One of the benefits of growing up in New Zealand was that I was a lot luckier than a lot of children in the world. I was
born in a country that had a comprehensive immunisation programme. I had parents that had transport to take me to the doctors to get the jabs. I had parents that could take the time required to take my siblings and i to the doctors practice to get the jabs. And parents who agreed with it was the logical and safe thing to do. Therefore I received a full course of immunisations.
What we take for granted is probably the most effective thing we can do for preventing illness from a public health and individual point of view. Sadly this fact is lost on certain facets of society who instead interpret this program to be somewhere on a spectrum of unnecessary injections to being the devil incarnate.
Zambia does have an infant and childhood vaccination schedule that covers most of the main illnesses, as recommended by the World Health Organisation. It is widely available at the rural health centres which are widely spread throughout the rural communities, but like a lot of things, stock-outs are common, and more importantly getting to the centres for all the required doses when for many the only available transport is on foot. When the fertility rate is well over 5, the sequence of vaccinations recommended for each child multiplies up, and simply the time taken away from the fields or market stalls are an economic barrier enough to prevent some from getting all is recommended.
When you see the sequelae of vaccine preventable diseases in the flesh, it hits home the impact that vaccines have. The extraordinary lengths our ancestors went to to prevent outbreaks of smallpox are lost on most generations today, thanks to the discovery in 1796 By Edward Jenner that inoculating people with a related strain of cowpox induced protection agaist the ravages that smallpox wielded. I am fond of graphic representations of statistics, and simply comparing the impact of smallpox compared to other causes of death in the 20th century is impressive. If you look at the following graph, and compare the size of the circle from smallpox to other comparable causes of death, it is amazing to see the change vaccination has effected.
Why then, within subgroups of western society, are vaccines seen as the devil incarnate is varied ranging from genuine concern through to global conspiracy theory mongering. These (in my view) misfounded concerns about the content of vaccines, conspiracy theories about the reasons we attempt to vaccinate, and alleged adverse events of vaccination are commonly purported by powerful lobby groups such as the ‘Australian Vaccination Network’ (a group vehemently against vaccination despite its misleading name). They are a ripe source of hysteria for any parent seeking to find out the pros and cons for whether to vaccinate their pride enjoy, it is easy to see how it is difficult to try and have a balanced discussion.
A lot of misinformation stems from a man called Andrew Wakefield , who wrote a paper that was published by the leading medical journal The Lancet on a link between the Measles, Mumps and Rubella (MMR) vaccine and risk of autism in 1998. Although the paper’s data was a gross misrepresentation for the actual figures, that no link even existed in his data, and massive international studies with tens of thousands of children have repeatedly failed to find any association, this myth still persists. The Lancet has long since retracted the paper, Wakefield has been struck of the British medical register due to the fact the main reason he wrote the article was actually due to massive potential financial gain should a link be proven (and therefore a huge undeclared conflict of interest) but years on we are still reaping the damage. Measles, one of the most easily transmissible diseases (it has a reproductive coefficient of 12-18, meaning that one infected person could give it to between 12 and 18 people), is making a resurgence in New Zealand, the United Kingdom, Australia and other parts of the west, with fatal consequences.
As a society we entrust the responsibility of children to parents, to do what is best for their children. And medicine is not a perfect science nor clear cut in many cases. But how do we react whe parents make decisions that not only the lives if their children but also those around them. Australia has now legislated that unvaccinated children cannot attend preschool unless they have had either their course of vaccinations or have completed paperwork should their parents object to them having vaccinations. This attempt to clear up those forgetful parents has been considered a success, but still leaves those that conciountously object as a source of harm to the collective good.
Most Vaccine prevatable diseases benefit from a concept known as herd immunity, as they are transmitted between people. As to have spread of the illness, you need to have someone with the illness spread it to someone who was susceptible and then them pass it on to someone else who is also susceptible. if those who are around you have the protection of vaccine induced immunity, your chances of getting the illness plummet even if you are not immunised yourself, as there are less people around to catch it from. What percentage of the community needs to be vaccinated depends on who easily the disease is transmitted, population movements etc. Some parents site this as a reason why they don’t need to vaccinate. But when this mentality spreads, we get a situation similar to a ‘failure of the commons’, and outbreaks occur. Furthermore, herd immunity protects those who need it most – those too young to be vaccinated or with the relatively uncommon medical conditions that make immunisation with certain vaccinations unsafe. So when a child whose parents opted out of immunisation, acts as the harbinger of disease such as measles to a whole bunch of infants under one whose immune systems are not capable of yet reacting effectively to a vaccine and therefore vulnerable to the severe pneumonia, meningitis or death that this disease can render, how should we react. A decision was made to not take a perfectly safe action, and instead expose others to increased risk as a result. Society locks up drunk or speeding drivers who are risks to the health of others, we confine those with serious mental illness who are a risk to themselves or others to enforced treatment and accommodation, and criminally charge those who poison others whether intentionally or through negligence. I am not saying that an unvaccinated child is the same risk as a driver who can’t string a sentence together, or someone who dumps arsenic into waterways, and obviously magnitude of risk is reflected in the determined punishment. It does raise an interesting dilemma for western society where generational change has moved the focus from the common good to the rights of the individual. The possibility of parents being sued for their children being the source of vaccine preventable disease should transmission occur has been raised in the US, and would be a very interesting precedent to watch.
In my own mind, I have no question about the utility of vaccinations. Having told at least half a dozen men, many in their 20s, 30s or 40s, that their lifespan will likely be weeks to months due to advanced hepatocellular carcinoma, caused predominantly by their now entirely preventable hepatitis B infection. Or watch the local tailor navigate his way around his stall on his crutches due to his legs being paralysed by a polio infection lileky many years before. Or urgently transfer out a patient with arched back, locked jaw and taught face from presumed tetanus to a hospital with ICU capability so that they could be monitored and given a tracheostomy if needed before the muscle spasms progressed to closing the airway and paralysing the muscles of breathing, suffocating the patient to death.
Given the bacteria that causes tetanus is not spread from people, but ubiquitously found in our environment, and therefore there is no benefit from herd immunity, a jab or two and the attendant crying and writhing that accompanies it, is a small hassle compared to watching the horrors of the other option unfold.