As a family physician, Dr. Ben Brashear’s thoughts are usually occupied by providing quality medical care to the citizens of Kaufman, developing a rapport with his clients, and enjoying his happy life with his own family. But lately, he’s also been thinking quite a bit about his role in shaping the conversation around what has become a surprisingly controversial topic: vaccinations.
As Dr. Brashear looks back on his time in medical school in the late ‘90s, he remembers a time when vaccinations were just one of many topics he studied as he prepared to enter into the medical field. But a notorious study from Andrew Wakefield published in The Lancet in 1998 linking the MMR vaccine and child autism set the stage for the mainstream debut of the anti-vaccination (or anti-vaxx) movement, a group that opposes the administration of vaccines on any level.
As Wakefield’s study was quickly proven to be inadequate (he fabricated and inflated his results from a small number of test subjects and ultimately lost his license) Brashear and his colleagues didn’t give much thought to his study or the anti-vaxx movement initially.
“It was kind of thought of as a very fringe movement that would probably die off quickly,” Brashear said. “Not something that we spent a lot of time discussing and learning about.”
But as celebrities and eventually politicians (perhaps most famously current President Donald Trump who said that there were “many cases” of children diagnosed with autism as a result of vaccinations in 2014) began giving credence to the anti-vaxx movement, it grew exponentially. And as people questioning the validity and safety of vaccines gathered and spread their ideas, their opinions cemented.
“You get a lot of people in a social circle and you start to get emboldened,” Brashear said. “They can create action when it otherwise might have just been a thought.”
As an active physician, Dr. Brashear has treated thousands of patients, and overseen the administration of countless vaccinations. While he acknowledges the side effects that can sometimes accompany their initial injection and their less than 100 percent success rate (though their success rate does typically register in the high 90s), overall Brashear considers vaccines “extremely effective” and critically important to public health. While he’s more than happy to get technical and discuss the differences between inactivated and live-attenuated vaccines and how they affect the human body differently, what he’s most concerned with is helping his clients and others who question the viability of vaccines understand their importance.
“I want to engage and create a dialog,” Brashear said. “My target audience is the vaccine-hesitant rather than the anti-vaxx crowd. Doctors should be active against the anti-vaxx crowd if that doctor has a big enough problem. I think my role is a little more smaller-scale.”
The dangers of an unvaccinated public are self-evident. Brashear points to the outbreak of measles that sprung up in Disneyland in 2015 and says that thanks to the movement, “we’re back to where we were 40 years ago.” But the success stories of vaccines treating diseases like polio and smallpox are also well-documented. Doctors call the eradication of those once debilitating diseases as herd immunity, which is the ultimate goal for any vaccine. Once a population reaches herd immunity, even those who are unvaccinated are able to travel in public safely.
“If we can just lower the total volume of where we can, we get to the point where the chance of them even coming across the virus is so low they can feel safe,” Brashear said. “That’s why we need the vaccine numbers as high as possible.”
Although the vaccines that are recommended are relatively uniform across the United States, the mandate of their administration varies from state to state. This has resulted in what Brashear calls “hot spots” in particular pockets of the country. Several areas in Texas, which doesn’t mandate vaccines at all, are designated as hot spots. And while Brashear says that he and his colleagues are obligated to do what they can to help convince their patients to vaccinate themselves and their children, in order to really combat these hot spots a statewide mandate with only specific exemptions is necessary.
“I’m in favor of as many people being vaccinated as possible,” Brashear said. “ I think mandatory vaccines are fine. Any time somebody says that, it feels like this Big Brother type thing. Those kind of mandates should be reserved for when there’s not really any bold reasons not to. The reason is not because I know better, the reason is from a public health perspective. You making a decision can actively harm someone else. I don’t know of any other medical initiative where if you don’t do it for your body, it can actually harm someone else. You don’t see that very often. So that’s why I feel this is the exception to my normal rule. I’m very much a proponent of a patient’s individual decision making. But I believe people in our society should be able to be out in public and not have to worry about being exposed to viruses.”
While some members of the anti-vaxx community claim exemptions based on religious grounds, Brashear notes that there really aren’t any mainstream religions that are specifically at odds with them.
“There’s not really any religions that specifically say you shouldn’t get vaccinated,” Brashear said. “So [the state] doesn’t really call it religious exemption; they just call it personal. But by allowing that, that’s what keeps us in that hotspot.”
While Brashear is ultimately sympathetic to those who have questions about vaccines and may not fully trust their doctors particularly when they don’t know them very well, he implores them to remember that he and the majority of other doctors around the country are parents, too, and they have investigated the same questions, read the same articles, and ultimately carry out the plan that they think is best for their own kids. Although he generally agrees with the sentiment that people should be free to do what they want with their own bodies, the refusal to vaccinate is the one area of personal treatment that can negatively affect the public health.
“I do believe in the freedom of choice,” Brashear said. “A great example is freedom of speech. There are limitations to it, like if you want to yell fire in a crowded theater. I used that analogy with someone who was pretty anti-vaxx and she said ‘I’m yelling fire because there is a fire.’ And I said ‘Not really. You’re yelling fire when there’s firemen there and they’ve checked out the smokey smell or the wisp of vapor that you see. I understand that you see something; you’re not making it up. But there’s people there that are more knowledgeable about that than you are who have looked into it and checked it out.’
“Remember those things that your fifth grade science teacher taught you. Just because you have a hypothesis and it matches up with your current bias, if you do legitimate tests and they show different, you can’t just hide it. If we’re all standing on the shoulders of other people who have done research, let’s talk about the shoulders that we’re standing on and let’s see which one has more credibility.”