X Minus One for vaccination

Yesterday was a bit of a rough patch; so today there won’t be the usual Orac magnum opus to which you’ve all become accustomed. Instead, maybe I’ll do a briefer post with semi-random thoughts. Of course, even Orac’s shorter posts are longer than the average blog post; so you’re still getting your money’s worth. Oh, wait. The blog is free. Never mind.

First up, as I’ve mentioned before, over the last couple of years, I’ve gotten into old time radio through Radio Classics. The other day, I happened to be listening to an episode of the 1950s science fiction radio show X Minus One. The specific episode was based on a story by Robert Scheckley, The Native Problem. The story was a rather straightforward story about a future misfit who decides he couldn’t live in civilization anymore and had himself marooned on an uninhabited planet. Later, a group of colonists arrives. The central misunderstanding in the story is that the colonists won’t believe that the protagonist is not a native of the planet, and they fear he represents thousands of natives who will attack.

What attracted my attention, though, wasn’t so much the story, which, while amusing and entertaining, wasn’t anything out of the ordinary or particularly memorable. Rather, it was a public service announcement right in the middle of the story. I’ll give a little context here and point out that this episode aired in 1957. The audio is here, and the PSA starts around the 7:03 mark:

Friends, for as many years as any of us can remember, the sadness that polio has brought to so many homes has been almost unparalleled. But a greater sadness than this lies ahead for any who from now on catch polio: Because it may be due to carelessness. Vaccination against polio, the well-known Salk shots, is more than 75% effective. And it’s due to such vaccination that there was a drop of 47% in polio cases last year. But this year, vaccination has been lagging. There are 108 million persons under 40, and of these only 45 million have had as much as one shot of the vaccine. And please remember that while the first and second shots are helpful the third shot is necessary for maximum protection. Now there’s plenty of vaccine and the doctors are anxious to cooperate. Remember, the end of polio is at hand, but it takes three visits to the doctor to lick it. Can you afford not to go?

I also found a Canadian PSA, that also gives you the idea:

This got me to thinking. Polio had been a scourge for decades before the Salk polio vaccine. Between 1916 and the 1950s, polio outbreaks occurred every summer in at least one region of the U.S., resulting in scares in which public swimming pools were closed and people avoided public gatherings. The worst outbreaks occurred in the 1940s and 1950s, not long before the Salk vaccine was introduced. In 1949, for instance, there were 2,720 deaths from polio in the U.S. and 42,173 cases. The image of the iron lung was a familiar one, as were the leg braces that so many victims of infantile paralysis wore. Most people knew someone (or knew someone who knew someone) who had suffered from polio. Polio quarantine cards were an all-too-common site. If you were alive and old enough to appreciate a show like “X Minus One” in 1957, chances are very good that you were aware of this and had reason to fear polio.

This was only 55 years ago. People in their mid-sixties and older remember this time.

Yet, in 1957, there was the need for a PSA like this. Vaccination rates were apparently falling off to the point where public health officials were concerned enough to start running ads like this. To me, this PSA shows the power of complacency and inertia, more than anything else. There was no significant antivaccine movement in the 1950s, certainly not in the wake of the success of the polio vaccine. Even in an environment in which there were still polio outbreaks and very severe polio outbreaks had occurred less than a decade before, human nature and its complacency had apparently already begun to reassert itself only a couple of years after the early mass vaccination campaigns against polio had begun.

In light of how thoroughly so many infectious diseases that once ravaged the land have now been brought under control through vaccination, this 1957 PSA made me marvel at how well we have thus far managed to keep vaccination rates high and keep those diseases under check. Complacency is still there, and now most of us have never seen a case of so many of the infectious diseases that we used to fear. Perhaps the best example is Hib, which used to cause horrific disease in children as recently as the late 1980s and early 1990s. Then the Hib vaccine was introduced, and it’s not a major problem anymore. Indeed, many pediatricians trained since the mid-1990s have never seen a case.

Given most people’s lack of personal experience with the diseases we vaccinate against, it’s actually rather amazing how well vaccination rates have held up in light of how easily complacency sets in again. We apparently have done pretty well combatting the effects of inertia and complacency when it comes to vaccines, but now there’s another force working to undermine hard-won gains in vaccination rates: An antivaccine movement that spreads fear, uncertainty, and doubt through misinformation and pseudoscience. Battling the natural tendency towards complacency is difficult enough, but how do we prevent the combination of complacency and fear stoked by misinformation from causing a slide back towards the situation in the middle of the last century, when multiple diseases that are now under control stalked the land. The problem is that, although they are under reasonably good control now, they are not by any stretch of the imagination gone, and it wouldn’t take a huge fall in vaccination rates over large areas to bring back the bad old days. Right now, we’re relatively lucky in that outbreaks have tended to be local and associated with pockets of antivaccine sentiment. It wouldn’t take a huge fall in vaccination rates to provide an opening for those diseases to spread more widely.

I hope it doesn’t come to that.