November 6th, 2017

 

I’ve been thinking a lot about denialism lately. Why is it, despite abundant objective scientific evidence, visual proof, and basic common sense, that what is so obvious and truthful to most people, is rejected and disparaged (“fake news!”) by others?

Denialists come in all ideological shapes and political sizes, even though the issues at stake — climate change and immunizations are two examples — are not (or, at least, shouldn’t be) ideological or political. All of us in some way have the ability to deny something we know is true; we are all capable of being hypocrites.

They say “the squeaky wheel gets the grease,” and that’s true enough if you follow the news on TV or online, where it seems like the loudest, most obnoxious voices receive the most attention. It’s heartening to note, therefore, that the vast majority of Americans (and, I suspect, most people living on this Earth) are reasonable and rational beings capable of separating fact from fiction, particularly when it comes to science. For instance, it is now widely accepted that an overwhelming majority of Americans agree with the scientific consensus that climate change is real (70%) and happening now. A comfortable majority also believes that humans are the primary cause of the climate crisis (53%), demanding curbs on greenhouse gas emissions (75%) and supporting renewable energy solutions (82%.) For those of us who care for our children’s future in a clean and safe environment, these numbers are good, but not good enough.

Then there are vaccines. A new report from the Centers for Disease Control and Prevention confirms what most pediatricians will tell you: The vast majority of parents immunize their kids according to the standard immunization schedule. As the map of MMR compliance above indicates, the United States does pretty well compared to the rest of the world. In fact, over the years, compliance with recommendations to get vaccinated completely and on time have been pretty stable — around 90% of American children under the age of 3 have received their immunizations.

The reason why the rest don’t get their vaccines on time (or at all) is not all because of the Andrew Wakefield-inspired anti-vaxxer movement. As a matter of fact, denial plays an extremely small role in suboptimal vaccine rates here in the U.S. It turns out that only a very small fraction of parents buy into the science-denying rejection of the factual benefit and safety of childhood vaccines. Instead, researchers writing last week in the CDC’s Morbidity and Mortality Weekly Report (MMWR — 11/3/17) found race, socioeconomic status, and access to health insurance to be the major factors determining who did and who did not get vaccinated:

Disparities in coverage persisted for black children and those living below the poverty level, and coverage was generally lower for children who were uninsured or covered by Medicaid than among those with private insurance. These disparities indicate that improvements are needed in access to and delivery of age-appropriate immunization to all children, regardless of insurance or financial status (i.e., “the immunization safety net”).

Health insurance and poverty status are interrelated factors associated with lower vaccination coverage in young children. Compared with children who had only private insurance, those with Medicaid had lower coverage, and those who were uninsured had much lower coverage, for most vaccines.

 

All children deserve the health benefits that result from receiving the full menu of childhood vaccines, and the American people deserve the public health benefits of immunizing this vulnerable population as well. Pediatric immunization rates of 90% are good, but not good enough. They shine a light on some of the racial, social, and economic inequities that continue to plague the United States. We must keep trying to do better.

 

(Google Images)

 

One Response to Good But Not Good Enough

  1. I think Influenza vaccination is a good example and one of immediate impact since the peak season is right around the corner. I again contend that mass vaccination programs at schools and day care centers (much like “Sabin Sundays” of days past) will yield the best results when compliance is an obstacle.

  • MEET THE EDITOR

    Ned Ketyer, M.D.

    Ned Ketyer, M.D.

    Dr. Ketyer has special interests in developmental pediatrics and preventative medicine, specifically how nutrition and the environment affect health. He earned his bachelor’s degree from the University of Vermont and his medical degree from Northwestern University Medical School. He completed his residency at Children’s Hospital of Pittsburgh.

    As one of the founding physicians of Pediatric Alliance, PC, Dr. Ketyer served as its president from 1997-2004. He has been practicing general pediatrics at Pediatric Alliance since 1990. Dr. Ketyer and his wife have three boys and live in Pittsburgh's South Hills. 



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