Now that I have debunked myths and presented basic facts to support what I stand by: vaccinations are necessary and good! Every parent should immunize their child except for in rare cases, such as SCID patients. We can now go one to criticize the current vaccination infrastructure and propose solutions to gain social trust back and boost vaccination rates. This critique is largely derived (so much so that one may call it a summarization) from the nonpartisan scientific paper, Vaccine risks: real, perceived and unknown, by Robert Chen. I chose an “outside” source as to steer clear of research and claims made solely by the companies who benefit monetarily from vaccinations.

Why have anti-vaccine attitudes been gaining strength?

  • As vaccination increases, vaccine-preventable diseases decrease. Though this is wonderful and means the vaccines are effective, it also means that adverse reactions to vaccination have outnumbered the occurrence of vaccine-preventable disease in “‘Mature’ immunization programs.” While from a logical standpoint this makes perfect sense, it may seem concerning at first glance. What truly compounds fears about adverse events are media claims about them that are not always well researched. If someone hears just a snippet of negativity about a vaccine from a reputable new source they may be quite impacted, even if the news source is solely reporting that other have those negative sentiments, making no claim to there being a solid reason for those attitudes. One must remember that news channels are much more comparable to a politician than a scientist and I certainly would prefer a scientist to influence my healthcare decisions.
    • About 11,000 reports per year are made to the United States Vaccine Adverse Event Reporting System (VAERS). This high number is in some proportion attributed to reports of events that may or may not be directly related to the administration of vaccination, but rather solely temporally related.
  • Chen cites the medical mantra of “first do no harm” as explanation for the low threshold of risk tolerance accepted for vaccine adverse reactions. If the same chance for adverse effects for vaccines applied to a treatment for a pre-existing disease, it would be deemed a miracle drug! It is unfortunate but true that vaccines will always be subject to much more rigorous criticism than treatments for existing disease, even though they themselves are indeed a treatment for disease (or even cancer i.e. Gardisil 9) much more powerful than those used for existing disease, they just work pre-emptively.
  • Once the anti-vaccine trend began, it seemed to compound itself and run away, turning real concerns into runaway, blatantly slanderous or unscientific claims. Anti-vaccine proponents have made claims that various vaccines are linked to chronic illness such as autism, multiple sclerosis, Guillain-Barré syndrome, diabetes, and asthma. No scientific experiments have found any solid evidence for such claims and those that supposedly do have been attempted to be repeated by other organizations and no such results were found. A scientific theory may not be deemed truthful if it may not be repeated by anyone using the same methods.

 

What real issues are these anti-vaccine attitudes fueled by?

  • According to Chen, “increasingly well organized consumer groups, the popularity of alternative health care, increasing competition in the news media and new rapid communication technologies have all contributed [to the rise of anti-vaccine milieu].” These are just realities of the world we live in today. Other factors, following, are much easier addressed.
  • Since extreme adverse reactions are so rare, they are difficult in respect to both scheme and funding to study. Most research done on adverse reactions has been in the form of case studies, from which is infinitely more difficult to draw a solid conclusion from than from a formal, controlled experiment. Therefore, we know little about the nature of the occurrence of rare adverse events (which may or may not be attribute to the vaccine).
  • Pre-licensure trials of new vaccines are not designed to solely assess safety, but rather efficacy. While they do accomplish the job of providing the rate and nature of typical adverse events, they fail to provide solid information on rare adverse events, delayed adverse events, or adverse events specific to sub-populations of peoples.
  • Case definitions of specific adverse events, such as fever, have not been standardized on any large scale so it is difficult to compile different studies’ findings to provide valuable meta-analytical statistics.
  • Sufficient resources have not been allocated to investigate reports to the VAERS. We do not know how many adverse reports are veritable (caused by the vaccine) versus how many happened to occur after vaccination, carrying no relationship.
  • In 1991 The World Health Organization recommended that all of its Expanded Programs on Immunizations implement surveillance of adverse events to vaccination yet by 1997 only 14% had instated such an infrastructure. Since this is our only true source of information about the frequency with which adverse events occur it should be universal and well attended to, but that is not the case.
  • In the 1990’s the Institute of Medicine (U.S.A.) reviewed existing literature concerning adverse events and found the data so incomplete in 76% of the research that there could not be a for or against conclusion drawn. They identified the following inadequacies, which agree with the previous statements in this article, “inadequate understanding of biologic mechanisms underlying adverse events; insufficient or inconsistent information from case reports and case series; inadequate size or length of follow-up of many population-based epidemiologic studies; limitations of existing surveillance systems to provide persuasive evidence of causation; few experimental studies published relative to the total number of epidemiologic studies published.”
  • There is indeed a lot of risk in vaccines since a lot of new research and technology is being implemented. For example, we narrowly escaped infecting everyone vaccinated with polio vaccine from 1955-1963 with a virus. The vaccination virus was grown in monkey cells such that it became adapted to them and was no longer infections to humans. No one was aware that SV40, a virus was present in many of the cell lines. By nothing other than luck it so happened to be that the particular virus found in those cells is not able to infect humans. Thank goodness, because SV40 causes disease which turns into cancer in the simians which it affects. That being said, yes! There are indeed huge risks involved with new vaccinations that are scary but I regret to say necessary to the world. Even if those vaccinations had been infectious with SV40, they still would have saved many lives and had the potential to change the world’s infection with polio forever.

