Jeremy Friedman
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More has been written on the topic of immunization over the years than just about any other issue in child health. I can't pretend to have any profound wisdom that hasn't been expressed more eloquently many times before, so best to just share my reflections as a pediatrician for the last 20 years and as a father of two.
I don't remember getting my shots as a kid, maybe because there was a much smaller number available back in the 1960s. I have a "scar" to show for having been born in a faraway land requiring immunization against tuberculosis. I had mumps and chicken pox as a child (according to my mum) and rubella as a medical student (the MMR and chickenpox vaccines had not been available in my youth). As a medical student training in South Africa I saw too many beautiful children die an awful death from exotic-sounding diseases like diphtheria and tetanus and measles that few Canadian medical students would be able to recognize today.
These diseases, together with others like polio, are almost never seen any more. Smallpox has been eradicated. Why? Because of successful immunization. So it seems a bit ironic that what many consider to be the greatest advance in childhood health and survival worldwide would be such a source of emotion and angst for many parents.
I was privileged to do my specialty training at the Hospital for Sick Children in Toronto in the early 1990s. As a general pediatric resident, one of my worst fears was admitting a young child with bacterial meningitis, or even worse, not recognizing the often innocuous non-specific early symptoms and thereby delaying the potentially lifesaving antibiotic therapy.
Bacterial meningitis in even the best health-care facilities could take a perfect healthy baby and within hours cause permanent brain damage or even death. Then along came the Hib (Haemophilus Influenzae type B) vaccine and essentially wiped out this type of bacterial meningitis in Canada.
Very rarely since then have I seen cases of severe brain damage resulting from a potentially preventable Hib or pneumococcal meningitis. These heartbreaking cases are almost exclusively in those who did not receive the recommended vaccine either from lack of opportunity, as in new immigrants or refugees, or out of parental choice.
My younger sister is an intelligent, incredibly loving mother who still lives in South Africa. She decided not to follow the local recommended immunization schedule, which is relatively similar to ours (if you can afford it and have access to those resources). Her first child was hospitalized with a severe case of whooping cough (pertussis). This prompted her to go ahead with some of the recommended shots.
Why do some parents reject the advice of their health-care providers and the national regulatory agencies and ignore the tremendous weight of evidence of the benefits of immunization? These are generally sophisticated and loving parents who have the exact same goals as I do as a pediatrician and father – give my patients and my children the best shot at health.
In 2014 we are advising parents to immunize their children against 15 different diseases resulting in approximately 22 "shots" by the age of five years. That may explain some of the reluctance and discomfort. There are likely many different reasons for different parents.
But do we realize that by being lucky enough to live in Canada we are given this free "insurance" policy that so many families throughout the world have no hope of receiving?
Canada's vaccine safety system is extremely stringent and risk averse – in addition to the thorough government-regulated review prior to licensing a vaccine, there is an independent expert review of all safety and efficacy data. After new vaccines are introduced there are a number of surveillance systems instituted to detect any possible adverse events. Each event results in rapid assessment, and reports are scrutinized by independent experts.
But like many things in life, vaccines are far from perfect. Protection is not 100-per-cent guaranteed, although if you are unlucky enough to get infected after vaccination, in most cases the severity of the illness is significantly reduced. They often cause some pain and swelling at the injection site and mild side effects like fever and crankiness. There may be the odd, very rare significant adverse event. But the risks would appear to be so much less than those of the diseases that can be prevented.
Humbled by years of professional practice and especially by parenting my two teenage children, I'm a compromiser by nature. My own children are fully immunized as per the Canadian Paediatric Society and Health Canada recommendations. It seems like a "no-brainer" to me.
But when it comes to the annual flu vaccine, I recognize that there is often controversy. I'm always vaccinated as soon as the flu shot is available, as health-care providers will be exposed to influenza and can potentially infect their patients. I immunized my children when they were younger. As a parent, I had decided to save my now-teenaged children the inconvenience of one extra needle this year, because school-age children without underlying medical conditions, unlike their counterparts under age 5, aren't considered as "vulnerable" by public-health authorities. But with quite a severe wave of influenza currently creeping across North America in the last month, I'm no longer sure I made the right decision. And with the availability of the new flu vaccine that can now be given by nasal spray, Friedmans … you are back on the flu-shot roster.
Dr. Jeremy Friedman is the chief of paediatric medicine and associate paediatrician-in-chief at Sickkids Hospital in Toronto, and a professor of paediatrics at the University of Toronto. He has written a number of books for parents including bestsellers Canada's Baby Care Book and Canada's Toddler Care Book, and A to Z of Children's Health (Robert Rose publishers, October 2013). Follow him on Twitter @DrJFriedman