It's 5 am, I'm lying on the hard wood floor in the fusspot's room as she twists and turns and worrying about ...vaccines. Again.
In short, we vaccinate. For many, many reasons. I certainly bought Dr. Sears Vaccine book before the fusspot was born, read widely, and understand that there are risks. I really do get it: there are risks. But part of my prior work was documenting the ravages of common childhood diseases pre-vaccines. And when you travel the world, unlike in the U.S., you meet children who were born deaf because of in utero exposure to rubella or who are crippled by easily preventable diseases. And honestly, vaccines fit into JD and my larger worldview: we are on the bone marrow donor registry, we are on the organ donor registry (with matching living wills), we take risks to help other people. I hope that in the future our house will be one where the religious kid can come over for a playdate without packing his own snack, where the mom of the kid with a severe peanut allergy can send her over for a playdate without worrying, and where the kid who is going through chemo can come over to play without having to ask questions about who else will be there (2 of my friends went through chemo in elementary school. They are both alive and well. Chemo tends to kill your full immune system and children need to avoid exposure and then get re-vaccinated afterwards). And anyway, after your beautiful, perfect baby is conceived with the help of advanced science, it gives you a good deal more trust in those who devote their lives to these issues.
I also believe that for the vast, vast majority of non-vaccinators, it is about evaluating risk. If they had to suddenly move to the slums of Mexico City or Rabat, they would decide to vaccinate because the risks of catching a disease would so far outweigh the dangers of vaccination. In that way, they rely directly on the risks that I was willing to take with myself and my fusspot and the benefits they gain from it, and that bothers me. And it's what I mean by a different worldview (and nothing more sinister or mean-spirited, but just that despite the risks I believe that the benefits accrued to society are worth it in our calculation).
Fine, I'm a self-righteous pro-vaccinator. The problem is that three of my friends have become loud anti-vaccine advocates. Complete, 100% no vaccines (I am well aware that not all vaccines are necessary for the public good, but the MMR certainly fits into that category and it's the one I worry about the most. Especially in my current 'delicate state.'). And while I get that it's their choice, and they have reasons (which are different than mine probably less because of the science than because of the worldview about risk and responsibility to others. As the book I just finished put it (paraphrased): You don't vaccinate for your health 2 year old, you vaccinate for the 4 week old pregnant woman/embryo sitting next to her.), I really do wonder what my responsibility is to the fusspot and to the mini-fusspot.
Vaccines work with herd immunity. They are not particularly effective on their own. We live in one of the most densely populated parts of the United States, rely on public transportation, and are exposed 1000 times more often than people in the suburbs/rural areas/with cars to strangers. An unvaccinated kid riding the subway in NYC and staying in my apartment is a serious risk to our health. I can't find the exact numbers, but the risk of an unvaccinated child get measles if they're on a plane with someone who is positive is well above 90%. And little incidental things start to add up:
- the immense fear I had after learning that a former roommate was TB positive, possibly contagious and refusing treatment (her right, and she wasn't an idiot. She wanted to finish the program and then return home to her native country with free healthcare for treatment). In the meantime, I slept next to her for weeks on end and have had endless TB tests (and stress) as a result. She was pissed at the program for not giving her a single, but adamant that it was well within her rights to keep her medical status confidential and delay treatment.
- the little signs on the fusspot's daycare door in a European population similar to or slightly higher than the U.S. in non-vaccination rates: 5ths Disease in Room 1, Chicken Pox in Room 2, Measles in Room 1. Speak to your doctor immediately if you are pregnant (and yes, they will recommend an abortion if they think your exposure risk was high because there is practically no way to test in utero for deafness or brain damage of the effects of these diseases during the time that abortion is still legal).
- the fact that even though I had my titers checked pre-pregnancy and was 'fully immune' on paper to chicken pox, I managed to catch it from the fusspot (who was too young to vaccinate when she caught it). Which only goes to show why herd immunity is so much more important than individual decisions. Thankfully I was not pregnant and it was just an itchy inconvenience, but if I had been ...
