On January 24th, 2018, I turned 52—in good health and feeling great. I had six marathons under my belt and was training for my second Boston Marathon, so I was eating well, maintaining good health, and increasing my mileage.

But just two days later, I started feeling feverish soon after getting up. I’m not one to take it easy at all, but I had so little energy, I had to lie down on the couch. I called work and told them I needed a sick day, something I’d done maybe twice in the past 10 years.

As the day went on, I felt worse—more feverish, and I started having some difficulty breathing deeply. I called my wife and told her I had a bad head-and-chest cold and would be on the couch all day, then took some Tylenol and my asthma medication. I’d just had my flu shot at my annual physical a few weeks before, so we didn’t think it was that. The next morning, things were worse. My head was pounding. I had a solid fever, sweats, chills, and more difficulty breathing. My wife called our doctor, who told me to come in. They gave me a flu test, which was negative, then did a chest X-ray. But even with my immunization and negative test, they still suspected the flu and sent me home with some meds.

Unfortunately, the meds didn’t help. The following day, my head felt like it was in a vise. I was shaking with chills and fever, feeling cold even with my winter coat on and covered with blankets. My wife took me to the ER.

After seeing my vitals, the nurse brought me straight back to the ER doctor and hooked me up to oxygen. My pulse oximeter reading was 85 percent —10 percentage points below the normal level of 95. A chest X-ray revealed double pneumococcal pneumonia, a lung infection that can cause inflammation around the heart and block airways into the lungs. According to the Centers for Disease Control and Prevention, about 1 in 20 who contract pneumococcal pneumonia die, so we were all taking this seriously. And because of my severe head pain, doctors suspected meningitis as well. My wife was getting more and more worried as they did a CAT scan and prepared me for a spinal tap.

The good news was that I didn’t have meningitis. They blamed inflamed sinuses for my head pain and gave me morphine, along with antibiotics and intravenous steroids for the pneumonia. An RSV test came back positive, something more commonly seen in adults with weakened immune systems.

I was put in an isolation unit and monitored closely for almost a week, eating hardly any solid foods. After two days, my blood oxygen levels began to improve—the meds were doing their job. Every day, I felt a little better, and after six days, they released me with prescriptions for oral steroids and antibiotics. I had lost about 12 pounds and was no longer the robust marathoner who had just celebrated his birthday.

In all, it took about three months for my lungs to recover. Before any of this happened, my wife had told me that I should get the pneumococcal vaccine, which is recommended for all folks over 65—and people even younger who have asthma like me and certain other health conditions. I had just seen my doctor in early January, and perhaps if I had mentioned it or my doctor had suggested it, all of this might have been avoided. But I learned my lesson, and today, I’m fully immunized and back on the marathon circuit!

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The general public felt that chickenpox was something everybody got, it was usually pretty mild, you got over it, and then you were immune. No big deal. Chickenpox was so common that, as a physician, you developed a certain comfort level with it: Here’s how we alleviate symptoms, this is how long they’ll be out of school, this is when they can go back.

But my perspective was radically altered soon after the vaccine came out. I was a junior faculty member with about three years’ experience in practice. One of my partners asked for a second opinion about one of his patients. He had been in practice maybe eight to 10 years longer than I, his patient was a little girl around 24 months, and he sensed that something was amiss.

It turns out that she did have chickenpox…and was in the ICU for weeks.

He pulled me into the exam room and said, “This looks like chickenpox, but she doesn’t look good. There’s something wrong here.” I knew right away that she did have chickenpox—I’d seen plenty of cases before—but this girl was on the verge of being critically ill, with fever, respiratory difficulty, and other clinical issues.

We rushed her to a children’s hospital across the street, straight into the ER for an evaluation. It was grim: serious bacterial infections including a streptococcal empyema and a streptococcal infection in her mediastinum—all complications from chickenpox. She was in the ICU for a couple of weeks with multiple chest drains, IV fluids, antibiotics, and sedation for the discomfort and frightening surroundings (for a 2-year-old).

Thankfully the ending was a happy one, and in the succeeding years I continued to see her in the office when she came for appointments with my partner. I remember her as a teenager, a healthy young woman who had made a complete recovery. But she had very nearly died from a case of chickenpox run wild, a “mild childhood illness” we all expect to get and get over.

There’s a reason we have vaccines, and it’s to prevent infections that can cause incredible hardship.

