To vax, or not to vax

The life and longevity of the anti-vac­cine move­ment

The McGill Daily - - News - Lind­say Burns Sci+tech Writer

It is dif­fi­cult to ap­pre­ci­ate the ef­fects of vac­cines on modern medicine to their fullest ex­tent. De­spite a po­ten­tially both­er­some in­jec­tion sched­ule or the myths as­so­ci­ated with their in­gre­di­ents and ad­verse ef­fects, vac­cines have saved mil­lions of lives since their in­cep­tion in 1796. Vac­cines are con­sid­ered to be one of the ten great­est pub­lic health achieve­ments of the 20th cen­tury, on par with mo­tor-ve­hi­cle safety and the recog­ni­tion of to­bacco as a health haz­ard. Akin to seat belt re­quire­ments, or anti-smok­ing cam­paigns, the wide­spread use of vac­cines has been met with con­tro­versy.

Vac­cines ad­min­is­tered to in­fants or young chil­dren dur­ing the past two decades are ex­pected to pre­vent 322 mil­lion ill­nesses, 21 mil­lion hos­pi­tal­iza­tions, and 732,000 deaths over the course of their life­time, ac­cord­ing to a 2014 re­port from the Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC). Pre­ven­tion of po­ten­tially dev­as­tat­ing ill­nesses among chil­dren is es­ti­mated to save $295 bil­lion in di­rect costs, such as med­i­cal ex­penses, and an ad­di­tional $1.3 tril­lion in so­ci­etal costs. How­ever, skep­ti­cism of vac­cine safety — and fad­ing mem­o­ries of vac­cine-pre­ventable dis­eases — have led some par­ents to be­come hes­i­tant to vac­ci­nate their chil­dren. “For a lot of peo­ple, they per­ceive that the risk is gone,” said Dr. Brian Ward, a re­searcher in the field of im­mu­niza­tion at Mcgill, “and so they start mak­ing cal­cu­la­tions on what’s the risk of the vac­cine ver­sus not get­ting the vac­cine. And for them the risk of not get­ting the vac­cine is zero. So they are com­par­ing the very tiny risks of the vac­cine to noth­ing.”

Only three Cana­dian prov­inces have leg­is­lated vac­ci­na­tion poli­cies, which strictly ap­plies to chil­dren start­ing school. On­tario and New Brunswick re­quire vac­ci­na­tion against diph­the­ria, tetanus, po­lio, measles, mumps and rubella, while Man­i­toba re­quires a measles im­mu­niza­tion. In each case, how­ever, the leg­is­la­tion in­cludes an ex­emp­tion clause on the ba­sis of con­science, med­i­cal or re­li­gious grounds.

In 1796, Ed­ward Jen­ner, a ru­ral Bri­tish doc­tor, ob­served that in ac­cor­dance with lo­cal folk­lore, milk­maids were pro­tected from small­pox after nat­u­rally suf­fer­ing cow­pox. Jen­ner the­o­rized that cow­pox not only pro­tected peo­ple against small­pox, but can also be de­lib­er­ately trans­mit­ted from one per­son to an­other as a novel tool for con­fer­ring pro­tec­tion. To prove his the­ory, Jen­ner in­jected eight-year-old James Phipps with pus taken from a cow­pox pus­tule on the hand of a milk­maid. The boy de­vel­oped a mild fever but re­cov­ered shortly after. Af­ter­wards, Jen­ner in­oc­u­lated Phipps again, with mat­ter from a fresh small­pox le­sion. No dis­ease de­vel­oped, and Jen­ner con­cluded that the pro­tec­tion was com­plete. Ed­ward Jen­ner had ef­fec­tively pi­o­neered the world’s very first vac­cine. He sub­mit­ted his find­ings to the Royal So­ci­ety for pub­lish­ing, but his find­ings were re­jected. In­stead, Jen­ner pri­vately pub­lished a small book­let out­lin­ing his hy­pothe­ses, ex­per­i­ment, and ob­ser­va­tions ti­tled An In­quiry into the Causes and Ef­fects of the Var­i­o­lae Vac­ci­nae, a Dis­ease Dis­cov­ered in some of the Western Coun­ties of Eng­land, par­tic­u­larly Glouces­ter­shire, and Known by the Name of The Cow Pox. The pub­li­ca­tion of Jen­ner’s in­quiry was met with a mixed re­ac­tion, and he was widely ridiculed by his peers in the med­i­cal com­mu­nity. Although Jen­ner had made one of the most im­pact­ful health dis­cov­er­ies in his­tory, his dis­cov­ery was met with a spu­ri­ous epi­demic of panic and fear. Jen­ner’s crit­ics, pri­mar­ily the clergy, deemed it re­pul­sive and un­godly to be in­oc­u­lated with ma­te­rial taken from a dis­eased an­i­mal. Skep­ti­cism of vac­cines re­mained wide­spread, de­spite lack of records en­tail­ing such side ef­fects. Op­po­si­tion to vac­ci­na­tion has ex­isted as long as vac­ci­na­tion it­self.

