Vaccines (and vaccine requirements) save lives

Photo by Mufid Majnun on Unsplash

Incoming Minnesota state legislator Walter Hudson recently said at a public event that people who support vaccine requirements are equivalent to "slave holders." The event was ostensibly about COVID-19 specifically (hosted by "Mask Off MN" - which is a weird name, because I live in MN now and outside of the doctor's office I haven't seen a single place requiring masks). But Hudson didn't seem to make any distinction between COVID vaccine requirements and requirements for other types of vaccines that have been in place for decades in schools and daycares — either in his initial remarks or when he later doubled down on his slave-holding analogy.

This is kind of important to me personally because if he's including other vaccines in his remarks, then I'm one of those people who are, in Hudson's words, "equivalent to a plantation owner who enslaved Black people and forced them to work for you." And that's sort of off-putting.

For almost 20 years I have been advocating for the meningitis vaccine to be required for school attendance, dating back to when meningitis nearly killed me and took parts of all four of my limbs. One of the first things I did when I got out of the hospital was call for the University of Kansas to require the vaccine for incoming students. Later I testified for teenage meningitis vaccine requirements at state legislatures in Kansas, Nebraska, and Missouri. I did this because I didn't know there was a vaccine for meningitis when I got sick, and after I got sick I knew all too well what can happen to you if you don't get the vaccine.

The timing for my advocacy was good. Bacterial meningitis vaccines had existed in some form since the 1970s, but the first-generation shots didn't provide long-lasting protection and as a result they really weren't required anywhere outside of military barracks and scattered colleges. Then a new type of vaccine was developed and released to the public in 2005. It provided strong, durable protection against four of the five major strains of bacterial meningitis in the U.S. (A,C,Y and W). That's when efforts really ramped up to get this new shot required for school attendance, and I played a small role in those efforts. 

Now, most states do require the "quadrivalent" meningitis shot, and the results have been pretty remarkable. By 2018, about 80% of kids were vaccinated against meningitis and far fewer were getting sick. Bacterial meningitis cases in the U.S. used to fluctuate from about 1,500 in a good year to 3,500 in a bad year (doesn't seem like a lot, but when you consider that about one in every three cases results in death or permanent injury — brain damage, hearing loss, vision loss, amputations — that's significant carnage). Since the 2005 vaccine there have been no more peaks and valleys. Cases have just dropped steadily, and now sit at about 300-400 per year. That's a 90% reduction from peak, which means that in the past 18 years, thousands of Americans have avoided death, disability and disfigurement just by getting a simple shot. That's pretty much a miracle. Of the cases that remain, about 200 a year are caused by Type B meningitis — the one type that the 2005 shot doesn't prevent. In a nutshell, one type of meningitis now causes more cases in the U.S. than all of the other types combined, because most at-risk people are now vaccinated against the other types.

Could we have gotten there without the state-by-state requirements? Maybe, but I doubt it. Here's why: while we were making great progress with the 2005 quadrivalent vaccine, a new vaccine against meningitis B was developed and released to the public in 2014. It's now widely available in most doctor's offices and pharmacies. It prevents the same awful disease as the other shot. But the uptake of the Men B vaccine has been poor — only about 20% of kids get it. Why? Lack of awareness no doubt plays a role. But it's also because, outside of a few dozen colleges nationwide (many of which have experienced a tragic Men B outbreak), the Men B shot is not required. This is partly a financial decision on the part of health policymakers: the Men B shot is new and under patent, it's relatively expensive as vaccines go, and policymakers don't believe they have enough data yet to recommend a costly mass-vaccination program for an illness that strikes only about 200 Americans a year. In fact, it's likely that the Men B-specific shot will never be required for most kids, because Pfizer is at the tail-end of clinical trials for a "pentavalent" vaccine that will combine protection against Men B with protection against the other four strains. One meningitis vaccine to rule them all, I guess you could say. 

But just as this incredible tool for possibly eliminating bacterial meningitis approaches approval, our collective will to use it seems to be waning. Since COVID, more Americans, especially those who fall on the right wing of the political spectrum, apparently believe that no vaccines should be required for school attendance — about 35%, according to a recent survey. Politicians like Hudson are tapping into that discontent with rhetoric meant to inflame emotions, rather than engender a calm discussion. 

I understand that people don't like being told what to do, especially when it comes to health care. And I would be fine with not having vaccine requirements if that still resulted in more than 90% of families voluntarily getting their shots. I'm results-oriented on this and if we can get the same or better results without any vaccine requirements, I'm all for it. But as a practical matter, we know that's not what happens. We know because studies have shown that states with weaker vaccine requirements tend to have more opt-outs and more disease outbreaks. And we know that as vaccination rates have leveled off or even fallen in recent years, diseases that we should be rid of, like measles and even polio, have come back. The practical costs of undoing vaccine requirements quite clearly outweigh the benefits, which are purely ideological. You may not like vaccine requirements, but they save lives. They're not slavery — they're freedom: freedom from disease, freedom from being tethered to a ventilator in an ICU, freedom from an early death.

Let's remember that before we make childhood vaccine requirements part of a political culture war that is already having deadly consequences.