While the chickenpox vaccine was still too new at the time for this patient to have received it earlier, it still could have spared her the trauma of an ICU stay and her parents the agony of watching and waiting at her bedside for two weeks.

For me, it was a wake-up call. I don’t think there are any vaccine-preventable illnesses that are free of potentially catastrophic complications, even “just the measles,” even “just chickenpox.” There’s a reason we have vaccines, and it’s to prevent infections that can cause incredible hardship. Straightforward illnesses can take a horrible turn, and on those rare occasions, you’ve never been as grateful for anything as you are for their vaccines.

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I think of it because children have been given the polio vaccine ever since it arrived in the early 1950s, but I wonder how many parents today have any reference for polio, the disease. The paralysis and iron lungs, the scary summers people spent avoiding swimming pools for fear of contracting this horrible virus.

Vaccines really are miracles, and the misery and death they avert are the best reasons of all to get them. But when a new one is introduced, we quickly adapt to a healthier, safer way of life, and the illness it prevents becomes abstract.

I think a lot about this pattern of forgetting the suffering that vaccines prevent.

This moving on is understandable, but after seeing the arrival of three other life-changing vaccines during my career—Hib, Hepatitis B, and HPV—I think a lot about this pattern of forgetting the suffering that vaccines prevent.

When the Hib (Haemophilus influenzae type b) vaccine came out in the late 1980s, I was a resident. There were about 20,000 cases of Hib annually, and in the U.S., it was the leading cause of bacterial meningitis among children under 5 years old. If you had a patient with Hib, an earache was a lucky outcome. But I saw a lot of kids with the invasive version of this bacterial disease, usually toddlers. Parents would bring them in with a purplish black eye and you just knew. We dropped everything, started antibiotics immediately, and hoped we had acted in time. 

I remember seeing three of these children in one week—one died, one ended up deaf, and one ended up with a severe seizure disorder. The vaccines were new, but ultimately, the parents figured out that what had happened was preventable. Their grief was overwhelming. Since the vaccine, incidence of Hib has declined 99%.

People have wished for a ‘cancer vaccine’ for decades…the HBV (and, later, HPV) vaccines really are exactly that

Right around the same time, a vaccine for the hepatitis B virus (HBV) arrived. People have wished for a “cancer vaccine” for decades, which of course isn’t realistic because it’s not just one disease. But the HBV (and, later, HPV) vaccines really are exactly that for many specific cancers.

Infants and children who get HBV are the ones most likely to develop a chronic infection, which down the road can lead to liver failure, liver cancer, or cirrhosis. The vaccine means most of us will never have to worry about HBV—newborns today usually get their first dose before leaving the hospital. But we still have people coming from around the world who’ve never been immunized, and while the vaccine can prevent infection, there isn’t a cure once you catch it. Before the vaccine, there were about 9.6 acute infections per 100,000 cases; today, that figure is down by 90%.

And then there’s HPV, which we didn’t really understand until fairly recently. Human papillomavirus is probably best known for the strains causing genital warts, but they’re in a family of viruses causing cervical cancer and vulvar cancer, and even head, neck, and penile cancers in men (I’ve lost a couple of male colleagues to HPV-related head and neck cancers). The HPV vaccine has dramatically changed the landscape: Before the vaccine, close to 80 million people had HPV infections, with 14 million new infections each year. Within 10 years of the vaccine’s introduction, the prevalence of HPV types 6, 11, 16, and 18 has decreased 86% among females 14-19 and 71% among females 20-24. That’s fantastic news, but unfortunately, head and neck cancer in men now surpass cervical cancers. The expanded age recommendation of this vaccine—from 9- to11-year-old girls to all persons up to age 45—will hopefully reverse this troubling trend. 

Nothing makes me happier when I say to a patient, ‘We need to give you a vaccination today,’ than to hear, ‘The nurse already did it.’

We’re still living with other diseases, of course, so imagine having vaccines that could wipe out HIV, malaria, tuberculosis. Could we ever forget the brutality of these diseases—or the anguish of 2020? And, yet, polio.

To counter this complacency, I’m a strong believer in turning routine vaccinations into standing orders so they’re always given to patients automatically. Thinking of those paralyzed by polio, or who suffered the effects of any disease now erased by a vaccine, nothing makes me happier when I say to a patient, “We need to give you a vaccination today,” than to hear, “The nurse already did it.”

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