The immunization discussion: Combating privilege, entitlement and ignorance

Issue: June 2015

ByWilliam T. Gerson, MD

“This boy is Ignorance and this girl is Want. Beware them both, and all of their degree, but most of all beware this boy for on his brow I see that written which is Doom, unless the writing be erased. Deny it,” cried the Spirit, stretching out its hand towards the city. “Slander those who tell it ye. Admit it for your factious purposes, and make it worse. And abide the end.”

— Charles Dickens,“A Christmas Carol,” 1843

And you cannot be trusted

Do you even know you are lying?

It’s dangerous to kid yourself

You go deaf, dumb, and blind

You take with such entitlement

You give bad attitude

You have No grace

No empathy

No gratitude

You have no sense of consequence

Oh, my head is in my hands

Bad Dreams are good/

So who will come to save the day?

Mighty Mouse. . . ? Superman. . . ?

Bad Dreams are good

In the Great Plan

In the dark

A shining ray

I heard a three-year-old boy say

Bad Dreams are good

In the Great Plan

— Joni Mitchell “Bad Dreams Are Good,” The New Yorker, Sept. 17, 2007

**Dickens’ allegory, more accessible and perhaps universal than Franklin D. Roosevelt’s “Four Freedoms” of which I have recently written, is so clearly focused on the fate of children that its timeless take on ignorance and want should continue to humble child advocates. Dickens’ prescient censure of those in power for their use of ignorance to intimidate, or worse, to manipulate for their own gain and toward the harm of children is darkly sobering to reread today, nearly 2 centuries since its first publication.**

Vaccination

Some readers might have a false impression about Vermont: Healthy, progressive and safe. You might even have received such a message from our travel industry. However, as the ongoing national measles resurgence reinforces, we have a dark side — an attribute that is unfortunately shared with much of the rest of the country except, interestingly enough, Mississippi. We simply do not adequately vaccinate our children. Worse, our political leadership, including public health officials, are often complicit in this dangerous act and, in doing so, place our children at unnecessary risk.

William T. Gerson

I’m not sure about bad dreams being good nor even about a great plan. To be completely honest, I don’t even know about Joni Mitchell. I was only recently able to listen to her again after a sensory overload many decades ago courtesy of James Meier: a Californian, college roommate, Mitchell fan and noble soul. However, I do know the peril of privilege and entitlement particularly when complemented by ignorance. We all see it in daily practice, even here in bucolic Vermont. The resulting outcome is surely more dangerous than a bad dream and if there is a great plan, it is a devious one whose origins lie in ignorance, fear and greed.

Our role

One of my roles as a general pediatrician is an educator — to both patients and families. From infant feeding, sleep position, circumcision to medication use, risk analysis plays a large part in these conversations, as it does, in part, in conversations about immunizations. The immunization discussion, whether in our office space or in the public forum, is obviously much broader than mere risk, and often can go in directions unexpected.

I have no difficulty appreciating that families have a misunderstanding about risk — we all do. I also do not take umbrage at a lack of scientific understanding; I attach that to a more global failure of our education system. It is the reckless mixture of risk, fear and anxiety that tortures me. Suspicion of government, the press, pharmaceutical companies and even scientific reasoning so complicates the debate that it often defeats attempts at communication. This is of course a tragedy, for communication is the lingua franca of pediatric practice.

At its heart, our office immunization discussions attempt to focus the issue on the patient. Most often it is an infant and its intrinsic vulnerabilities. However, it extends to the well-being of young adults and often requires pediatricians to assist parents in understanding the health risks of adult behaviors and the parents’ inability to control their child’s exposure to risk. It also quite correctly includes themes of social responsibility.

Intimidating ignorance

Intruding into these office conversations is Ignorance: often innocent, unusually malignant and rarely but painfully intimidating. The odds ratio likely reverses in the public sector debate. Uneducated is not really ignorance. As Karl Popper has said, “True ignorance is not the absence of knowledge, but the refusal to acquire it.” The most annoying of ignorance is this species and its intimidating cousin is the realm of zealots and the self-aggrandizing.

Ignorance, in and of itself, may not spell doom, but intimidating ignorance surely is apocalyptic. Privilege combined with ignorance is a heady brew as intoxicating and insular as a mind-altering drug and perhaps as dangerous. Praying on fear, on mistruths, and on incomplete understanding, those behind the intimidation need to be called out and exposed for what they are and for how they profit on the lives of innocents.

Dickens is correct in identifying ignorance as more dangerous than want, but who would think that we are not far removed from the 19th century image of Ignorance and Want under the robe of the Ghost of Christmas Present. Worse that we continue to be victimized by the deniers, the slanderers and the portrayers of the factitious.

Who will save the day? The robes of the spirit of Christmas could transform into a modern superhero — or the pediatrician could become the new hero. For just as Scrooge asked whose children are Ignorance and Want, the Spirit’s answer is as true today — “They are Man’s,” and man’s to solve.

Dickens’ storyline ended in redemption, but will our own? My hope would be that the 3-year-old in Mitchell’s poetry is eventually proved correct and a shining ray enables a bad dream to be good in the great plan.

For more information:

William T. Gerson, MD, is Clinical Professor of Pediatrics at the University of Vermont College of Medicine and a member of the Infectious Diseases in Children Editorial Board. He can be reached at 52 Timber Lane, S. Burlington, VT 05403; email: William.Gerson@uvm.edu.

Disclosure: Gerson reports no relevant financial disclosures.