Imagine that you’re watching a friend or loved one get vaccinated for rabies. You want to encourage your friend or loved one to get vaccinated, but you can’t help but notice that his energy level seems low.
Your friend gives you a look, as if to say, “I wasn’t expecting this to happen.”
Your friend is undergoing a rabies vaccine because your doctor told him it was important for him to get vaccinated.
Is this friend feeling under the weather? Are you seeing results in any way? Maybe your friend is resting. Or maybe he’s forgetting that day’s lessons in school.
If a doctor treats you for low energy, does that give you the right to understate the amount of energy you see in your friend’s face?
These may be questions new health policy experts are asking themselves right now, as some federal health advisors are voicing serious concerns about the potential overuse of vaccines. The Food and Drug Administration and Centers for Disease Control and Prevention also could weigh in on the issue.
A story by David A. Fahrenthold in The Washington Post’s “Wonkblog” recently raised serious questions about why America is on track to vaccinate more kids this year than we ever have before. The study found that 9 in 10 kids under the age of 10 have received at least one dose of the MMR vaccine, the standard recommended shot for measles, mumps and rubella. (Kids ages 2 to 6 are eligible for another vaccination.)
Fahrenthold also found that more than 40 percent of children receive multiple doses of MMR vaccine at roughly the same time. He notes that the rationale for multiple MMR doses is that they are needed to kill some of the harmful bacteria and viruses that aren’t being killed by the first two doses.
It’s hard to argue with the idea that multiple MMR vaccines are the right way to go. According to the CDC, MMR vaccine protects about 99 percent of those who get it, and a single dose only protects about 10 percent. There have been “no reported severe side effects or deaths among adults or children receiving three doses of MMR vaccine” between 1994 and 2007, according to the agency. Plus, every person who received a single dose of MMR was protected against measles, mumps and rubella.
There’s just one little problem: How are we going to keep track of all of the vaccines we’re going to administer?
To answer this question, doctors rely on separate records for different vaccinations, each of which may have different physicians. A single primary doctor could track a person’s medical history in this way, and also must report if his or her patient develops the flu.
Doctors receive standardized medical records from states. These records come in annual reports that report the performance of all patients that had any medical treatment at any given time. In May, the federal Center for Medicare and Medicaid Services released data showing that the performance of the nation’s primary doctors declined over a three-year period, through 2015. There were seven percent fewer doctors who were rated “excellent” or “good” in 2015, compared with 2010.
You could argue that this federal push for vaccination is already showing up in medical records. Children with medical histories of ADHD, rheumatoid arthritis and type 1 diabetes have been recognized as having higher education levels and higher incomes. So doctors are likely already overreporting these diagnoses to raise their potential Medicare and Medicaid payments.
Efforts like these are nice, but can they really be measured?
“These sorts of catch-all data are useful to identify groups who are at risk, but we really need to think about patterns in vaccine dosing,” said Dana Sugerman, associate professor of pediatrics at Tufts Medical Center in Boston.
She notes that the research in this area, while much deeper, still isn’t completely conclusive. And there are limits to that research. One study didn’t involve screening kids for dietary intake of a particular vitamin, and another study wasn’t large enough to show an actual effect of vaccination.
More research is needed, Sugerman said. For example, more research needs to be done to see if repeated vaccinations are actually a good thing. Researchers are also still looking at whether vaccinating people who had suffered some loss of immune function, or a low immune function, would be a good idea.
Given all of these uncertainties, Sugerman questions the push for routine vaccinations. If one child’s immune system isn’t at