FAQ – To Vaccinate or Not to Vaccinate (Corbet Mix)

A new mother has just arrived her doctor’s office with a few questions…

Mrs. Chernos: Good afternoon Dr. Galway! How are you doing today?

Dr Galway: Oh I am just fine Mrs. Chernos, how are you and baby Carolyn doing?

Mrs. C: We are great thank you! But the reason I made the appointment is that Carolyn is due for her first vaccinations in the next few weeks, and I just had a few questions. I guess to begin with, are you able to explain to me exactly what vaccines are and how they work?

Dr. G: Of course Mrs. Chernos! Basically, a person’s immune system has two different branches: the innate-immune system which is a nonspecific form of defense and the acquired-immune system which is much more specific. The innate-immune system is the first line of defense when a foreign particle containing an antigen is detected within the body. Antigens are substances that are capable of stimulating the immune system and are usually a protein that is not found normally within the body (BIOL 346 Class Notes: Immunology). If you have a cut that gets inflamed, swollen, or oozes pus, or if you experience a brief fever, this is your innate-immune system in action trying to flush out the infection. The acquired- immune system works a little bit differently. If the innate-immune system is unable to clear up an infection on its own, it will enlist the help of the acquired-immune system. The innate-immune system will present an epitope to the B and T-cells of the acquired immune system. An epitope is the part of an antigen that allows an antibody to bind with it. If the body has never encountered the antigen before, it will have to make an antibody to match the specific epitope and this may take up to two weeks (BIOL 346 Class Notes: Immunology). However, in making a matching antibody, the immune system also makes a memory B-cell. The memory B-cells allow the body to have a head start if the same foreign particle were to invade the body again because they are able to remember that antigen, quickly produce the appropriate antibodies, and kill the invader (Sherwin, 2006).

Through vaccination, this ‘memory’ within the immune system is artificially created before the disease or infection can be contracted. A person is injected with a harmless form of an antigen that closely resembles that of the actual disease, usually a dead or weakened form of the pathogen (Winston, 2004). Polio and typhoid vaccines are made from dead forms, while mumps, chickenpox, and rubella are made from weakened forms of the pathogen. When the immune system comes into contact with these antigens, it is stimulated into producing the appropriate antibodies and memory B-cells, without inducing a full-fledged infection (Winston, 2004). As a result, if the actual pathogen were to enter the body, the immune system can recognize it immediately and deploy the appropriate antibodies to combat it.

Mrs. C: But is that safe? Couldn’t injecting a live pathogen, even though it has been weakened, pose some serious risks?

Dr. G: You bring up a good point, and in some cases reactions to vaccines do occur, but these are rare. About 1 in every 100, 000 children have severe allergic reactions to the measles vaccine and out of every million injected with the polio vaccine, 2-4 children have developed symptoms of the disease (WHO, 2005). Also, you may have heard that severe neurological illness can occur with vaccination, but calculating the risk of this side effect is very difficult because it occurs so rarely (Public Health Agency of Canada, 2005).

Any cases of death resulting from vaccination are also so rare that a risk assessment cannot accurately be made. Any death speculated to have been caused by a vaccine is taken very seriously and is thoroughly investigated by the Public Health Agency of Canada (Public Health Agency of Canada, 2005). Mild side effects are more common and these might include developing a fever or soreness at the injection site. However, in gauging these side effects it is important to remember that they are minor in comparison to the diseases vaccines are designed to prevent.

Mrs. C: Are there any long-term side effects I should be concerned about? A few other mothers have told me that vaccinations are the cause of a huge array of disorders later in life like autism, allergies, and autoimmune diseases (Vaccine Risk Awareness Network, 2009).