- the guilt when my darling fusspot became the 'typhoid mary' of our group of SAHMs in Lalaland because she picked up every known childhood disease at daycare and we then spread them around inadvertently (have you ever had to call a tell a friend you might have exposed their newborn to RSV?)
And so the question for me is where my responsibility lies to my own children. We are of course exposed to many strangers every day, and those are certainly risks worth taking rather than hibernating in a box. Is it completely artificial to say that I don't ask people about it, but that I need to keep us away from those who have made it exceedingly public that they are non-vaccinators? How in the world do you deal with that awkwardness, given that I really do feel it is one of choice and perspective, and not something that can be 'argued' on a scientific basis (meaning for me the science is 100% clear and the only question is how to evaluate the risks given that)? Or should I overlook this like I overlook so many other dangers I expose my children too (hello concrete playground and crazy public bus driver who sent me flying)? But what would I do if the fusspot got sick? Or even worse if the dream of a baby in utero were damaged in some way? Could I ever handle that guilt since this has now become a known risk?
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13 comments:
I look at it this way- I wouldn't let Pumpkin play with a kid with chicken pox- or who I knew had a sick sibling at home since she hasn't been exposed/vaccinated yet. If I have no idea there is really not much I can do- but if I know I will not put her (or dream baby- love that phrase!) at risk. We vaccinate. Which I am sometimes surprised at given my crunchy bent and approach to parenting- the longer she is alive the more I think homeschooling (I guess that one's probably more location based though...) And I wish we had been prepared for cloth diapering.
I refused to bring the pumpkin to a friends house to visit a newborn because she had a cold. I really do feel that relying on the 'herd vaccination' is selfish. It puts a strain on the overall immunity of a population and there was nothing credible I could find that definitively steered me to the risks outweigh the benefits side of the argument.
Long story- but in short- if I knew there was a possibility of harm from your friends choices I would avoid them. If you have to say something then I am sure that a simple- I understand and respect your choices, but my choices need to be understood and respected too- should hopefully suffice. Of course- the problem I usually find with people that make decisions emotionally (rather than a measured weighing of facts, figures, and knowledge) is that it is extremely difficult for them to see the other side as a choice to be respected. I hope that isn't the case! Good luck.
Couldn't agree more. I find people - ok, Americans - who rely on the (vaccinated) immunity of others to protect their kids, so they don't have to go through the risks of vaccinating them, themselves, to be horribly selfish. And I don't think it's selfish at all, once you've brought your child up to the standards of "public good" to limit their contact with others who haven't. And if non-vaccinators cannot understand that, then they definitely need to be doing more research and less "gut-thinking".
I agree with the previous commenters (which is saying a lot because I disagree with one of them on pretty much everything) in that people who don't vaccinate are relying on other people being vaccinated which is highly selfish: "It's good enough for you but not worth the risk for me." Like you, our lifestyle is way too mobile to even consider denying vaccines. And when I think of drug-resistant strains of TB that exist in the part of the world we will likely live, vaccines hardly give me pause.
By the way, after your last post I have cut out fish and have downloaded the book you referenced. You're very informative these days!
I don't think there's a single thing wrong with avoiding your non-vaccinating friends, at least while you're pregnant and Fusspot Jr. is vulnerable. I also think it's perfectly fine to tell them exactly why you're avoiding them. I mean, if they live 100 miles away and there's no way you'd be seeing them anyway, I think it'd be silly to call and announce that you will avoid them because of the vaccination issue, but if you generally see them around and it's clear you are avoiding, I think they should know why.
Any reasonable adult must realize that the consequence of their decision not to get their kids vaccinated is that other people may decide not to have contact with those kids. A friend who gets pissy over such a consequence isn't exactly dealing with a full deck.
This may be simplifying it, but here's the way I see it:
They're asking you to respect their choice to not vaccinate their kids because they feel they are exposing their children to unnecessary harm.
They need to respect YOUR choice to not expose the Fusspot, yourself or the wee Fusspot to them because it would be exposing your family to unnecessary harm.
I agree, too, that not vaccinating your kids but relying on the herd immunity is selfish...and stupid.
I am also on the 'selfish and stupid' train here.