Al­beit, the anti-vac­ci­na­tion move­ments ide­ol­ogy has shifted since the days of Jen­ner. The over­all mes­sage re­mains the same: vac­cines are dan­ger­ous and those re­spon­si­ble for de­vel­op­ing vac­cines are not to be trusted. Re­cent myths prop­a­gated by the anti-vac­ci­na­tion move­ment in­clude: the in­fa­mous “vac­cines cause autism”, safety of com­mon in­gre­di­ents, su­pe­ri­or­ity of nat­u­rally ac­quired im­mu­nity over vac­cine-ac­quired im­mu­nity, and the be­lief that vac­cines are no longer nec­es­sary against dis­ap­pear­ing vac­cine-pre­ventable dis­eases. Re­cent anti-vac­cine claims seem more plau­si­ble than the myth of turn­ing into a cow after the small­pox vac­cine, how­ever, grow­ing sci­en­tific ev­i­dence ex­ists de­bunk­ing nearly ev­ery one.

A 1998 case se­ries pub­lished in Lancet, a Bri­tish jour­nal, sug­gested that the measles-mumps-rubella (MMR) vac­cine may pre­dis­pose chil­dren to de­vel­op­ment of autism spec­trum dis­or­der (ASD). De­spite in­ad­e­quate sam­ple sizes (n = 12), un­con­trolled de­sign, and the spec­u­la­tive na­ture of the con­clu­sions, the pa­per re­ceived wide­spread pub­lic­ity, and MMR vac­ci­na­tion rates be­gan to fall. How­ever, im­me­di­ately fol­low­ing the pa­per, sub­se­quent epi­demi­o­log­i­cal stud­ies failed to pro­duce the same link be­tween MMR vac­ci­na­tion and autism. The logic that the MMR vac­cine was re­spon­si­ble for trig­ger­ing autism was crit­i­cized be­cause the in­jec­tion of the MMR vac­cine and ASD di­ag­no­sis both oc­cur in early child­hood. Sub­se­quently, the link be­tween the two could sim­ply be cor­rel­a­tive in na­ture. As a re­sult, the pa­per was for­mally re­tracted by the jour­nal in 2010, cit­ing its “fail­ure to dis­close fi­nan­cial in­ter­ests”, as well as, “guilty of eth­i­cal vi­o­la­tions”, and “sci­en­tific mis­rep­re­sen­ta­tion” on part of the orig­i­nal au­thors.

Fol­low­ing the MMR scare, vac­ci­na­tion pro­grams started to re­cover its rep­u­ta­tion. How­ever, shortly af­ter­wards, a new con­tro­versy re­gard­ing vac­cine in­gre­di­ents was pop­u­lar­ized. Thimerosal, an or­ganic, mer­curycon­tain­ing com­pound added to some vac­cines as a preser­va­tive, be­came the cen­tre of a new “vac­cines cause autism” con­tro­versy. Although there is no ev­i­dence to sug­gest that the amount of thimerosal used in vac­cines poses a health risk, lead­ing pub­lic health, med­i­cal or­ga­ni­za­tions, and vac­cine man­u­fac­tur­ers agreed to re­duce or re­move the in­gre­di­ent from vac­cines as a pre­cau­tion­ary mea­sure. In 2001, The In­sti­tute of Medicine’s Im­mu­niza­tion Safety Re­view Com­mit­tee con­cluded that there was in­suf­fi­cient ev­i­dence to prove or dis­prove claims that thimerosal ex­po­sure from child­hood vac­cines and the neu­rode­vel­op­ment dis­or­ders of autism, at­ten­tion deficit hy­per­ac­tiv­ity dis­or­der (ADHD), and speech or lan­guage de­lay were con­nected but “favours re­jec­tion of a causal re­la­tion­ship” on a more re­cent re­port. The com­mit­tee did con­firm that the as­so­ci­a­tion be­tween thimerosal-con­tain­ing vac­cine ex­po­sure and neu­rode­vel­op­men­tal dis­or­ders was bi­o­log­i­cally plau­si­ble, though not well-de­fined.

