Shots for School: Keeping Kids Safe -- Together

I get the argument that it's not fair to force parents to immunize their kids in order for them to go to school. But schools have a responsibility to keep students safe and healthy.
05/10/2012 12:49 pm ET Updated Jul 10, 2012

The other day, my 11-year-old got vaccinated against pertussis and meningococcus. I have seen what both of those illnesses can do to children, and I felt real relief knowing that Natasha is much less likely to get them now.

As a doctor who has seen vaccine-preventable illnesses, I always feel better when my children are vaccinated. And because I know the latest recommendations, I know when to take my kids in for them. But for some parents who don't see these illnesses and don't know all the recommendations, what prompts them to get their child immunized are school immunization requirements.

When schools require immunizations, immunization rates rise. We know this, and a study released this week in the journal Pediatrics underlines it. Researchers from the Centers for Disease Control (CDC) looked at immunization rates of middle-schoolers. These kids have lower rates than younger children, as they tend to go to the doctor less often. The researchers found that when states required immunizations, more kids were immunized. With the meningococcal vaccine, the rate went from around half to more than two-thirds.

This may seem like stating the obvious, but it's an obvious thing worth stating in a time when we are seeing outbreaks of vaccine-preventable diseases like pertussis and measles -- and when twenty states allow parents to opt out of vaccines not for a medical or religious reason, but simply because they don't want to do them.

I really do understand vaccine hesitancy. Vaccines are a medical treatment, and like any medical treatment, they have risks. They are carefully tested before being licensed and continuously monitored afterwards and the most common problems are minor, but serious problems do occasionally happen. I can understand not wanting to take on any risk of a serious problem.

But here's the thing: for almost every vaccine-preventable illness, complications from the illness itself are more common than complications from the vaccine. Take the meningococcal vaccine, for example. Meningococcal disease kills 10 to 14 percent of all the people who get it -- and of those who survive, 11 to 19 percent have serious problems such as brain damage or lost limbs. According to the package insert for the vaccine, in adolescents the chance of having a serious side effect is one percent.

But, some people argue, why take the risk at all when these diseases are rare? In fact, thanks to vaccines, some of them are indeed rare (not so much meningococcal disease, sadly). If enough people are immunized, it creates what is called a "herd immunity" that helps protect those who can't be immunized (for medical reasons or because they are too young) or choose not to be. But recent outbreaks have underlined that you can't count on herd immunity -- especially if the herd gets smaller.

I get the argument that it's not fair to force parents to immunize their kids in order for them to go to school. It does feel a bit weird for schools to require a medical treatment -- although schools have a responsibility to keep students safe and healthy during school hours, and cutting back on the spread of infectious illnesses does just that.

The fairness thing goes both ways, too. When you rely on herd immunity to protect your child, you are depending on others to take the vaccine risks you don't want to take. And, if your child catches the illness, it exposes other children -- some of whom may have medical problems. This isn't fair to those who do vaccinate.

So what do we do? We need a bigger herd -- and we need to respect the questions and concerns of parents. I recently wrote a post asking what I could do for parents who are afraid of vaccines -- and I got lots of responses. People said they want more openness in discussions with their doctors, more transparency and more study of the serious side effects that happen. I think these are all good things to have more of.

There was also a lot of anger and accusations in many of the comments -- from both sides. Somehow, we have to get past this. Nobody on either side of the argument wants a child to get either a vaccine-preventable disease or a side effect from the vaccine.

Vaccines work -- and vaccines have problems. Both are true. Since all of us are passionate about the health of children, let's work together, not against each other, to find the middle ground we can live with.