Fear Shouldn't Drive Policy: CHOP Expert Offers Vaccine Commentary

Noting “vaccine-preventable diseases remain a significant threat to children’s health,” in a recent editorial The Children’s Hospital of Philadelphia’s Kristen A. Feemster, MD, MPH, MSHP, calls for “ongoing vigilance.” Dr. Feemster’s editorial, which was published recently in JAMA Pediatrics, reviews vaccines’ successes while also pointing out that exemption laws and increasing vaccine hesitancy mean “the success of vaccines can be fragile.”

Dr. Feemster’s article follows the publication of a study — also in JAMA Pediatrics — showing the effect the introduction of a new vaccine had on invasive pneumococcal disease (IPD). A team of researchers led by the New York City Department of Health’s Andrea C. Farnham, MPH, evaluated the effect the 13-valent pneumococcal conjugate vaccine (PCV13) — which was introduced in 2010 and contains 6 more serotypes than the previous pneumococcal vaccine (PCV7) — had on IPD rates in a population of children younger than five years of age.

The researchers showed the vaccine decreased IPD incidence by 69.6 percent, from 21 cases per 100,000 to 6.4 cases per 100,000. Pneumococcal infection can cause a variety of conditions, from the routine (as in ear infections) to serious conditions like meningitis.

No stranger to weighing in on contentious topics, Dr. Feemster recently contributed a The New York Times opinion piece arguing for an end to philosophical and religious exemptions to school entry vaccine requirements. She also wrote about the need to balance religious freedom and responsibility to one’s community, writing that “society has an obligation to stand up on behalf of children who do not yet have their own informed voice.” Dr. Feemster is currently an attending physician in the Division of Infectious Diseases, a PolicyLab faculty member, and the Vaccine Education Center’s director of research.

Dr. Feemster’s JAMA Pediatrics article comes on the heels of a measles resurgence, with 169 people across the country reported to have the disease between January 1 and May 1, 2015, according to the CDC. In a press briefing about the measles outbreaks, the CDC’s Anne Schuchat, MD, noted most of the people who have been reported to have measles had not been vaccinated. “This is not a problem with the measles vaccine not working,” Dr. Schuchat said. “This is a problem of the measles vaccine not being used.”

Dr. Feemster’s editorial echoes this, as she notes “events show us that the success of vaccines can be fragile; the measles cases associated with Disneyland were preceded by 644 cases in 2014. In 2012, there were more than 40,000 cases of pertussis, the largest number since 1960. These events have garnered media attention and provide a dramatic reminder that vaccines remain an important and necessary health tool.”

“Fear has led to hesitancy and is now influencing the push to make it more difficult to refuse vaccination. Fear should not be driving policy,” Dr. Feemster notes in her JAMA Pediatrics editorial. “Instead, a real-time example of the effect of a successful immunization program should move us to continue to advocate for strong vaccine policies that support uptake of all routinely recommended vaccines.”

To read more, see the May issue of JAMA Pediatrics.