A practice that aims to prevent diseases is often up for debate.
For Lilyana Salazar, it was never about making a statement.
As a child, she rarely got sick. Nothing more than the occasional cold. Her mother, a nurse, would often deal with patients who had very contagious illnesses, but neither Lilyana’s mother nor anybody who lived in the house with her ever got seriously sick. So Lilyana’s mother decided that her daughter should not receive any non-mandatory vaccinations. In her opinion, there was no point to get vaccinated if she never got sick.
Now a biology pre-vet major in her first year at Ball State University, Lilyana is content with her mother’s decision not to give her all the recommended vaccinations as a child. She plans on doing the same with her own children when she is older.
A 2016 study by the American Academy of Pediatrics found that an increasing number of parents are choosing to not vaccinate their children because they believe vaccines are unnecessary. This conclusion differs from the trend over the last few decades, when people refused to vaccinate themselves or their children over concerns that the vaccine would weaken their immune systems or cause another disease or disorder.
The study found that the number of pediatricians who encountered parents who refuse to vaccinate their children increased more than 12 percent, from 74.5 percent in 2006 to 87 percent in 2013. The pediatricians felt a trend of overall discontentment with the effectiveness of vaccines.
Dr. Sanjay Garg, a practicing pediatrician for more than 20 years who has his own private practice near the outskirts of Ball State’s campus, believes people who choose not to vaccinate because of religious or moral conflictions inevitably put the community at risk.
Dr. Garg believes in herd immunity, which is the idea that in order for a society to avoid mass-disease outbreak, 95 percent of the community must receive any available vaccinations.
In the past, opponents of vaccinations argued that the measles-mumps-rubella (MMR) immunization was a possible cause of autism among young children. The argument arose from a now-retracted 1998 article in The Lancent, a British medical journal that dates back to 1823. The Centers for Disease Control and Prevention, the American Academy of Pediatrics (AAP), and several other top medical research institutions all published studies that found no link between the MMR vaccine and autism.
Dr. Garg was quick to point out that the study published in The Lancent only included a dozen children, which he says is never an acceptable number for a medical study. The lead author of the study, Andrew Wakefield, also had a conflict of interest, says Dr. Garg. Wakefield was paid by lawyers who were in the middle of suing producers of the MMR vaccine. He has since had his medical license revoked.
However, one year after The Lancent retracted their article, 18 percent of adults still believed vaccines could cause autism, according to The Harris Poll. A 2015 Pew Research Center study found that 9 percent of Americans believe the MMR vaccine is unsafe for healthy children. Several who believed this argued that there is no need to inject a disease into a child who is already healthy.
Dr. Garg says even a false report can have lasting damage. Some of his patients voice concerns about the MMR vaccine, which he says is administered to babies when they are 12 to 15 months old, around the same time when autism is typically identified in a child. This causes some parents to believe that the vaccine gave the child autism.
Dr. Garg also tells parents that he gives the same vaccines to his own children and the children of the people who work for him at the office, trying to prove the legitimacy of the vaccine. Dr. Garg wants his patients to know he truly believes in his practice.
Lilyana doesn’t know the exact science of vaccines, but she says she believes there is a possibility that some vaccines could cause autism. She doesn’t understand why somebody should be injected with a disease if that person is already completely healthy.
Dr. Garg says the component of the disease in any vaccine cannot cause that particular disease and is a necessary component of the vaccine because the component is transported by white blood cells to the body’s lymph nodes, where the disease’s antibodies are made.
Dr. Garg believes parents are getting false information from the internet. He sees the internet as a source of unregulated information, some good and some bad.
Parents try to show Dr. Garg opinionated articles they found on Facebook that possess little to no scientific facts. Dr. Garg says Facebook is a bane of his existence. Younger generations have yet to experience a true outbreak, he says, so they might not understand the necessity of vaccinations.
Indiana, along with 46 other states, allows children to attend public schools without receiving required immunizations if a parent fills out a religious exemption form. The form, which requires a physician’s approval, allows a child to bypass a smallpox, polio, measles, and anthrax vaccines, among others. Eighteen states outside of Indiana also allow a similar exemption for non-religious beliefs, such as moral or philosophical differences.
All 50 states allow medical exemptions if a child’s body can’t handle the vaccine. More than 1 percent of kindergarten and sixth-grade students used one of these exemptions during the 2014-2015 school year in Indiana, according to the Indiana Department of Health, with about two-thirds of those students using the state’s religious exemption form.
Dr. Garg doesn’t agree with any non-medical exemption for vaccines and does not sign any forms of such nature. He says it is his practice’s policy to not accept any patient whose guardian will not approve a vaccination for his or her child, a policy which he says is common in most pediatric centers in Muncie.
According to the AAP, any non-medical vaccine exemption creates unnecessary risk to society, especially to those who can’t receive the vaccine for medical reasons and rely on community immunity to lower their chances of catching a disease. Regular immunizations among children born in 2009 will prevent 42,000 premature deaths and 20 million cases of disease among that group of people.
Gardasil is the first vaccine developed to prevent human papillomavirus (HPV), which causes cervical cancer and different types of genital warts. According to the CDC, HPV is the most commonly transmitted sexual disease, with more than 5 percent of the nation’s population infected with the disease. After HPV is transmitted from one person to another, there is no cure. Nearly 70 percent of cervical cancer cases and 90 percent of genital warts cases are linked to a strain of HPV, according to the National Conference of State Legislatures.
As of 2017, only Rhode Island, Virginia, and Washington, D.C. require Gardasil vaccines for their citizens. Dr. Garg thinks the vaccine should be mandatory everywhere because it has led to a statistically significant decline in cervical cancer patients.
In 2015, after a bill failed in Indiana that would have set a goal for 80 percent of Indiana teens to receive all three of the HPV shots by 2019, Vice President Mike Pence said receiving the vaccination should be up to the parents.
Dr. Garg says some people believe a vaccination for an STD would promote underage sex, an allegation he calls “absolutely untrue.”
He believes teenagers are going to engage in sexual activity either way, so it’s better that they’re vaccinated.
The Indiana House of Representatives passed a bill in early July adding meningitis to the list of required vaccinations, joining the 35 other states to do so. Recipients of this required vaccine include all attendees of public schools and state colleges. Meningitis is one of the many immunizations offered at Ball State’s health center.
Dr. Garg gives the meningitis vaccine to all of his patients, as well every other vaccine required to attend public school. He also offers any vaccine recommended for children by the AAP, including Gardasil and the latest flu shot.
Governor Eric Holcomb signed a bill into law this year that increased the number of vaccines that can be administered by registered pharmacists. Senate Bill 51, which took effect in July, adds the MMR, bacterial influenza, chicken pox, and hepatitis A and B vaccines to the list of available immunizations at pharmacies. The state of Indiana also keeps a database on all vaccinations for all citizens per the consent of the patient. The database, called ‘MyVaxIndiana,’ is meant to provide accurate records for medical officials during treatment. A patient can opt out of the database by notifying his or her pharmacist. Patients can access their own database or the database of their children by going to the database’s website.
Lilyana never plans on promoting vaccine-choice to any of her friends or peers. She believes that vaccine-choice, like other issues, is each person’s business that should be respected and understood.