On Immunization, Ignorance and Cultural Amnesia

-Peter S. Kibbe, MD, FHM   August 29, 2017 

I remember my mother speaking fondly of her cousin who had gone deaf in childhood from a measles infection.  As a young woman she died when she was struck from behind by a trolley she could not hear.  Kids remember stories like that. It put measles into a new realm of fear for me. Today we read of outbreaks of mumps and measles in scattered communities in the United States where significant numbers of parents refuse to immunize their children.  The refusal to immunize has stemmed, at least in part, from a completely debunked study linking autism to immunization.  To the typical physician this is baffling.  I would assert that these refusals are also due to a cultural amnesia regarding what havoc these diseases—polio, measles, mumps, diphtheria, pertussis and rubella wreaked on patients prior to the practice of immunization.

At the time I was born children were immunized in the U.S. for diphtheria, pertussis and tetanus.  Smallpox vaccination was also available and I can recall a public health nurse jabbing it into my arm in a starburst pattern when I was four.    The other immunizations were merely on the horizon.  Dreaded most of all, perhaps, was polio, which crippled children and often killed adults.  I went to school with children who wore steel braces on their legs, having contracted “infantile paralysis,” as polio was called, in their first years of life.  Polio was disfiguring, paralyzing;  I remember photos of stricken  men and women who were living out their lives in an  iron lung.  For less terrifying diseases like chickenpox, measles, mumps and rubella there was a sense that they were inevitably suffered.

For those formerly “inevitable” infections, a wily general practitioner or pediatrician who cared for you, particularly in a small community where he usually cared for almost everyone, had to offer you the chance to become immune to these diseases by making sure you suffered from them at the optimal time of your childhood.  So between the ages of four and six I was exposed to children in my small community who had mumps, measles, rubella and chickenpox at various intervals, to make sure that I was immune. The doctor would call and I would be exposed to whoever in the neighborhood was suffering from whatever it was a good idea for me to catch.  Chickenpox was a no-brainer, a fairly mild infection for a four-year-old but virulent, scarring and no fun at all for an adult.  Obviously, one wished for mumps in the small boys, lest they contract it during adolescence when it might have disastrous effects on the testicles.  Rubella and measles were a must, particularly Rubella for  girls due to its ability to complicate pregnancy and produce children with congenital rubella syndrome.

From personal experience I can say that suffering these diseases was no fun.   A good physician wanted you to get them when you were healthy and young because the suffering from them in adulthood is far worse.   These diseases were particularly distressing for parents because, I assure you, something like the mumps turns you into a very sick puppy for days. Moms would typically have two or three drooling, febrile children lying about looking like lethargic chipmunks.  And certainly there could be complications to these disorders— neurological damage from mumps, superimposed bacterial infection in almost all these viral diseases, deafness from measles, here and there blindness or rarely death.  Smallpox had about a 30 percent death rate among descendants of Europeans, higher in other ethnicities, so virtually no one was foolish enough to refuse to immunize their child against that.  Culturally, smallpox retained a cachet drawn from cultural memory that placed it some where in the ballpark of the bubonic plague even through the 1950’s.

The rock star of immunizations would be the first effective polio vaccine developed by Jonas Salk.  When it appeared parents sought it for their kids as if it were a holy grail of health.  It relieved parents in the developed world from the worry that, like F.D.R, they or their children might be suddenly crippled by an invisible but highly infectious agent.  In 1955 The March of Dimes sponsored a wildly popular campaign of immunization that in six years reduced the Polio disease rate in the United States from 35,000 cases a year prior to vaccination to 167 cases in 1961.

Subsequent vaccines became available suggesting near eradication of measles and mumps in 1963 and  rubella in 1969,resulting in striking  declines in disease prevalence.

The children immunized had parents with a cultural memory of how nasty these diseases could be.  Many had parents who served in the armed services, World War II, Korea or Vietnam who had been forced to undergo multiple immunizations and required to take anti-malarials in certain combat theaters.  Cultural memory fades.  Within a generation or two following the discovery of effective vaccines, no one remembers going to school with a child whose mother died of polio and no one can recall a cousin who went deaf from measles.  For too many parents, the cultural amnesia is bolstered by what appears to be willful ignorance, a refusal to learn about the past by reading or listening to those who have lived it.  This is coupled with a refusal to respect the hard scientific work involved in creating on a national level an environment virtually free of these diseases.

Negative attitudes toward vaccination appear to me to be part of a darker trend in our culture; a deprecatory view of hard science and intellectual work and a tendency to lash out at intellectuals who bear discomforting news.  Of course this is not new in western culture.  Semmelweis, the Viennese physician who proved good hand hygiene prevented the spread of infection, had his career destroyed for doing so.  In our day, and very recently, there were attempts to pillory the pediatrician in Flint Michigan who first raised the alarm regarding high lead levels in her patients due to the horribly faulty work the city had needlessly done to change its water source. The list of courageous thinkers abused for their brilliance is long.

I am also struck by the ahistorical character of many people who are otherwise literate.  Many seem to have no curiosity regarding how life was lived before they were born.  To have no curiosity regarding the past, to be stuck staring at the computer or cell phone screen of only today is to be a prisoner of the present.  Absent a comprehension of the past it is impossible to form any brilliant imagination of what we want of today or of the future.    If we are not students of history, we may be doomed to repeat past mistakes and endanger those who follow.