For most of the past fifty-odd years, I’ve moved through life with the smugness of someone who has an inner superhero on call. I mean my immune system, which demonstrated its superiority early in my life by allowing me to skip the then-common childhood experiences of measles, mumps, chicken pox, and rubella (then commonly known as “German measles”).
Then came the anti-vaccination movement. Over the past ten years, mounting headlines slowly began to dislodge that perhaps-delusional sense of confidence in herd immunity: the toddler who died of measles in Berlin in 2015, a great-nephew hospitalized for severe complications of chicken pox in 2018. Spring 2019 saw mumps outbreaks at three Philadelphia universities, a measles outbreak in Brooklyn’s Orthodox Jewish community, and measles cases in San Francisco. These are all cities I visit with some regularity. The Centers for Disease Control shows that the number of measles cases in the United States quadrupled in 2019 to 1,261. As a percentage of nearly 400 million people it’s infinitesimal, but it only takes one person to infect a planeload.
In October 2019, measles began rampaging in Samoa. Two months later, there have been nearly 4,000 cases and sixty deaths, mainly of children under four, and the disease is spreading to nearby Fiji. The government has declared a state of emergency, closed the schools, canceled Christmas celebrations and public gatherings, and is sending medical squads door to door with vaccines. However, the drop in Samoa’s vaccination levels is understandable, considering in 2018 two children died when their vaccines were incorrectly prepared. It’s less easy to understand why an educated person in a Western country would take this risk. And yet the WHO lists “vaccine hesitancy” as one of the top ten public health threats worldwide and has counted 413,308 cases of measles in 2019 through November.
Either way, the result is the same: outbreaks of a highly infectious but entirely preventable disease that soak up resources. A 2018 paper in JAMA Pediatrics estimated that containing the 2013 New York outbreak of fifty-eight cases cost the city $394,448 in direct costs and 10,354 personnel hours. A 2016 study of the 2012–2013 U.K. outbreak in the northern English county of Merseyside put the cost of containing that outbreak, which saw nearly 2,500 people infected, at £1.8 million in public health costs and £2 million in lost productivity. The cost of the extra 11,793 MMR vaccinations needed to achieve herd immunity? £182,909. Little surprise that the United Kingdom has begun debating whether to make vaccination mandatory as a condition of attending school; in 2019, the WHO withdrew the United Kingdom’s measles-free status.
Estimates such as these do not include opportunity costs. The 2017 measles outbreak in Minnesota cost the state $1 million to contain and far more in public education and community outreach. The opportunity costs in resources that could be spent on our other mounting public health problems are incalculable.
And so it was that in July I presented myself at the GP’s surgery (as they call doctors’ offices here) and said I should probably get the MMR vaccine. The nurse was willing but skeptical. “You probably just don’t remember having them,” she said. Both the National Health Service and the WHO assume that if you were born before 1957 you had them. I was born in 1954.
“That’s right,” I said. “I don’t remember having them. But I do remember my mother asking me, ‘Were you close to them?’ every time a note came home from school saying that someone had developed one of them and a reminder of the incubation period and early symptoms.”
I couldn’t help feeling being vaccinated was a terrible insult to my inner superhero. On the other hand, I didn’t want to die of measles at eighty-seven feeling really, really stupid. So I did the thing. Two days after the first shot, a friend I’d gone to the theater with a week before emailed to say she had mumps, one of a cluster of cases in Dalston, north London. Eek. She’d been vaccinated as a child so had a very mild case.
Younger friends ask things such as, “You weren’t vaccinated when you were a kid?” You have to explain that no, the vaccines weren’t available before the mid-1960s. I actually do think I remember receiving an early version of the measles vaccine, because one of my father’s best friends worked with the WHO.
But then you wonder: How many unprotected adults are floating around? I now think it’s unfortunate that all the push for MMR is aimed at children. The story of Ethan Lindberger, who discovered at eighteen that his parents had never gotten him vaccinated, leads me to speculate that there is a growing tranche of adults who have never been vaccinated, some of whom won’t know they’re at risk or how serious that risk is. The folk knowledge of how much more dangerous these diseases are for adults has faded enormously since I was a child, when everyone knew.
Judging from my random conversations, many people don’t realize that adults can get the MMR, and even fewer realize that some really should. The good news is that older adults are more likely to remember what those diseases are like and will be a lot more persuadable than your 20-something friend who’s convinced that vaccinating their children is just too big a risk.