
“Not all doctors, not all providers, push them,” said Fortuna. “Some aren’t covered under Medicare Part B, only Part D.” And, he added, the United States lacks the “prevention culture” other countries have, where citizens feel they share responsibility for one another’s health.
They certainly don’t have it in the pediatrics ward, where a stubborn bloc of vaccine objectors has taken hold. Fueled by persistent rumors that vaccines are either ineffective or harmful, some parents are either refusing outright to have their children immunized, or else lengthening the schedule on their own terms.
Diseases like pertussis are making a comeback; the state of Washington announced in April that whooping cough had reached epidemic levels there, with 640 cases in 23 counties.
Health officials in California and Vermontare considering toughening their states’ opt-out provisions in part because of disease outbreaks.
According to a story in American Medical News, a 2010 pertussis outbreak in California caused more than 9,000 infections, 800 hospitalizations and 10 deaths.
Personal-belief exemptions from required vaccines in California have risen more than 25 percent over a two-year period.
Still, Michigan scores well in comparison to the rest of the nation; in 2010, it had the third-best vaccine compliance in the country, with just 21 percent of children aged 19 to 35 months lacking all recommended immunizations, according to data compiled by the Trust for America’s Health.
But pertussis in Michigan increased from 1.28 per 100,000 people (127 cases) to 8.91 per 100,000 people (902 cases) from 2000 to 2009, according to the state’s Department of Community Health “and (continued) to increase into 2010.”
School requirement easily set aside
In Michigan, the Department of Education requires a standard array of immunizations before a child enrolls in a traditional public, charter or private school, although parents or guardians may submit “a physician-signed waiver that the required immunizations could not be given because of medical contra-indications; or a parent/guardian signed waiver that for religious or other reasons the immunizations have not been given.”
The “other reasons” may be as simple as an objection -- a fact Suzanne Waltman, spokeswoman for Michigan Opposing Mandatory Vaccines, tells parents who want to enroll their children without getting all the recommended shots.
MOMV has about 1,000 people on its membership list, about one-third of whom are paying members. Waltman said it includes parents and others who address health concerns from several untraditional perspectives. Some blame vaccines for their children’s autism diagnoses; others are like Waltman, who believes “you just can’t drug your way to health. There are other ways to stay healthy. Our bodies aren't made for that.”
Waltman follows alternative-health recommendations made by practitioners such as Dr. Joseph Mercola, a Chicago-area osteopath with a large Internet presence and product line. Her daughter, now 22, was vaccinated for polio, diphtheria and tetanus, but not measles, mumps or chickenpox. A later blood test revealed she’d had mumps, but her mother never knew, which she takes as an indication that the threat of these once-common diseases is overblown.
They are not, says Dr. Marcus DeGraw, medical director of outpatient pediatrics at St. John Hospital in Detroit. But it is in the distant enough past that contemporary parents might think so.
“Nowadays, we’re trying to convince people who are already locked into their opinions, and also don't have historical perspective on history of these diseases,” said DeGraw, who is a paid consultant for two pharmaceutical companies. “A child born in 1912 had a 1-in-5 chance of dying by its fifth birthday. Even my parents' generation knew someone who died of these diseases.
“Pertussis is a great example,” he said. “In the '30s and '40s, before the vaccine, 7,000 to 8,000 kids would die in the U.S.(from whooping cough). Now, in the last decade, you only get a couple dozen.”
To DeGraw, it’s very simple: If vaccination rates fall, more children will die. In his practice, though, more parents are opting out.
“I would guess roughly 70 percent (of parents) will do what I'm asking them to do and follow the schedule,” he said. “A good 10 percent to 15 percent will have serious questions, but, with good conversations, will do it. Another 10 percent are set on none or an alternative schedule.”
While some pediatricians refuse to see patients whose parents refuse vaccinations entirely, DeGraw doesn’t. But he does offer his most powerful testimony.
“I have three daughters,” he tells them. “Anything I'm asking you to do for your children, I do to my own kids. If I had any kind of fear whatsoever, I would alter my own plan. And I haven’t.”
Staff Writer Nancy Nall Derringer has been a writer, editor and teacher in Metro Detroit for seven years, and was a co-founder and editor of GrossePointeToday.com, an early experiment in hyperlocal journalism. Before that, she worked for 20 years in Fort Wayne, Indiana, where she won numerous state and national awards for her work as a columnist for The News-Sentinel.