A Cost-Benefit Analysis of Vaccines

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PARENTS WHO SKIP VACCINATIONS

Given the rarity of adverse events and the safety vaccines provide, why do some parents refuse them? One recent study found that 77 percent of parents had asked their child's pediatrician to alter the recommended vaccination schedule, with roughly 60 percent of pediatricians agreeing to the adjustments, usually a simple delay in giving one or more vaccines. When all was said and done, about one in 10 parents chose to alter the routine vaccination schedule for their children in some way.

This trend to alter the vaccination schedule is likely fueled by the persisting worry that vaccines are linked to conditions like autism and Guillain-Barre Syndrome (GBS), an autoimmune disease in which the immune system attacks part of the nerve cell, rather than by the fear of adverse events. Some parents may ask to separate vaccines that are typically given together, space them further apart, or skip shots completely. But as the evidence keeps showing, the likelihood of vaccinations being connected to serious disorders or disease is so small -- or, in the case of autism-vaccine connection, overturned completely by newer research -- that skipping doses or changing the schedule is likely unwarranted.

Likewise, where a connection between the flu vaccine and GBS was once raised, recent evidence suggests there is no such link, and the CDC suggests that the risk of flu and its complications is much greater than any GBS would possibly be.

For these reasons, parents are usually encouraged to follow the vaccination schedule as best as possible. The effects of voluntarily adjusting the recommended schedule have not been measured yet, but it will be interesting to watch in the coming years, as it surely will be.

Relying on Others Is Becoming Less Reliable

We do know that parents' decisions to skip vaccines have had some important impacts on community health. Parents who wish to skip their children's vaccines are essentially relying on the fact that other children in the community will be vaccinated. Since in some communities this assumption is becoming less and less true, communities can be more at risk of disease than ever. In California, a sizable percentage of parents of kindergartners have applied for vaccine exemptions based on personal belief. In 2010 an outbreak of whooping cough killed 10 babies and affected more than 9,100 people.

Outbreaks of measles have been popping up again in this country, which the CDC has found at least partially due to children not receiving the MMR vaccine because of parental concerns for its safety. (They offer a pamphlet for parents who are considering altering the schedule.)

Luckily, despite the fact that doctors are often willing to alter the vaccination schedule for parents who wish to do so, they were less willing to alter vaccines against diseases that are still very much a threat today: H influenzae type b vaccine (Hib), diphtheria-tetanus toxoids-acellular pertussis vaccine (DTaP), and pneumococcal conjugate, which protects against meningitis. It is important to talk to your child's doctor about the risks and benefits associated with skipping doses as opposed to sticking to the recommended schedule.

MANUFACTURING CONCERNS

Vaccine production has accelerated rapidly in recent history, with half of existing vaccines developed in the last 25 years. The biomedical processes of vaccine-making are complex and beyond the scope of this article, but know that the organisms in vaccines need to be grown in the lab over a several-month period. And given the need for vaccines in this country, and around the globe, the production system can be taxed, so supply becomes an issue. Complicating the picture is that because the profit margin for vaccines is not large, the number of vaccine manufacturers has actually declined quite considerably in the past few decades, leaving only a handful in the U.S. today.

Because of the significant need for vaccines across the globe, production practices are changing to meet the growing demand, particularly in the locations in which they are manufactured. Recently the World Health Organization (WHO) gave the OK to China to begin producing vaccines.

This development could help people across the world gain access to the life-saving vaccines that are clearly needed. But given China's history of product safety concerns, it could be a while before people are comfortable accepting the "Made in China" label for vaccines. Last year, Chinese-imported drums of honey were seized because they contained an antibiotic known to be toxic to humans. In 2008, tens of thousands were sickened from milk powder, and a year earlier tainted cough syrup was responsible for the deaths of 94 in Panama. Time will tell how China's entry into the vaccine market will affect public confidence in their production practices -- and how it will affect access to vaccines across the world, and here at home.

A DOSE OF REALITY

It is understandable that parents -- or anyone -- might be concerned about the risks posed by vaccines, but the bottom line is that for almost any individual their benefits clearly outweigh the risks. For a select group of people, vaccines may cause an allergic reaction, but these cases are rare, and can often be avoided if one is aware of existing allergies (egg or gelatin) that might trigger it. Extreme adverse events are even rarer. The individual additives in vaccines are present in such small doses that the likelihood that they would affect a body in any meaningful way is virtually nil.

It can be easy to forget about the serious consequences of the diseases that vaccines protect against if you haven't seen them firsthand. The diseases that are prevented by giving vaccines are not pretty and can be life threatening -- and the complications, like meningitis, for example, can be grave. Tiffany Thornton, a spokesperson for Voices of Meningitis, is a survivor of meningococcal disease. She has devoted her time to raising awareness of the disease because so many are unfamiliar with fact that it can cause long-term brain and organ damage, and that it can be life threatening.

We also tend to discount the severity of the diseases that we do not see because they have been close to eradicated by inoculation. The FDA reminds us that "[t]oday there are far fewer visible reminders of the suffering, injuries, and premature deaths caused by disease that can now be prevented with vaccines." Just ask someone who's seen diphtheria in action whether vaccination against it is a good idea. Luckily, there aren't many people who have seen a diphtheria infection these days, since it's been virtually wiped out by vaccination.

The vaccine issue essentially boils down to a numbers game. Pitting the risks of vaccines against the risks of disease is really at its center. The number of people who become sick -- and die -- each year from diseases that could have been prevented by vaccination far outstrips the number of people who are affected by the vaccine itself. It can be easy to lose sight of this fact since the exceptions -- the few children whose health has been damaged by a reaction to a vaccine -- are more visible than the millions of cases of disease that never occurred. But the numbers don't lie. The research does the math for us, and continues to arrive at the same answer: Virtually across the board, vaccines' benefits outweigh their risks, making them the best way to ensure a healthy future for children and adults.

Image: Sura Nualpradid/Shutterstock.


This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

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Alice G. Walton, PhD, is a health journalist and an editor at The Doctor Will See You Now.

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