Vaccination hesitancy: A different take on the ‘anti-vaxxer’ outrage

Outbreaks of preventable illnesses such as measles and the flu have stoked the ongoing battle between vaccination advocates and “anti-vaxxers,” a nasty term for people who do not believe in vaccination.

But when looking at the history of vaccination information in the U.S., it is understandable that a parent might have concerns. Misinformation has run rampant for decades. In the 1990s, Andrew Wakefield published a paper and video suggesting that vaccines might cause autism. The article was not scientifically sound and was proven false. Wakefield lost his medical license, but the damage had already been done.

Today, celebrities and concerned parents spread misinformation about vaccines online. A growing number of doctors are signing medical exemptions for childhood vaccinations. In Dallas County, the rate of students with conscientious exemptions more than doubled from 0.35 percent to 0.74 percent between 2011 and 2018. As a result, unvaccinated children and the people around them are exposed to otherwise controllable diseases.

The World Health Organization has identified limited access, inconvenience, and lack of confidence in doctors as the leading reasons for “vaccine hesitancy,” or concerns about vaccination. In our practice, the health of women and babies is our utmost concern. As such, it is important for us to provide convenient access to vaccinations during prenatal visits and respond to our patients’ questions and concerns about vaccines in a nonjudgmental way.

Related reading: Beyond healthy babies: Why we discuss vaccines, maternal health during pregnancy

Two vaccines moms sometimes worry about

Mothers-to-be often ask us questions about two vaccines we recommend during pregnancy: the flu shot and the Tdap vaccine for tetanus, diphtheria, and pertussis (whooping cough). These vaccinations require unique considerations because the benefits for babies and moms are slightly different but equally important.

Flu shot

During the 2017-2018 flu season, 900,000 people were hospitalized for influenza, and of these, 80,000 died. To put that number in perspective, imagine that 70 percent of the population of Richardson, TX, just vanished. Of the children who died from the flu, 80 percent had not received a flu shot.

Infants cannot be vaccinated against the flu until they are 6 months old, so caregivers and family members should get the flu shot to protect babies from infection. It can protect infants from the flu and severe symptoms such as dehydration, loss of appetite, and fever-induced seizures.

There’s another important reason for women to get vaccinated for flu. Because of changes in the immune system, pregnant women with the flu often develop more serious cases of the illness, requiring hospitalization and intensive care admission more often than non-pregnant women. And when this happens, pregnancy complications increase, including premature delivery and stillbirth. Still, only about 60 percent of pregnant women get the flu shot.

Women who are vaccine-hesitant might be concerned that the shot will make them sick. While a flu shot might cause mild cold symptoms, it will not infect a patient with the flu. In fact, expecting mothers who get vaccinated but still develop the flu are likely to have a less-severe infection than if they hadn’t gotten the shot. Being healthy allows moms to more easily care for their babies, so it is a win-win.

Tdap for pertussis (whooping cough)

While the flu vaccine protects the mother first and the baby by proxy, getting a Tdap vaccine with each pregnancy is really meant to protect the infant with regards to pertussis, or whooping cough. The condition typically causes minimal symptoms and presents little risk to adults but can be fatal in infants. The recommendation for non-pregnant adults is one shot every 10 years. But your immune system produces more antibodies when you get the immunization – the antibodies are then passed on to your infant.

Whooping cough resembles a cold in its early stages but turns into a persistent, severe cough accompanied by a whooping sound. In 2017, nearly 19,000 people in the U.S. reportedly were diagnosed with whooping cough, including 1,545 infants younger than 6 months old – and 43 percent of these babies were hospitalized.   

Pertussis is a year-round concern, not a seasonal ailment like the flu. We recommend that all pregnant women get the Tdap vaccine in the third trimester of pregnancy to provide the most benefit to the baby. When pregnant women get the Tdap vaccine, antibodies pass from the mother to the fetus and help protect the baby after delivery. At 2 months old, babies should get the first of five doses of the pertussis vaccine; the series should be completed by age 6.

The same as with the flu shot, it’s important for people who are around the baby to also get vaccinated for whooping cough. A Tdap booster is safe, so if a friend or family member can’t remember when he or she got the shot, we recommend getting another vaccination. 

A few closing thoughts

Today’s vaccines are safer than they’ve ever been. The Food and Drug Administration requires rigorous long-term testing before a vaccine can be licensed for use, and chemicals such as thimerosal that were mistakenly linked with autism in the past have been removed. 

The ugliness of the “anti-vaxxer” debates online have made some expecting mothers leery of discussing vaccination with their doctors. But I encourage my patients and my colleagues to be honest and acknowledge that questions exist because there is a lot of misinformation that patients must wade through. Establishing and nurturing a collaborative care environment can go a long way toward helping women make the healthiest choices for themselves and their babies.

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