Home > Get Involved > Is Fear the Only Motivating Factor?

Is Fear the Only Motivating Factor?

By Christine Vara

Yesterday, I read an LA Times article, written by Pamela Nguyen, a resident physician in pediatrics at UCLA’s Mattel Children’s Hospital.  Sadly, the article confirmed what I had already suspected.  Due to the fact that vaccines have been highly effective, it is not uncommon for medical students and residents to go through their training without ever seeing vaccine preventable diseases such as measles, mumps and pertussis.   

While on the one hand this statement can be considered a rallying cry for vaccine advocates, on the other hand, some are smart enough to realize that this is why we find ourselves at risk.   Without prevalent disease society fails to see a threat.  Subsequesntly there is less fear of disease and some wrongly believe less need for immunization.     

In referring to measles, Ms. Nguyen states that, “In four years as a medical student and three years as a pediatric resident, I have never seen a case. As a result, all I know about the illness, I learned from textbooks.”  However, she substantiates the significance of measles by stating that “According to the Centers for Disease Control and Prevention, the disease remains the leading cause of vaccine-preventable deaths in children. In 2007, there were 197,000 measles deaths worldwide, 90% of them in children younger than 5. That is nearly 450 deaths every day.”

What these statistics suggest is that although vaccines have been effective in limiting the number of cases we see in this country, vaccine refusal and inaccessibility continues to perpetuate the risks of diseases making a comeback here in the states, as they still remain a concern worldwide. 

What I found to be especially compelling was her recent encounter with a patient who had brought her five year old child in for an H1N1 shot.  Surprisingly, the child had never received any other immunization.  When offered other vaccines, she again declined.    

As Ms. Nguyen states, “She explained matter-of-factly that it was because the flu was “going around” whereas the other vaccine-preventable diseases, she said, were no longer a threat.  She went on to tell me that she was a lawyer who had grown up in a country where measles is still endemic. Since moving to the U.S., she had never known anyone to suffer from measles, but she did know several children who had autism. So, while she understood that vaccinations had not been definitively shown to cause autism, she felt that, here in America, the risk of autism was a bigger threat than that of vaccine-preventable diseases.”

Basically what this says to me is that fear is an effective motivator.  In this case, fear of the unsubstantiated suggestion that vaccines can cause autism prompted this parent to decline all vaccines for her child.   However, publicized deaths as a result of H1N1 created enough fear to drive this same person to receive a vaccine. 

Does this make sense?  Are we a society that only responds to fear and not common sense?  And if so, are we not fearful when we hear of an infant diagnosed, or even dying, from a vaccine preventable disease? 

We need only to look at another LA Times article to prove this point.  It details a “cautionary tale” of a new mom, who unknowingly infected her two children with pertussis, resulting in the death of her 17 day old son Dylan. 

The article explains that the problem was in the diagnosis.  Dylan’s mother had a serious cough for several weeks prior to delivery.  She encountered a variety of doctors and medical personnel during that time, but only the pediatrician checking Dylan seemed to suspect that she had pertussis. Even then, that suspicion failed to elicit treatment.  When following up with her physician, he dismissed the possibility of pertussis and diagnosed her with a cold. Perhaps this goes back to the “learning from textbook” phenomenon.  As a doctor, if you’ve never seen it and think it’s rare, than it’s unlikely you would diagnose it.    

The sad reality is that pertussis is highly infectious and extremely dangerous for infants.  As the article states, four newborns, all younger than 3 months, have died in California so far this year, already exceeding last year’s total of three whooping cough-related deaths. 

I would venture to guess that the Bianchi family would encourage others to receive booster shots in order to protect themselves and other infant children from pertussis; much like we are seeing with Callie Van Tornhout’s family and countless other parents who currently advocate for vaccines.  But why does this kind of awareness have to come at such a price?  What steps must we take to ensure that every child is protected? 

Ms. Nguyen’s concludes her article with a call to action.  “It is time to change our perspective and make the safety of all children our priority.  The first step is to demand stricter guidelines for personal-belief exemptions. Vaccinations should be mandatory for public school entry in all but the rarest of cases. The next step is to put pressure on private and charter schools to follow these same guidelines. It is selfish for parents who intentionally don’t vaccinate to make other children vulnerable.”  I would like to add that we should be encouraging booster shots for adults as well, to limit disease in general and to protect those too young to be vaccinated. 

Do you feel the need to address vaccine refusal in order to reduce risk of disease to the greater public?  Is fear the only motivator that will prove to be effective?  In what ways can we approach this challenge?  Share your comments so that we can all be part of the conversation and solution.

  1. June 3, 2010 at 9:29 am

    As the mother of an only child who died with a vaccine preventable form of meningococcal meningitis I am frustrated even angered with the never ending propaganda of the anti vaccine movement. As the founder and director of a national organization and advocate for immunizations, life and health, I feel sad and heart broken.

    I am daily praying for several of our kids in the organization who had both vaccine preventable meningococcal and pneumococcal meningitis several years ago. Yet one is in the hospital again, already a quad amputee and needing facial reconstruction surgery fighting life treating infection. One is about to have brain surgery to remove part of her little brain to stop the seizures. One is just home from the hospital fighting for his life against pneumonia because his lungs were left so weak by his meningitis. All had vaccine preventable meningitis more than 5 years ago, Yet their life is a never ending hell and one of life treating issues. Several of them suffer from forms of autism syndrome due to their meningitis. We can prove this.

    Each time I look at my family album I am reminded that vaccine preventable diseases were here and are still here. My grandfather died at age 35 from tetanus. My uncle-my moms twin brother died at age 21 months from diphtheria. My sister at age 7 almost died from chicken pox. One of my best friends was left severely devastated by polio at the age of 5. My mom died from HIB pneumonia just 3 years ago. Of course, Ryan died from meningococcal meningitis and HPV cause me to loose the part of me that carried him. All vaccine preventable.

    Some of my family have juvenile diabetes. In fact one of my brothers died at age 43 from it. That is not vaccine preventable, at least yet. If the anti vaccine propaganda is not stopped then I fear all research and development of new vaccines that could prevent it will cease.

    So the answer to the question above? Fear? I live in fear each day that yet another one of my family could or someone I love could die from a vaccine preventable disease. I am in fear we will add another name to our roll of dead or debilitated children from meningitis. I am in fear we will see epidemics of all vaccine preventable disease reappear with a vengeance.

    The anti vaccine movement uses an unproven fear to promote their dangerous movement every day.

    One simply has to walk around an old cemetery to see the value of vaccines. For me I simply have to turn the pages of my life. No parent should live the hell I live everyday of never holding my son again. No infant, child, teen or adult should live in pain and the fear of dying due to a vaccine preventable disease.

    Should we use real fear of proven disease and the results of not vaccinating to save lives. YOU BET YA!!!

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  2. June 3, 2010 at 12:10 pm

    Christine, fear is a powerful motivator but it needs to be relevant to parents. As you said, fear of potential side effects -even if the science says differently – is what is driving vaccine refusals. Many parents know other parents who have a child with autism. These parents often believe there is a causal relationship between their child’s autism and vaccine – regardless of the science. Many parents know first-hand about autism but cannot think of anyone they know who has had a vaccine-preventable disease. Autism is relevant but VPDs seem remote. We have to make sure that personal stories about those who have experienced VPDs are told- like Frankie’s and the Van Tornhout’s. We somehow have to be better at communicating the protective effect that benefits the community and lessen the individual rights mantra. I have no simple answers but I do believe it is important work. Thanks for raising this question!

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  3. June 3, 2010 at 1:33 pm

    Thanks for the thoughtful and useful comments.
    There is no “single shot solution”–no pun intended. Education of new parents, the public and all health professionals has to be ongoing, candid and designed for our heterogeneous communities.
    Great to hear from the parents.

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  4. Donald Shifrin MD
    June 3, 2010 at 10:24 pm

    For those of us who deal with parents daily, we realize that all parents vacillate between the beacons of hope and fear. The informational glut of the internet and the presumed expertise of its inhabitants have skewed parents toward fear rather than hope. Guiding them back towards hope will require trust in our ability to demonstrate care, compassion and competence. Our recent experience as clinicians reveals that the hardest thing to open is a closed mind. Frankie’s message reminds us never to stop trying.

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  5. June 4, 2010 at 8:23 am

    I have found in recent years that the only thing that does seem to make a dent in the argument that vaccines are indeed essential is anecdotal stories of people I have met who have suffered the horrors of losing a child to a vaccine preventable disease. All the statistics in the world don’t seem to make a dent because people can easily rationalize the odds of being one of those who fall ill. We live in a society of people who believe the worst will never happen to them.

    I do feel that it is critical for us to continue to share stories of those who are so very courageous and loving that they are willing to share the heartbreak to save others lives. Katie Van Tornhout received a facebook message from a doctor in her hospital who heard about her story and was therefore made more aware of the high rates of pertussis among adults. She subsequently tested a woman who was soon to become a grandmother for a suspected case of pertussis. Guess what – the test came out positive and the grandmother was treated for pertussis. Katie and Craig may have saved the future newborn’s life. I think I will need to find a way to share this success story with others b/c it gave me chills yesterday when I first read it!

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  6. Jenn
    June 8, 2010 at 5:18 pm

    I came across your site after researching offices who offer the MMR in stages as opposed to a combined vaccine. And to answer your question – yes it is fear that has me choosing to do my vaccinations in stages, rather than combined. I do not believe in the autism link as most people do. And, I am still unsure of how I feel about vaccines bringing about autism signs earlier than those who are not vaccinated. Either way, I personally feel that a child with autism is unfortunately going to end up with autism with or without vaccinations.

