As vaccine-preventable diseases have returned as a public-health threat, many observers have questioned the parents who opt not to vaccinate their children. Describing vaccines as a whole as bad, as many fringe groups do, is a mistake. But it would also be a mistake for public-health advocates to treat all vaccines as equal. Some of them prevent their associated illnesses better, and if Ioffe had blamed nonvaccinating parents for measles, to give one possible example, this critique would be unnecessary. But pertussis is different.
Whooping cough has become much more common over the past decade. But unlike other infectious diseases that have made a similar resurgence in recent years, pertussis immunity has waned because a new pertussis vaccine, Tdap, was formulated in the 1990s to have fewer and less-severe side effects than an older version of the vaccine. While clusters of nonvaccinating parents have worsened epidemics in specific areas, they are not the primary cause of the epidemic nationwide, as the Centers for Disease Control and Prevention (CDC) has explicitly stated.
In 2005, Tdap — a vaccine for tetanus, diphtheria and pertussis designed to boost immunity in adults and teenagers who were previously vaccinated — was introduced. The CDC says all adults should get the vaccine. However, very few U.S. adults do, and Ioffe appears to have been one of them. When readers pointed out in the comments section of the story that she should have been vaccinated, Ioffe responded in a follow-up article stating she she didn't need to (despite printing recommendations suggesting the opposite). While getting the vaccine does not guarantee immunity, it does lessen the severity of symptoms once infected.
As journalist Tara Haelle pointed out, blaming McCarthy ignores a major gap in defenses against infectious diseases. Ioffe's American audience could do more to help reduce the spread of pertussis, since the vaccination rates for the disease remain disappointingly low among U.S. adults. In January the CDC released its morbidity and mortality weekly report showing pertussis coverage among U.S. adults at just 12.5 percent in 2011. Although that number seems dire, it actually represents a significant upgrade from 2010, when vaccination was in the single digits.
A number of issues factor into this low rate. First, immunization among adults is generally uneven. "Adult immunization is a much more heterogeneous environment than infant and child immunizations," said Dr. William Schaffner, a professor of health policy at Vanderbilt University and a former president of the National Foundation for Infectious Diseases. "The funding is less certain, and insurance coverage, copays and deductibles for vaccines are far more variable."
With fewer shots to give than pediatricians, adult practitioners may be less vaccine conscious, he added. "There's still a lot of pretty good internists who are kind of fuzzy about Tdap, its role and who should get it — even among good providers."
The Tdap vaccine is recommended for only one shot, except for pregnant women, who have to renew it at each pregnancy. Schaffner noted that several ongoing studies may show that the vaccine should be given at 10-year intervals.
There is more to the debate, however, than good information. Public-awareness campaigns about the vaccine are not enough. Ultimately, many adults will need to take personal responsibility and talk to their doctors about vaccinations they may need, including Tdap. While there are some people who cannot get the shot for health reasons, the rest of us need to do so.
Many health observers continue to speculate about why parents avoid vaccines and listen to celebrities who lack dependable health information. Incidentally, many of the parents who avoid vaccines are well educated. Simply dismissing them as stupid for making harmful choices ignores the role of trust and personal biases in decision-making. In some cases, parents could have excessive faith in "do-gooder" celebrities like McCarthy, who has (rightfully) drawn scorn from many for her pseudoscientific attacks on vaccines.
Invocations against the McCarthys of the world not only puts the blame for the pertussis epidemic on the wrong people but also fails to inform individuals about what many of them could do to prevent contracting diseases. Sharers of Ioffe's article on social media (it received 243,000 Facebook likes and more than 3,500 tweets as of Nov. 21) include doctors and science journalists who otherwise spend their time spreading solid health information. Given the article's errors, how many of them were expressing frustration with McCarthy without realizing the article outright ignored one of the problem's solutions, which they should be advocating? Instead of going after easy targets, people need to focus on the facts — what vaccines do to help, how much the benefits outweigh the risks and who should update their vaccinations.