A recent issue of JAMA includes a viewpoint article titled “Is Vaccination Approaching a Dangerous Tipping Point?” authored by Peter Marks, Director of the FDA’s Center for Biologics Evaluation and Research, and Robert Califf, who is the Commissioner of the FDA. The subject of the article is the increasing resistance in the US to vaccination (P Marks and R Califf. JAMA 2024; 331:283).
The overriding concern of the authors is the possibility that long-established population immunity against serious diseases like measles may be waning. Measles is not always just an upper respiratory infection with a rash. It can cause pneumonia (commonly) and encephalitis (uncommonly). In underdeveloped countries with limited availability of vaccines, measles has a substantial mortality rate. In 2022, according to the CDC, measles infected nine million children and caused 136,000 deaths worldwide.
In a recent outbreak of measles in 85 children in Ohio, 36 (42%) were hospitalized for complications. The FDA authors of the article in JAMA note that these cases were clustered in middle- to high-income areas with college-educated parents who presumably made decisions about vaccines for their children based on advice from social media rather than their doctors.
And then there is the pitiful uptake in the US of the newest vaccines for COVID-19, which only 41% of people older than 65 have received despite what the FDA authors describe as clear evidence that these vaccines prevent hospitalization and death, both still occurring in that age group.
Health professionals, we have work to do.
More@MedLetter 
Once your credibility is gone and all you have left is the degree hanging on the wall, it may take decades or a lifetime to accomplish the “work” you ‘have to do’. Maybe never.
As a Family Physician who started practice (and saw a child die of the disease) well before we had Hemophilus Influenza vaccine, I am an advocate for vaccines for their impact on patient and population health. As the horizon becomes more saturated with new products that are widely marketed (such as RSV in lower risk adults or Zoster vaccine) that have a large NNT and smaller impact on longevity, it has become more challenging to make a cogent case for every vaccine that is available to us. Shared decision making is ever more complicated!