Dr. G: Another good question. Reports have been circulating recently that suggest vaccines as the reason for a lot of chronic illnesses that currently plague Western society. As you mentioned, allergies, autoimmune diseases, and autism are often cited, but some reports also state diabetes, arthritis, degenerative neurological conditions, and a wide variety of cancers are also caused in large part by vaccinations. (Vaccine Risk Awareness Network, 2009). Correlations between the large increase of these conditions in the last quarter-century and mass immunization efforts in the 50’s and 60’s are usually drawn to support this hypothesis. However, I think it is important to remember that there are many other factors at play when investigating this correlation. The types of food we ingest have also changed and pollution has increased, both of which may have influenced chronic disease prevalence. As well, in order for vaccines to be licensed for use in Canada, the short and long-terms effects must be researched extensively to prove that any potential harm is minimal. The Public Health Agency of Canada states that any claims of long-term negative effects caused by vaccination are unsubstantiated (Public Health Agency of Canada, 2005).

Mrs. C: Alright, but when you vaccinate Carolyn, a combination of diseases are done in the same dose, correct? Like measles, mumps, and rubella? And then another combination of diphtheria, tetanus, and pertussis? Couldn’t that many diseases in her bloodstream overwhelm her immune system?

Dr.G: That is true, vaccinations are usually administered in combination doses, but it should not cause a problem. The average child is exposed to hundreds of pathogens daily through the foods they eat, the things they touch, and mild respiratory infections. For example, one cases of strep-throat can introduce a child’s immune system to up to 50 different antigens (Public Health Agency of Canada, 2005). As such, combination vaccines are unlikely to overwhelm a child’s immune system to the point of harm and there has been no scientific evidence to suggest otherwise. Another reason to vaccinate in multiple dosages is that we want to immunize kids as early as possible. Infants are more susceptible to these communicable diseases, so by vaccinating early, they have the protection they need.

Mrs. C: All this is a bit worrying to be honest. What would happen if I didn’t vaccinate Carolyn? Most other people are vaccinated, so wouldn’t she be ok?

Dr. G: You are correct in saying that most other people are vaccinated, but that is only in the Western world. Aside from smallpox, which has been globally eliminated due to mass immunization efforts, many diseases that we are protected against are still prevalent in many parts of the globe. Over a million children died of measles, neonatal tetanus, and pertussis in parts of Africa and Southeast Asia in 2002 (WHO, 2005). And due to travel, people can unknowingly bring these diseases home so if people are not immunized, there is a high chance of them contracting the disease. Another reason to get immunized is to protect others. Some people are unable to be vaccinated because of allergies or other health factors, as well as people for whom the vaccine fails, so if others are vaccinated, there is a much smaller chance for these people to fall ill. This concept is called ‘herd immunity’ and basically means reducing the number of susceptible individuals below a certain point so that the entire population is protected. The more infectious a disease, the more people need to be vaccinated to achieve herd immunity. For example, with measles and whooping cough, 95% of children would need to be immunized in order to gain herd immunity, while with malaria (were a vaccination to exist), 99% would need to be vaccinated (Sherwin, 2006). So vaccination is important to ensure that both your child and the entire population are protected.

Mrs. C: Couldn’t I just take my chances and deal with the costs and complications of a disease if it actually affected Carolyn? I mean we have good medical care in Canada…

Dr. G: Of course you could. Vaccination is not mandatory, but it is required for children to attend public school in most of the provinces. However, vaccination is one of the easiest ways to prevent disease, especially in the Western world where extensive immunization coverage is given. While no vaccine is 100% effective, there is about a 90% chance that a person vaccinated will be completely protected against the specific disease, and as I mentioned earlier, vaccines are shown to be extremely safe with very few cases of adverse reactions. Another thing to consider is the cost effectiveness of vaccination. It is quite inexpensive to vaccinate your child compared to the potential costs that would ensue if he or she were to actually get sick. The World Health Organization did a cost-benefit analysis that showed for every dollar invested into vaccinations, anywhere from $2 to $27 were saved in healthcare costs down the line (WHO, 2005). In another study done by the WHO, a one-week immunization program in Kenya was estimated to yield a total savings of US$12 million in healthcare expenditures (WHO, 2005). The money saved through vaccination efforts could then be used for other health research and development, not to mention that through vaccination you could avoid the risk of infection almost all together.