Other com­mon in­gre­di­ents were also quickly branded as un­safe, in­clud­ing formalde­hyde, mer­cury and alu­minum. While th­ese chem­i­cals are toxic to the hu­man body at cer­tain con­cen­tra­tions, only trace amounts are found in the Food and Drug Ad­min­is­tra­tion (FDA) ap­proved vac­cines. Formalde­hyde is pro­duced at higher rates by our own meta­bolic sys­tems than in a typ­i­cal vac­cine dosage. The low lev­els of chem­i­cals added to vac­cines do not sur­pass the re­spec­tive rec­om­mended al­lowances out­lined by the World Health Or­ga­ni­za­tion.

Vac­cines in­ter­act with the im­mune sys­tem to pro­duce an im­mune re­sponse sim­i­lar to that re­sult­ing from nat­u­ral in­fec­tion, but do not cause dis­ease or put an in­di­vid­ual at risk of its as­so­ci­ated com­pli­ca­tions. Risks of ac­quir­ing im­mu­nity through nat­u­ral in­fec­tion in­clude in­tel­lec­tual dis­abil­ity from Hae­mophilus in­fluenza type b (Hib), birth de­fects from rubella, liver cancer from hep­ati­tis B virus, or death from measles. In Canada, to gain nat­u­ral im­mu­nity through con­tract­ing measles, one wa­gers a 1 in 1000 chance of death from the dis­ease, and a 1 in 1000 risk of de­vel­op­ing en­cephali­tis. In con­trast, an in­di­vid­ual opt­ing to vac­ci­nate has zero risk of de­vel­op­ing measles from the vac­cine and a 1 in 1 mil­lion risk of en­cephali­tis.

For­tu­nately, in­ci­dence rates of vac­cine-pre­ventable dis­eases are on the de­cline in most de­vel­oped coun­tries. Some vac­cine-pre­ventable dis­eases are de­clared as erad­i­cated in North Amer­ica. How­ever, this does not mean that vac­ci­na­tion pro­grammes in th­ese ar­eas can be elim­i­nated. “One of my favourite [myths] is that we don’t need vac­cines be­cause th­ese dis­eases were dis­ap­pear­ing be­fore vac­cines were in­tro­duced,” said Ward, “and in terms of mor­tal­ity, that is ab­so­lutely true […] but not the in­ci­dence of dis­ease.”

Modern san­i­ta­tion, im­proved nutri­tion and the de­vel­op­ment of an­tibi­otics have con­tributed to the re­duc­tion or elim­i­na­tion of in­fec­tious dis­eases. Although vac­cine-pre­ventable dis­eases are be­com­ing less com­mon, the in­fec­tious agents that cause them con­tinue to cir­cu­late in some parts of the world. In a highly in­ter­con­nected so­ci­ety, in­ter­na­tional travel is a com­mon oc­cur­rence. In­fec­tious agents are ca­pa­ble of cross­ing ge­o­graph­i­cal bor­ders, in­fect­ing the most vul­ner­a­ble in nearly any cor­ner of the world. Due to the suc­cess of im­muni-

De­spite in­ad­e­quate sam­ple sizes (n =12), un­con­trolled de­sign, and the spec­u­la­tive na­ture of the con­clu­sions, the pa­per re­ceived wide­spread pub­lic­ity, and MMR vac­ci­na­tion rates be­gan to fall.

