03/18/2010 05:12 am ET Updated May 25, 2011

The (New) Great Debate

When I was in high school, the debate over abortion reached its first climax. Pro Choicers and Right to Lifers clashed at every possible turn: on the front pages of newspapers, in the courtroom, on street corners and even on the Mall in Washington. As the discourse evolved and grew like a furious dust bunny with slightly gross and sometimes unpredictable contents, one fact always seemed consistent: the Pro Choice camp and the Pro Life camp never actually debated.

Sure, they disagreed about a lot. And representatives from each group appeared all over the media in face-offs. But they never really talked to each other; instead, they talked over and under and around each other. They never had to really debate because their premises were so totally different. The Right to Life movement was founded on the belief that life begins at conception, and so they argued that abortion was murder. The Pro Choice movement patently disagreed: life does not begin at conception; if anyone's "life" was on the line, it was that of a pregnant woman (and by this they clearly meant the quality of her life, the likelihood that she would attain the degree or job or future she desired). Precisely because of this fundamental difference in starting point, the Pro Choice movement never really had to even engage in the murder conversation. How could it be murder when there wasn't anyone being killed?

The national conversation about vaccination is starting to feel an awful lot like the talk about abortion felt 25 years ago. There is no real argument between the two camps -- they don't really even address the same issues. Sure, experts from both poles appear on morning shows, daytime talk, and evening news panels. Often a voice of moderation -- someone who is supposed to represent the middle -- is added into the mix as well. But the middle of what?

The groups that oppose vaccination have lots to say about it. Among other things, they contend that immunizations don't necessarily work; they trigger a host of other problems from autoimmune disorders to autism; and they ultimately represent a massive game designed for pharmaceutical industry profit, within which doctors are sometimes pawns, sometimes profiteers. But going beyond the details, the anti-vaccine movement is really about individual choice. I don't have to do what you say. I don't have to give my children shots if I don't want to. The world is not as scary as you fill-in-the-blank (with doctors, scientists, government officials, even other parents) say it is. I have the right to choose what goes into my body -- and my child's body -- and I say no to vaccines.

The pro-vaccine camp has answers to each of these claims -- just like the Pro Choicers had with the Pro Lifers--but their fundamental argument is totally different. At its core, theirs is not an individual argument but a social one. Where the anti-vaccine subscribers see trees, the pro-vaccine enthusiasts see forests. If we stop vaccinating, diseases we no longer fear (because they are all but gone) will be back. We have a social responsibility to vaccinate, they contend. When your child is not protected against measles and none of her classmates are either, then measles will return and there will be consequences. Some will get sick; kids will miss school; adults will miss work; people will be hospitalized; some will die. This risk of acquiring a vaccine-preventable disease threatens your child individually but it also looms over society as a whole.

These two camps believe so firmly in their mission statements that there is no conversation to be had. Parents used to ask me whether I vaccinated my children as a point of interest, as if the pediatrician's input might have some bearing if she was willing to give her own children immunizations. Today, when I am asked the question (and the answer for me is a resounding yes), I have become accustomed to hearing some variation on the following theme: Why? Weren't you afraid you were going to give your children autism? They aren't asking my opinion anymore -- they are staking their claim. People self-identify as for or against, oftentimes before their first child is even born. Almost certainly before they have read any actual scientific data.

The difference here -- the reason that this is not -- the same as the abortion debate -- is that there is a gigantic group of people stuck in the gray zone. They are caught in the middle with no idea what to do. They cannot rely upon hearing opposing views in order to reach a decision because the views don't talk to each other. And so they are left at loose ends, completely confused and many of them scared. The difference is that this isn't some theoretical conversation about "What if I was pregnant and 16, what would I do?" but rather this is a very real decision that every one of the 4 million new parents in this country need to make every year. And they don't just make it once, they make it 25 or 30 times, each time a child is scheduled to have a particular vaccine.

The great travesty here is that we are not debating. It's us versus them. And just like with abortion, if the default answer is no, don't give it to me, then there will be consequences. In my office, when parents tell me they just want to wait before they give their children vaccines, I explain that this is a choice not to vaccinate. They don't like hearing that -- most of them really do want to have more time. But just like a pregnant woman who says no to abortion winds up with a baby, a parent who says no to immunizations may wind up with a sick baby. They just don't tend to think about it that way.