Mrs. C: But if pharmaceutical companies are the ones who produce vaccines, couldn’t vaccination efforts just be a way to produce a profit?

Dr. G: It may seem like pharmaceutical companies are pushing immunization on people to make a profit, but in reality, vaccine production is much less profitable than other pharmaceuticals. In fact, many pharmaceutical companies are less inclined to develop and invest in vaccines, especially because many of the people and countries that really need the vaccines may not be able to pay for them (WHO, 2005). This is not much of an issue in the Western world, but in places like Sub-Saharan Africa and parts of Southeast Asia, many nations are unable to purchase vaccines simply because they are too expensive- and if the pharmaceutical companies do not have a market, they are not inclined to produce the drug.

Mrs. C: So I take it that most countries in the world try to vaccinate their citizens? Is it actually that effective in preventing disease? Every time I turn on the news, it seems like more and more people are dying of infectious diseases in poorer parts of the world.

Dr. G: Like I just mentioned, many nations are unable to finance vaccination efforts for their citizens, but are trying to immunize as many of their citizens as possible. There are a number of financial programs in place aimed at assisting these countries. The Expanded Programme on Immunization on the Global Alliance for Vaccines and Immunization (GAVI) provides funding and technical support to help increase vaccination coverage in many developing countries and the proposed WHO-UNICEF Global Immunization Vision and Strategies will aim to expand vaccination coverage and provide the logistical systems needed to achieve this (WHO, 2005). Another program aimed at the financial challenges of vaccination is the Region of Americas Revolving Fund for Vaccine Procurement. Nations pay an annual due to become a member of this organization who then use the fund to purchase vaccine lots at a reduced price, which ensures the pharmaceutical companies a predictable market (WHO, 2005).

In terms of the effectiveness of vaccinations, nearly all of the evidence I have encountered firmly supports the efficacy of immunization. In 2001, a mass immunization effort against measles was launched in Africa and within a year, the rate of the disease had dropped 89%. In 2000, the year before the immunization effort began, 395,000 people died from measles but in 2001, that number had dropped to 45,000. This vaccination effort is thought to have save 3.6 million lives, most of which were children (Dunham, 2008). This drop in infection rate is hugely significant and can really only be attested to the immunization efforts. I don’t know if you are aware, but many people who are skeptical about vaccination believe that lower disease rates don’t have anything to do with vaccination (Vaccine Risk Awareness Network, 2009).

Mrs. C: Oh wow, I hadn’t realized the disease rate could drop so much. Why don’t people believe that vaccination has anything to do with lower disease rates? That evidence seems pretty obvious to me.

Dr. G: It seems pretty obvious to me as well, but many people opposed to vaccinations say that improved hygiene, improved socioeconomic conditions, better nutrition and access to fresh food, less crowded living conditions, advances in medical treatment, and decreased virulence in pathogens are the reason for lowered disease rates (Vaccine Risk Awareness Network, 2009). While these factors have undoubtedly influenced lower disease rates, there are several case studies that show vaccination as being a key factor in preventing disease. As you may remember, just a few years ago meningitis was prevalent in a large number of infants. After appropriate vaccines were developed and distributed to many infants, the rate of this infection dropped from 2,000 cases in the year prior to the vaccine, to 52 in the year after. Since there have been no drastic changes in hygiene or nutrition or in any of other the other factors cited, immunization is the logical reason for why the rates of meningitis have decreased (Public Health Agency of Canada, 2005). Another point to ponder is that if given no vaccination, chickenpox still affects nearly all people, usually when they are children, just as it affected people 80 years ago. If diseases were losing virulence or disappearing naturally, shouldn’t chickenpox have disappeared as well? (Public Health Agency of Canada, 2005) Also, when countries stop vaccinating against a certain disease, more often than not that disease makes a comeback. In England in 1974, they stopped vaccinating people against pertussis. An epidemic followed in 1979 with 100,000 reported cases and 36 deaths (Vaccine Risk Awareness Network, 2009). Similar epidemics occurred in Japan and Sweden at around the same time, showing that vaccination does have a direct cause on disease rates.

