In My Humble Opinion
Having the Vaccination Conversation Bob H. Reinhardt ’00
Parents sometimes hear about “routine childhood vaccinations,” but the current discussion about vaccines is anything but routine. In addition to pediatrician offices, the vaccination conversation is happening in unexpected places: the legislative halls of Oregon, California and other states trying to stiffen childhood vaccination requirements; Twitter, where author Sherman Alexie invoked Native Americans’ historic experiences with deadly contagious diseases and railed against “superstitious, selfish anti-vaccination ***holes”; and late-night TV, where Jimmy Kimmel joked that parents in Los Angeles are “more scared of gluten than they are of smallpox.” Alexie’s vitriol and Kimmel’s barb invoke the history of smallpox and its eradication, a remarkable story that holds unexpected insights for today. We are fortunate to live in a world without smallpox, a disease that once wrought terrible horror and death. Although some victims experienced only slight rashes, many more suffered greatly from fever, pustules and hemorrhagic bleeding. Most people survived the experience with scars and sometimes blindness, but smallpox killed around 25 percent of its victims — an estimated 300 million deaths in the 20th century. There was and is no cure for smallpox — only a preventative vaccine, which the U.S. Communicable Disease Center (now the Centers for Disease Control and Prevention (CDC)) and the World Health Organization (WHO) used to wipe out the disease in the 1960s and ’70s. In 1980 the World Health Organization officially declared smallpox eradicated — the only human disease (so far) deliberately wiped off the face of the Earth. Today’s vaccination defenders like to point to smallpox eradication as an example of the importance of vaccination. But they misunderstand how the way we talk about vaccination has changed. Consider the venues for vaccination conversation. During the smallpox eradication program, most of the discussion happened between physicians, public health officials and scientists — experts talking to experts about the relative benefits and costs of smallpox vaccination. Today, people of varying degrees of expertise and influence exchange ideas about vaccination on Twitter, Facebook and other forms of social media that provide a soapbox for anyone with Internet access. In addition to presenting scientific papers to their colleagues, experts must now be as adept at Tweeting with laypeople, a challenge that smallpox eradicators did not face. Today’s vaccination experts face another problem their
smallpox eradicator forebears largely avoided: science is no longer widely regarded as infallible. Vaccination skeptics can and do point to a variety of broken promises about the safety of science: DDT pesticide, toxic polychlorinated biphenyls (PCBs) once widely used in manufacturing, and ozone-depleting chlorofluorocarbon compounds (CFCs). Such examples serve as “proof” that experts have been wrong before and might be wrong again, either because the science is incomplete or, more insidiously, because the experts answer to vested interests, like Big Pharma. This process of questioning scientific authority had already begun during the smallpox eradication effort — Rachel Carson’s “Silent Spring,” an exposé of DDT’s hazards, came out in 1962 — but public health authorities rarely had to defend themselves against charges of ignorance or malfeasance. Today’s vaccination experts should not only understand this new environment of doubt, but also acknowledge that science has, in fact, been wrong. Such humility and honesty could help create a vaccination conversation in which skeptics are willing to listen to well-meaning and welleducated experts. Vaccination proponents might more directly learn from smallpox eradicators when justifying the importance of vaccination for the wider community. Many skeptics, from vehement “anti-vaxxers” to ambivalent parents, express concern about what vaccines might do to their children. This is completely understandable, which is why pediatricians explain to parents how vaccines protect their children. But protecting one’s own children is not the sole, or even the most important, justification for vaccination. By vaccinating my child, I prevent her from catching a harmful and potentially deadly disease, such as measles, that could spread to another child, and another, and another and so on. Participants in the smallpox eradication effort understood this fact: we vaccinate for everyone’s children. When officials at the CDC and WHO explained the value of smallpox eradication, they noted that it would save lives and money in the developed world. But smallpox eradication most directly improved lives in lessdeveloped countries — while also benefitting all of humanity, then and into the future. By thinking not just about my children, but our children, we might evoke that vision of cooperation and sense of responsibility, and move toward a meaningful conversation about vaccination.
Bob H. Reinhardt ’00 is executive director of the Willamette Heritage Center in Salem and author of “The End of a Global Pox: America and the Eradication of Smallpox in the Cold War Era.”
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SUMMER 2015