On Apr. 17, 2019, I was interviewed by cardiologist Juan Rivera, MD on the “Dr. Juan” health segment of Univision’s Despierta América morning program. The interview, which was conducted in Spanish, focused on the current measles outbreak in the United States.1 2
Dr. Rivera wanted to understand the position of the National Vaccine Information Center (NVIC) on this issue and I appeared on his show via Skype as a spokesperson for NVIC, based largely on my ability to speak Spanish and my position as managing editor of NVIC’s online journal newspaper The Vaccine Reaction. Two other medical doctors—pediatrician Andrés Cotton3 and neurologist Carlos Ramírez-Mejía4—appeared in studio with Dr. Rivera for the interview.
The first question Dr. Rivera asked me to open the show was:
We are in a situation in which there are 550 cases [of measles] in the United States. We know that the most important preventive measure for this is the vaccine. What is your position in this respect?1
My response was:
Well, our position as an NGO is to ensure that individual rights [with regard to vaccination] be preserved. It has been said that this is a crisis. We’re talking about 500 people, more or less, in a country of 320 million people. But let’s not talk about this because, really, this is not our point, which is that you cannot obligate people to get vaccinated. That decision has to be made by the parents of the children. If the State wants to obligate, wants to force people to get vaccinated, well then, we’re no longer living in the United States… we’re living in Cuba or Venezuela. So this is our position.1
Dr. Rivera asked me several other questions about the measles outbreak, notably with regard to New York City and some of the moves by the city’s government to tighten the enforcement of mandates to vaccinate children with the MMR (measles, mumps, rubella) vaccine. My responses remained consist with my opening response—No forced vaccination. We do not live in a dictatorship like in Cuba or Venezuela.
Predictably, the question of “herd immunity” came up. Dr. Rivera turned to Dr. Cotton and asked:
There is a part of vaccines that have to do not with protecting the individual… something that is known in English as herd immunity… that is an immunity… or en masse, I don’t know what is the term in Spanish. But it is, basically, that when you get a get a vaccine you protect others also.1
Herd immunity is almost always trotted out early in any debate on vaccination, and it always has a way of transforming the debate into one of personal choice versus public responsibility. As I wrote in a 2016 article in The Vaccine Reaction, “The argument being made is that individual choice must be removed from many healthy people to protect the few sick people who cannot protect themselves.”5
Dr. Cotton responded:
Exactly, that’s the idea. For one to get vaccinated and protect other people. There are persons who cannot get vaccinated because they are immunosuppressed or they are elderly or are too young who will get sick and have a high probability of dying.1
At first glance, the argument seems sound. To be a humane society, we must protect those unable to protect themselves. But the argument is based on a false underlying assumption. According to the Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP):
The ACIP has also stated that vaccination is not a problem for people suffering from chronic illnesses. The reality, then, is that, regardless of whether or not you or your child gets vaccinated, nearly all immunocompromised individuals in America will still be subject to vaccination as well.5 6
“For all practical purposes, the Centers for Disease Control and medical trade organizations now direct pediatricians and other vaccinators to deny the medical vaccine exemption to 99.99% of Americans,” says Barbara Loe Fisher, co-founder and president of NVIC.5 7
The reason the CDC and most health care professionals believe almost nobody merits a medical or any other exemption to vaccination is that it is assumed that vaccines are “safe and effective” and, thus, they pose no harm to anybody—that, on the contrary, vaccines are beneficial to nearly everyone, and so the more, the better.
Dr. Cotton added:
So we say that, yes yes, the children, people have to get vaccinated. They get vaccinated at one year of age with one dose of MMR and at four years with the other dose. In that way nobody gets the disease. Nobody dies. We’re all at peace. We don’t receive babies, children in the hospital who die from things that we can prevent, and… what the gentleman said, in Cuba the government makes sure that the patients get vaccinated because they don’t want patients to get sick.1
It is hard to know where to begin to further deconstruct Dr. Cotton’s rosy description of how herd immunity works. Even in highly vaccinated communities, fully vaccinated people come down with the diseases vaccines are supposed to prevent. Like with all pharmaceutical products, vaccines can cause severe side effects for some people and doctors rarely predict who will be harmed. Consequently, not everyone is “at peace.”8
Dr. Cotton’s understanding of herd immunity and, thus, his eagerness to use it as justification for mandatory mass vaccination programs is based on the assumption that vaccines confer lifelong immunity. However, vaccines do not confer lifelong immunity. Saying that they do is like saying a woman can be pregnant, but not completely.
Immunity implies permanent protection from an infectious disease. At best, vaccines confer only temporary, short-term protection. That is why the “booster” vaccine was invented, because it was discovered that the protective effects of vaccines tend to wear off or “wane” after a certain amount of time. How much time depends on the vaccine, and even that varies, depending on the individual and the environment in which he or she lives.8
The theory of herd immunity was developed prior to the modern era of mass vaccination campaigns. It was developed based on observations of how a herd of animals or human populations seemed to become immune to an infectious disease like measles after a percentage of a population had contracted the disease and acquired long lasting natural immunity to it.9 10 11
That permanency element is the key to herd immunity. Without it, the theory falls apart, and that is why it is invalid to use as the crux of an argument for mandating that everyone be vaccinated for the “greater good.”
If Americans wish to vaccinate themselves and their children because they have confidence that a vaccine will prevent them from contracting a disease or, if they do get infected, the disease will be milder, then that should be their choice to make. What is lacking is a reasonable argument for insisting that others make the same choice.
Again, we live in the United States of America, not Cuba and not Venezuela.
This article or commentary provides referenced information and perspective on a topic related to vaccine science, policy, law or ethics being discussed in public forums and by U.S. lawmakers. The websites of the U.S. Department of Health and Human Services (DHHS) provide information and perspective of federal agencies responsible for vaccine research, development, regulation and policymaking.
1 Despierta América. Por qué es importante la vacuna contra el sarampión (mas no obligatoria) | Dr. Juan. YouTube (published Apr. 17, 2019.
2 Dr. Juan? DrJuan.net.
3 Dr. Alberto Cotton, MD. U.S. News & World Report.
4 Carlos Ramirez-Mejia, MD. First Choice Neurology.
5 Cáceres M. The Immunocompromised Still Get Vaccinated. The Vaccine Reaction Jan. 18, 2016.
6 Centers for Disease Control and Prevention.Recommendations of the Advisory Committee on Immunization Practices (ACIP): Use of Vaccines and Immune Globulins in Persons with Altered Immunocompetence. Morbidity and Mortality Weekly Report Apr. 9, 1993.
7 Fisher BL. Blackmail and the Medical Vaccine Exemption. NVIC.org May 18, 2015.
8 Cáceres M. This Herd Mentality is for the Birds. The Vaccine Reaction Sept. 1, 2016.
9 Cáceres M. The Misunderstood Theory of Herd Immunity. The Vaccine Reaction June 20, 2015.
10 Cáceres M. Herd Immunity Theory Has Been Repeatedly Disproven. The Vaccine Reaction May 30, 2017.
11 Cáceres M. The Theory of Herd Immunity Has Nothing to Do With Vaccination. The Vaccine Reaction June 18, 2018.