Regarding the Aug. 12 editorial “The arrogance of Trump’s vaccine policy”:
President Donald Trump recently signed on to major changes to childhood vaccine recommendations. One of those recommendations is to make vaccination against rotavirus subject to parental discretion, despite it being a frequent cause of diarrhea and dehydration in infants, potentially leading to hospitalization for intravenous fluid injection.
The putative basis for these recommendations is vaccine safety and the rights of parents to make decisions about their children. This reasoning disregards the fact that failure to vaccinate puts other children at greater risk, as well as the unvaccinated boy or girl. The large population of the United States also increases the risk of spread from person to person.
Philosophically, the issue here is “Am I my brother’s keeper?” Public health practice is based on reducing the risks of disease for every individual by decreasing spread of bacteria and viruses from person to person. Vaccination recommendations made by the Centers for Disease Control and Prevention and other public health organizations have been based on reducing that spread as much as possible in order to maximize the health of everyone in the nation.
The reversal of those recommendations by Trump and Health Secretary Robert Kennedy Jr. is a step toward the past that will have negative consequences for Americans of all ages.
Stanley A. Plotkin, Doylestown, Pennsylvania
The writer, a physician, is the developer of the rubella vaccine and a co-developer of the rotavirus vaccine.
President Donald Trump recently signed an executive order overhauling vaccine guidance. The order stated that “scientifically supported medical advice” dictates that only a limited number of vaccines be recommended for children and further insists that the measles, mumps and rubella (MMR) vaccine, administered as a single injection, instead be given as three separate doses.
This executive order is not based on scientific evidence. Decades of data clearly support childhood vaccines as safe and effective. No evidence supports separating MMR into its components — the Centers for Disease Control and Prevention’s website says as much — or shows the number or volume of injections as deleterious. The evidence shows the contrary. Delaying or not getting vaccines is dangerous.
Objective reality eventually wins, but real damage happens along the way. Vaccine hesitancy has been accelerated by the current denial of scientific evidence. The past two years have seen thousands of new measles cases and a few deaths, mostly among the unvaccinated. And after decades with no disease, paralytic polio reappeared in the United States in 2022.
The laws of nature eventually win. Two plus two really does equal four. And the infections that ravaged scores of children in previous decades will return without adequate preventive measures.
Kirsten Bibbins-Domingo, Chicago
Eric J. Rubin, Boston
Holden Thorp, Washington
The authors are the editors in chief of JAMA, the New England Journal of Medicine, and Science, respectively.
Scrutinizing a sun rash
The Aug. 15 online Well+Being article, “I developed a sun allergy out of nowhere. It’s more common than you think.,” gave a fair treatment of the sun allergy called “photosensitivity,” which is seen in polymorphous light eruption (PMLE). But PMLE is just one of many causes of photosensitivity.
If a patient presents with a rash that has a distribution clearly consistent with sun exposure, a clinical diagnosis of photosensitivity can be made. But then the physician has to establish why the patient has photosensitivity. Is the photosensitivity produced by a drug? Is the photosensitivity a result of an underlying disease process such as lupus or dermatomyositis? These and other causes of photosensitivity need to be ruled out before arriving at a diagnosis of PMLE.
PMLE is a diagnosis of exclusion. Unless the physician has excluded other possible diagnoses, she or he could be missing the underlying cause of the photosensitivity and compromising the patient’s health.
Andrew Bronin, New Haven, Connecticut
The writer, a dermatologist, is an associate clinical professor of dermatology at the Yale School of Medicine.
The toll of caregiving
I am the father of an 18-year-old who has Angelman syndrome, so the Aug. 16 front-page article, “She spent years caring for her child with disabilities. The toll mounted quietly.,” hit home.
In fact, the article only scratched the surface of the challenges parents like my wife and me face. The worst part — and I blame nobody, because I see no obvious solution — is the complete lack of educated, trained caregivers to assist when these kids reach adulthood. We have come to learn, as a practical matter, that they don’t exist.
The result is endless physical strain at a time in life when parents are no longer optimally situated to bear the strain of changing diapers, lifting their child into their wheelchair or bed, and showering and dressing them. There is also the social isolation that comes from not being able to visit with friends near and far. One parent may be able to slip away for a long weekend with the other kids, but that comes with the guilt of leaving the other parent home alone with the special-needs child.
Without a proper caregiver, the result is the loss of hopes and dreams, not only for the child with special needs, but also for the siblings who see for themselves a generational transfer of the caregiving responsibilities.
You wake up every day to the crushing sadness of it all. You have no choice.
Dan Wolff, Washington
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