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Why do vaccines arouse such passions?

AlaskaDenise

In Memoriam
When the Princess of Wales put forward her children for inoculation, the procedure quickly caught on.

The year was 1721, and her offspring received an early and sometimes fatal prophylaxis against smallpox - in which the pus from someone with the disease was smeared into a wound of the uninfected.

By the end of that century a country doctor invented a method using lymph from an infected cow instead, providing the same level of protection while using a much milder form of the disease - and the word vaccination - from vacca for cow - was born.

In 1850, the English authorities made immunisation compulsory, with fines and prison for those who refused to comply, and the first mass anti-vaccination campaign began.

Vaccinations have long had the power to polarise.

Me and you

The nineteenth century campaigners were a diverse group who rallied against state intervention in family life, but such movements have transcended time and place.

In the UK, recent campaigns have focused on the safety of the MMR vaccine amid suggestions of a link with autism, in the US the mercury used, while in Germany there are a number of organised groups hostile to vaccinations.

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The relationship between the state and the individual has always been an element of the antipathy to some vaccine programmes.

But signing up to immunisation also asks the individual - and often a parent - to consider their role in the community as they decide whether their healthy child should be treated for a condition they may never get - and which may be mild even if they do.

In the case of measles, "herd immunity" - when 95% of the population are immunised - is necessary if the vulnerable are to be protected.

"We are certainly much more atomised, individuated, so we don't necessarily think of ourselves in terms of our community - although we shouldn't forget that the majority do support immunisation," says Dr Mike Fitzpatrick, a London GP who has written extensively on health fears.

"But it's certainly true that nowadays we have a very skewed understanding of risk and danger, to the point where it can be very hard as a doctor to provide reassurance to a patient that their risks are very low.

"And while I am all for people questioning authority, it's bizarre that we often reject the voice of science in favour of the purveyors of quackery."

What's the problem?

It is also widely acknowledged that immunisation programmes are a victim of their own success.

In the West, the long absence of many childhood diseases is taken for granted as debilitating and sometimes fatal diseases - including poliomyelitis, diphtheria, whooping cough, measles and meningitis - have either been eliminated or are very rare.

But it is estimated that within the 53 countries of the WHO European region, more than 500,000 do not receive full immunisation and 32,000 die each year from vaccine preventable diseases.

The WHO says access and cost is often the problem, but that there is apathy on the part of health professionals as well as parents who have never seen a case of such diseases.

In some areas of the former Soviet bloc there is also general mistrust of authorities and the services - including immunisation - they provide.

There are also the points at which fear of the vaccine becomes greater than fear of the disease, and no vaccine is without risk.

The young girl who died last week after receiving the vaccine against the virus which causes cervical cancer is now known to have been killed by a malignant tumour in her chest.

But the vaccine will cause a severe, life-threatening reaction in around one in a million, so at some point a young girl may well die.

This however must be juxtaposed against the risks of the disease itself. In 2007, nearly 1,000 women died of cervical cancer.

No more anger

And we appear to have little trouble with fearing a vaccine for one condition while worrying that not enough is being done to develop another - concerns about the speed at which a swine flu vaccine could be delivered being a case in point.

A recent WHO report noted the "conflicting pressures" on health services, dealing with claims that one vaccine is unsafe or inappropriate while facing criticism for not moving quickly enough to provide another.

But the future, according to Professor Ray Spier, editor in chief of the journal Vaccine, is vaccines.

"There will always be anxiety about what is new, and you can argue that anti-vaccine movements have had a role in improving the quality of what is offered. Of course there should be debate, it's just a shame that it so often ends up in sensationalism.

"But I do want to see a prophylactic future. We shouldn't be dealing with disease after it happens, we should be working out how to prevent it in the first place.

"From coughs to cancer, with anger and addiction in the mix - these are the ideas we need to engage with."

http://news.bbc.co.uk/2/hi/health/8293149.stm
 
Re: Why do vaccines arouse such passions?

Whilst there is a vocal anti-vaccine fringe in the UK and overseas, not all doubts surrounding vaccines are driven by quackery, poor science or hysteria as intimated within this article by one of the persons interviewed.

The issues of the merits of vaccination are ones of benefits vs risks. For certain diseases, where the risk of lifelong debilitation or even death are high, taking a vaccine is undoubtedly beneficial - but which has some risks, however small. however, acceptance of vaccines and a decision to accept a vaccination must be an individual choice that is based on consideration of risks vs benefits. Decisions like this can only be served by full transparency with the data and the scientific facts on the vaccines and their components. Hiding any fact, no matter small, or obfusticating only casts doubt and distrust on every piece of information that is officially provided.

The situation with vaccines is that there is little trust in the companies that make them to be fully open and transparent.

Take the cervical cancer vaccine as a prime example. As this post http://www.flutrackers.com/forum/showthread.php?t=127595 shows, the addition of adjuvant does not show clear increased patients benefits, and as other posts on the issue of squalene based adjuvants have shown, the safety of these additives have not been amply been shown to be safe and effective for all popualtion groups. Serious adverse events can occur with Ceravix (the US is far more transparent on the nature of these than the UK and there are a number of cases where legal prosecutions are being considered), and so the relative risks of later death from cervical cancer vs. serious harm or death from the vaccine is far from clear when you take these into account, and especially when you conisder that screening and prompt therapeutic action can equally reduce these risks of death.

