Gary S. Marshall, MD Pediatrics

December 03, 2009

Influenza is on everyone’s mind. Milwaukee has already seen thousands of cases of H1N1, and parents are wondering: should their children be vaccinated?

It’s not easy being a parent. Young children are completely dependent on us for food, clothing, shelter … and making the right decisions on their behalf. Vaccination against H1N1 has been recommended for all children, but some parents are reluctant, not wanting to make a decision that might harm their children. This hesitancy echoes concerns that have been raised about childhood vaccines in general.

On the one hand, some celebrities and a handful of investigators tell us not to vaccinate, or to vaccinate by a different schedule from the one the pediatrician recommends. The risks, they say, outweigh the benefits. They cite increases in autism and chronic medical conditions that have paralleled increases in the number of vaccines that are given to children. Some suggest that the dangers have been downplayed in order to further the profits of vaccine manufacturers.

On the other hand, doctors and scientists tell us that vaccines are among the most thoroughly tested medical interventions ever used. They remind us that billions of doses have been given worldwide, and that no intervention short of sanitation has meant more to public health. They quote study after study showing that, while vaccines can have minor side effects like sore arms and low-grade fevers, they do not cause autism – or diabetes or asthma or any other chronic condition. Virtually every authoritative medical and scientific organization – from the American Academy of Pediatrics to the Institute of Medicine – agrees, and in a recent landmark decision, so does the Federal Claims Court, finding unequivocally that MMR and thimerosal in vaccines do not combine to cause autism. Some autism advocacy groups have moved on from the “vaccine question” to finding the true causes of (and validated treatments for) this devastating condition.

So what should parents believe? Here’s the rub: belief has nothing to do with it. It’s a matter of science, and on behalf of our children, we need to learn how to think like scientists. We need to resist the tendency to think anecdotally (“Johnny got the vaccines and developed autism”) and instead think statistically (“Millions of children got the vaccines and didn’t develop autism”). We need to think critically (“Is autism truly increasing or are we just detecting cases that were there all along?”). And we need to be skeptical (“Where’s evidence of a conspiracy?”).

Unfortunately, critical thinking provides no guarantees, and nothing, including vaccination, is without risk. That’s why in the end we need to weigh the risks and benefits. On the one hand, the diseases are real, potentially serious, and only a plane flight away (and sometimes right next door). On the other hand, the vaccines are safe, they work, and the side effects are minimal. In the case of H1N1, the vaccine is just like the seasonal vaccine that millions of people get every year, only the influenza strain is different (just as it is from year to year as scientists adjust the fit between the vaccine and the circulating virus). The truth is that, whether it is H1N1 or measles, far greater harm can come from not vaccinating.