Protecting children from devastating diseases through vaccination with Diego Hijano, MD

I came to St. Jude to help save children’s lives from some of the most catastrophic pediatric diseases. While my colleagues offensively tackle cancers, neurological disorders and hematological diseases, I work to defend our kids from opportunistic infections. Many treatments here are lifesaving but immunosuppressive, opening patients up to the threat of pathogens, such as viruses and bacteria. For most of my career, we have made steady progress in preventing these diseases; however, since the COVID-19 pandemic, infectious diseases once controlled, even eradicated from the United States, have risen due to vaccine hesitancy. It breaks my heart to see pediatric patients around the country, including at St. Jude, come to the clinic with diseases that could be easily prevented with common childhood vaccinations.

Childhood vaccines serve as a shield against devastating diseases. They protect individuals and the community they live in. However, for many reasons, parents are now choosing not to vaccinate their children. I think one of the most significant problems may be that many in the U.S., including my fellow physicians, have never seen the most common infections we vaccinate against and their consequences. 

In a way, vaccines are victims of their success. They have protected us so well that they have removed memories of measles, poliomyelitis (“polio”) and a variety of other historically dangerous infections from our collective consciousness. People have begun to fear what they experience in their daily lives, the vaccines, rather than the diseases they protect against. We overreact to the familiar while underestimating the dangers posed by infections that haven’t been major problems for decades. However, these diseases are still around and represent major threats to human health when people, especially children, are not vaccinated. As George Santayana said, “Those who do not remember the past are condemned to repeat it.” The reemergence of many vaccine-preventable infections is truly a testament to his thoughts.

Understanding the threats that childhood vaccinations protect us from

Childhood vaccinations should be considered in the context of the diseases they prevent. For example, the measles vaccine has been one of history’s most important infectious disease interventions. Measles is highly contagious. If one child in a classroom has measles, and the rest of the class is unvaccinated, 90% of the children will be infected. Many perceive measles as a minor rash and fever that resolves in a few days. However, it can lead to severe health complications, particularly in children under 5, with one million children dying annually from measles worldwide before 2000. 

Measles was eliminated in the United States in 2000 after years of high vaccination rates. However, since 2011, we have observed clusters of measles cases that were absent from 2000 to 2010. As of mid-November 2024, 277 measles cases were reported, with nearly 90% occurring in unvaccinated individuals. Despite schools and employers mandating the measles vaccine to prevent widespread illness and mortality, exceptions and hesitancy have reduced vaccination rates, increasing the risk of measles outbreaks nationwide.

Polio, like measles, is a historical health threat controlled by pediatric vaccination. Poliovirus can cause paralysis, permanent disability and death by affecting respiratory muscles. Prior to vaccines, the U.S. saw about 16,000 annual cases in the 20th century. In 2022, the first U.S. polio case in nearly three decades was reported. Three vaccine doses are 99-100% effective in preventing the disease and its transmission, rendering such epidemics historical. However, military conflicts significantly disrupt civilian vaccination infrastructure in some countries, demonstrating that halting polio vaccinations would lead to increased infections and severe consequences.

Improving childhood vaccination rates means listening to patients and parents

Despite abundant scientific evidence showing vaccines’ safety and efficacy, patients and families are still hesitant. I have asked them why and received a variety of answers. However, the solution is the same: Health care providers must listen to their concerns. In my experience, if a patient does not feel heard or understood by their provider, there is no chance they will change their behavior. Therefore, listening is a necessary step to overcome vaccine hesitancy. 

During the pandemic, I faced a challenging vaccine-hesitancy situation involving a pair of brothers. The older brother was caring for his younger brother, my patient, who was at increased risk of infections. They were hesitant to receiving the COVID-19 vaccine, fearing negative impacts. First, I told them about the benefits of science without success.

However, during our conversation, I made a breakthrough. The brothers could not judge the scientific information but knew I could. Therefore, they wanted to know my actions regarding vaccination in the context of my personal life, not esoteric knowledge. I managed to change their minds by speaking about my family’s experience. I told them how I took my daughters to get vaccinated, including where and when I went. They then wanted the exact vaccine my family and I received and agreed to get their vaccines, trusting my actions over my scientific explanations. 

This experience showed me that we must address patient concerns by building trust. By framing my communication within the context of my family, I became more relatable. The brothers could empathize with a father who wants to protect his children. Once they understood the context, they were more open to hearing why it was essential to get vaccinated. We moved from an academic argument to a relatable decision to protect families. That message resonated: Physicians and scientists get their children vaccinated, demonstrating a genuine faith in the benefits and safety of vaccinations.

To increase childhood vaccination rates, we must refresh our cultural memory of historically vaccine-preventable diseases. Vaccine hesitancy is a complex and often irrational problem that can’t be overcome just with knowledge. Patience, time and empathy are critical and will go a long way in addressing it. We must listen to families’ concerns and help them understand that vaccinating our children prevents measles, polio, and a variety of other infectious agents and their potentially devastating consequences. I do it to protect my children; will you do it to protect yours?