What problems do these anti-vaccine attitudes create?

  • Since poliomyelitis is the only vaccine-preventable disease soon to be eradicated worldwide, all other vaccines currently being administered will certainly need to continue to be administered for unknown periods of time until either adherence to vaccination and the efficacy of certain vaccines (and the ability to administer them in third-world conditions) is elevated such that more vaccine-preventable diseases are on the verge of being eradicated. In the face of anti-vaccine actions there has actually been a decline in progress towards eradicating certain vaccine-preventable diseases such as measles even just in the United States (though it is slightly irrelevant to categorize eradication by location since travel and emigration is so extensive nowadays). The anti-vaccine attitudes certainly put not only the unvaccinated children at risk, but much more importantly the entire population of the world is being robbed of their shot at eradicated diseases that have claimed millions of lives in third world countries for centuries.
    • I must digress and note that there is current research investigating why occurrence of pertussis (whooping cough) outbreaks have not been as exactly related to a decline in vaccination rates. It is currently being hypothesized and tested whether the vaccination is effective at fighting the disease but not the infection.

What can we do to solve this?

  • Recent improvements have been made in the programs available for surveillance of adverse reactions, yet lack of funding (and therefore interest) has kept them from being globally implemented. While time will fix this, with increasing awareness in the medical community of the need to combat anti-vaccination fuel but this can be accelerated through spread awareness and petitioning. Finding more funding for the support of adverse reaction surveillance may need to be diverted from injury compensation, provided by the U.S. vaccine excise tax.
  • In the case of a reported severe adverse reaction, there ought to be a follow-up procedure including care and interviews such that it may be confirmed whether the reaction was truly due to vaccination as well as to assure the patient is taken care of. Again, the issue here is funding so there must be a policy change to divert funding towards adverse reaction compilation and care.
  • Another great area such resources should be allocated towards is study of un-immunized individuals. Data of the rates at which they contract vaccine-preventable diseases and what role they play in transmitting such diseases to the community would certainly be fresh and intriguing data to present in defense of vaccination.
  • Chen makes an indispensable suggestion (indispensable because it solely necessitates a shift in primary care and is therefore not restricted by funding), “a shift from traditional paternalistic to a shared decision making model can help produce more informed consumers.” He prescribes a two-tier model for implementing this doctor-patient information, one general vaccine education for the majority of patients, and a more detailed, scientifically involved argument (with sources) for medically informed populations of patients.
  • A National (or more ambitiously, Global) Immunization Review Safety Board ought to be instituted to quell society’s distrust in scientific data provided by the CDC, etc due to suspicions of bias.

https://ac.els-cdn.com/S0264410X99002923/1-s2.0-S0264410X99002923-main.pdf?_tid=10c97df4-d45a-11e7-9d45-00000aacb35f&acdnat=1511887075_5bfe7f2eef8c60628b96e0eabe81982b

https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf

http://www.cidrap.umn.edu/news-perspective/2016/03/study-relates-vaccine-refusal-rise-measles-pertussis

http://www.sciencedirect.com/science/article/pii/S0140673682922140?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb

 

 

 

 

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