There is a voluminous amount of information describing the risks of vaccinations that really has no consistent evidence based support. There is a myriad of shock and awe anecdotal correlates of how lifelong debilitating disorders are connected to childhood vaccines.  The word is “heard.”  So and so heard it causes…, and they told two friends, who read and said and more and more heard that there is no need to vaccinate children or those at greatest risk of contracting some of the most deadly and communicable diseases.  Those are the diseases that killed millions, with real data supporting the prevention of spreading the same diseases and saving many more lives through vaccine programs.  Meanwhile, thousands of people are dying yearly who are not fortunate enough to receive vaccinations, but would line up with their families for the opportunity if available.  What a shame it is.

“The number of measles cases from the outbreak linked to Disneyland has now risen to at least 98. But measles remains extremely rare in the United States.  The rest of the world hasn't been so fortunate. Last year roughly 250,000 people came down with measles; more than half of them died.”  Measles Is A Killer: It Took 145,000 Lives Worldwide Last YearJason Beaubien, NPR Goats and Soda, Jan. 30, 2015.  Some of the most educated folks in this country, and many with resources, proactively and emphatically refuse to vaccinate their children or others who may be at greatest risk for contracting life threatening illnesses.  I decided to jump off the “to vaccinate or not to vaccinate” precipice in blogging, knowing that the landing could result in some long lasting sore spots. However, I was not pushed off the cliff. I jumped willingly.  The shared insight by two separate groups of public health experts both nationally and locally who voiced deeply rooted concerns about what could become a global calamity lasting for decades made it easy to leap.  Both groups noted that maybe it was necessary for a large scale epidemic outbreak to occur as the only way to get enough attention to make a real difference soon enough. This instilled a dire need for me to be more proactive and vociferous in support of more rigid vaccination legislation. I have reflected on distant interpersonal encounters and current challenges in my clinical practice involving the unvaccinated.

As a medical student, I was very grateful for the friendships I had with several neighbors, as a part of my support network, in a close knit Boston neighborhood.  There, I had discussions with several families who chose not to vaccinate, regardless of what information was available to them. But, and I watched it happen, when people experienced personal crises or felt threatened, they changed their mantras on a dime.   One neighbor, a mother with a six year old, had methodically crossed all the t’s to assure that her child could attend school without being vaccinated.  The child was delightful and has since grown up to be an equally wonderful woman.  However, it was a very different maternal mindset when her daughter was bitten by their pet rat.   There would be no tetanus vaccine or immunoglobulin, despite her daughter’s swollen rat-bitten hand.  I have nothing against rodents, but the focus is on the vaccine issue.  Once her daughter started getting very sick, the mom was horrified.  It was time for antibiotics and to start vaccinating her child.  She realized that she was creating unnecessary risk for her child, depriving her of clearly effective vaccines that could keep her life intact, as she continued to thrive and experience the world. This, too, was the case for the family with a one year old who became very sick very quickly, requiring invasive tests and admission to the ICU.  They also became pro-vaccination converts.   Since then, for more than 20 years, I have continued to encounter more children and adults in the ER who have never been vaccinated.  When they present appearing ill and febrile, what would be considered simple complaints warranting straight forward evaluations become complicated workups. It is simply turning back the clock on medicine, upping the ante for epidemic outbreaks of diseases that are preventable. "'Vaccines have made these diseases rare,' Zikmund-Fisher added. But some – namely whooping cough and measles – have re-emerged as people stopped vaccinating against them.  The number of measles cases this year in the U.S. – 600, according to the Centers for Disease Control and Prevention – is the highest in two decades, and in 2012, there were 50,000 cases of whooping cough, with 20 deaths. 'It’s not going to take much more before we see these diseases everywhere.'”  Brian Zikmund-Fisher quoted in To Vaccinate or Not to Vaccinate? US News and World Report, Kristine Krane, Sep.10, 2014.

As health care providers and those who should support the lessons of the past, we should also give accolades to Governor Jerry Brown and others who adopt similar means to assure the public health of our children and the planet through necessarily aligned public health legislation “California’s weakened public health defenses against measles and other preventable diseases led to the adoption of the measure, signed Tuesday by Gov. Jerry Brown, intended to stem the rising number of parents who opt not to inoculate their children.”  California Gov. Jerry Brown signs new vaccination law, one of nation’s toughest. LA Times, Phill Willon and Melanie Mason, June 30, 2015.

With larger numbers of those who have no respect or accurate understanding of the historical record of the epidemiology of diseases, legislation should be consistent throughout the country, to prevent the poor and risky decisions of those who simply just don’t get it from being able to infect or kill thousands of people.  Maybe we should consider donations to send vaccination contrarians and their unvaccinated families to other parts of the world to witness those sick and dying from illnesses that the contrarians generally only have some awareness of because they “heard” about it, and see how many takers there may be.

Regards and somewhat apologetically,

Lukas Kolm, MD, MPH


Keep banging the drum Lukas.  You speak for most of us.


Thanks for "jumping", Lukas. Grate column for some, great for others.


I have always felt that physicians have more than a moral obligation to oppose quackery, pseudo-scientific medicine and health fads. I believe that our licensing from the state obligates us to be guardians of the public health. This is true when individuals make life decisions that impact their own health directly and the social cost of medicine indirectly. The argument is even more compelling when these life choices put their children as well as the general population at risk. There has been a painstakingly slow history of the curtailment of "individual freedom" for the public good. Seat belts, motorcycle helmets, sexually transmitted infections reporting, neonatal blood screening are among many. For years scientific medicine in the United States has been sensitive to criticism that opposition to quackery was self-serving; it is hard to justify such reticence on the childhood immunization issue. In my mind this is a clear example of social obligation trumping an individual's right to be misinformed.