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An Ounce of Prevention

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Here's a motto we don't hear so much anymore: "An ounce of prevention is worth a pound of cure." But I live by it. These words have guided my professional career. Why would anyone want to get an illness that can be prevented?

The American public doesn't care enough about preventing diseases through vaccination. In fact, large segments of society debate the value of vaccines. Well, I'm here to tell you, there is no debate. Vaccines are still necessary and still the ounce of prevention that save us from pounds of cure. Pounds, I might add, that don't always work.

Evidence? Ten unimmunized infants, all younger than 3 months of age, died from whooping cough in California last year. As I write this we have 156 confirmed cases of measles in the U.S. this year and half of them have been hospitalized because of it. That's the most cases since 1996 and we haven't even reached the halfway point in 2011.

Vaccines do a remarkable job of keeping diseases at bay. But make no mistake; that is all they do. The viruses and bacteria are still there, but our vaccine firewall protects us. The only exception is smallpox. Vaccines have completely eliminated smallpox--so we no longer need to give smallpox vaccine. We continue to vaccinate against other diseases because for those, we still need that ounce or prevention.

Public resistance to vaccines appears to be mostly about safety. Individuals calculate the risks and benefits of vaccines and many decide the equation isn't in their favor. Public health doctors do the same calculating. So why do our results differ? The public equates the lack of disease they can see with a lack of risk. But the risk is there--all you have to do is start lowering your firewall and it'll hit you. Whooping cough; ten babies dead in one year. Measles, more cases and hospitalizations than we've seen in over a decade. Keep lowering those defenses and you can expect to see more illnesses back on the list with higher numbers of deaths.

And on the issue of safety--vaccines are safe. True, I can't sit here and write that vaccines are 100 percent safe; nothing is. But vaccines are among the safest products in medicine. They have to be because they are given to healthy people. We all have a certain tolerance for side effects. If you're battling cancer, you might be willing to tolerate nausea, vomiting, hair loss and lack of sleep for a drug that might cure you. You wouldn't tolerate those same side effects from a vaccine. Good news--you don't have to! The safety standards for licensure of vaccines are much higher than they are for therapies used to treat people who are already sick.

Another point--the U.S. has the best post-licensure surveillance system in the world. That's why we can say with absolute confidence that our vaccines are safe. We have extraordinarily strong data from many different medical investigators all pointing to the same results. That should give us great comfort; after all, repetition is the hallmark of rigorous science.

William Schaffner, M.D., President of the National Foundation for Infectious Diseases