There has been an online raging war about the pros and cons of vaccination, for a long time. People on both sides say they are basing themselves on science and it gets a bit hard for all of us out here to sip through all the jargon and quoted studies, and to decided what is real evidence and what is not.
This is an open letter of sorts to both sides. I’m not a scientist. I’m only a mother trying to decide what’s best for the little love of her life, sometimes with a superhuman effort to look beyond her own preconceptions and prejudice. And you’re not making my life any easier.
I’m extremely reluctant to use pharmacology. I cringe each time I have to use any kind of medicine on myself or my daughter. Don’t get me wrong. I marvel at the giant steps medicine achieved over the past 100 years. Mortality rates in developed countries today are a thing of wonder compared to the past. Much of it was achieved by the use of medical pharmacology. But it’s still poison that we’re taking in, most of the time, so I don’t like to do it. But when I have to, I do.
When time came for me to decide what, if any, vaccines my child would take, like a responsible mother, I went on a little research trip. I came late to all of this, so by the time I started reading statements on both sides, it was all buried under a huge blanket of sarcasm, witty responses and personal insults. That tends to wear me and my patience very fast.
So I went another way. I talked to my child’s doctor. He’s a great professional who provides information in a level tone, respecting the fact that its the parents who have to make and live with their decisions. We talked about the risks of the different vaccines, and their expected benefits. Some of the vaccines are covered by our National Health Service, some are not, which means we would have to pay for the latter.
I’m fortunate enough to have both my grandmothers and mother alive and well, and I asked them to tell me what it was like for them, to make such decisions. And I discovered that my family history is a stunning example of the social and scientific evolution of medicine in Portugal.
Sixty-something years ago, when my parents were just born, Portugal was living under an oppressive, aggressive, paternalist, right-wing dictatorship, akin to Nazism in Germany and Fascism in Italy. To the powers that were, the people should be weak, meek and uneducated. Centralized health systems were near to unexistent, but even if they weren’t, knowledge did not flow freely, so it was difficult for doctors to keep pace with science. Moreover, vaccines weren’t abundant or generalized. Child mortality rates were around 144 in 1000.
Socially, doctors were among the most educated people around, and the cultural and educational gap between them and their patients was huge. They tended to be seen and treated like demi-gods and they got used to it. People did what the doctor told them, without question or discussion.
Hygiene and food were not at its best. Malnutrition was rampant. Every time there was news of a sick child in the neighbourhood, reactions were akin to panic. Diseases like measles, smallpox, polio, mumps, diphtheria, whooping cough, meningitis, and even tuberculosis, were, if not rampant, wildly disseminated and haunting ghosts of every mother’s nightmares. Treatments didn’t exist or were extremely rare and costly, with no promises for efficacy. No mother of that age would have any qualms in vaccinating their kids, had they been asked.
By the time my sisters and I were born, almost forty years ago, things had changed. Democracy was in an infant stage in Portugal, the population was more educated and health services served almost everybody. There was a National Plan for Vaccination, with most of the available vaccines at the time, mandatory if you wanted to enter public school. Smallpox was close to be eradicated worldwide and vaccination wasn’t much more than a trip to your local health centre. Moreover, while you could still get infected with measles and some other diseases, treatment was much more wide spread and its efficacy had raised considerably. Child mortality rates were around 35 in 1000.
Sanitation and food distribution were much, much better. Mothers talked to doctors, if not on equal terms, from a much less imbalanced position. They asked questions and refused procedures if need be, but not often. Vaccines were a normal thing of life and there wasn’t much thought on whether to do it or not. You just did it. The ghosts were still there, but most of them had been rendered almost helpless.
When my time came to make these decisions, things were considerably different. Food availability and distribution are not a problem nowadays, and although we pay much more than we should for it, its quite inexpensive in comparison. Health services in Portugal are efficient for the most part and much more up to date. The National Plan for Vaccination still exists and encompasses most of the available vaccines. Portugal is a success study case for the lowering of child mortality rates, having brought it down from the already low of 10 in 1000 in 1990 to 3 in 1000 in 2012.
I speak to doctors in equal terms, as I would with any skilled professional in an area that isn’t my own. And the internet is around. And I’m connected to the world. And I like to read and learn.
After all this, the only available vaccine my child didn’t take, was the rota-virus one. And only because of the perceived low efficacy. There are a lot of strains around and the vaccine only protected her from one. After a general risk-benefit assessment, we decided not to inoculate her with that one. This means that, without major side effects, my child is now protected against every major disease she could contract otherwise. And those ghosts don’t haunt my nightmares. And I’m a mother to a very smart, happy, healthy child
So this was my decision, based on my experience and my family history, as well as on what I read online. I’ll finish by saying that although both sides of this discussion equally villipend and insult each other beyond any rational discussion, science as surely the better case. The studies are there to prove that vaccination has saved and continues to save countless lives. It doesn’t do its work on its own. Better sanitation and better nutrition obviously play a part in this equation. But vaccination has provoked quantum leaps in the fight against disease, and people living in developing countries, where it is not readily and cheaply available, are the main proof that it is needed and it works.