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Needling Worry

Why are we so crazy when it comes to vaccines?

Marjorie Ingall
November 16, 2009
(Justin Sullivan/Getty Images)

(Justin Sullivan/Getty Images)

I’ve been writing about parenting for eight years. And for eight years I’ve joked that if you want to make readers crazy, you only need two words: “vaccines” and “breastfeeding.” So I shouldn’t have been struck by the passionate rantings on Facebook following my colleague Allison Hoffman’s story on how anti-vaccine fears caused a rise of measles in the ultra-Orthodox community. And I shouldn’t have been surprised by the blog world’s responses to my story on the venom aimed at women who don’t breastfeed. Anything we put in our children’s bodies—milk (whatever its mammalian origin), medicine, McNuggets, high-fructose corn syrup, petrochemicals leaching out of baby bottles—it’s all a huge source of anxiety for modern parents.

Back in the day, of course, we just wanted our kids to survive childhood. I once wrote a piece for the Forward theorizing about why Judaism historically didn’t address stillbirth or miscarriage. Why weren’t babies who lived less than 30 days given funerals? Why weren’t they attended with the rituals associated with mourning? I’m guessing it’s because attitudes were different in a time when an infant’s death was a regular occurrence. It was better to move on, push past grief, plan for the next kid. Today we have the luxury of neurosis. We get to dwell. We have fewer kids, and we not only expect them to survive to adulthood, we expect them to go to Yale and become gastroenterologists and program our TiVos. We get worked up about vaccines and breastfeeding because we can. But it’s more than that. I’ve been pondering why vaccine advocates can cite reputable studies until the cows come home, insisting with ever-increasing vehemence that Legitimate Science does not show that vaccines cause autism and let us explain the concept of herd immunity and you put all our children at risk if you don’t vaccinate yours and do you know that People Used to Die of Measles—and the anti-vaccine folks come back just as forcefully with anecdotal evidence and studies that the Friends of Science see as substandard.

Meanwhile, I wave around studies showing that once researchers correct for maternal age, income, smoking, intelligence, and education levels, the evidence is inconclusive about whether breastfeeding is better than bottle-feeding with modern formula—but lactivists continue to hurl insults at bottle-feeders and insist they’re harming their children and society. Why do we talk such different languages, at such cross-purposes?

I thought about this while sitting in a school meeting that turned into a heated referendum on the H1N1 vaccine. Like all New York City public schools, my kids’ school is making the vaccine available, but the Department of Education has been surprised by how few parents want it. Current estimates say that 25-35 percent of families want it for their kids, far below the original 50 percent estimate. Why? “There are still a lot of parents who want the vaccine for their kids, but many really don’t,” said Neal, my brother-in-law and a pediatrician who runs school health programs in the Bronx. “No one is lukewarm about it.” In my kids’ school, one person ranted about how a holistic doctor told her sister’s friend that the vaccine can eat the lining of the heart and kill you as two other mothers campaigned furiously to get the vaccine sooner rather than later and to be called to hold their child’s hand in the nurse’s office while it was administered.

So why the passion? I think it’s because we’re terrified of an unknowable future. Parenting is about making choices—how to feed a newborn, whether to work or stay home (if you’re an upper-middle class Jewess who is fortunate enough to have that choice), whether to vaccinate. We hope that what we do provides a magic bullet that keeps our kids safe and healthy in a terrifying, uncertain world. And yet, we’re supposed to let our kids disappear into a mysterious school nurse’s office, to be jabbed or made to snort something, some substance provided by a government we haven’t trusted since Watergate? Can’t I just let my kid wear a hamsa and feed her organic bananas?

“I think the anxiety about vaccines and breastfeeding is about seeking a false sense of control,” said Kiki Schaffer, director of the Parenting & Family Center at the 14th Street Y in Manhattan. “You can’t be anxious about everything, because it’s too much, so you pick a few manageable things to get really, really upset about. A few years ago it was asbestos, then alar in apples. But picking one or two things feels safer than having anxiety about the whole world.” And I think part of making your choice about what to get worked up about involves slamming the choices of others. Because what if they’re right? What if you’re the one who’s screwed up when it comes to your kid? Nothing could be more horrible to contemplate. Better to close your eyes and go on the attack. At this point, the notion of kids dying of old-school diseases seems far more remote than the notion of your specific kid getting autism or an immune disorder. We don’t know any kids with rubella. We know lots of kids with autism.

Next year, I’m going to have to decide whether to allow Josie to have the vaccine that protects against the human papillomavirus. The idea of 9-to-11-year-old girls getting vaccinated for a sexually transmitted disease is a certainly discombobulating. Jojo’s a baby! She’s not going to have sex until she’s at least, I don’t know, 35.

Indeed, many parents are opting out. Some worry that the vaccine will encourage promiscuity; others have concerns about the contents of the vaccine itself. Yet the Centers for Disease Control and Prevention believe that the vaccine is safe. (So do my kids’ pediatrician, my own G.P., and my brother-in-law.) The fact that 11,000 women are diagnosed with cervical cancer every year and 3,700 die is a compelling argument for the vaccine. The fact that 70 percent of American girls have had sex by age 18, while the vaccine is most effective among people who have not yet have sex and thus haven’t been exposed to any strain of this very common virus, is a compelling argument for giving a kid the vaccine while she’s young. (Should boys get the vaccine? Good question.)

Neal thinks that the HPV vaccine offers an important opportunity for pediatricians. “From a clinical perspective, I like the idea of using a discussion about the vaccine as an opportunity to talk to parents about how they’re going to keep communication channels open as their kids get older,” Neal says. “We need to acknowledge parents’ emotions and anxieties. Just offering and re-offering the vaccine is not the only intervention we should be doing.”

Would reframing the public health concerns around pediatric immunizations increase the numbers of kids getting vaccinated? Do we have to wait for more massive outbreaks, along the lines of the ones in ultra-Orthodox communities, perhaps involving even scarier diseases? Perhaps if we stopped treating opt-out parents as if they were stupid and instead treated them as though they were frightened for their own children’s welfare, it would color our approach and let us communicate more effectively. Or maybe we should make it harder to opt out. Or both.

All I know is that judgmental eye-rolling doesn’t help anyone. Not kids, and not parents.

Marjorie Ingall is a columnist for Tablet Magazine, and author of Mamaleh Knows Best: What Jewish Mothers Do to Raise Successful, Creative, Empathetic, Independent Children.

Marjorie Ingall is a former columnist for Tablet, the author of Mamaleh Knows Best, and a frequent contributor to the New York Times Book Review.

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