Robert Issenman is a physician in pediatric gastroenterology at McMaster Children’s Hospital and a professor of pediatrics specializing in gastroenterology and nutrition at McMaster University.
What Robert F. Kennedy Jr. doesn’t know about measles could fill 1,000 small coffins.
Prior to the development of the measles vaccine (its first public approval in the U.S. was in 1963), every year around 50,000 people were hospitalized and between 400 and 500 Americans died from the virus. These figures are from a time the Canadian and U.S. populations were approximately half the size they are now.
Measles is relatively easily diagnosed. All you have to do is look for the sickest-looking child in the emergency-department waiting room. With her red eyes, harsh cough and a high fever, she is absolutely miserable and possibly on the verge of a febrile convulsion. Telltale white spots on the inner cheek confirm the diagnosis for which there is no effective treatment. Wait a week or so and you could be seeing a dozen more cases – perhaps the same people who were waiting in that emergency department to be seen for other reasons. Since it is airborne, measles is superinfectious – more infectious than chicken pox, COVID or the Ebola virus.
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As miserable as it is, the kids who only suffer from a cough and fever are luckier than the ones who develop pneumonia or measles encephalitis. I will never forget the howl of a child with measles encephalitis, wailing throughout the night on a dark pediatric ward during my training – before the development of the measles vaccine.
Something you hear from the Archie Bunker generation is, “I had measles and it was no big deal.” This “all-I-know-is” sentiment is expressed by people who think the experiences they’ve had in their own lives can simply be extrapolated and applied to the world at large. The probability of getting hit by lightning is about one in 15,000, while the probability of dying from measles is one in 500-1,000. A minority of children will have a reaction to measles immunization, consisting of a sore arm or fever. One reaction that the measles vaccine certainly doesn’t cause is autism, a theory propagated by a now-discredited British doctor 28 years ago. However, the damage done by this unfounded conjecture is incalculable.
The probability of a child dying of measles is zero if they get immunized. The U.S. accepts that the deaths by gun violence of 2,500 children and teens per year is part of the price to be paid for the freedom to carry military-grade weapons. So to some Americans, the deaths of 1,000 children a year from measles could be seen as an expression of personal liberty. The rest of the world has looked at these statistics and kept expecting Americans to come to their senses. Then along came Donald Trump.
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Mr. Trump picked RFK Jr. to head the Department of Health and Human Services, despite Mr. Kennedy’s vocal anti-vaccine attitude. In assuming the mantle of chief health officer for the United States, he now says vaccination is important, but also a matter of parental choice.
The prevention of measles depends on herd immunity, which requires at least 90 per cent of individuals in a given group to be vaccinated in order to prevent viral spread. This differs from RFK’s “heard immunity,” as in, “I heard that Vitamin A prevents you from getting measles.” The truth differs from what RFK thinks he heard. The real story is that measles was once a leading cause of diarrheal death in children in underdeveloped countries. These obscene death rates were mitigated by giving Vitamin A and zinc supplements in response to malnutrition, which affects the immune system’s ability to deal with measles, in concert with vaccination. The key concept here is “in concert with,” as vitamins are not an outright replacement for vaccines – in fact, big doses of Vitamin A don’t do anything good and megadoses might give you cerebral edema (brain swelling). This is another example of the expression “While a little is good for you, a lot is not.”
Vaccination left to personal choice isn’t sound public-health policy. If the vast majority of parents don’t get their children immunized, you start to see the beginnings of epidemics as we have witnessed in west Texas and in Ontario’s Niagara Peninsula.
These life-and-death decisions should be made according to good science. RFK Jr. may think that “scientist” is a debatable designation, but scientists are the folks who understand facts – the way things actually work in the physical universe, not the way we would like them to work (that is the realm of wishing, hoping and praying). “Hopes and prayers” were pretty much all humans had before we learned how to harness the power of science, and to think logically. If RFK Jr. wishes to return to that bygone era, we should all start praying.