Hidden in the July 4^th holiday headlines this year was the fact that a 20-year-old woman in Washington state died from measles on July 3.  In the US.  An entirely preventable death.  I’m heartsick over it.

The woman had other health issues and her immune system was weakened.  This is a medical explanation for her death but hardly a consolation of any kind.  The point is that her life was prematurely ended, and it didn’t have to happen.

There was a measles outbreak in her community earlier this year due to parents choosing not to vaccinate their kids against measles.  For every 1000 people with measles in general, 250 are hospitalized and 1 or 2 of them die.  Most of the measles sufferers came through.  She did not.

This was the first time in 12 years that we’ve had a measles death in the U.S.  We beat this thing, and now we’re inviting it back in.  Because we’re afraid of vaccines.  So I’m going to ruminate on this a little.  I’ll try not to rant, because it’s been proven that that doesn’t change people’s minds.  But I’m profoundly sad, and I respond to that with some research.  And so I have some talking to do.

Over a million kids die each year from measles, but they’re not in the U.S., so we tend to forget about them here.  They don’t make the headlines.  We have vaccines, which are so effective and widely used in the U. S. that no confirmed deaths due to measles have occurred since 2003.  We’ve gotten complacent.  Most of us have forgotten that measles is a dangerous disease.  Some websites and blogs use the word mild to describe it.

So is it mild?  Are they lying?  Not exactly.  For many people it is somewhat mild.  For some it hospitalizes.  For some it kills.  Describing it as mild overall cheapens the lives lost to it.

I want to be clear about living with risk, something I’ve been thinking a lot about lately.  I wrote in my precancer blog that there is a certain amount of risk in the world we can’t do anything about, but it is better to know about it and to study it rather than sit in ignorance because it’s scary.  Knowing is better than not knowing, even if we can’t avoid the risk.

Measles is not cancer.  We can avoid this risk.  It’s a big risk, and it’s almost completely avoidable.  People are choosing to take this risk, endangering their own lives, their kids’ lives, and, worst of all, other people’s lives, including other people’s kids.  They must have some really good reason, right?

As far as I can tell, and I really have tried to hear the reason in the anti-vaccination arguments, is that measles and other childhood diseases are natural and vaccines are unnatural, and we have often learned in modern society that natural is better than unnatural.  At least that’s the sense I can make of it.  There are others who say that anyone should have the freedom to take on any risk they want to.

I’m all for individual freedom as long as you’re not hurting others.  But that’s not the case here.  You’re risking other people’s lives, not just your own, when you don’t vaccinate.   We’ve chosen as a culture to limit smoking in places where second-hand smoke can be a health risk to others, so we do understand the need to support public heath as a society.  Maybe people don’t realize that there’s a risk.  So I’ll deal with this objection by saying that there is a risk.  Measles doesn’t always kill its victims, but it sometimes does.  And the measles bugs often get into the U.S.  If you chose not to vaccinate your child, you put their health and life in danger as well as the life of anyone around who is too young or has too weak an immune system to get the vaccine themselves.  It’s a public health problem.

The other argument, about the vaccine being unnatural, makes a little more sense to me, so I’m going to talk to it at greater length.

Drinking tap water that has been treated to remove disease-causing microbes is unnatural, but we prefer it to drinking dirty water because it saves lives.  In most cases of women giving birth, unnatural means are not necessary, but in many cases (not a majority, but significant fraction), medical intervention is needed to save the lives of the mother and the baby.  Deaths of women in child birth are natural, but we’ve decided to do the unnatural thing and prevent them whenever we can.  That’s a good thing, in my book.  We also value the unnatural extension of life and the reduction of suffering and death that comes with that.

Okay, so there’s good unnatural and bad unnatural.  Let’s take a closer look at this vaccine.  What’s in a measles vaccine, anyway?<

Measles vaccine Ingredients:

First, the measles virus itself.  Every vaccine has a weak, dilute strain of the virus it prevents so that it can make your immune system produce antibodies without making you sick.

Then, in order of abundance:

• Sorbitol, a sugar alcohol naturally found in fruits. It’s there to help grow the virus, which needs something to eat.
• Sodium phosphate, a salt naturally found in our body cells. It’s an emulsifier, so it helps the virus stay mixed and not separated out in layers (like oil and water).
• Sucrose, plain old sugar. Also there for virus food.
• Sodium chloride, table salt.
• Gelatin, a natural component in our bodies and animals that helps the vaccine hang together (makes it thicker than water).
• Human albumin, the main protein in human blood plasma. It’s used in growing the virus, and you’ve already got it.
• Bovine serum (less than one part per million), blood plasma from cows. It doesn’t have actual blood cells in it.  It’s some of the protein-rich stuff between the cells.  A little weird but not alien.
• Neomycin, 25 micrograms (very little) of the antibiotic in Neosporin, to prevent E. coli and other germs from growing in the vaccine.

So there it is.  I’ll let you decide how comfortable with these ingredients you are.  But there’s no mercury here.  Not even any aluminum, which seems to be the new argument against the vaccine – I don’t understand that one either, but it’s beside the point.  This is the list of ingredients.  Mercury (very rarely) and aluminum do show up in other vaccines, but mercury is never in the ones given to kids, and neither one is in this vaccine.

I get that it’s stressful, to parents and to children, to give a child a shot in the arm.  We feel terrible subjecting kids to even a little bit of pain.  But there are big big pros, and the cons are tiny.  This is not poison.  It’s only the short-lived pain of the shot that is the disadvantage side of the equation.

Avoiding unnecessary death.  That’s a big big pro.  But wait, there’s more.

Measles doesn’t just make you sick for a while.  It weakens your immune system, and, more than that, it wipes your immune system’s memory.  So every infectious disease you’ve had before and gotten immunity to?  You can now get it again.  So the vaccine doesn’t just prevent measles.  It helps you maintain the disease memory in your immune system and not get all the other stuff you’ve already had again.

A new paper out in the prestigious journal Science studies the effects.  We used to think that measles just weakened the immune system for a while, maybe a few months.  But no, it looks like the effects last years.  For instance, people who have had measles are much more likely to get pneumonia, which kills at higher rates in the young than measles itself does.  Yes, these people died from pneumonia.  But measles was the real culprit, and it got away with it – we don’t count those when we’re counting measles fatalities.

So the vaccine prevents measles.  But it also prevents deaths due to lots of other infectious diseases while we’re at it.

Having more childhood infectious diseases leads to decreased brain development, another problem that can be reduced with the vaccine.  When you’re busy growing and learning, there’s only so much energy your body can expend.  And if it has to expend a lot of energy fighting disease, the brain won’t grow as well and as fast.  Multiple studies have found a link between higher childhood disease rates and lower cognitive ability.  That lasts a lifetime.

Measles vaccines save lives in several ways.  They save the lives of those who are vaccinated and those with weakened immune systems.  There is little downside.  Yes, they are unnatural.  We value unnatural things that save lives.  Choosing not to vaccinate is to open the door to unnecessary suffering and death, and we as a society are not willing to do that.  Let’s beat measles back to the point where our pediatricians forget what it looks like, and no one has to watch a loved one die from this preventable disease.
Mina MJ, Metcalf CJ, de Swart RL, Osterhaus AD, & Grenfell BT (2015). Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science (New York, N.Y.), 348 (6235), 694-9 PMID: 25954009