za­tion, Canada has not re­ported any cases of en­demic measles since 1998. In­fec­tious agents that boast only hu­man reser­voirs are ca­pa­ble of be­ing com­pletely erad­i­cated, as in the case of small­pox, but un­til global eradication can be achieved, it is nec­es­sary to con­tinue vac­ci­nat­ing against dis­eases that per­sist as po­ten­tial threats to the Cana­dian pop­u­la­tion. How­ever, “as a gen­eral rule, if there is an en­vi­ron­men­tal reser­voir, we have to vac­ci­nate for­ever,” noted Ward. This ap­plies for dis­eases such as po­lio and diph­the­ria, as they ex­ist nat­u­rally in the en­vi­ron­ment and thus the risk of in­fec­tion can never be com­pletely elim­i­nated.

There are two fun­da­men­tal rea­sons to vac­ci­nate: to pro­tect our­selves, and pro­tect those around us. Suc­cess­ful vac­ci­na­tion pro­grams de­pend on the co­op­er­a­tion be­tween in­di­vid­u­als to en­sure an over­all ben­e­fit. This con­cept is re­ferred to as “herd im­mu­nity,” specif­i­cally when the re­sis­tance to the spread of a dis­ease within a pop­u­la­tion is achieved only when a suf­fi­ciently high pro­por­tion of in­di­vid­u­als are im­mune to the dis­ease, mainly through vac­ci­na­tion. When a crit­i­cal por­tion or a com­mu­nity, typ­i­cally rang­ing from 83 to 94 per cent, are pro­tected against a dis­ease, there is lit­tle to no pos­si­bil­ity of out­break. The con­cept of herd im­mu­nity is cru­cial to pro­tect­ing those mem­bers of so­ci­ety that can­not re­ceive vac­cines, due to age, se­vere al­ler­gies, suf­fer­ing from spe­cific dis­eases, or are im­muno­com­pro­mised (di­min­ished im­mune sys­tem ca­pa­bil­i­ties). When vac­ci­na­tion rates fall be­low ac­cept­able lev­els, mem­bers of the pop­u­la­tion be­come in­creas­ingly vul­ner­a­ble. Over­all, the cov­er­age rates for vac­cines are high in Canada, although some fall be­low the min­i­mum range to main­tain herd im­mu­nity. The anti-vac­ci­na­tion move­ment fur­ther jeop­ar­dizes th­ese cov­er­age rates by propagating mis­in­for­ma­tion re­gard­ing the ne­ces­sity of vac­ci­na­tion in ar­eas where in­ci­dence rates of vac­cinepre­ventable dis­eases are low. For some par­ents, the herd im­mu­nity ar­gu­ment is in­suf­fi­cient to con­vince them to vac­ci­nate, re­sult­ing in a dif­fi­cult con­sid­er­a­tion of in­di­vid­ual risk ver­sus moral obli­ga­tion. Ward agreed: “It’s the in­di­vid­ual harm ver­sus the greater good that is al­ways the dy­namic around vac­cine safety […] what’s the hit that you’re will­ing to take, in terms of th­ese very low risks, to par­tic­i­pate in this larger likely ben­e­fit.”

For many vac­cine hes­i­tant par­ents, vac­cine-pre­ventable dis­eases rep­re­sent an un­fa­mil­iar, in­sub­stan­tial threat. Many par­ents have sim­ply never wit­nessed the po­ten­tially dev­as­tat­ing ef­fects of con­tract­ing measles or po­lio, or known some­one to suf­fer from th­ese dis­eases. Physi­cians and nurses in North Amer­ica, de­spite work­ing in the med­i­cal field, have only en­coun­tered such cases in lit­er­a­ture. Vac­cine pro­grammes are largely re­spon­si­ble for a gen­er­a­tion of par­ents un­fa­mil­iar with the symp­toms and risks as­so­ci­ated with in­fec­tious dis­eases, “we are very much vic- tims of the suc­cess of our pro­grams,” said Ward. Many im­ages of dis­ease ex­ist only as ob­scure relics of the past. Long for­got­ten are the puffy cheeks and swollen neck of mumps, the se­vere di­ar­rhea, vom­it­ing and ab­dom­i­nal pain of rotavirus, or the flat, red blem­ishes of measles. Aside from the signs and symp­toms, many of th­ese dis­eases can have last­ing health risks rang­ing from per­ma­nent deaf­ness, brain dam­age, and paral­y­sis lead­ing to death.

