To Vaccinate or Not To Vaccinate

To Vaccinate or Not To Vaccinate

To Vaccinate or Not To Vaccinate

'That is the question' that continues to be unresolved even after the landmark study that linked the increased incidence of autism to vaccinations was found to be fradulent

     
To Vaccinate or Not To Vaccinate
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syringeAlmost everyone agrees, well, almost everyone - that vaccination has been one of the single most effective public health measures ever undertaken. Vaccination eradicates disease. Then why the controversy?

When it comes to vaccinations, there is a strong argument about public good versus individual rights. And in certain specific cases, vaccines have been associated with significant disease or possible long term damage to a percentage of people, primarily children. More recently evidence suggests that the adjuvants used in vaccines could have played a role in the development of gulf war syndrome.

Within these two broad arguments are dozens of subcomponent disagreements. We will take a look at these controversies, attempting to dispel truly fallacious information and focusing on real issues of concern to families. As in any complicated subject, it’s useful to begin with a basic understanding of the nature of the topic.

Vaccines Explained

A vaccination is an administration of a material (usually some form of the disease in a non-threatening form) that causes the body to react by producing antibodies or other substances that fight the foreign material. This response creates an immunity or protection from the disease which may last forever or for a period of time, requiring a booster at a later date.

There are three types of vaccine approaches.

  1. Inactivated virus – Killed virus is used; although the virus is dead, the protein capsule is intact, causing the immune response to occur. However, these types of vaccines, such as the polio vaccine usually require booster shots.
  2. Attenuated viruses – A live virus, either weak or altered to eliminate the ability to strengthen is injected. This type of vaccination creates a strong immune response. Examples are the measles, mumps and rubella vaccines.
  3. Recombinant vaccine – The virus itself is not used. Instead, viral proteins that create the immune response are removed from the virus cell and placed into benign viral cells. The benign cells express the protein without presenting a risk. The current Hepatitis vaccine is in recombinant form.

Vaccines can be injected, ingested, scratched into the skin or in some cases inhaled, such as the new inhaled influenza vaccine. Vaccines are often mixed with other ingredients to make them more stable or more robust or prevent contamination. Sometimes these other ingredients create side effects or allergic reactions and in some cases, such as the use of thimerosal as a preservative, have been linked to significant problems.1

Vaccine History

There is written evidence of vaccination in China dating from about 200 B.C. and in India by about 1000 AD. The Ottomans Turks were using powdered smallpox scabs to protect themselves from smallpox in the 1600s. The procedure began to migrate to Europe in the early 1700s and vaccination finally became acknowledged in 1796 when Edward Jenner, an English physician presented a body of research which demonstrated the success of an inoculation of weak virus in warding off death or serious illness due to smallpox.

Jenner’s discovery began a long march to the discovery of vaccines for many life threatening diseases. As the efficacy of vaccines was proven, governments began to make vaccines available to the public and in many cases require that everyone be immunized.

The following table provides a summary timeline of the introduction of significant vaccines and eradication of vaccine-preventable diseases.2,3

1881 - Anthrax 1971 - Live attenuated measles, mumps and rubella (MMR) vaccine licensed
1884 - Cholera 1971 Smallpox ceases
1885 - Rabies 1974 – Chicken Pox
1897 - Plague 1977 (Oct 26) - Ali Maow Maalin in Somalia becomes last person to be infected with wild smallpox, He survives.
1917 – cholera 1976 – swine flu – halted due to association with Guillain – Barre syndrome
1917 - Typhoid (parenteral - injected)   1977 – pneumonia
1923 – Diptheria 1978 - Fluzone
1926 – Pertussis 1978 - meningitis
1927 – Tuberculosis (BCG) 1980 – Smallpox declared eradicated
1927 – Tetanus 1981 - Recombinant DNA hepatitis B Vaccine licensed ,
1935 – Yellow fever 1989 - Haemophilus influenzae conjugate vaccine licensed
1937 - Typhus 1990 – Hepatitis B for infants (Hib)
1940’s DPT 1992 – Hep A
1945 – Influenza 1995 Varicella
1955 - Poliomyelitis (IPV) 2003 – Flumist (live attenuated virus) inhaled
1960 - Sabin oral vaccine 2004 - Pediarix, a vaccine that combines the DTaP, IPV, and Hep B vaccines, into one shot, is approved.
1963 – trivalent (OPV) 2005 – Meningococcal – Menactra
1964 – Measles 2006 – Gardisil (HPV)
1967 – Mumps 2006 - RotaTeq
1970 - Rubella  

 

There are currently vaccines to counter HIV, hay fever allergies, high cholesterol, Hepatitis C and cocaine in clinical trials.

Programs of Vaccination

Once the efficacy of vaccines became established, governments rushed to both make vaccines available to the populace and to make vaccination compulsory in many cases. In Europe and North America, smallpox vaccination was made compulsory in the nineteenth century. In the twentieth century, as immunizations for childhood diseases were developed, including diphtheria, measles, mumps and rubella, vaccination became required for public school attendance.4

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have together advanced vaccine programs onto the global arena. In 1974, the WHO launched the Expanded Programme on Immunization (EPI), with the goal of dramatically increasing vaccination rates among children in developing countries. Through their efforts against smallpox in the 1960s and 1970s, the last naturally occurring case of smallpox in the world occurred in Somalia in 1977.5

Governmental entities strive to immunize as many people as possible in order to reach “herd immunity”. Herd immunity takes place when enough people are vaccinated to substantially lower the likelihood that a susceptible person will come into contact with an infected person. Herd immunity thresholds vary by disease and vaccine effectiveness, as illustrated in the table that follows .6

Disease Transmission Herd immunity threshold
Diphtheria Saliva 85%
Measles Airborne 83 - 94%
Mumps Airborne droplet 75 - 86%
Pertussis Airborne droplet 92 - 94%
Polio Fecal-oral route 80 - 86%
Rubella Airborne droplet 80 - 85%
Smallpox Social contact 83 - 85%

The United States has achieved a very high degree of vaccination, reaching herd immunity threshold in every case.7

Estimated Vaccination Rate of U. S. Children Enrolled in Kindergarten 2003 - 2004

Polio

DTP/Dtap

Measles

Mumps

Rubella

Hep B

Varicella

95.6%

95.5%

95.4%

96%

95.9%

95.7%

93.3%

Vaccine Safety

Unfortunately, while the discovery of vaccines has probably been one of the single most important steps in eradicating disease (along with sanitation and antibiotics), there have been and continue to be safety issues associated with vaccine administration.

Historically, there have been a number of situations where vaccines clearly caused harm.

  • In 1955, two batches of polio vaccine contained live virus, which caused an outbreak of polio.
  • In the 1970s a paper was published linking pertussis vaccination to permanent brain damage. The ensuing boycott of vaccinations and slate of lawsuits drove vaccine manufacturers out of the business, creating shortages and a rapid increase in disease incidence. The theory was later disproved7 but the controversy led to the development of the National Vaccine Information Office, the National Vaccine Injury Act, which provides some liability protection to manufacturers and the National Vaccine Injury Compensation Fund which provides monetary compensation when a vaccine is proven to have had a deleterious effect.8
  • In 1976, there was evidence that the swine flu outbreak could create an epidemic as bad as the flu epidemic of 1918, which killed 50,000,000 people worldwide. Swine flu vaccine was rushed to the public without adequate testing, resulting in about 500 cases of Guillain-Barré syndrome before the program was cancelled.

Vaccines, like any drug or foreign material that enters the body, can cause allergic reactions, often due to the adjuvant, i.e., materials that the vaccine uses as a vehicle for administration. Side effects such as localized swelling, fever, crying and more are often associated with injections.

Controversial Safety Issues

Beyond the concern about specific vaccine problems, there is still a strong minority of people who believe that the increasing rates of autism and learning disabilities in the U.S. are related to its mandatory immunization program. Autism is a developmental disorder characterized by impairment of social behaviors and interactions. These behaviors usually become observable at about eighteen months. Most vaccinations are given on a schedule that begins at age 2 months, creating a question about whether the immunizations cause the autism. Historical review shows that the incidence of autism in the U.S. did increase at about the time of the introduction of the MMR vaccine but in the UK it did not. But, awareness of autism as a distinct disease also increased at the same time.

The study of 12 children in 1998 is frequently cited as proof that vaccines cause autism or play a part in the disorder, despite the fact that it was later retracted. However, in January 2011, the British Medical Journal cited that the landmark study published in The Lancet in 1998 by Dr. Andrew Wakefield linking autism to the MMR vaccine was fraudulent...“fatally flawed both scientifically and ethically”.9,10

In the past, thimerosal, organic mercury, was used as a component of vaccines. Fears of a link between mercury and autism caused the Institute of Medicine to request removal of thimerosal from vaccines as a precautionary measure. This move, which was not based on scientific evidence, lent credibility to these fears. The current scientific consensus is that thimerosal causes or worsens autism; by 1999, this ingredient was removed from almost all vaccines. Of interest, the seasonal flu vaccine may still contain thimerosal.

The Controversy

Vaccines have improved the lives of billions of people worldwide, eradicating many diseases or reducing them to small, manageable outbreaks. However:

  • While vaccines are spectacularly successful in the macro sense, on a person by person, basis, vaccines can pose mild to severe risks for side effects and/or permanent and debilitating damage.
  • There are unresolved controversies about the role of vaccines in autism and learning disorders.
  • There is a fundamental belief that the government should not be able to force people to submit to unwanted medical interventions.

As a result, some people, especially parents of vaccination-age children, are opposed to vaccination. There are both scientific and ideology-based arguments on both sides.11

Here’s a look at the issues:

Heads

           

Tails

Getting vaccinated protects the individual and the community; it’s an obligation of living in a society to support the public good. It’s also not fair for some to have to shoulder the burden of whatever risks may be involved, while others choose not to.

While most vaccination proponents recognize that there maybe individual situations where vaccination is not recommended, they point to the fact that if vaccinations weaken the immune system, there should be a higher rate of infections after immunization. A 2001 study of over 800,000 children in Denmark determined that there was no correlation.12

The U.S. faces the dilemma that there is very little profit margin in vaccines so there is little motivation for drug companies to produce vaccines. This situation has led to flu vaccine shortages in the past as well as to problems stockpiling vaccines against biological terror agents like anthrax.

In the recent vaccine case, the court found that an individual child had a mitochondrial disorder that was aggravated by the vaccinations and resulting in autism symptoms; the vaccine did not itself create the autism.

The Vaccine Adverse Event Reporting System (VAERS) has been compromised by personal injury lawyers who file many of the reports as a way to boost evidence for lawsuits.14 However, no one is arguing that there are no adverse effects – the issue is that the adverse effects are minor in scope compared to the devastating effects of failing to immunize against preventable diseases.

Hepatitis B vaccine is provided to children because they are a captive population in order to confer protection when they are teens and young adults, a time when many choose not to take effective safety measures.

It is not fair to subject vaccinated children, especially those who have been vaccinated because their medical conditions suggest that the disease would have serious negative effects, to the potential of getting the disease from those who have chosen not to be vaccinated (since vaccinations are not 100% effective in most cases.)

Manufacturers are constantly working to reduce chemical agents in vaccines such as thimerosal.

Children who are not vaccinated with MMR (Mumps, Measles and Rubella) are 35 times more likely to get the diseases, which can be severe.

Varicella (chicken pox) can lead to hospitalization and/or death.
Polio vaccination is still important because polio is still present in developing countries. These diseases are rare because of the high degree of immunization. If people choose to stop vaccinating, the diseases will rebound as studies in other countries have shown.15

There is still no credible evidence of a correlation between autism and vaccination. This position is supported by the World Health Organization, the CDC, The AMA and the American Academy of Pediatrics.

 

The U.S. vaccination rate is already way above herd immunity thresholds.

Each person or family has the right to make their own free choice about invasive medical procedures. Recognizing the macro value of vaccination, each person or family need the liberty to evaluate their own situation, particularly with respect to vulnerabilities, and then choose the best course of action for the individual.

Vaccines are actively promoted due to the profit motive of manufacturers. When lawsuits related to immunizations go to trial, pharmaceutical manufacturers can supply “purchased” experts to plead their case.

The U.S. Vaccine Compensation Program has paid over 2000 awards (over $1.2 billion) for damages due to vaccines including a recent case where the court found that simultaneous immunizations caused autism symptoms.13 Children with auto immune diseases are at greater risk for serious side effects from vaccination and should be able to be exempted from participating.

The Vaccine Adverse Event Reporting System (VAERS), a government-run program that collects data on adverse events related to vaccines receives over 1,000 reports per month, estimated to be approximately 10% of actual events.

Hepatitis B immunization is not worthwhile – the disease does not even affect children (less than 1% of all reported victims are under the age of 15) yet it carries some risk of adverse effects up to and including death.

