I am a retired physician, old enough to remember the quarantines when a family member had chicken pox, measles, or one of a couple of other illnesses.  I remember being quarantined, with my two brothers, as measles marched from one of us to the next.  Shortly after the measles left, we went through the same scenario with chickenpox.  To save her sanity, my mother had a once weekly arrangement with a neighbor: she would dress to go out, walk to the neighbor’s house, and be served a quiet lunch, with adult conversation.

I also remember the fears of polio, images of children with braces and crutches, in wheelchairs and in iron lungs, and avoidance of public events and public swimming locations.  I remember the joyous news of a polio vaccine having been developed, and celebration in school when we got our shots (few years later we got the oral polio vaccine).

I worked in Malawi (Central Africa), in a tuberculosis control program, from 1966-68, in a district hospital and numerous health centers.  I regularly saw adults and children with serious diseases, often with fatal outcomes, that were preventable with vaccinations (Influenza, measles, rubella, polio, pneumonia, cervical cancer (HPV infection), hepatitis, whooping cough (pertussis), tuberculosis, smallpox, tetanus, and malaria).

In the years since, immunization programs have drastically reduced illness, disability, and death due to these diseases.

I am concerned about the pending vote to reinstate non-medical deferrals for immunizations.  I understand the concerns of parents wanting such deferrals for their children and am sympathetic with their motives.  However, they are putting their children and their communities at risk of significant illnesses and their consequences.  And this is particularly concerning for those with expectations of global travel and experiences that will expose them to immunization-preventable diseases that are not encountered in our country.

There are, obviously, great benefits of successful immunization programs. A downside, however, is that successful programs make the problem disappear; when people are appropriately immunized, you see…..nothing.  There is little or no personal experience of living with others who suffer and might die because of preventable illnesses.  There is no shared experience of witnessing severe illness, permanent paralysis, chronic neurologic or physical disability, or death, caused by these illnesses.

The concept of “herd immunity,” (reduced risk of becoming ill with an infectious disease because most of the people around you are immunized, don’t become ill, and cannot infect you with that illness) becomes abstract, having no real meaning in our daily lives.  These factors hide the very real risks posed by complacency about immunizations and avoidance of them.

Ironically, medical progress has made herd immunity more important.  Progress in treating cancers means that there are more people for whom cancer has almost become a chronic disease.  They can survive for years, with recurrent and varying treatments involving chemotherapy and radiation, both of which suppress the immune system and make them more susceptible to infectious diseases, more at risk for severe complications, and less responsive to treatment for infections.

Most transplant recipients will spend the rest of their lives on medications that impair their immune systems to varying degrees, leaving them more susceptible to infectious diseases.  New and almost miraculous treatments for autoimmune diseases (think rheumatoid arthritis, lupus, multiple sclerosis, Crohn’s disease and ulcerative colitis, psoriasis, and moderate to severe eczema) impair the immune system.  There are few families that do not have a member or members with one condition or another that impairs their immune systems, and an infected person could be the contact that brings the disease to that person.

Infectious diseases are contagious before symptoms fully develop; susceptible friends and relatives in close contact with the infected person are unknowingly exposed.  What might be an uncomfortable nuisance illness for a child, could be a catastrophe for a family member with an impaired immune system.

When safety measures work, nothing happens, and they then become invisible, and the reasons for them forgotten.  In situations (local and in other nations) in which immunization levels dropped because of concern about them, there have been universal increases in the diseases and the complications.  The re-emergence of “historic” diseases reliably prompted return to appropriate immunization programs.

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