4 Striking statistics about vaccination

1. Influenza kills more people in the United States than all other vaccine-preventable diseases combined.

infographics - statistics-flu

In the U.S., we tend to underestimate flu. Perhaps it’s because it’s so common (an average of 5 to 20 percent of the population gets the flu every year), but many people don’t think the flu is that big of a deal. In actuality, the flu can be very deadly — even in previously healthy individuals.

Let’s be clear: all of these diseases can cause potentially devastating consequences. But the flu vaccine is just as important as the other vaccines included in the recommended immunization schedules, yet it is one of the least utilized. Less than half of the U.S. population over the age of 6 months get the vaccine every year.

2. More than an estimated 80 percent of U.S. adults are not up-to-date on their whooping cough vaccination. 

infographics - statistics-tdap

It’s recommended that adults over the age of 18 receive at least one dose of a pertussis-containing vaccine to continue being protected. Yet many adults have no clue whether they are up-to-date and can inadvertently transmit the bacteria to small children without even realizing it. For these infants, pertussis can be incredibly dangerous. In fact, roughly half of children under 1 year old who get pertussis will be hospitalized, and one or two out of every 100 will die.

Pregnant women in particular should talk to their medical provider about getting a dose of Tdap (tetanus, diphtheria and pertussis) vaccine during their third trimester in order to pass protection onto the child before they’re born. This early protection is crucial to protecting young infants during those first few months of life until they can be vaccinated themselves.

3. Vaccines save more lives than seat belts in the U.S.

infographics - statistics-seatbelts

Please don’t get me wrong. This statistic isn’t here to belittle the life-saving impact of seat belts. They are an important safety tool to protect ourselves and our families. But so are vaccines. And when you look at the estimated number of lives saved, vaccines prevent even more deaths than seat belts and child care seats (combined). That’s really saying something.

4. We’re missing out on an opportunity to protect thousands of young women from cancer.

infographics - statistics-hpv

Despite early results demonstrating the high effectiveness of HPV vaccine in preventing cancer-causing HPV, only about 1/3 of young women in the U.S. complete the 3-dose series. According to the Centers for Disease Control and Prevention, “For every year that increases in coverage are delayed, another 4,400 women will go on to develop cervical cancer.” That number is unacceptable. We can do better.

 

To the nurse who “bullied” me into getting the HPV vaccine: Thank you.

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By Robyn Correll Carlyle

My first year of public health grad school, I went into the student health center for my general checkup. My blood pressure was well within range. I was a healthy weight. I exercised three times a week and ate vegetables – Not to brag or anything, but I felt like I was pretty much going to ace the checkup.

Everything was going well (and I was feeling pretty good about myself) until the nurse Betty* came into the exam room, looked over my chart and said, “I see you haven’t gotten the HPV vaccine yet, and you’re about to age out. Do you want to go ahead and get it today?”

Wait, what?

Prior to grad school, I had been in the Peace Corps, where they poked me with what I thought was every vaccine conceivable. I didn’t relish the thought of yet another. Besides, I had heard about the HPV vaccine. It was the STD vaccine.

I was engaged, thank you very much. To a guy I had been seeing for four years. I didn’t sleep around. I was pretty sure I didn’t have – nor would I ever get – genital warts. It seemed totally unnecessary. And didn’t the vaccine just come out only a few years prior? That’s a little too new for me. I didn’t want to be a guinea pig.

“Umm, is it something I have to get?” I ask. “For school, I mean?”

“No,” Betty said. “It’s not required. But it is really important. It’s to protect you from cancer.”

I didn’t really hear that last part. I just heard “not required.”

“Then no,” I said confidently. “I’d rather not.”

Betty put down my medical chart and sat across from me, giving me her full attention. “What’s got you nervous about it?” She asked gently.

And then she listened. For every concern I had, she had a response.

The vaccine wasn’t “totally unnecessary.” HPV is very common – most adults in the U.S. will get it at least once. And it doesn’t just affect those with risky sexual behaviors. Most new infections are in young people, just shortly after their first sexual experience. Because it can be transmitted skin-to-skin, condoms don’t fully protect against it either. It didn’t matter that I was about to get married, I was still at risk.

It’s not that new of a vaccine. Prior to licensing, the vaccine had been tested for several years in thousands of people. And what’s more the vaccine technology used to make the vaccine is even older. The HPV vaccine is made using the same technology as the Hepatitis B vaccine – a vaccine that not only has been around since the 80s, but also is so safe that it’s recommended for infants on the day they’re born.

It won’t give me HPV. The vaccine doesn’t contain the whole virus, just a slice of virus DNA. So it’s biologically impossible for the vaccine to give me HPV.