Un­de­terred, anti-vac­cine ad­vo­cates may con­tinue to pivot the tar­get of their ac­cu­sa­tions. The baf­fling longevity of the anti-vac­cine move­ment partly speaks to its im­pres­sive mal­leabil­ity. “Like most myths, all of them have a grain of truth,” said Ward, “[…] they seize on the grain of truth and then ex­trap­o­late.” How­ever, it is nearly im­pos­si­ble for re­searchers to keep up with evolv­ing fears as they oc­cur. Not only is study­ing ex­tremely rare vac­cine-as­so­ci­ated ef­fects dif­fi­cult, an­tic­i­pat­ing them is im­pos­si­ble. “One of the re­ally prob­lem­atic things with vac­cine-as­so­ci­ated ad­verse events is that they are so rare. And so it is ac­tu­ally re­ally hard to study some­thing that is so rare,” said Ward. Take for ex­am­ple a new vac­cine that has an un­known se­ri­ous ad­verse ef­fect of caus­ing throm­bo­cy­tope­nia (low blood platelet count) in 1 per 2.9 mil­lion cases. Canada has an an­nual birth co­hort of ap­prox­i­mately 400,000 ba­bies. This means that it would take over seven years for a true vac­cine-as­so­ci­ated oc­cur­rence of throm­bo­cy­tope­nia to ap­pear, amidst a back­ground of cases of throm­bo­cy­tope­nia re­sult­ing from some other fac­tor.

How is it pos­si­ble for re­searchers to pin­point this sin­gle case as be­ing caused by the vac­cine? Worse than look­ing for a nee­dle it a haystack, it would be com­pa­ra­ble to search­ing for a sin­gle spe­cific nee­dle in a stack of nee­dles. “Peo­ple who stand up and shout [that] we have the tools to de­ter­mine what vac­cines are safe or not be­fore we give them to peo­ple, that’s com­plete non­sense. We don’t. We’re pretty good but nowhere near that good for look­ing at th­ese in­cred­i­bly rare events,” added Ward, “but that’s the ex­pec­ta­tion of the pop­u­la­tion… We just don’t have the tools.” Although tech­nol­ogy is ad­vanc­ing, and ad­verse event re­port­ing pro­grams are improving, we are far from a CSI: Crime Scene In­ves­ti­ga­tion level of sci­en­tific field-work.

The Pub­lic Health Agency of Canada [PHAC] child­hood Na­tional Im­mu­niza­tion Cov­er­age Sur­vey of 2013 asked Cana­dian par­ents about knowl­edge, at­ti­tudes and be­liefs re­lated to vac­cines and vac­ci­na­tion. The sur­vey re­vealed that 95 per cent of par­ents agreed that child­hood vac­cines are safe. Sim­i­larly, 97 per cent of par­ents thought that vac­cines are ef­fec­tive and im­por­tant for chil­dren’s health. How­ever, nearly 70 per cent of par­ents ex­pressed some de­gree of con­cern on the pos­si­ble side ef­fects of vac­cines. More than one third falsely be­lieved that a vac­cine could cause the dis­ease it was in­tended to pre­vent. Al­most five per­cent of par­ents strongly be­lieved that al­ter­na­tive prac­tices, such as home­opa­thy or chi­ro­prac­tic, could elim­i­nate the need for vac­cines.

Homeo­pathic al­ter­na­tives, such as nosodes, are not a sub­sti­tute for vac­cines. There are no suit­able sub­sti­tutes for vac­cines. A CBC Mar­ket­place in­ves­ti­ga­tion found that al­ter­na­tive health prac­ti­tion­ers of­fer un­proven vac­cine “al­ter­na­tives,” adding to many par­ents’ con­fu­sion re­gard­ing vac­cines. Nosodes are pre­pared as di­lu­tions of dis­eased tis­sue or ex­cre­tions se­creted dur­ing the course of a dis­ease be­low con­cen­tra­tions ex­pected to have pro­tec­tive ef­fects, to a point where any trace of the orig­i­nal sub­stance is likely not present. Homeo­pathic prac­ti­tion­ers claim that the “mem­ory” of the orig­i­nal sub­stance is suf­fi­cient to cre­ate im­mu­nity. While no reg­u­la­tions pro­hibit homeo­pathic prac­ti­tion­ers from of­fer­ing health ad­vice or al­ter­na­tive reme­dies, and to prove their pos­i­tive ef­fects, th­ese treat­ments are not ap­proved by Health Canada as an al­ter­na­tive to im­mu­niza­tion. Med­i­cal ex­perts agree that there is no sci­en­tific proof to sub­stan­ti­ate their ef­fi­cacy.

