The unprotected among us

The development of increasingly effective vaccines is one of medicine's great triumphs. Thanks to large-scaled vaccination programs, the World Health Organization has wiped out smallpox and is close to doing the same to polio.

But here at home we have a problem. As Scripps Howard News Service reporter Lee Bowman found, "Hundreds of thousands for children are going to school this fall without protection from deadly diseases."

It is a worrisome development and one whose resolution is neither simple nor cheap.

Bowman reviewed filings with the U.S. Centers for Disease Control and found that more than 135,000 children started school last fall exempt from vaccine requirements. And anecdotal evidence suggests their number is growing. Further, more than one in four toddlers under age 2 are not being vaccinated on schedule.

Infectious disease specialists say that for some diseases the level of vaccine coverage had dropped below the level of "herd immunity," where isolated cases of the disease won't spread into the general population. This could threaten to undo years of progress in public health.

Dr. Paul Offit of Children's Hospital in Philadelphia puts it most starkly: "At some point, we're going to be forced to decide whether it is an inalienable right to catch and transmit potentially fatal infections."

There are many reasons for this growing gap in vaccine coverage.

Younger parents especially grew up in an era where the childhood diseases that afflicted earlier generations -- polio, measles, whooping cough, mumps, rubella -- were simply not an issue.

As the number of vaccines has grown, so has their cost and the complexity of giving them over $900 for a boy and $1,200 for a girl, birth through 12. The problem is particularly acute for underinsured families and those with no insurance.

There are a growing number of parents, stoked by the Internet, who believe the shots themselves are harmful, responsible for autism or developmental problems.

And it is relatively easy to opt out of mandatory school vaccinations. All but two states allow exemptions for religious beliefs and 20 allow exemptions for personal or philosophical reasons.

Addressing the growing number of unvaccinated -- and, by definition, at risk -- children is a matter of public education, research, adequate funding and a medical community engaged with the problem. It should not take the inevitable epidemic to get us to act.

(Distributed by Scripps Howard News Service, http://www.scrippsnews.com)