It was a good day when I was in first grade and my parents suddenly announced that we would be going to a party. There were kids I did not know, and we played for hours, games like Twister and tag and all sorts of things. The next morning, I woke up with red dots on my face. My parents were happy and explained to me how immunity works.
The lesson was counterintuitive. The primitive instinct is to stay away from the sick. The modern sensibility was that early exposure and acquired immunity is much better than getting chickenpox (varicella) later in life, which can lead to scarring. As a kid, it is startling to see parents happy that you have red dots all over you. But there is an unforgettable lesson here.
Naturally acquired chickenpox also and predictably grants some measure of cross-immunities to other diseases such as shingles. In any case, you are done with chickenpox for life. It was an early lesson in modern science, one that all kids gained. It’s an unforgettable experience.
Kids born after 1995 have not had this experience. That’s because the Food and Drug Administration approved a new vaccine for chickenpox and it was quickly added to the childhood schedule, thus protecting the manufacturer from liability. A second booster was added to the schedule in 2006.
Since then, it has become much more difficult even to find a chickenpox party. The unvaccinated have to hunt them down and drive long distances.
If you understand how vaccines work, you know that they can be effective against stable pathogens; that is, diseases born of pathogens are not subject to mutation. In that class we can include smallpox, mumps, measles, and chickenpox. Ebola and the common cold are other matters. They are always changing, and no vaccine can confer immunity.
This too had been explained to me from an early age. It was why we could game the immune system with regard to some diseases but not others. Everyone knew this. Meanwhile, the Food and Drug Administration and the Centers for Disease Control and Prevention have blurred all of this. These days, everything is called a vaccine, even shots that confer little or no immunity at all. The definition has gradually changed so that no one knows what is what.
It so happens that chickenpox falls in the category of stable pathogens against which the shots are effective. We should avoid the word “safe” because no medical product is without some possible side effects. In addition, a vaccine’s immunity will always be less broad and lack cross-immunities that might otherwise be advantageous.
Another crucial point to remember is that none of these shots is studied in combination with others on the schedule. It could be that one shot is safe and effective if taken alone but becomes problematic when mixed into a vaccine cocktail. This aspect of the studies is wholly neglected, which is one reason the explosion of the childhood schedule from three to 17 shots did not trigger safety signals in any particular product.
The Department of Health and Human Services, in combination with the Advisory Committee on Immunization Practices, is currently working to curb the number of shots on the schedule, taking them off one by one in hopes of addressing the growing number of childhood diseases, including autism. Research is limited, so these experts are working from intuition formed from long experience and data as we have it.
On the list for possible elimination will be the chickenpox shot. It’s going to be a tough decision to make. This is because it works and, taken alone, seems not to set off safety signals. One possible avenue is the problem of adult shingles, which has increased fourfold since 1995. The possible connection to the shot is rather obvious.
A key point to remember is that acquired chickenpox is not, in fact, dangerous for children. There is no real downside to organized and systematic strategies of early exposure. But with shot proliferation, they are harder to find for those who have concerns about the sheer number of shots given to children.
Let’s look at the calculation here. There is no serious downside to early exposure. There are possible downsides to artificial inoculation, including the addition of another shot to an untested cocktail plus the possible curbing of cross-immunity. Unless you think that vaccination is better just because it comes from pharma, there seems to be no strong reason to keep recommending this shot.
This is despite its effectiveness against a known disease. In other words, it seems like a bad idea to deploy artificial means of inoculation when we have a perfectly workable solution to the problem of chickenpox. We could even say that the shot was never necessary in the first place but for people who otherwise have no social mechanisms of providing early natural exposure. Even if you grant that this is true, there is no case for a general recommendation.
This suggests a good general principle. Unless the benefits of the vaccine far outweigh the possible costs—if, for example, the shot protects against deadly disease and otherwise has a strong safety profile—the vaccine should be included only as an option with shared clinical decision-making by parents and physicians. That is to say, it should be off the schedule and made entirely optional.
Keep in mind that taking a particular product off the schedule does not mean making it unavailable. There might be some liability implications for products off the schedule, thus exposing the makers to possible litigation for proven harms. That seems like a good thing, even if the manufacturers will resist this.
What are not often considered in the making of these choices are the pedagogical benefits that come to a child who is deliberately exposed to the natural pathogen as a method of gaining lifetime immunity. The child learns an important lesson about the human immune system, one that seems to have been diminished or even lost since the practice of deliberate exposure has gone away.
Primitive instincts might inform us that the only way to deal with infectious disease is to stay far away. It was one of the great achievements of 20th-century virology to discover that this is not always the case.
The settled social protocols surrounding chickenpox exposure (and probably measles too) made the point very clearly, thus conferring not just lifetime immunity but also a lifetime lesson in science. We would all do well to rediscover natural immunity. This is a safe way to do that. Health does not always come from pill bottles and vials. Sometimes nature herself has important lessons to teach.