Th­ese re­sults demon­strate a need for im­proved pub­lic ed­u­ca­tion on im­mu­niza­tion. If the will­ing­ness to vac­ci­nate is placed on a spec­trum, there are com­mit­ted per­cent­ages at both ends, those whom are res­o­lutely be­hind vac­cines, and those against. How­ever, from the PHAC data above, ap­prox­i­mately 70 per cent of par­ents wa­ver some­where in the mid­dle of this spec­trum. Th­ese vac­cine-hes­i­tant par­ents are the tar­get of most physi­cian and re­searcher ef­forts to com­mu­ni­cate with, bet­ter un­der­stand, and come to some sort of com­pro­mise with.

When the bur­den on the pub­lic and sci­en­tific com­mu­nity to com­mu­ni­cate was dis­cussed, Ward said, “Of course it’s al­ways on the shoul­ders of the sci­en­tists to com­mu­ni­cate and make sure the peo­ple un­der­stand, and do so in a way that’s easy for peo­ple to un­der­stand. It’s also in­cum­bent on the sci­en­tists and [physi­cians] to be com­pletely trans­par­ent about risks. You have to ac­knowl­edge right up front that there is no such thing as a safe vac­cine.” The dis­cus­sion of­ten boils down to one of un­der­stand­ing and ac­cept­ing risk. “You have to be sen­si­tive to each in­di­vid­ual’s con­cept of risk […] to say to some­body who’s wor­ried ‘there’s no risk.’ It is much more ef­fec­tive to say ‘the risk is re­ally small and I vac­ci­nate my chil­dren.’ ” By mov­ing the com­plex dis­cus­sion of fac­tors in­volved in vac­cine safety to a sim­ple un­der­stand­ing of the as­so­ci­ated risks, as well as per­sonal re­as­sur­ance, “it’s com­pletely trans­par­ent and it also says I know a whole lot more than you about the rel­a­tive risks and I chose to ac­cept those risks for my chil­dren,” said Ward, “So ei­ther I’m a shitty par­ent, or I’ve made an in­formed de­ci­sion.” Heidi Lar­son, an an­thro­pol­o­gist at the Lon­don School and Hy­giene and Trop­i­cal Medicine echoed this sen­ti­ment dur­ing an in­ter­view with BBC News, “the rea­son that peo­ple get more en­trenched in their op­po­si­tion to vac­ci­na­tion is they feel like they’re not be­ing lis­tened to. So you don’t throw in­for­ma­tion at the prob­lem. In­stead you learn to lis­ten.”

“As a pro­fes­sion, our first step has to be to look at our­selves [and] say what are we do­ing wrong,” noted Ward. An im­por­tant so­lu­tion to dis­pelling mis­in­for­ma­tion around vac­cines could there­fore be that physi­cians and re­searchers de­vote more time to ad­dress­ing doubts in a closed set­ting with hes­i­tant par­ents.

In or­der for this method to be pro­duc­tive, par­ents must have the will and ca­pac­ity to put risks into per­spec­tive. For most, hon­esty is the best pol­icy, and trans­parency is im­per­a­tive to trust­ing. Like any medicine, vac­cines may carry real risks, rang­ing from mi­nor swelling and fever, to rare but se­ri­ous ad­verse ef­fects in­clud­ing seizures and ana­phy­laxis. Doc­tors can be­gin to build trust by fram­ing th­ese risks along­side the dan­gers of dis­ease, or com­par­ing them to risks as­sumed in daily life. For ex­am­ple, a se­ri­ous en­cephalomyeli­tis (in­flam­ma­tion of the brain and spinal cord) due to ad­min­is­tra­tion of the MMR vac­cine oc­curs once in 1 mil­lion doses. In com­par­i­son, an in­di­vid­ual is more likely to die in a car ac­ci­dent (one in 113), to suf­fer a se­vere ana- phy­lac­tic al­lergy to peni­cillin (one to five in 10,000), or to be struck by light­ning (1 in 13,000). Th­ese com­par­isons can be use­ful to truly ap­pre­ci­ate the safety of cur­rent vac­cines.

