It’s A Small World After All

Pharmacists are used to receiving frantic calls from family members. Typically these arise when a physician has prescribed a new medication and there are worries about polypharmacy or drug interactions. However, the call I received a few weeks ago from my cousin who resides in Southern California was quite troubling and different. She and her family have season passes to Disneyland, the happiest place on earth! Yet instead of planning out their day – Space Mountain or the Big Thunder Mountain Railroad first – she wanted to know whether she should visit the family physician and whether there were new treatments for measles.

I knew that my cousin was vaccinated for measles since we are close in age and we both went to school in Iran where vaccination was provided through the public health and school systems and everyone was mandated to be vaccinated. We all grew up knowing someone who was disabled because of polio or died at a young age because of complications from measles. Thus, the choice of whether to be vaccinated was not a philosophical decision; it was a matter of life or death. I asked her about her daughters’ vaccination history and she assured me that they were both vaccinated. That’s good not only for them but for everyone with whom they come into contact at school, at church, in the neighborhood grocery store.  Why?  The Centers for Disease Control recommends immunization rates of greater than 90% for diseases like measles as the threshold for herd immunity, the phenomena by which a high rate of vaccination in a community protects even those individuals who have not developed immunity. Yet in California and 18 other states around the country, so-called vaccine “personal belief exemption” laws are fueling the drop in vaccination rates. The protections afforded by herd immunity are further complicated and compromised as individuals who exempt their children from routine vaccinations congregate in certain geographies within the states.

The recent outbreak that started at Disneyland, though, may just be the catalyst for needed change. Legislators in states as diverse as California and Vermont are taking action to curtail personal belief exemptions, and federal lawmakers have offered a bipartisan endorsement for the use of vaccines as a safe and effective means of protecting against preventable infectious diseases. Last year, Michigan tightened its vaccine exemption policy and efforts to broaden vaccine exemptions in West Virginia and Mississippi were defeated this year.

Outbreaks of vaccine preventable diseases like those reported at Disneyland are nothing new; in fact in 2010 ten babies, most of them whom resided in Long Beach, California (a neighboring city to Anaheim where Disneyland resides) died due to a whooping cough epidemic. The next year, public health officials began an aggressive vaccination education campaign and Assembly Bill 354 became law requiring proof of the T-dap booster shot for all students entering grades 7 through 12. What was the result of this important policy recommendation in 2011? Zero deaths in California due to whooping cough. Meanwhile there have also been outbreaks of measles and mumps in other states, many due to lax exemption policies. College students are not immune from outbreaks. Administrators would do well to follow the advice of the American College Health Association which “strongly supports the use of vaccines to protect the health of our individual students and our campus communities,” and “…discourages nonmedical exemptions to required vaccines.”   The ACHA further recommends that institutions of higher learning follow best practices which include “…. encouraging students who request nonmedical waivers to be counseled by a health service clinician, and considering exclusion of unimmunized students from school during outbreaks of vaccine-preventable diseases.”

Internationally, the spread of epidemics is even scarier. The World Health Organization has declared that the spread of polio constitutes an international public health emergency. WHO states “if unchecked, this situation could result in failure to eradicate globally one of the world’s most serious vaccine preventable diseases.” As we no longer live in a geographic bubble, it is just matter of time before these epidemics will be imported to the United States. How can we allow the societal-altering work of Dr. Jonas Salk, the March of Dimes and others to be undone simply to appease a personal philosophy?

When the concern is budget based, decision makers should take note of this observation by bioethicist Dr. Ezekiel Emanuel:  “Vaccines are the most cost-effective health care interventions there are. A dollar spent on a childhood vaccination not only helps save a life, but greatly reduces spending on future healthcare.”

Vaccines are one of the most important medical interventions ever discovered and developed. It is time for healthcare professionals, policy makers and the public to stop allowing personal philosophy or fears with no scientific foundation to supersede the overwhelming evidence of the benefits to public health. I suspect even Walt Disney would agree that the happiest place on earth is a place with good health.



Robert Popovian, Pharm.D., MS is the Senior Director of Pfizer US Government Relations

Morning Consult