Mrs. C: Sorry to change the topic, but you mentioned there is a vaccine for pertussis and chickenpox. Will Carolyn be immunized against both these diseases?

Dr. G: Yes, she will. In Canada, babies are first immunized at two months against diphtheria, pertussis, tetanus, hepatitis B, polio, haemophilus influenza type B, pneumococcal cojugate, and meningococcal C conjugate or meningitis. Then at four, six, and eighteen months, and at four years old, they receive booster doses of most of these vaccines. At twelve months, they are given the measles, mumps, and rubella shot along with a chickenpox vaccine if they have not already experienced the disease. In grade 9, most girls will also receive a vaccine that protects against human papilloma virus, known as HPV.

Mrs. C: So where should I be going to get these shots done?

Dr. G: There are lots of clinics around Vancouver that perform vaccinations, but you need an appointment for most of them. I will give you a brochure but you can also look them up on the Vancouver Coastal Health Authority website. All the locations that perform vaccinations are listed there along with their phone numbers, addresses, and drop-in times. You can also find lots more information on vaccination, like how to care for your child after she has been immunized, links to several public health websites, and lots of frequently asked questions.

Mrs. C: What if I get Carolyn vaccinated and she has one of those horrible reactions? Then what do I do?

Dr. G: When Carolyn receives her shot, a doctor or nurse will stay and observe her for about 15-30 minutes after it is injected (Vancouver Coastal Health). If there are any signs of an allergic reaction, the doctor or nurse will be able to recognize them and treat Carolyn accordingly. If you notice any kind of serious reaction once you get home, call me immediately and go to the emergency department. They will be able to treat her and afterward, they can help you report this reaction. On the Public Health Agency of Canada’s website there is an adverse reaction reporting form along with all the instructions for submitting a report.

Mrs. C: OK, well thank you so much for your help! I don’t think I have any more questions, but I am going have to do some more research before I decide whether to get Carolyn vaccinated.

Dr. G: Of course Mrs. Chernos! That’s what I am here for. Just remember that when you are reading research or reports of any kind, to be critical of what they say. There is a lot of bias out there and with that comes a lot of exaggeration. It was nice to see you again and I hope everything goes well for you and Carolyn! See you at our next appointment!

References

Davies, Julian and Jennifer Sibley. BIO 346 Class Notes: Immunology. March 9, 2009

Dunham, Will. “Global Effort Prompts Huge Drop in Measles Deaths.” Canada.com http://www.canada.com/Health/Global+effort+prompts+huge+drop+measles+deaths/1037849/story.html (accessed March 27, 2009)

Sherwin, Irwin W. The Power of Plagues. Washington DC: ASM Press, 2006

Public Health Agency of Canada. Immunization: The Most Successful Public Health Measure. Immunization & Vaccination. http://www.phac-aspc.gc.ca/im/measure-intervention-eng.php
(accessed March 27, 2009)

Public Health Agency of Canada. Misconceptions about Vaccines and Facts. Vaccine Safety. http://www.phac-aspc.gc.ca/im/vs-sv/factsfigs-eng.php (accessed March 27, 2009)

Vaccine Risk Awareness Network. Vaccination: What You Need To Know. VRAN. http://www.vran.org/ (accessed March 27, 2009)

Vancouver Coastal Health. Immunization & Vaccination. Public Health. http://www.vch.ca/public/immunization/ (accessed March 27, 2009)

Winston, Robert and Dr. Don E. Wilson, ed. Smithsonian Institution: Human. New York: DK Publishing Inc., 2004

World Health Organization. Immunization Against Diseases of Public Health Importance. Media Center. http://www.who.int/mediacentre/factsheets/fs288/en/index.html (accessed March 27, 2009)