With one of the lowest MMR vaccination rates in the country, Maine has many people who are fearful of vaccines. But their fear is misplaced.  
Some fear vaccines cause autism. Not only has it been scientifically proven that vaccines do not cause autism, in fact, the MMR vaccine helps prevent autism. Pregnant women who are infected by rubella (the “R” in MMR) often bear children with congenital disorders such as deafness, heart problems, and autism. It’s estimated that MMR vaccinations have prevented hundreds to thousands of cases of rubella-associated autism.  
Some harbor fears that can be neither proven nor disproven, such as overloading their children’s systems with too many vaccines, harming their children due to the chemical content of vaccines, or their children being too young to handle the vaccines. More education would help health care providers, parents, and parents-to-be appreciate what is at stake. 
We forget that the MMR vaccine is very safe and that the risks of MMR vaccine pale in contrast to the risk of acquiring any one of the diseases it prevents. Some will experience mild short-term side-effects, like arm soreness and low-grade fever. The most significant serious risk is an allergic reaction, which occurs rarely (1 in a million) and can be managed.  
We don’t remember what it was like before widespread vaccinations. Before immunization, each year measles caused 48,000 hospitalizations, 1,000 permanent disabilities, and 500 deaths; mumps caused over 10,000 cases of meningitis (swelling around the brain), some resulting in death; rubella caused thousands of fetal and infant deaths.  
Today there are more people with weakened immune systems who would face devastating consequences from a measles, mumps, or rubella outbreak. These include infants and pregnant women and people whose immune systems are weakened by cancer, chemotherapy, steroids, organ transplantation, bone marrow transplantation, disease-modifying treatments for auto-immune diseases (e.g., rheumatoid arthritis, MS, Crohn’s disease) or have HIV. For example, cancer patients who are infected with measles have a high mortality rate (70 percent). The very old and those with multiple chronic diseases are also more likely to have serious consequences from infection. Many people cannot be immunized themselves (notably, infants under one, pregnant women, people with leukemia, lymphoma, a bone-marrow transplant, or on chemotherapy or high-dose steroids), placing them in double jeopardy. 
We’ve forgotten what’s at stake because widespread immunization has greatly reduced the likelihood of infection. The more people who are vaccinated, the less likely infection will spread (the herd effect). But when people perceive no risk of infection, they see no benefit from vaccination and any vaccine-associated risks seem unjustifiable. Parents who forego vaccinations rely on the protection conferred by everyone else getting vaccinated to protect their child from infection, becoming a “free-rider”. But when there are too many unvaccinated, the herd effect breaks down and infection can spread quickly among the unvaccinated, as is now happening in Maine. Ironically, parents who believe they are removing their child from risk by refusing vaccinations are actually placing their child on the front-line of the battle, because the unvaccinated are the first to suffer. But those paying the greatest price, perhaps with their lives, are those who cannot be vaccinated.  
The health of a child can change at any moment, raising the stakes even higher for unvaccinated children who develop diseases that increase their vulnerability to infection.  
Because vaccinated people protect not only themselves but the unvaccinated, the rationale for vaccinations should be reframed to emphasize the benefits and risks that accrue to the child as well as the community. Vaccinations should be required unless a physician deems it unsafe for the child (medical exception). These complex medical decisions about who should or should not be vaccinated should only be made by licensed Maine medical prescribers who complete mandatory training on vaccines, with oversight by licensing authorities to avoid bogus medical exemptions. Provider training should include pointers on how to effectively communicate the risks and benefits of vaccinations to patients. Public health outreach replacing fear with compassion will be essential. 
Dr. Nananda F. Col is the founder and principal of Shared Decision Making Resources of Georgetown. 

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