Having parents in their 80's, who remember these diseases, and were very ill with them as children, I don't have romantic illusions about whooping cough making it's own best immunity!
Also, I had a cousin who was severely brain damaged in utero because of German measles--these are real diseases with real consequences.
I think it is totally reasonable to say let your friends know why you are avoiding them. Calm, frank and to the point is all that is required.
/sigh/ Feeling a bit sad. I've been trying to figure out what to say all day, and I still haven't exactly figured it out.
For me, I don't think that herd immunity applies as far as keeping my nonvaccinated children safe because... let's face it, vaccines wear off if you don't get boosters. Also, there is a pretty big population of people (albeit a small minority compared to the US as a whole) who are delaying/selectively vaccinating their children now, immigrants who aren't up to par with our 28 vaccination schedule, and teenagers whose parents aren't scheduling boosters for. I don't expect herd immunity to protect us. I accept the risk of not vaccinating my children.
"One hundred years ago, children received 1 vaccine (the smallpox vaccine). Forty years ago, children received 5 vaccines routinely (diphtheria, pertussis, tetanus, polio, and smallpox vaccines) and as many as 8 shots by 2 years of age. Today, children receive 11 vaccines routinely and as many as 20 shots by 2 years of age." Taken from an AAP publication... (Table showing the stats listed: http://pediatrics.aappublications.org/cgi/content-nw/full/109/1/124/T1)
That concerns me as a parent. Twenty shots?! It makes me uncomfortable to think about that, and the fact that we don't know the long term effects of some of the vaccine ingredients or the effects of giving them FIVE shots (sometimes with multiples vaccinations in each shot) at one doctor's appointment...
That said. I take responsibility for the risk that I am putting my children in by not having them vaccinated, and it's likely that at some point in the next year that they will get one or two of the vaccines that we are at a higher risk for in order to protect our next child (like the DTaP, if the twins start any sort of school and because Dave's a high school teacher). We practice extended nursing, no day care, use probiotics, and are a bit religious about hand washing. And, I feel comfortable with our decision.
Also, because I'm a woman of childbearing age, I took it upon myself (before we knew we couldn't actually get pregnant on our own) to get my titers tested and update my Rubella vaccination to protect my unborn child. In my opinion, it is a mother's job to protect her unborn child... It's not my job or my child's job.
But, for that exact same reason, if you'd prefer we not stop by when we are up that way in August, just let me know. We haven't solidified our dates yet (just generally the 2nd though the 8th), so it wouldn't be all that much to change. :-/
Are these friends you see often or two or three times a year?
If I asked you if you respected your friends right to make decisions for their family you would say absolutely. Cosleep or no cosleep. TV or no TV. Vaccinate or no vaccinate. So why wouldn't that extend to what you decide to do based on those decisions?
In reality, we spend very little time pregnant or taking care of newborns. Your question is do I risk offending friends for a year or being comfortable with the amount of risk I am taking with knowingly exposing our family to unvaccinated toddlers. Everything in their mouths, diaper leaking, spit swapping toddlers.
I'm just saying, if my friend says "You know I love you. But I'm growing this human..." No questions asked,no hard feelings -- Email, skype, letters, see you next time! Because I would never forgive myself if there was even a chance that I exposed this baby to rubella. And this is part of the risk I assumed when not vaccinating my kids. No international travel for a while, slim chance of encephalitis from chicken pox, and my preggo friends taking a pass on coffee.
But in the end, we respect and love each other. Because that is what friends do.
Um,yeah, I agree with everybody else. Part of claiming the right to weigh risks for yourself is accepting the fact that those around you are ALSO going to weigh risks for themselves, and they may conclude that being around your unvaccinated children is too big a risk. You should absolutely feel free to calmly explain that to your friends.
We vaccinate, and have already been extremely grateful that we made this decision. Once, when LL was barely over one and I randomly came down with shingles. By the time I knew what it was, LL would have undoubtedly caught chicken pox from me, which is horrible in a toddler. And no amount of hand-washing or avoiding daycare or extended nursing or probiotics could have kept me from getting it (doctors don't yet know what causes outbreaks, but it's NOT hygiene or contact with others), nor would any of those things have protected him from catching it from me. My doctor, LL's pediatrician, and I all did some frantic immunity calculations at the time to see exactly how much risk he had, and the answer was "very low" because he was up-to-date on his vaccine.