One by one, she patiently shot down each and every one of my concerns until I was fresh out of excuses. She gave me the first of three doses then and there, and then made sure I knew when I needed to come back to finish the series.

I didn’t really appreciate it at the time (in fact, I thought she was bit of a bully), but now I’m grateful to Betty for taking the time to talk to me. It wasn’t until a few years later that I truly understood how grateful I should be.

One day a good friend of mine called me in tears. She had just been into her doctor for her annual checkup when she got the news: she had what is known as high-grade cervical dysplasia. The step right before full-blown, rock-your-life cervical cancer.

She wasn’t even 30.

The thing is she had requested the HPV vaccine from her OB/GYN years before, when she was still eligible to receive it (the vaccine’s approved up to age 26). But her doctor actively discouraged her.  There were potentially serious side effects, her doctor said (not adding that these side effects are very rare). She should really think about it and then come back if she still wanted it.

My friend didn’t push it. After all, she was just the patient. Of course, time slipped by, and it was annoying to make an appointment. So my friend never got the vaccine. And her doctor (as well as every other medical professional she encountered thereafter) never mentioned it to her again.

Now, she was facing the reality that she could be developing cancer – cancer that probably could have been avoided had she been vaccinated. Her doctor told her they would wait six months and check again. “These things can clear up on their own sometimes.” Otherwise, they would need to remove the pre-cancerous cells, an often painful and uncomfortable process.

Much to everyone’s relief, her body did clear the precancerous cells. But it was a terrifying six months. And throughout that time (and in the time since), she wondered what would have happened had she been vaccinated.

Hearing about her experience made me want to chase Betty down and hug her. My friend wanted the vaccine and was discouraged from getting it. But I actively rejected the vaccine, and Betty didn’t give up on me. She pushed me to really understand what made me so nervous and responded to my concerns in a way that I understood. She took the time to talk it through with me. Even though she was busy. Even though she had other patients to see, other things to do. She didn’t have to do that. But she knew how important the vaccine was, and she didn’t want me to miss the opportunity to protect myself simply because I was ill-informed.

I might have felt (slightly) bullied at the time, but it wasn’t because Betty was rude or dismissive. She was simply being assertive. Standing up for what her education and training assured her was the right thing to do for me and my health. I was taken aback by her confidence, and uncomfortable because she challenged my (I now realize, totally unfounded) beliefs. I thought I was fairly well-educated on the topic — after all, I was in graduate school studying public health — but I didn’t realize how limited my understanding of the vaccine truly was. Betty wasn’t afraid to share — and assert — her expertise as a medical professional. And she did it in a way that was patient and kind to my misunderstanding of the topic.

To Betty – and to all those nurses and doctors like her – thank you for standing up for (and to) me. It might have saved my life.

 

*Not her real name.


Robyn Correll Carlyle, MPH, is a project manager for educational programming at The Immunization Partnership

Measles Control Made Easy: Stronger Laws Equal Less Disease

This post originally appeared on The Network for Public Health Law on February 4, 2015. 

Virtually no other set of public health laws have had as direct an effect on health as immunization laws. Sbaby-with-rashtrong laws lead to high immunization rates, which in turn lead to lower incidences of disease. Some diseases have been nearly eradicated such as polio, rubella, and until recently, measles. However, keeping immunization rates high takes constant vigilance. Unfortunately over the past two decades there has been a weakening of immunization laws in many states. When immunization laws are weak, it puts the public’s health at risk.  For instance, while all states allow medical exemptions to vaccines, and many allow religious exemptions, there are 20 states that also allow non-medical exemptions, meaning that parents may opt-out of vaccines for any reason and their children may still attend public schools. For years, the public health community has been watching the increase in the number of children not fully immunized, and have warned of a resurgence of dangerous diseases. Sadly, that time has come. Measles is back, and it hit Disneyland, “happiest place on earth.”

It’s not surprising that California, a state that has seen dramatically rising exemption rates, was the setting for the most recent outbreak of measles.  In response to the rising exemption rates, California lawmakers recently passed a law requiring parents opting out of vaccines to obtain the signature of a provider stating that they have been counseled on the risks and benefits of vaccines.  This was an excellent step in the right direction to protect Californians, but considering the extent of the outbreak, it may have been too little too late. The measles outbreak that originated at Disneyland has so far affected 102 people from 14 states and Mexico. Unfortunately, this is not an isolated occurrence. There have been an additional 23 outbreaks over the past year, with cases reported in 27 states and affecting 644 people, the most cases since measles was declared eliminated from the US in 2000.

