“Were you close to her?” my mother would ask intensely. I was never entirely sure what she meant by “close”.
The occasion was always a mimeographed (!) note sent home from school: one of the other human petri dishes had come down with chicken pox, measles, rubella, or mumps. The note would explain — again — the length of the incubation period and the likely dates the child had been contagious. Parents were supposed to watch their children and keep them home at the first sign of the disease developing, to help contain the outbreak. Maybe it was OK for children to get these diseases, but everyone knew that they could be dangerous for adults. We were always particularly conscious that exposing a pregnant woman to rubella can cause birth defects.
There was — I explain for younger people — an etiquette. If your child was contagious you always warned anyone who might come into contact and checked if they’d be safe.
The NHS and US Centers for Disease Control both say that for anyone born before 1957 their birth date is evidence of immunity. I was born in 1954.
“You probably just don’t remember having them,” the nurse at my GP’s surgery said when I said I’d never had any of the “childhood diseases”, and given the escalating outbreaks in various cites, and being 65 and travelling on planes, I probably should be vaccinated. She added, however, “You can have it if you want.”
I told her about my mother’s repeated questions.
As it happened, I didn’t want. It just seemed wise. The measles vaccine was developed, Wikipedia says, in 1963 and improved in 1968. A close friend of my father’s worked for the World Health Organization, and as I recall he got me in when I was about 14. The MMR arrived in 1988, and vaccination ramped up in the 1990s. For decades, therefore, it seemed safe enough to rely on other people’s “herd” immunity. Besides, my having escaped these diseases as a child suggested that my immune system was like a superhero.
It doesn’t seem safe any more. I pause here to stick “measles” into a news search engine. On April 1, 2019: 18 cases in Detroit in the last two weeks; a cluster in Chico, California; and in Rockland County, NY 150 cases have led the authorities to ban unvaccinated minors from public places. In Philadelphia, mumps cases have passed 100 at three universities — Temple, Drexel, and Pennsylvania — nearing 100 cases in Philadelphia at Temple and Drexel Universities. Mumps can make post-pubescent males sterile.
In Kentucky, rather than vaccinate his nine children against chicken pox, the state’s governor deliberately sent them to get it from a neighbour’s child. This is inexplicable to me. What logical sense does it make to deliberately expose your children to the full disease with all its risks when you can expose them with greater safety to a weakened form that will confer the same immunity without making them sick and miserable? Last year, chicken pox put my London-based six-year-old great-nephew in the hospital for weeks with secondary infections. Yes, that’s an anecdote: it’s not data any more than is the governor’s nine children’s getting through chicken pox without incident. (The NHS does not provide free vaccinations against chicken pox, and his mother thought he’d already had it.)
But it is indicative of the escalating financial costs vaccine opposition imposes on the rest of us. I don’t know how much my great-nephew’s case cost the NHS. However, a recent Wired article highlights the story of a six-year-old Oregon boy with tetanus; he spent 57 days in the hospital because his parents refused to vaccinate him — and refused again before taking him home afterwards. Not including 17 days of rehab or the airlift ambulance he also required, his treatment cost $800,000. Granted, all prices are eye-watering in the dysfunctional US healthcare system. But still. Wired goes on to lay out the other costs of refusing vaccinations: states, cities, and counties are spending millions to contain outbreaks that need not have happened. And that’s not to mention the opportunity costs: the millions of dollars and months of human power being spent on containing cheaply avoidable outbreaks are unavailable to every other public health problem they could be working on.
None of these costs are borne by vaccination refuseniks themselves; they are “network externalities”. Similarly, people with poor computer security place the rest of the internet at risk; the burden of pollution falls on everyone but the polluters; and the compromised health of those who cannot be vaccinated places unrelated bystanders at risk. I would not be comfortable with making vaccination a legal requirement, and yet today’s escalating situation is untenable and unfair. I don’t know what the answer is. But two days after the nurse pushed that plunger, a 30-something friend calls from north London to tell me: she has mumps. A mild case, because she was vaccinated.