The Changing Politics and Consistent Science of Vaccinations

The recent outbreak of measles in the United States launched a national debate on vaccinations that has spread rapidly throughout the media and even involved some of the likely 2016 presidential candidates. A Gallup survey and other recent developments make clear that it's a public discussion that we need to continue.

The Gallup survey, released earlier this month, revealed that "a slight majority of Americans, 54%, say it is extremely important that parents get their children vaccinated, down from the 64% who held this belief 14 years ago. Another 30% call it 'very important' - unchanged from 2001." That 10 percent drop should be a major concern, as should the fact that a slim majority of Americans understand how important vaccinations are.

As a physician and medical researcher who has spent years studying infectious diseases -- and now as President of Stony Brook University, a major research institution -- I'm struck by a number of aspects of the debate and by the vital need to rebuild public support for one of the most crucial methods of improving public health.

During the 20th century, life expectancy for Americans increased by more than 30 years -- an extraordinary achievement that we now, too easily, take for granted. Crucial to that advance was the development of vaccines and their remarkable impact -- especially the eradication of smallpox, elimination of polio, and control of measles, rubella, tetanus, diphtheria, and various types of flu, among other diseases. Polio alone killed 3,000 Americans and left 21,000 paralyzed in a single year (1952).

The debate surrounding measles may seem harmless, since there's no comparison between the horror of Ebola and the symptoms of measles. Yet measles are far more contagious. One of the striking revelations of Ebola was that household members who had not come into bodily contact with a symptomatic patient were not likely to contract the disease. In contrast, every unvaccinated person in the same household -- or even a train car -- with a measles patient is likely to contract the disease.

The implications for people who cannot be vaccinated are, therefore, profound: children too young to be vaccinated and those who have compromised immune systems; children with leukemia, for instance. For them, any exposure to a measles patient -- even just being in the waiting room of a pediatrician's office - can be extremely dangerous, subjecting them to potential brain damage, among other debilitating symptoms. And the danger of transporting the disease to other parts of the world in our globalized economy is substantial as well.

The 16 percent in the Gallup survey who think that vaccinations are not even very important may, too, seem like a small percentage. But that percentage, if it goes without vaccinations, represents a large number of people in a nation our size. In the New York City area alone, WNYC radio recently found 165 schools where more than 10 percent of the students have not been vaccinated.

It's remarkable how rapidly we as a nation have swung from asking why an Ebola vaccine has not been developed to wondering why we have to take a vaccine against measles. It was just months ago that the nation was panicked over the prospect of Ebola reaching our shores and faulting government officials for not having developed a vaccine to protect us.

But the importance of this discussion -- and of public support for vaccinations -- is evident in the history of developing an Ebola vaccine. It can take more than a decade of research to develop and test a safe and effective vaccine, and too often disease moves much more rapidly than that. Experimental vaccines against Ebola are only now being tested in West Africa. That's why we cannot afford to let down our guard and become complacent -- either about the need for vaccines or their widespread application.

It's fascinating how anxiously we await cures to the most horrible diseases like cancer, and yet how easily we dismiss cures to diseases when they exist. It's intriguing, too, how willing we are to put myths ahead of scientific proof -- a fact that played a major role in the spread of Ebola in West Africa and that now sustains opposition to vaccines in America.

There is no scientific evidence, for instance, that vaccination against measles is harmful in any way. The reality is simply that the time when the vaccinations are best administered -- at about one year of age -- is also the time when developmental disabilities first become evident. That coincidence has sparked public worry about vaccinations, and that worry seems to be more important to some than the scientific evidence, even when that evidence is absolute.

Interestingly, Ebola and measles are now being linked by new research showing that the disruption to health systems in Ebola-affected countries also disrupted vaccinations against measles. The fear is now that any outbreak of measles will be far more devastating than normal because immunizations have declined greatly. "The secondary effects of Ebola -- both in childhood infections and other health outcomes -- are potentially as devastating in terms of loss of life as the disease itself," says study leader Justin Lessler, PhD, an assistant professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.

We're fortunate to live at a time when we know more about the human body and its relationship to disease than ever before. Now is the time for us to eradicate more diseases, not lessen our commitment to vaccinations.

We must not only be ever vigilant in the fight against disease, we must anticipate new fronts in the battle and be ready for them. In order to be ready, especially in an age of potential bioterrorism, we must have a firm national commitment to scientific research and the development of vaccines - and to their use when public health requires it. That's essential to the safety of all Americans.

The author, a physician and medical researcher, is President of Stony Brook University.