There are many ways that laws can be strengthened to protect the public from the measles. However, as with most law aimed at protecting the public’s health, individual rights must be balanced against the risk of harm to the community. For example, the risk of harm to individuals and to property is high if a person drives while intoxicated, therefore we prohibit it.  In the context of immunizations, if there are many unvaccinated people in the community, the risk of an outbreak of disease is very high. With the threat of measles returning to the U.S. as a widespread disease, it’s time to have a national dialogue about our social contract with each other and the risk of harm to the general community if immunization rates continue to drop. The risk of harm from immunization to the individual is low. The Measles, Mumps, Rubella (MMR) vaccine has been used for decades and has an excellent track record for safety (despite the misinformation that the anti-vaccine community would like people to believe).  However, the risk to the public is very high if there is an outbreak. According to the CDC, measles is so contagious that if one person has it, 90 percent of the people close to that person who are not immune will also become infected. And it’s not just the children who are unimmunized who pay the price. The very young (under 12 months of age) and those with a weakened immune system and cannot be immunized are at the highest risk. If a person becomes infected with the measles there are severe consequences including pneumonia, brain damage and death.

With the outbreak that originated in Disneyland continuing to spread, states clearly have a compelling interest in strengthening immunization laws to protect those among us who are too sick or too weak to be immunized. The time has come to develop more aggressive strategies for protecting the public’s health. Some strategies that could be considered:

Reduce or eliminate non-medical exemptions: In the U.S., all states have requirements for kindergarten entry and many have also added adolescent vaccines to the school requirements. School entry requirements are highly effective in achieving and sustaining high immunization rates, yet the allowance of non-medical exemptions and the ease in obtaining these exemptions have slowly chipped away at the protections these requirements provided. And now the rate of disease is climbing. We must eliminate or significantly reform the laws allowing non-medical exemptions. While non-medical exemptions are permitted in 20 states, there is no constitutional requirement that these exemptions be permitted. In fact, the majority of states (30) do not permit non-medical exemptions. Some states have or are currently taking steps toward limiting or eliminating non-medical exemptions. For example, a 2012 bill in the Vermont Senate proposed the removal of philosophical exemptions from the state’s school vaccination requirements. Also, several states including Washington (Wash. Rev. Code § 28A.210.090) and Oregon (Or. Rev. Stat. § 433.267), now require parents who request a non-medical exemption to provide evidence that they were advised by a health care provider about the risks and benefits of immunization.

Pursue Tort Claims: Some legal scholars have suggested examining the viability of bringing a cause of action against parents who refuse to immunize, and whose decision results in the spread of a vaccine-preventable disease. Much has been written about the potential for such a cause of action to be successful, how the case might be built, who might have standing to bring a cause of action and the likely outcomes in different scenarios. In the face of the current measles epidemic the viability of this type of legal action could be tested in an effort to compel parents to take responsibility for immunizing their children and for protecting others.

Actively engage in foreign relations: As concerning as the measles cases are in the U.S., there is an even scarier scenario playing out in Europe and other parts of the world. Unlike the U.S., most countries do not require any vaccines for school entry. Children in other countries get their immunizations on a recommended schedule, usually determined by the country’s public health officials. If they have not received a vaccine by the time they start school, there is no mechanism to compel their parents to get them up to date.  Last year there were 4,151 cases of measles in Europe, compared with 644 in the U.S. Since measles was declared eradicated in the U.S. in 2000, every outbreak has been tied to someone who traveled overseas and brought the disease home with them. Vaccine-preventable diseases are high in many countries in Europe and across the developing world. With infectious diseases, what happens in one country has far reaching effects in the U.S. This is why we have put so many resources into eradicating polio.  Until there are no more cases, we are all at risk because diseases can and do reemerge.

In order to truly impact the diseases coming into this country, we need to take an active role in helping other countries overcome their challenges in the fight against vaccine-preventable diseases. Access to care, affordability, logistics and education are all factors that contribute to low immunization rates in other countries. Additionally, with the rise of Neglected Tropical Diseases(NTDs) in the U.S., new opportunities for international collaborative research and vaccine development are possible. In order to protect Americans there needs to be increased efforts to address all of these challenges through vaccine diplomacy, vaccine development partnerships, increased support for immunization programs abroad and encouragement to implement strong laws and policies in other countries.

Note: The Network and the CDC Public Health Law Program will present a webinar on February 19 to examine the current measles outbreak in the U.S. and associated legal issues. Speakers will describe current vaccination recommendations, provide an overview of vaccination laws and exemptions, explore state temporary exclusion laws related to unvaccinated students, and highlight lessons learned by LA County in implementing legal disease control measures. More details here.

This guest post was prepared by Anna C. Dragsbaek, J.D., President/CEO of the Immunization Partnership, a nonprofit organization that educates individuals, parents and providers about the importance of immunizations, and advocates for evidence-based public policy and fosters collaborative efforts among immunization partners.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF