Are your vaccinations up to date?
“Vaccine hesitancy” is the research label for your indecision about whether or not to get a vaccination when offered. In the past, patients rarely questioned the need for vaccines. Perhaps it was due to differences in the doctor patient relationship. Or perhaps it was due to the constant reminders of what happened without the vaccine. For those of us old enough to have lived through the introduction of some vaccines, there were reminders of the diseases they prevent. I still have scars on my legs from chickenpox. But more haunting are the vivid memories of my friend Jim as he dragged his uncooperative legs around my 4th grade classroom using crutches with leg and body braces. Jim had survived polio.
So I can’t help wondering how sharing our past, telling stories of the bad old days before vaccines, might impact our willingness to be accurately informed about the net benefits of vaccination.
One of my favorite storytellers of disease is Berton Roueche. For years he wrote his mysteries of disease and the detectives who solved them in the New Yorker magazine and published several books of the short stories. They are mostly out of print and hard to find but they are spellbinding stories. He painted vivid pictures of the effects of the diseases, like his description of tetanus, a vaccine preventable disease, in his story, “A Pinch of Dust”. Using quotes from Hippocrates and another ancient physician, Roueche presents an unforgettable image of a patient whose first symptoms of difficulty talking were followed quickly by locked teeth and jaws and only three days later by muscle contractions of the back so severe that the head became bent down the back between the shoulder blades while the spine arched so severely that it appeared the patient was trying to touch his head to his heels. Six days later the patient was dead.
Roueche also describes the bacterium that causes tetanus, Clostridium tetani, and the incredible strength of the toxin it makes (“one of the most venomous poisons known to man”). And, he explains, it is an essentially incurable disease. Since the time of his writing, intensive care therapeutic support options have improved. Still, you may want to read the wikipedia description of treatment for severe tetanus, especially if you aren’t up to date on your Tdap vaccine or don’t know when you had your last vaccine. Or read the CDC description of your risk of death if you get tetanus. It’s one out of every 10 people, even with the best medical care.
You need the vaccine every ten years.
I’m not recommending fear as a strategy for reducing vaccine hesitancy. You can review the state of the literature on how to address vaccine hesitancy by going to PubMed and entering vaccine hesitancy. Or start with this systematic review. Spoiler alert - the causes of vaccine hesitancy are multifactorial and context specific and thus likely to need multi pronged interventions to address.
But stories from a past that no longer exists due to the success of modern vaccines may help prevent us from having to experience that past once again.
If you want to learn more about the vaccinations available to prevent disease in adults, check out the resources available from the CDC.