My daughter can't be vaccinated because she's still too weak from her chemotherapy cancer treatment. Children like her rely on herd immunity for protection. Here's how society is letting my family down when they do not vaccinate their children, and why a measles outbreak in my community is absolutely terrifying.

The author and her daughter at the beginning of cancer treatment. The child is wearing a mask to protect her from germs while she is getting chemotherapy. Her hair would be gone a week later.

Most people are surprised to learn that after a child is treated for cancer with chemotherapy or immunotherapy and they are lucky enough to survive their diagnosis, they must be revaccinated. Their little immune systems have to start over again, as any previous protection offered by vaccinations has been swept away by the powerful, prescriptive poisons used to save their lives. (Don't get me wrong—they are sweet, beautiful, amazing poisons for which I am forever grateful, but poisons none the less.) As we explained to our then six-year-old when she lost her hair, "In order to get rid of the bad cancer cells, you need very strong medicine. Sometimes, the strong medicine gets rid of the good cells, too."

Now, thankfully, my daughter is one year post-treatment (and one year cancer-free) but her "numbers" are still too low for her to be vaccinated. She is vulnerable and unprotected and has already been through so much. I would love the privilege of choosing to vaccinate her yet we are not afforded that choice. There is currently a measles outbreak where we live, and I can't help but fear for my daughter's health once again.

Why Vaccinations are Important for Kids Who Can't Get Them

When people discuss vaccinations for common infectious diseases, like measles, sometimes the phrase "immune compromised" is tossed around. I think it's worth knowing what "immune compromised" means and who those people are. People who have gone through cancer treatment or are currently in treatment for cancer are immune compromised—particularly children who are considered both more susceptible and more vulnerable to serious infection.

Until I became a medical mom, my understanding of the human immune system had been a hazy, abstract construct, since my last formal biology lesson was decades ago. I thought Vitamin C, essential oils, and exercise could cure a common cold. It turns out, the immune system isn't actually a metaphor for self-care, nor is it something you actually have a lot of control over. It's a complicated network of cells, organs, tissues, and blood. As I now understand it, B cells—a component of our blood—serve as the memory of our body's immune system. A child who doesn't have mature B cells in their blood cannot support the gift of protection a vaccine could provide. Think of it this way: You can't heal a broken leg with a cast if there is no leg.

My daughter depends on IV immune infusions, good hygiene, and "herd immunity" to protect her. "Herd immunity" is when a community prevents the spread of an infectious disease by all receiving vaccinations. Who is a part of this herd that I am relying on to protect my daughter? You are. We all are. Same viruses. Same air. And it's not only my daughter and other children who had or have cancer who rely on "herd immunity." It's also pregnant women, babies, and the elderly who are most at risk from infectious diseases. These are people you know and care for; your friends, your neighbor, your family.

How an Infectious Disease Outbreak Affects Cancer Families

Before becoming a cancer-mom I never considered getting a vaccine to be part of my social responsibility. We currently live in Brooklyn where there is a measles outbreak—as of May 29, 2019, New York City has confirmed 550 cases since September 2018. We use public transportation and my children go to public school. Anger comes to me quickly as my phone buzzes with news alerts that the measles outbreak continues to escalate. But as angry as I am about those who chose not to vaccinate their children and by doing so, put my daughter in harm's way, I try to steel myself with compassion. I understand that most of us are trying to do our best with the information we have available, but I don't think that's good enough anymore. Particularly when there are people pushing misinformation on others.

Earlier this month, we received a letter in our daughter's homework folder, informing all New York City Public School children that there have been two cases of measles at public schools in Brooklyn, not far from where we live. According to the letter, both students had religious exemptions to being vaccinated.

I wake in the middle of the night, my mind swirling with frustration, worry, and more questions. I wonder about parents who choose to file a religious exemption so their child can attend public school with mine, even though nearly every major religion has come out in support of vaccines. I wonder if they might choose differently if they had to sit with their child in the hospital for weeks or months, due to measles or some other medically complicated, scary situation or watch me sitting with mine. I wonder if they would have enough personal days or would have to take FMLA—if it was available to them—to cover their absence from work. Would they be able to keep their job? Would their insurance hold? Do they have health insurance? If not, are they risking financial ruin with their child's illness? Believe me when I say, it doesn't take long in the hospital before the astronomical costs kick in. I continue to wonder, would they expose others when they go to see a doctor?

In April 2019, the Health Commission in New York ordered every adult and child who lives or works in the impacted neighborhoods to be vaccinated for measles, mumps, and rubella (MMR). As of May 24, more than 25,000 doses of the MMR vaccine have been administered to people under the age of 19 who live in Brooklyn, not far from my home. Individuals refusing this vaccination could be fined $1,000. But still, the outbreak continues.