In ad­di­tion to di­rectly in­ter­act­ing with the pub­lic, it is in­te­gral for physi­cians and re­searchers to ac­quire an “ex­pert ver­sus ex­pert” mind­set to dis­pel prop­a­ga­tion of false in­for­ma­tion by mem­bers of the med­i­cal and sci­en­tific com­mu­ni­ties. “The one’s I sin­gle out for the most pointed crit­i­cism is my peers. The med­i­cal and sci­en­tific ex­perts. There has got to be con­se­quences for peo­ple who stand up and spout non­sense,” in­sisted Ward, “I think we’ve been too pas­sive.” The onus is on mem­bers of th­ese re­spec­tive com­mu­ni­ties to call out and chal­lenge fraud­u­lent claims made by their peers.

“We ask cit­i­zens to get vac­cines to pre­vent 14 dif­fer­ent dis­eases, which can mean as many as 26 in­oc­u­la­tions in the first few years of life, to pre­vent dis­eases that peo­ple mostly don’t see, us­ing bi­o­log­i­cal flu­ids that most peo­ple don’t un­der­stand,” said Paul Of­fit, the head of an in­fec­tious- dis­eases di­vi­sion at the Chil­dren’s Hospi­tal of Philadel­phia dur­ing a Q&A with Univer­sity of Penn­syl­va­nia news­pa­per the Penn Cur­rent, “it’s not sur­pris­ing that peo­ple are hes­i­tant.” Peo­ple can re­ject vac­cines for a va­ri­ety of rea­sons, such as per­sonal or re­li­gious rea­sons, scare sto­ries in­cu­bated on the in­ter­net and am­pli­fied by head­line- driven me­dia out­lets, or due to fad­ing mem­o­ries of vac­cine-pre­ventable dis­eases that pro­grammes have so ad­e­quately elim­i­nated that we gladly for­get their symp­toms and risks.

Par­ents are re­spon­si­ble for the well-be­ing of their chil­dren, in­clud­ing pro­tec­tion from dis­eases that are eas­ily pre­ventable. But with the pop­u­la­tion of vac­cine-hes­i­tant par­ents con­tin­u­ing to ex­pand, we can only ex­pect the com­mit­ted anti-vac­ci­na­tion move­ment to grow as well. How­ever, this is a dif­fer­ent is­sue from smok­ing, or re­mov­ing a seat­belt, where one know­ingly accepts the risks as­so­ci­ated as an in­di­vid­ual. The choice made by par­ents not to vac­ci­nate their child puts the liveli­hood of in­no­cent chil­dren at risk.

“When I am con­fronted by some­body like that [par­ents who refuse to vac­ci­nate chil­dren] I say I re­ally hope for the sake of your chil­dren that your de­ci­sion, which I think is ill-in­formed, [does not re­sult] in them dy­ing from tetanus or be­ing hurt by measles. That, to me, would be a hor­ri­ble out­come for both of us,” said Ward. Un­for­tu­nately, trends in the pub­lic per­cep­tion of sci­ence, the gov­ern­ment, and the vac­cine in­dus­try highly con­trib­utes to par­ents’ dis­trust of vac­cines. The pub­lic must learn to sup­port cred­i­ble sci­en­tific re­search and facts, to avoid mis­guid­ance and make wellinformed de­ci­sions.

The re­sis­tance to the spread of a dis­ease within a pop­u­la­tion is achieved only when a suf­fi­ciently high pro­por­tion of in­di­vid­u­als are im­mune to the dis­ease, mainly through vac­ci­na­tion.

Homeo­pathic al­ter­na­tives, such as nosodes, are not a sub­sti­tute for vac­cines. There are no suit­able sub­sti­tutes for vac­cines.

Hay­ley Mortin | The Mcgill Daily

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