WORK/LIFE BALANCE FROM A MOM AND NURSE PRACTITIONER

On immunity review

5/22/16


I initially heard of On Immunity: An Inoculation, through an NPR interview with the author in the context of the anti-vaccine debate. As a medical provider I have become very interested in the anti-vaccine movement. Growing up I never knew anyone who didn't vaccinate their kids or encountered anyone of this ideology. My parents had me and all of my siblings vaccinated without question. It wasn't until I moved to Southern California when I became exposed (pun not-intended) to the anti-vaccine craze. The idea that vaccines were anything other than beneficial seemed so ludicrous to me at first. My pediatric clinical hours required of my nurse practitioner program were split between a private group pediatric practice in an affluent area of Orange County, and a small school-based clinic in L.A. county, serving mostly newly immigrated low-income children without an established pediatrician. The contrast between attitudes towards vaccinations at these two sites was stark. The more affluent parents in Orange county frequently refused vaccines or wanted the vaccines spaced out based on the "Sears" schedule.  The low-income families, many recent immigrants (ranging from Central America, South American, and Asia) were all welcoming and eager to receive vaccines, many of which their children had not had access to. My pediatric rotations also happened to be during the time when a Measles Outbreak occurred in Orange County. I was surprised by the convictions that these vaccine objectors had in refusing their children to be vaccinated. Discussing the benefits of vaccination was futile, in addition to the fact that most of the people refusing vaccines were well-educated individuals who already were aware of both sides. I was floored when I was pregnant and a Physician's Assistant at my work ask me if I was going to vaccinate my child. When I responded "of course" she then proceeded to go on a anti-vaccine rant about how it lead to Guillan Barre Syndrome in a patient she vaccinated, and how she was going to home-school her children if it meant she had to vaccinate to attend public schools. The public's fear of vaccinations seems to be worsening, and I constantly encounter this in practice. I had two female patients in their early twenties frightened about the HPV vaccine after a professor in their human sexuality course introduced the idea that the HPV vaccine was linked to deaths and ineffective in preventing cervical cancer. I then researched this claim and found it completely without base and verified with several OB/GYNs whom also debunked this claim. Why were so many highly-educated people afraid of vaccines? I was hoping this book could shed some light into these fears. To me understanding and educating the public about vaccine pros and cons is paramount, as I work in primary care, and a huge component of primary care is prevention of disease. As a parent, I understand the need to protect your child from everything in utero and out in the World. The fear of autism is one that is challenging as a parent, because still there is not a medical census on any causative factor. When the media highlights studies on possible links to autism, naturally there is alarm among parents and expectant parents. One small inconclusive study suggested a link between autism and vaccines, however the media-hype and damage from this study has been long-lasting. In recent news one study found evidence even folic acid, which is proven to be preventative for neural tube defects when taken prenatally, to be linked in high-levels to autism. As any concerned parent, it's natural to take whatever precautions possible to prevent autism, but at what cost?
This book was a good read, although it was not what I expected. I expected the author's account from a perspective of a once-radical anti-vaxx who after research reframes her thoughts on vaccines. The author was never a radical anti-vaccination proponent, but just a concerned parent with a healthy level of skepticism about the healthcare system. This book is in no way propaganda, but a historical and anthropological exploration of human immunity to disease, with interlaced personal anecdotes and literary references. I enjoyed this book for the fact I do love learning about the history behind medicine. She delves into the history of primitive forms of vaccines, the paradox of parents trying to protect their children from the vaccine meant to protect them, mistrust of government, environmental impact on health, and risk-benefit analysis all in an eloquent academic way. Her book although published in 2014, is even more relevant in light of the new suggestions of folic acid being linked to Autism, Zika virus, and the Flynt Michigan water crisis. She also highlights the observation I had in my pediatric rotations, that refusing vaccines is a matter of privilege, rather than an anti-establishment statement. Some interesting facts I learned from this book: Breastmilk is full of environmental toxins (paint thinners, dry cleaning fluids, flame retardants); The publication of the  Book Silent Spring lead to increase rates of malaria in Africa as a result of the decreased use of DDT; The CIA used a fake vaccination campaign in Pakistan administering hepatitis B vaccine while also gathering DNA evidence to locate Osama Bin Laden's whereabouts.
I did not necessarily change my views on vaccines from this book, but I find myself looking at the global impact of the United States vaccination policies and decisions differently. Subsequently I have become involved in a campaign called Shot@Life to increase federal U.S. funding for vaccinations abroad in countries where there are children mortalities from vaccine-preventable deaths, such as Rotavirus, Diphtheria and Pertussis. More information is available here. I would recommend this book to any parent or anyone interested in learning more on immunity and vaccination history.
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