Our friend and colleague, Art Caplan, has a new column at msnbc.com on requiring meningitis vaccines for students as he fittingly points out, Americans hate to be told what to do, but we hate losing our kids more:
Which is scarier to you - coming down with deadly bacterial meningitis or being required to get a vaccination against it? The disease itself should scare the living daylights out of you, especially if you are an adolescent or the parent of one. Yet it is the idea of mandatory vaccination that strikes fear in many.
We need to get our priorities straight when it comes to mandating or requiring vaccines. When there is a fatal disease that is easily prevented by a safe vaccine, the shot ought to win out every time over our dislike of being told what to do.
Bacterial meningitis, an infection of the fluid in the spinal cord or the tissues that surround the brain, can kill within hours. One in 10 victims dies and up to 20 percent of those who survive suffer hearing loss, deafness, brain damage, amputations or other serious complications. Around 3,000 people a year get the disease and it can kill within hours. Almost all of that is preventable with a vaccine.
Teens and young adults ages 15 to 24 are at especially high risk for bacterial meningitis since it can be spread by coughing, sneezing, kissing, sharing drinking glasses and other behaviors where people are in very close contact. College students are particularly at risk since they live in tight quarters and often have weakened immune systems due to lack of sleep.
In January 2005, the Food and Drug Administration approved a new vaccine against bacterial meningitis. The MCV4 Meningococcal Conjugate Vaccine, marketed under the name Menactra, protects against four very common bacterial strains and is longer lasting and more effective than earlier meningitis vaccines. The Centers for Disease Control recommends that everyone ages 11 to 18 should get it, as well as those headed off to live in college dorms or going into the military. But in 2006, only 12 percent of teenagers got the vaccine.
So why isn't everyone in this age group getting vaccinated? The answers are the same ones that continue to haunt vaccines - unjustified safety concerns, resistance to mandates and cost.
When Menactra first appeared, some cases of Guillain-Barre syndrome were reported. This is a serious disease in which the body's immune system attacks nerves and leads to gradual, temporary paralysis.
Those opposed to vaccination - and there are many in the United States and other countries - quickly pointed to the 20 cases that were reported as a reason not to get vaccinated. But, Guillain-Barre occurs in about one in 100,000 people in the United States. Vaccination is almost never the cause. In fact, when the 20 cases cited by vaccine critics were closely examined, none were associated with the meningitis vaccination.
23 states require shots
Today, 23 states mandate the vaccine for college freshmen.
Americans are generally leery of requiring or mandating vaccines. They value informed choice. But do you really want to leave an issue as important as vaccination left up to busy college freshmen to think about? Menectra is safe, so it's hard to know why anyone living in a dorm or close quarters would not want to get vaccinated.
And if you don't get vaccinated then you are not only putting yourself at risk but others whom you come in contact with on and off campus as well.
What is really startling is that mandating vaccines really only means strongly urging young people to get them. Most states recognize the right of anyone to refuse a vaccine on religious grounds. And even the states that have required or mandated vaccination allow someone not to do so if they sign a statement saying they have seen information about meningitis vaccine but still don't want the shot.
Getting insurance to pay
The real reason to mandate meningitis vaccine is to get it into the heads of kids and parents that this is an important thing to do and to help force government and insurance companies to pay the cost. If you don't mandate vaccines then insurers often won't pay for them. In our screwy world of health care, mandates have more to do with reimbursement then they do the police blocking access to the dorm until you show your vaccination card.
Americans do love choice. But they also hate to lose a child, a sister or a granddaughter. Sometimes choice ought to yield to common sense and evidence. We ought be doing all we can to get young people vaccinated against meningitis and to make sure that the costs of doing so are covered.