    However, I still have a fear of combined vaccines. My first daughter got all of her vaccines before we left the hospital. She continued to get her vaccines on schedule and never had a problem. However, when she was 12 months old, she received the MMR. At 3 am that morning, my husband and I were running in to her room as we heard choking. She was vomiting uncontrollably. Her entire crib was full of vomit. Then, came the fever! It got to 102 before we finally made it to the hospital. She then had diarrhea, a fever rash, dehydration, etc. She had never been sick (not even the common ear infection) before this. When discussing this with the ER doc, he stated that it appears she had a bad reaction to the MMR shot. He explained that it is very rare, but that it can happen. He explained that we would do an IV for dehydration, and monitor her fever, but that she should recover within a day or two. She ended up just fine 24 hours later. But, he suggested doing the MMR in phases next time, and to monitor which one causes her to vomit. Almost 4 years later, it is time to do the next round of MMR vaccines, and we’re choosing to do it in stages for our daughter.

    This is just my experience. Take that combined with all the other bad experiences, fear of autism links, etc and you have a bunch of parents living in fear over vaccines. What needs to be done is more open communication between doctor’s and mothers/fathers. Doctor’s seem too busy to sit down and discuss what shots are being given, what the reactions may be, what the pros of such vaccines are, etc. With all the hype on allergic reactions, bad reactions, autism links, etc parents are going to be more skeptical of immunizations. And where do we turn for information? Our friends, or other parents with experience. Why? Because the doctor’s don’t take the time to discuss with their patients their concerns. If the ER doc wasn’t slow the night we went in, and didn’t take time to discuss everything (in detail) with us, my husband and I might have opted out of vaccinating our other children. However, because we received proper information and referrals for further (credible) research, we have been able to stay away from the anti-immunization hype.

    But until the medical society has a way to effectively communicate vaccine benefits, and reactions to risks, parents will continue to live in fear. I would propose that pediatric offices start holding monthly vaccine seminars for new parents to get the proper, scientifically valid, information on vaccines. And they shouldn’t be afraid to discuss allergic reactions or bad reactions. They should be upfront and let parent’s know that the benefits outweigh the risks. After-all, my daughter had a bad reaction, but she’s one of the healthiest kids out of the ones we associate with!

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  7. Jenn
    June 8, 2010 at 5:23 pm

    Also, this is really bothering me.

    “Ms. Nguyen’s concludes her article with a call to action. “It is time to change our perspective and make the safety of all children our priority. The first step is to demand stricter guidelines for personal-belief exemptions. Vaccinations should be mandatory for public school entry in all but the rarest of cases. The next step is to put pressure on private and charter schools to follow these same guidelines. It is selfish for parents who intentionally don’t vaccinate to make other children vulnerable.” I would like to add that we should be encouraging booster shots for adults as well, to limit disease in general and to protect those too young to be vaccinated.”

    That’s all and great. She wants to enforce vaccinations on everyone, and wants strict guidelines implemented for public, private, and charter schools. But, what is being done for the parent’s who have this fear? Again, we need education on vaccines. If our pediatrician’s are too busy for seminars, why not start with mandatory vaccine seminars for pregnant mothers. We require those birthing classes and I guarantee I learned less in my birthing class than I would have learned in a vaccine related seminar! Just my thoughts 🙂

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  8. christinevara
    June 9, 2010 at 9:45 am

    Jenn,

    Thank you for sharing your story. You bring up some very relevant points for discussion.

    First, you recognize the importance of the communication you received directly from the ER doctor. My follow-up post discussed how doctors can really make the difference in regards to vaccination fears. Your personal story clearly illustrates this. The time the doctor spent explaining things to you and your husband, along with the recommendations and referrals he made, seem to have encouraged you to find a way to accommodate your daughter’s reaction, while still protecting her with immunizations.

    I also want to take this opportunity to commend you for the efforts you are making to get the answers you need in order to address your concerns. Ms. Nguyen’s closing comments are very strongly worded. I believe these comments illustrate the conviction that most medical professionals have in regards to the importance of immunizations. However, your suggestions are valid:

    “… until the medical society has a way to effectively communicate vaccine benefits, and reactions to risks, parents will continue to live in fear. I would propose that pediatric offices start holding monthly vaccine seminars for new parents to get the proper, scientifically valid, information on vaccines. And they shouldn’t be afraid to discuss allergic reactions or bad reactions. They should be upfront and let parent’s know that the benefits outweigh the risks.”

    I agree that effective public education is essential to educating parents and allowing them to ask questions and address their concerns outside of the office visit. If we can direct parents to the proper resources, and encourage them to speak out in forums like the Shot of Prevention blog, than hopefully the medical community will take notice and bring about positive change.

    One of the reasons I contribute to Shot of Prevention is to help provide the parental perspective to vaccine advocates. Fortunately through this experience, I have begun to identify many reputable organizations that provide vaccine information to the public. However, there is a lot of misinformation out there as well. May I suggest you visit the Vaccinate Your Baby website (http://www.vaccinateyourbaby.org/) for more information and let us know if we can be of further assistance.

    Again, thanks so much for your insightful comments. I wish you all the best.

    Christine Vara Shot of Prevention

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