December 16th, 2015

To Vaccinate Or Not

Scott Cuyjet, RN, MSN, FNP-C

Scott Cuyjet, RN, MSN, FNP-C, practices adolescent medicine in the San Francisco Bay area.


The other day I was riding my bike and thinking about how I am required to get a flu vaccine every year or wear a mask during the entire flu season, and this really irks me because I work really hard to be healthy and I don’t like being told I have to do something, but then it hit me. Not a car, fortunately, but the realization that I was thinking like the antivaxxers. Well, not exactly. The flu vaccine is different from the vaccines in the childhood vaccine series. They make a new one every year based on the strain(s) of flu they think will circulate in the U.S. and make us sick. Last year, the vaccine was only 19% effective. I risked side effects for 19%. However, other information from U.S. government health agencies website put that in context: “Recent studies show vaccine can reduce the risk of flu illness by about 50–60% among the overall population during seasons when most circulating flu viruses are like the viruses the flu vaccine is designed to protect against.” as well as pointing out that: “Most childhood vaccines produce immunity about 90–-100% of the time.” But how can I expect parents to follow mandatory vaccine laws to protect their children and the people around their children if I am not willing to do the same?

nurse receives flu vaccine

In regard to mandatory vaccine laws, there is a new law in California, SB 277, which does not allow for religious or personal-belief exemptions. The law does however leave open the ability for a medical exemption. Previously, Mississippi and West Virginia were the only states to ban vaccination waivers based on religion. The law goes into effect for the fall 2016 school year and will be phased in over time. “Children who have a personal-belief exemption on file before Jan. 1, 2016 will have more time to comply with the law,” the LA Times reports. “Such children who are in nursery school or preschool must comply to enroll in kindergarten; those in elementary school must do so by 7th grade. Those already in junior high and high school will remain exempt.” Unvaccinated children would have to be home-schooled or do independent study.

When I first heard of this bill passing, I had mixed thoughts. There are people all across the country who are afraid of being overlegislated and subsequently losing the ability to have control over their lives and their families’ lives, and this is a prime example of that. Unfortunately, the law may not have its intended effect, as telling people what to do without choice often causes pushback in the opposite direction. We may actually see fewer people getting their kids vaccinated. With the new law, if people continue to choose not to get their kids vaccinated and the law is enforced, other infants, kids, pregnant moms, and health-compromised people might be safer at daycare and school — but not outside of daycare and school. Also, in a recent study in Pediatrics published March 3, 2014, researchers found that trying to change an antivaxxer’s opinion may actually make the problem worse.

I work as an FNP-C at a clinic for adolescents (ages 13–25) in California, and we get a significant number of patients who need vaccinations. The clinic where I work has a large population of recent immigrants with incomplete or missing records, and they need to continue their series or start it over in order to enroll in school. I was open to the research about vaccines possibly having negative effects such as autism, but the original research was falsified and subsequent research has not shown any correlation. Changes have been made to vaccines deemed less safe in the past. For instance, there was a question about risk versus benefit of the active/oral polio vaccine, as a very small group of kids being vaccinated were getting polio. There was enough evidence to compel people working in public health to assist in getting it changed to an inactive form, or IPV. What we have seen since the antivax information hit the media and people stopped vaccinating their children is a pertussis outbreak and a measles outbreak. A mom in Canada had all seven of her unvaccinated children come down with pertussis and now is questioning her choice not to vaccinate.A few months ago, there was an article in Scientific American about antivax parents refusing the vitamin K injection for their newborns, which can put them at risk for internal bleeding. These examples show how dangerous ignorance and distrust can be.


Infant undergoing treatment for severe pertussis infection

The bottom line is that if there are any risks of vaccination, they have been shown historically to be outweighed by the benefits, at least for the older vaccines.


7 Responses to “To Vaccinate Or Not”

  1. Glenn macwhorter says:

    All vaccines are not created equal, but too often presented as such. A pt. presented with ambivalent statistics with respect to the flu vaccine doesn’t necessarily have the insight to differentiate from pertussis. The numbers of Iz’s presented in Cal. to parents of infants and young children is dizzying. Confusion is to be expected. The presumption of compliance based on the authority of the provider is at best demonstrating ignorance of human behavior and education; at worst, compounding the problem.

    Personally, I don’t trust nor believe the statistics on the flu vax , while I wholeheartedly endorse many others. Lumping everyone who object to any vaccination as “antivaxers is a disservice to many others who have bonafide

    • Scott Cuyjet, RN, MSN, FNP-C says:

      In regards to people who refuse vaccinations, they all have what they think are bonafide reasons, just most of them are not backed by science. I also agree about the flu shot. It was just an interesting conundrum that I am telling people you must comply with the law, but wanting to refuse at my workplace. I just thought others might have similar experiences.

      Thank you for viewing the blog and for your thoughtful response.

  2. Elizabeth Smith says:

    As a PICU RN for 16 years before I began my career as an FNP, I have witnessed firsthand the tragedy of Pertussis. Yes, side effects of vaccines happen. But the results of disease are often devastating or fatal to infected infants and children.
    I know that flu vaccine can be hit or miss — but some is better than none. Having seen pregnant women die and adult men disabled from the swine flu was a sobering experience.

    Let’s remember, these vaccines have been created to prevent serious illness that has killed thousands in the past. When I counsel my adult patients on vaccinations, I discuss both the personal and community rationales. Not a few will consider vaccination after I discuss the risks to the community at large.

  3. As an FP who formerly had a large obstetrical and pediatric practice I remember when the varicella vaccine was being developed. I read an article in JAMA which acknowledged that chicken pox was a relatively benign disease for the vast majority of children and that the covert reason for using it was that it would allow families with both parents working or single parents to not miss work due to a child ill with chicken pox. Then, when the vaccine became readily available, varicella somehow morphed into a catastrophic disease that kills thousands every year. The corrupting influence of big pharma propaganda on the medical profession and society in general does, in my opinion, far more harm than good. The other issue I have especially with the live viral vaccines is that the immunity they induce may not be as durable as the natural disease leaving large numbers possibly even entire generations of elderly susceptible to childhood diseases. You may call this idea crazy but it has not been disproved and if it occurs it would be catastrophic.

    • Scott Cuyjet, RN, MSN, FNP-C says:


      Thanks for reading and your thoughtful response. In regards to varicella, I have patients who have gotten it in their late teenage and early adult years, and yes it did not kill them, but it was no walk in the park, and for some caused considerable detriment to their complexion. The vaccine, although far from perfect, I think 60% effectiveness is what I last read, can also lessen an outbreaks intensity and duration if one still gets chicken pox so it is not completely useless. Also, older adults who had the chicken pox in their youth are having shingles outbreaks now, so that immunity is not perfect either, and yes there is a vaccine for that. I do agree with your statement about marketing and don’t entirely trust companies with that much money lobbying our government.

  4. Jon Ahrendsen says:

    Vaccines prevent disease: True Vaccines have risk of adverse effects: True
    People who are injured by vaccines have legal recourse against the vaccine manufactures: FALSE This is another part of the problem, Name another consumer product that enjoys such blanket immunity. And the established compensation process for parents is a huge mountain to climb, and stacked against the claimants. The original study was falsified? I don’t believe it, read Wakefield’s account “Callous Disregard”. Watch the documentaries, “Bought”, “Trace Amounts”, and “VAXXED”, and then try to convince yourself that the CDC and Big Pharma are totally telling the truth.

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