There are roughly 30 million females in the UK, give or take, and say 12 million under 25 - so if all these were vaccinated 12 might die (aged under 25) as a consequence vs. 1000 women each year, many of whom may be much older. On the face of it, that might not seem like a sufficient benefit for many parents to take such a risk with their child - so people need to ask questions to help them decide. Questioning for more information does not make it true that people believe in 'quackery'.

I think that there is ample evidence that vaccines are generally safe and effective - however, adding things such as adjuvants changes things such that past safety data (use without adjuvants) cannot be applied and so these vaccines require not only throrough safety testing and transparency of the vaccine alone, but also the vaccine with adjuvant, and the adjuvant alone to allow full and frank evaluation and future disclosures of the risks. Despite oft repeated statements from spokespersons, such detailed safety data on adjuvants are still not publically available for public and detailed scientific scrutiny. Data does not exist for pregnant women nor young children, and the data that does exist is questionable and insufficient for older children and young adults.

This statement does not mean that I am against vaccines - simply that to settle the argument, far greater thoroughness and transparency is required in the testing of such additives to vaccines, and the effects of giving multiple vaccines closely spaced in timeor together, so that populations can have faith and trust in what they are told by the companies that profit from their use, and government advisors - whom it should be noted, rely on information supplied by the companies to form their recommendations.

Vaccines and vaccination are far too powerful and useful a weapon in the fight for public health to allow the squandering of public faith in such a manner, because if there should be widespread problems over the use of adjuvanted vaccines, untoward effects on foetuses, or long term immune problems in young children that can be traced back to the use of vaccines, AND data is generated somewhere in the world that confirms a probable link to the use of that adjuvant, additive, or vaccine combination, that is what will happen. A total collapse in confidence in vaccinations as a whole. Mistakes may have been made in the past, but to ignore lessons learned and carry on regardless for fear of admitting a past problem would be unforgivable.

Right now, we dont know the answers becuase there is not enough data. Governments and media should be honest about this, and allow individuals to make their choices when the risk vs. benefits have been laid out for all to see. Authorities must trust the judgement of populations in the 'we dont know' period and be properly transparent about the results when we have them. The vaccine debate will only be properly settled by taking away the lack of transparency that exists, and that only serves to feed the fears of the anti-vacine lobby, to the detriment of all.

These questions over vaccines and adjuvants cannot be solved immediately in the here and now as we counter this pandemic, but they should be thoroughly and properly investigated. If pharma are unwilling to fund the studies required, they should be carried out by national health authorities to settle the matter for once and for all, and data should not be 'cleaned' before public exposure in the manner it presently is.

As we enter a world of global warming, apparently increased viral evolution with more new pathogens threatening mankind than any other time in recent history, we may need vaccination as a strategy more than ever before. That means that people must also have faith in them. And for that to happen, rather than naysay those who express valid concerns, questions should be answered, and with full and proper science.
 
Re: Why do vaccines arouse such passions?

....we may need vaccination as a strategy more than ever before. That means that people must also have faith in them. And for that to happen, rather than naysay those who express valid concerns, questions should be answered, and with full and proper science.

Yes, it's terrible that debates of this type turn into personal attacks rather than searches for truth. Unfortunately, complex topics are difficult for the public to understand and they try to simplify the situation by reducing it to a good vs. bad drama.

How to you steer the debate into the strictly scientific arena?

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Re: Why do vaccines arouse such passions?

Public scrutiny also equals scientific scrutiny - there are many doctors and medically trained individuals who are as adept at interpreting data as a full time virologist or immunologist.

I think that the current situation re: the unwillingness of large proportions of medics to get vaccinated (becuase they feel there is insufficient safety data), speaks volumes. Provide the data to pursuade these guardians of our health that there has been adequate testing to prove both efficacy and safety, and people will be more trusting, and the rest will follow.
 
Re: Why do vaccines arouse such passions?

Unfortunately, there will always be the odd individual who has an adverse reaction to vaccination and people tend to remember these events and not the fact that thousands of other people had shots without ill effect. In our hospital, most of the staff on the neurology floor refuse to take flushots because they have looked after a few patients with Guillian-Barre syndrome (which can occur, rarely, after the flushot). When push comes to shove, I'll bet a great majority of people choose to take the H1N1 shot. It is the adamant few who are against vaccination that are most vocal. Time will tell.
 
Re: Why do vaccines arouse such passions?

It is worth noting that I have a UK centric view, where we have to consider adjuvant vaccine issues - the US does not, now that its been decided not to use the adjuvant there - so i would be surprised if there were big issues of non-uptake in the US for now...

My concerns tend to limit themselves to issues surrounding the adjuvant - and a lot of UK medics share these concerns. Because we are not all necessarily debating the same issues (i.e UK vs US - apples and oranges comparisons) it is easy to get confused.
 
Re: Why do vaccines arouse such passions?

Although influenza vaccine with adjuvant is new, adjuvanted vaccines have been used for decades and have been received by millions of people. So far, no ill effects have been attributed to adjuvants.
 
Re: Why do vaccines arouse such passions?

Thanks to AlaskaDenise for posting this and to Vibrant62 and North44 for thoughtful and reasoned discussion of the issues surrounding vaccination in general.
 
Re: Why do vaccines arouse such passions?

It is worth noting that I have a UK centric view, where we have to consider adjuvant vaccine issues - the US does not, .......... Because we are not all necessarily debating the same issues (i.e UK vs US - apples and oranges comparisons) it is easy to get confused.
Thanks for that clarification. :)

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