Monday, December 9, 2019

What's the truth about vaccination?

A headline I should never have had to see: “Worldwide measles deaths surge, reversing years of progress.” This was ABC News on December 5, quoting a report from the World Health Organization that over 140,000 people died in 2018 from measles, most children under 5. The same week, officials in Samoa asked the public to hang red flags outside their homes if they had an unvaccinated family member living there – reminiscent of a public health measure dating back to the Middle Ages, when homes and businesses affected by the black plague were marked.

Vaccination against infectious diseases is one of the great triumphs of medicine. It can be dated back to 1796 when William Jenner, an English country doctor did his now-famous experiment. Country wisdom and his own observations found that milkmaids who suffered from cowpox, a disease that caused blistering on cows’ udders and which caused a mild illness in humans, never developed smallpox. Smallpox was a very serious illness: 30% of those infected died, and many of the survivors were left blind or disfigured. Jenner inserted pus from a cowpox pustule into a cut in eight-year-old James Phipps’ arm and later inoculated James with smallpox and the boy did not get ill. He repeated this with other children, including his own 11-month-old son, with the same results. Vaccination against smallpox was rapidly taken up across Europe.

Vaccines are now available to prevent many once-deadly diseases, including polio, diphtheria, measles, tetanus, yellow fever, typhus and hepatitis. Over the past two decades, with the memory of these diseases fading from our daily consciousness, we have seen the growth of the “anti-vaccine” movement that threatens to undo much of this life-saving progress.

There has always been objection to vaccination. After Jenner’s vaccination became widely adopted, many opponents claimed it was repulsive and ungodly to inoculate someone with material from diseased animals. The widespread awareness of such dread diseases as smallpox overcame these objections, as the vaccine clearly worked, and everyone knew friends, relatives and neighbors who had died. When I was a child, polio was still a dread disease, and the public welcomed first Salk’s and then Sabin’s vaccines. By the late 20th Century, memory of most dreaded childhood diseases had faded, leading people to underestimate the severity of the harms that vaccines prevent.

Much of the current “anti-vax” movement can be traced to a paper by Andrew Wakefield in The Lancet, a British medical journal, in 1998. He and 12 coauthors claimed to have investigated a “consecutive series” of 12 children referred to the Royal Free Hospital with chronic enterocolitis and developmental disorders, including autism, which they linked to MMR vaccination. The General Medical Council of Britain found that the children were carefully selected and that the study was funded by lawyers representing parents suing vaccine manufacturers. In 2010, the editors of The Lancet retracted the paper, apologizing for published a clearly flawed paper, but the damage had been done.

Autism is a serious life-long developmental disorder, whose cause remains unknown. It has a strong genetic component, and even though it may not manifest until early childhood, researchers feel the underlying pathology is present at birth. Parents want an answer, and vaccines provide an easy answer. Multiple studies have been done that strongly repudiate any link between MMR vaccination and autism. Three large studies, in Denmark, the U.S. and Britain have found less autism among vaccinated children than those not vaccinated.

Just as the proliferation of clearly biased news presentations have left all-too-many of us in our own silos politically, those who oppose vaccination can find all the support they want in chat groups and Facebook, science be damned. The problem with letting parents decide is that it is not only their children who are harmed, but the general public. Just as courts have decided that parents cannot let their own beliefs allow them to refuse life-saving medical treatments for their children, parental objections should not allow them to refuse vaccination for their children. A small number of children with immune deficiencies are at risk from vaccines and should be exempt. They will be safe if the large majority of healthy children receive the vaccines, as this makes epidemics very unlikely. Parents who refuse are not “bad” people, but they are seriously misinformed, and should not be allowed to harm others if their minds are closed to evidence.

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