Chicken Pox?!

Many times during the past week, I wished my kids had been vaccinated against chickenpox. It's a miserable disease, and I hated to see them suffer through it.

But overall, it's a fairly mild disease when left to run its course among children. Children with chickenpox rarely experience complications. Adults, pregnant women, and immuno-suppressed people experience much more severe cases and sometimes death. The chickenpox vaccine - Varivax - is not currently "required." However, the American Academy of Pediatrics recommends it, and it seems likely to follow in the wake of the other standard (and currently required) vaccines against childhood illnesses - measles, mumps and rubella.

So is there a problem? Should we not be grateful to Merck - the maker of the vaccine - for saving us from this significant annoyance? Bringing a layperson's curiosity, parental concern for my own little ones soaking in their oatmeal baths, and an inbred distrust of large pharmaceutical companies and the FDA, I dipped into the available literature on the chickenpox vaccine - a book from my library, numerous newspaper articles, medical journals, and various web sites. Following are some of my concerns:

The vaccine is known to provide only temporary immunity, whereas actually contracting the disease is known to provide life-long immunity. Providing temporary immunity to children could drive chicken pox disease into the older adult population where it can cause many more deaths and complications.

Merck - the pharmaceutical company that makes the chickenpox vaccine - has been ordered by the FDA to follow vaccinated children for 15 years to better understand how long they can expect to enjoy immunity. Clearly, individuals need to be studied much longer - 80 years and more - to know whether the vaccine's immunity follows them into old age.

On the topic of longitudinal studies, how do we address the fact that varicella and its human hosts have been evolving together for thousands of years? Varicella developed the important knack of not killing off its host. Instead, it just causes minor illness, spreads easily through groups of children, and then lays dormant in the nerve cells until it (occasionally) emerges decades later as shingles. This painful re-emergence of the varicella virus makes the victim contagious for chickenpox. Anyone without immunity who comes into contact with someone with shingles is likely to come away with chickenpox. Thus, the ingenious varicella virus survives in its host, reactivating itself decades later with the ability to infect a whole new population of children.

In the process of fighting off chicken pox, children's immune systems go through the important exercise of identifying an unfriendly viral invader and rallying the body's resources to develop the proper antibodies in response. Some doctors believe that childhood illnesses such as chickenpox provide a training opportunity to the immune system, arming it with the "knowledge" and "experience" of fighting off disease that come in handy later on in life.

Furthermore, adult immune systems already equipped with chickenpox antibodies, continue to get stronger and develop as they come into contact with the varicella virus. Pediatricians who frequently see children with chickenpox tend to have powerful antibodies to the disease, and, so, rarely contract shingles later in life. During this last week and a half, in the process of taking care of my virus-ridden children, my immune system geared up against the disease, produced extra antibodies, and perhaps further refined itself, equipping me with disease-fighting power.

Is there any value to this immune system training? I don't know for sure. The question has not been studied. When Merck tracks the effect of the chickenpox vaccine, they do not ask what the cost to our immune system is. But they do look at short-term financial trade-offs. The vaccine costs about $40 per child, the argument goes. The annual cost to "society" of hospitalizations and lost work is estimated to be more than $400 million by the Center for Disease Control in Atlanta. The obvious short-term financial savings justify the vaccine.

Suddenly concerned with the practical aspects of a single mother's life, the head of the University of Florida vaccine study says, "If you have a single mother with five children and one child comes down with chicken pox, the mother either has to take off work or hire a baby sitter. When one child comes down with chicken pox, two weeks later another one comes down with it and then other cases may follow. A mother in such a family is literally out of work or paying for a babysitter for a month or more."

True. It is no piece of cake to nurse any number of children through the disease. And it's even harder in this society - with so many uninsured, rare instances of unpaid sick leave, and even rarer instances of paid time off to care for sick family members. The vaccine could be quite practical to a single mom of five children, but let's not accept that as a solution. A quick-fix vaccine should not direct our attention away from larger political goals and supports for families - such as universal health care and adequate benefits.

Other deeper concerns could be addressed as well. While Merck lines its pockets with profits through the sale of a vaccine that protects against one isolated virus, who is addressing themselves to our immune system's other needs? Such as an adequate diet, cleaner air and water, access to such stress-reducing resources as adequate housing, decent schools, fulfilling jobs, etc.

There are lots of ways we need to take care of ourselves, our children, and our single mothers. Varivax might indeed be a life-saving vaccine for some who are most vulnerable to the virus, and it should be an option for people. However, health protections should not be based only on short-term gains. It may be that our immune systems are somewhat inconvenient to maintain: they need the occasional annoying battle with a virus; they need bodies that are adequately nourished and cared for. Nor should health protections be based on the needs of a profit-driven economy that wants to prevent illness because illness is inconvenient.