The news that an active case of poliovirus with flaccid weakness/paralysis was confirmed in an unvaccinated, immunocompetent adult in June 2022 in Rockland County, New York, should give the medical community in the US great pause. This is the first US case in almost 10 years. A previous case was reported in 2013 in a 7-month-old immunocompromised infant who had recently immigrated from India, where the oral poliovirus vaccine is still used.
In the current patient, testing revealed the serotype to be type 2 vaccine-derived poliovirus (VDPV2), which means it was not "wild polio" but due to a mutated vaccine-derived variant from the oral vaccine. Of even greater concern is that the this vaccine-derived type 2 poliovirus has been identified in wastewater samples from neighboring counties, according to a timeline established by the CDC.
This polio case illustrates the tip of the iceberg of the dangers of disinformation leading to decreased vaccination rates in the US: It is a wakeup call. The safety of vaccines simply cannot be refuted. Period. This is not to say there is zero risk; it is to say that the safety and effectiveness of vaccines cannot be denied.
As a pediatrician with more than 27 years of clinical experience, I am very troubled by this situation. How is it possible I have seen two infants die of pertussis, a vaccine-preventable disease in the 21st century? How is it possible that I have had to incessantly refute the notion that the MMR vaccine "causes" autism — even though the original paper stating this was completely discredited and retracted and the author was taken off the medical register in the UK, the equivalent of losing his medical license?
Why have patients lost their trust in us as physicians? Why would a parent ever refuse to allow their child access to one of the most basic preventive measures? Why are there so many anti-vaccine organizations? Why do people believe information from social media instead of mainstream scientists and physicians? Is this a new phenomenon?
No question it has been accelerated by COVID's havoc and the inconsistent responses to the crisis, which have pushed extreme theories to the forefront and politicized a worldwide epidemic rather than looking at facts, and fueled the anti-vaccine movement. However, there has been an erosion of the physician-patient relationship for years for a multitude of complex reasons. Patients see their doctors only from the vantage point of peeking over a laptop screen. Well-baby or well-child visits last 15 minutes at most. Social media and its bizarre "experts" have crawled out of the woodwork.
How do we best convince skeptical parents that vaccines actually do save lives? We seem to have lost the ability to portray that we are the experts — not a celebrity in Hollywood, not a fear-mongering anti-vaccine group spreading disinformation, not social media filled with uncredentialed experts. Vaccinations have worked so well that younger parents have never experienced the death of a child or brain damage from certain types of meningitis. They don't even know what the diseases of diphtheria or tetanus are, and they think measles is just a bad rash. The list goes on. In other words, vaccines have done their job so well that many of these diseases have disappeared in industrialized countries. It's the ultimate paradox of a solution working so well that nobody even remembers the problem.
It is necessary to think about human nature in general if we are to address vaccine hesitancy in patients and parents. As humans, we are usually drawn to what we want to hear and what is in line with how we think. When a parent realizes his or her baby will receive up to 24 vaccines in their first 2 years of life, it is frightening. Makes sense! However, that does not mean 24 separate injections, as the anti-vaxxers will say; many of these are combination vaccines given in one injection. And, more importantly, they protect against 13 preventable diseases, many of which we have not seen in years — again, because vaccines work!
But a young parent may see the vaccine schedule and think, "How can this be good for my baby to have that many shots?" A parent wants to protect his or her baby from pain, and thinking of that many shots could give anyone needle phobia. The same young parent talks to friends and does "research" and realizes these diseases aren't even around anymore! Said parent now says, "Why would I inflict pain on my sweet little baby when these diseases don't even exist?" Enter stage left, the duplicity of the anti-vaccine movement with compelling stories and very slick marketing, saying, "No, young parent, don't do that to your precious baby. Here's why…" People are drawn toward what they want to hear. Basic psychology.
So, what can you do as a physician to try to educate your patients and/or parents? First, have empathy and realize where their fear is arising from. Fear and disinformation should be confronted head on. Use yourself as an example: I always have told vaccine-hesitant families that I would never ask them to do something I did not do for my own children. This is a very powerful action and statement that stands alone. It is best not to argue with the patient's sources and their "research," but instead to have a few go-to indisputable, vetted resources. One of my favorites is voicesforvaccines.org because it is a parent-led and parent-run organization.
Vaccines are one of the most important phenomena of modern medical history. Stand your ground. Talk to your parents and patients about their importance, safety, and effectiveness. Make sure they understand the very real threats to their child by not giving them vaccines. Help them understand that disinformation is deliberate deceit. Vaccines save lives. And vaccines "cause" adults.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Polio Making a Comeback? What Century Are We In? - Medscape - Oct 06, 2022.