The second time was several months later, when grandma came for a visit and spent lots of time with LL. In the middle of the visit, we got a call that my uncle, who grandma sees almost every single day, had just been diagnosed with whooping cough. Theoretically, grandma could have been sick and just not known it yet, which is enough to pass it to LL. Another set of phone calls to the pediatrician, and we rested easier knowing that grandma's vaccines and the vaccines given to LL were likely enough to buffer him. And again, probiotics and avoiding daycare really wouldn't have helped.
If grandma wasn't herself vaccinated, I would have sent her home. Like everyone has been saying, you do what you need to do to protect your children from whatever risks are important to you.
Trying not to feel attacked by you, Nicky. But, honestly, I can't imagine being concerned about being scared of my 20m old twins getting chicken pox.
A family friend recently got shingles, and I was so disappointed that she didn't tell me when she was contagious! I would much rather my toddlers get it now before I get pregnant again or before they are much older and will REALLY whine about it!
It's /just/ chicken pox. Really.
"By the time I knew what it was, LL would have undoubtedly caught chicken pox from me, which is horrible in a toddler. And no amount of hand-washing or avoiding daycare or extended nursing or probiotics could have kept me from getting it (doctors don't yet know what causes outbreaks, but it's NOT hygiene or contact with others), nor would any of those things have protected him from catching it from me."
ACTUALLY, all of those things would have protected him. Doctors actually DO know what spreads chicken pox and shingles (and it's different for both). Simply google it. Chicken pox is spread through coughing or sneezing or transfer of the pus from the sores before they scab over. Shingles is by contact with the pus only and is not even concerned "fully contagious" (since it's not spread through informal contact).
AND, my friend that got shingles has triplets who were too young for the vaccine when she got sick, and NONE of her children got chicken pox (because her rash was located only on her stomach which she kept covered and made sure that she kept her and her children's hands/faces clean).
Just an FYI. I'm comfortable with my decision because I /know/ the risks. I also completely stand behind whatever decision Rachel makes. It's her family. It's her decision. Period.
Carrie, I wasn't trying to attack you, and I definitely don't want to get into an argument with you, but I wanted to clear up a few things.
First, yes, it is understood that contact with someone who has chicken pox and/or shingles can spread it. What's NOT understood is what causes a perfectly healthy person who has NOT come in contact with anyone to suddenly break out in shingles. I meant that no environmental factors could have kept ME from getting it.
Second, contact with the rash does spread shingles, so the fact that your friend's rash was on her stomach, where she could keep her kids away from it, is fantastic for her. Mine was on my arms, which I use to cuddle my then-14-month-old, and when the rash first appeared, I thought it was an allergic reaction from contact with some plants in my yard, so I didn't try to protect my son from it. By the time I found out what it was, he absolutely could have caught it from me.
Rather than get into a completely pointless argument about the merits of intentionally exposing a one-year-old to any disease, even one that you are willing to dismiss so easily as "/just/ chicken pox", I'd like to repeat my main point: no amount of controlling your environment is going to protect your children from disease, because too much happens that is out of our control. And yes, that is always the case. You choose to minimize risk through diet and behavior. I do some of those things as well, but I also choose to minimize risk by vaccinating against the diseases that can be vaccinated against. I made my choice both because of doubts about the efficacy of diet and behavior alone, and because of a sense of social obligation.
The ironic part, I think, is that I was specifically trying to avoid the often contentious part of this debate by ignoring the social obligation arguments and focusing on the risk management issues instead. Most of the comments here focused on the social obligation aspects, yet mine was the one that you were offended by. Which seems... odd.
My real core belief, however, is simply that everyone should be informed about the risks before making a decision one way or the other. It sounds to me that you, like me, did your homework and made a decision. The fact that we ended up making different decisions is besides the point. My hope is that, if two educated people can lay out their reasons for making their decisions, then perhaps other people will at least be encouraged to do their homework and make their OWN informed decision.
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