For less dangerous diseases such as measles and chicken pox, natural immunity is preferable because it is 100% effective.

Vaccines contain known toxins and carcinogens such as aluminum and thimerosal.

Side effects of the MMR vaccination are similar to the disease and can be severe.

Varicella side effects are similar to the disease; naturally acquired disease provides lifetime immunity, vaccination requires boosters.

Polio vaccination is unnecessary because there hasn’t been a case of wild polio in the Untied States in 20 years. These diseases are so rare that it’s highly unlikely that anyone would contract them anymore.

While the correlation between the increase in autism and the increase in vaccinations may not be causal, it may yet be proved to be causal. Consequently, vaccinations should not be mandatory.

It’s not surprising that there are strong feelings on both sides of this issue, fueled by an enormous amount of misinformation on the Internet. While there are legitimate and real issues of concern for people regarding the safety of vaccination in individual situations and there is certainly room to think about the safety of multiple vaccinations at a time and the cost/benefit of some vaccines, there is a preponderance of bad information on the anti-vaccine side which, frankly, trivializes the real issues by providing so much misinformation that honest areas of disagreement seem questionable as well.

If you are interested in researching this topic, here are a few suggestions to help you avoid misinformation:

Do not accept pronouncements of fact without substantiation. If study results are cited, search out the actual study (not that hard to do using search engines). It’s amazing how many times you will discover that there is no such study or that the study’s conclusions are inaccurately reported.16

Evaluate the credentials of the authors. Credibility goes up if their information is published in peer-reviewed journals. This means that a panel of experts has reviewed their methods and conclusions and agree that their information makes a valid point.

Go to the World Health Organization’s website. They have reviewed and recommended a number of sites which, on the opinion of international experts, present balanced and credible information on the subject of vaccination.17

The Bottom Line

People still need answers to the question of autism and vaccines. Although the research currently says there is no evidence, most researchers suggest that more exploration is necessary. And even though the landmark study that linked the increased incidence of autism to vaccinations was found to be fradulent many continue to adhere to their long held beliefs.

The solution is more and better research on several fronts including new and better ways to engineer vaccines so that they can be more targeted and less likely to create adverse events in specific individuals.

Is there middle ground or any solutions to this controversy? The middle ground is probably represented by the United States and Canada, two countries that enjoy an extremely high level of vaccination and very, very low levels of preventable diseases. At the same time they provide the opportunity for individuals in most cases to be exempt from vaccination on the basis of religious or medical reasons. This balance allows the majority of the population to be well protected while still giving individuals the right to exercise the freedom to choose.

Published March 1, 2009, updated May 21, 2012

 

Photo By:  Paul Swansen


References

  1. The History of Vaccines, HistroyofVaccines.org
  2. Timeline of Vaccines, Wikipedia
  3. Historic Dates and Events Related to Vaccines and Immunization, Immunization Action Coalition
  4. Stern and Markel, The History of Vaccination and Immunization: Familiar Patterns, New Challenges, Health Affairs, 24, no. 3 (2005): 611-621 doi: 10.1377/hlthaff.24.3.611
  5. Smallpox: Disease, Prevention, and Intervention, CDC
  6. Herd Immunity, Wikipedia
  7. Vaccination Coverage Among Children Entering School --- United States, 2003--04 School Year, MMWR, CDC, November 12, 2004 / 53(44);1041-1044
  8. Griffith AH, Permanent brain damage and pertussis vaccination: is the end of the saga in sight, Vaccine, 1989 Jun;7(3):199-210
  9. The Lancet retracts Andrew Wakefield’s article, Science - Based Medicine
  10. Wakefield’s article linking MMR vaccine and autism was fraudulent, BMJ 2011; 342 doi: 10.1136/bmj.c7452, Published 5 January 2011
  11. Vaccine Controversies, Wikipedia
  12. Stein R, Childhood Vaccines Pose No Extra Risk for Diseases, Study Finds, Washington Post, Wednesday, August 10, 2005
  13. The National Vaccine Injury Compensation Program (VICP), HRSA
  14. The Vaccine Adverse Event Reporting System, VAERS
  15. Vaccines and Mercury, Healing Arts
  16. K.N.O.W. Vaccines
  17. Vaccine safety web sites meeting credibility and content good information practices criteria, WHO

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Last Updated : Saturday, February 14, 2015