The Consequences of Vaccine Refusal
May 2008
Last week, the East Bay Waldorf school, which educates children from preschool to high
school, was closed down on the order of the Health Department because of an outbreak of
Whooping Cough, or pertussis. With that decision, my office and other health
professional’s offices were contacted with instructions to prepare for an onslaught of kids
who were exposed to pertussis.
Pertussis is a vaccine-preventable disease—we don’t see a whole lot of it anymore. The
bug that causes it, Bordetella pertussis, infects a child’s airway, after which it releases a
toxin that cause inflammation and swelling. A week or two after infection begins,
children develop episodes of intense coughing spasms which cause a high-pitched
whoop—that’s the sound of a child gasping for air. In infants and kids who are too
young to be immunized, pertussis can kill very quickly: Instead of just coughing, these
kids simply will stop breathing, and they’ll be found dead by their parents in the morning.
The day Waldorf was shuttered, our orders from the county health department were to
test and treat students with antibiotics to prevent the further spread of the disease. So my
colleagues and I stocked our rooms with special testing swabs which usually stay buried
in our exam rooms and spent time recalling ancient medical school microbiology about
this bug.
Several of us got a booster of the whooping cough vaccine, which is recommended now
in adults because it’s been shown our immunity wanes over time.
In the case of the Waldorf schools, the outbreak happened because over half of kids who
attend it have never been vaccinated. Arthur Allen, a writer and author of the book
Vaccine, which exams the triumphs and suspicions about shots through history, explained
the school’s philosophy in a 2002 piece for the Atlantic Magazine: Rudolf Stiener, who
founded the Waldorf schools during the late 19th century, believed that “children’s spirits
benefited from being tempered in the fires of good inflammation.” That is, getting sick,
maimed, if it doesn’t kill a kid, builds character. Waldorf schools exist worldwide, and in
all of them is a demographic of kids who haven’t been immunized. Allen described the
Waldorf in Boulder, Colorado, a city of 96,000 people, which has one of the highest per
capita rates of pertussis in the country.
These days, parents increasingly seem worried about vaccinating their kids because they
hear that vaccines are unsafe. Like all things we do in medicine, vaccines have side
effects, but neurodevelopmental disorders like autism aren’t one of them. There are a lot
of loud, angry, suspicious voices out there who disagree, but none of them can point to a
real, peer-reviewed science to back their accusations.
The parents who chose not to vaccinate their kids did so out of their esoteric
system of beliefs. But those same parents need to consider, as Tom Friedman points out,
that it’s a flat, hot and crowded world. A century ago, an outbreak of pertussis, may not
have spread beyond the next town or village. But now, all those parents need to do is
pick up their unvaccinated, exposed and coughing child from school, and drive them
down the 680 to their neighborhood Gymboree, where they’ll be coughing on kids from a
different part of town. Just like that, the scourge spreads.
Parents who choose no to vaccinate their kids, or anti-vaccine folks darn well better think
about that. And if they choose to act selfishly despite it, they should be ready to accept
the ethical and social consequences of putting all of us at risk.