The Vaccine-Friendly Plan: Dr. Paul’s Safe and Effective Approach to Immunity

Book Preface

Though I was born in the United States, I grew up in Rhodesia—now called Zimbabwe—in the 1960s. My parents were young missionaries with the United Methodist Church, and my family moved to Africa when I was just five years old, my sister Mary was four, and my mother was pregnant. My little brother Bruce and my little sister Jean were both born in Rhodesia. Our first home, in the village of Arnoldine, was built out of sun-dried bricks. We had no running water, no electricity, no glass windows. It was crowded, loving, and chaotic. I loved it.

My mother, who had studied at Vanderbilt University, was a nurse, and our home quickly became the de facto health center for the village, with parents showing up with sick children in tow, hoping we could help them.

My family spent fifteen years in Africa. By the time I was in my teens, I had seen more deaths than most Americans—perhaps even my fellow doctors—will see in their lifetimes. It was not uncommon for mothers and their babies to die during childbirth in our village. Newborns, especially those with malnourished mothers, succumbed to infectious diseases. Car accidents, malaria, and fulminating infections that did not respond to treatment also claimed too many lives. As my Congolese friend Odette said years later, tsking and shaking her head, “Africans die young.”

But there was one death that hit me harder than any other. My playmate Taurai, who was only three years old. One day, very suddenly, Taurai got a high fever. The whites of his eyes turned red, and he became lethargic and stopped eating. He had a rash all over his body. When his mother took him to the hospital in the capital city, the doctors told her Taurai had measles. When she heard the news, my mother didn’t worry much at first: Measles were so commonplace that in her generation other mothers made sure their children got exposed whenever it was going around. She had had measles herself as a kid and had seen it many times as a nurse. Taurai died the next day. I eventually came back to the United States to finish my education and went to the Geisel School of Medicine at Dartmouth College, where we were taught about the history of vaccines, the victory of the eradication of smallpox, and the elimination of polio from the Americas and most of the world. I knew firsthand how important vaccines were—if Taurai had been vaccinated against measles, he might not have died. After four years of medical school, doctors in America are required to do what’s called a residency, three to five additional years in a subspecialty. By then I knew I wanted to become a pediatrician. And every time I gave a child a vaccine or spoke to parents about the recommended vaccines, I was glad. I knew those vaccines would help the families I was caring for stay safe and healthy.

I was still in residency when the Hib vaccine was first introduced. Haemophilus influenzae type B is a strain of bacteria that can cause severe infections like meningitis and even death, especially in small children. Meningitis is difficult to diagnose correctly because the symptoms are a lot like the flu, which is caused by a variety of influenza viruses. The only way to know if a child has meningitis is to test the spinal fluid with a spinal tap: You insert a tiny needle into the lower back until you reach the sac with fluid that covers the spinal cord. If the fluid looks clear, like water, the child does not have meningitis. If the fluid looks slightly cloudy, chances are it is meningitis. We would send the sample for testing and know in a few hours when the lab reported the cerebral spinal fluid results.

Back when I was doing my residency, children’s hospitals—if mine was any indication—had several cases of meningitis at any given time. That first year the improved Hib vaccine was introduced, in 1987, rates of pediatric meningitis at our hospital dropped by half. Before the Hib vaccine, about twenty thousand children under five came down with life-threatening infections caused by Haemophilus influenzae type B every year and about a thousand died. These days there are fewer than twenty-five cases of Hib a year and no deaths.

Vaccines save children’s lives, make families safer, and have helped me be a better doctor. And back then I could not imagine any reason not to give each and every vaccine as directed by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP). These two organizations, full of hardworking, highly educated, caring, and smart scientific researchers and doctors, put out childhood vaccination guidelines that saved lives and helped children. And I saw it happening firsthand.
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