Vaccine-preventable diseases: Where we were

A recent article from Medscape declared that across the USA:

New cases of COVID-19 in children continued their descent toward normalcy, falling below 100,000 in a week for the first time since early August 2021, according to the American Academy of Pediatrics and the Children’s Hospital Association.

This is very good news, and we can only hope it drops further. However, framing 100,000 pediatric infections as a “descent towards normalcy” shows how much COVID has warped our collective standards for what is normal and acceptable. I’m not trying to single out the author of the Medscape article. We’ve all changed.

I’ve been paying close attention to vaccine-preventable diseases for the past decade. I remember when an immunocompromised woman dying of measles in 2015 was a big deal. I remember when a baby dying of whooping cough in 2019 was a big deal. I remember that it was a big deal in 2019 when Gov. Matt Bevin of Kentucky exposed his children to chickenpox rather than vaccinate them. I remember in 2014 when the Disneyland measles outbreak was a big deal. I remember in 2019 when 1,261 cases of measles were considered a “public health crisis.”

An entire paper in The New England Journal of Medicine was written about the 649 measles cases here in NYC that year. Researchers reported that low vaccination rates and “measles parties” fueled the outbreak, which hospitalized 52 people and sent 16 of them to the ICU. This now seems like nothing, especially considering no children died, fortunately.

However, as I said at the time there is nothing benign about a virus that can send 16 people to the ICU. This is why prior to the pandemic, I advocated for the MMR vaccine, as well as the HPV, polio, rotavirus, pertussis, and flu vaccines. I don’t want any child to suffer from a vaccine-preventable disease.

None of this was controversial at the time, especially amongst doctors. We all agreed that children going to the hospital, especially the ICU, from a vaccine-preventable disease was utterly unacceptable. We all agreed that a child dying from a vaccine-preventable disease was a tragedy that we should strive to prevent, not something to normalize. Only the most rabid anti-vaccine quacks opposed vaccinating children. Only overt anti-vaxxers sheltered from the care of sick people argued with me on social media.

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Vaccine-preventable diseases: Where we are

Things are very different now.

Today, with over 10,000 pediatric COVID cases, 109 pediatric hospitalizations, and 2-3 pediatric deaths every day, we are told that we are approaching normal. In fact, we are told we must get there urgently. Being careful for a few more months, so perhaps children under 5-years can be vaccinated, is portrayed as an intolerable obstacle, even though over 400 children ages 0-4 years have died.

Today, doctors from prestigious universities – who are terribly offended to be characterized as anti-vaccine – vocally declare that healthy children should not be vaccinated against COVID. Using arguments indistinguishable from someone like Andrew Wakefield, several doctors waged a relentless and successful campaign to ensure as many children as possible were infected with the virus before they were vaccinated. One doctors said that “Vaccinating healthy ≤12 year olds makes hardly difference to them directly, however we look at it.” Another doctor lamented the possibility that children might avoid the virus saying, “school closures may also diminish the chances of developing herd immunity in an age group that is spared serious disease”.

Other doctors spread blatant misinformation, repeatedly downplaying the harms of the virus and hyping the harms of the vaccine. Regulators in some countries spoke of the “benefits” of infected, sick children. Doctors who previously called out anti-vaccine “quacks” now write pro-COVID essays titled “Should We Let Children Catch Omicron?” Amazingly, instead of saying “no, we should not let children catch Omicron”, the authors spew standard anti-vaccine talking points, saying,

When it comes to infectious disease, normality means a world where they are routinely exposed to, and overcome, viral illness. For children, getting sick and recovering is part of a natural and healthy life.

How is this all not a scandal? How have we accepted that it’s desirable for children to get sick? How is this even a topic up for debate amongst doctors who normally seek to prevent illness and suffering?

As Dr. David Gorski recently wrote,

As I like to ask all these physicians arguing that COVID-19 “isn’t very dangerous” to children, if you make that argument for COVID-19, then why don’t you also oppose school vaccine mandates for MMR and varicella? If you make the same argument about COVID-19 vaccines, like it or not, believe it or not, you are parroting very old and more general antivax talking points.

Indeed.

We have a choice

The NYC measles outbreak was declared over when it was completely over. According to health officials from NYC, “measles outbreaks are over when two incubation periods for measles — 42 days total — have passed since the last infectious day of the last infected patients”. In 2019, no one pretended that measles was gone until it was actually gone. We knew that wishing it away would not make it go away.

I’m under no illusion that we will soon eliminate COVID the way those measles outbreaks were squelched. While a big reason for this is that COVID vaccines aren’t as good as the MMR vaccine, poor uptake of the COVID vaccine in children – an outcome desired by many influential doctors divorced from patient care – is a main culprit too.

Few children will avoid exposure to SARS-CoV-2 their entire life. As such, we have a choice. We can fantasize COVID is gone and that sick children don’t matter as long as older people suffer more. Or, we can use an effective vaccine to blunt COVID’s harms. The vaccine is not perfect, but recent studies conclude “vaccination of children 5-11 years was protective against severe disease and is recommended”. The vaccine can save the lives of some children, even healthy ones. Just because it won’t save an enormous number of children doesn’t mean they are not worth saving.

A child getting sick with a vaccine-preventable disease was unacceptable prior to COVID. An unvaccinated child getting severely sick with COVID should be unacceptable today. We should not normalize children getting sick – and rarely dying- from any disease for which a vaccine exists.

Children are not supposed to die. This didn’t used to be controversial.

Author

  • Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.

Posted by Jonathan Howard

Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.