My position on immunization
I haven’t had many opportunities to go off on a rant, but I will take the opportunity to do so here. I deeply feel that one of the single most important advancements in medicine over the past 100 years has been the introduction of vaccines to control infectious diseases. This is a topic that has proponents on both sides of the fence today in the United States and elsewhere, but I see that many of the arguments against vaccination do not hold up under scrutiny. I believe that it is our duty and responsibility as future health-care workers to ensure that we are well informed about vaccination, so that we can make informed choices for ourselves as well as to advise the patients we will come into contact with.
Let’s look at the positive benefits of vaccination. First, as stated in class, once vaccines were introduced the number of cases of childhood maladies such as polio, measles, rubella, and mumps have diminished more than 99% in each case within a decade of introduction of the vaccines. Even in the case of diseases with low mortality rates (chicken pox, for example) the benefit of regaining lost hours for parents and caregivers is tremendous. Just ask anyone who has had to take off work for a sick, infectious child. Second, some diseases, are essentially non-existent now in the US, and some (polio) are well on the way to being eradicated worldwide in the very near future. Third, there are benefits from communal vaccination procedures even among the unvaccinated. This is a phenomenon called herd immunity, and works via the following principle. Let’s assume that you are in a room full of 100 people, and in that room 95 of them are vaccinated against a given disease, leaving 5 of them unvaccinated. Those unvaccinated people will be randomly distributed throughout the room. Now someone with the disease walks in through the door, and that disease is passed via direct contact transmission. Odds are that the people he would immediately contact in the room would be immune to the disease, and unable to transmit the disease to their neighbors, even if the neighbors are unvaccinated. Herd immunity allows us to have essentially complete protection afforded with vaccination, without having to have 100% coverage of the population.
Now some of the arguments:
- Vaccines are untested/unsafe. All vaccines that are used in the US population undergo rigorous Phase 3 clinical trials. The vaccine used against the H1N1 influenza variant last year underwent the exact same safety analysis that seasonal influenza vaccines undergo every single year. The additives in vaccines (things such as thimerosol and alum) are present in much smaller amounts in vaccines that we take in as contaminants in day to day life.
- Vaccines cause autism in my child. There is no experimental evidence that this is the case. You may have heard of Andrew Wakefield, who published a study a few years ago linking the development of autism with childhood vaccination series. Wakefield’s study was found to be profoundly flawed, unreproducible, and ethically unsound (he violated all sorts of informed consent rules with his study ‘volunteers.’)
- There are too many vaccines at once/it over stimulates the immune system. This is pretty much bogus. Consider the number of antigens that the human immune system comes into contact with every single day we are alive. Our B cells and T cells are coming into contact with antigens constantly pretty much from the day we are born, and the amount of specific antigen that enters our body vaccination is small in comparison the amount of antigen that enters our body when we eat our lunch.
- It’s my body/it’s a matter of free choice. Also bogus. Sorry, but we live in a society of other individuals that we have to deal with every day. You wouldn’t like it if I showed up to class sick with H1N1 influenza now, would you? Don’t put me at the same risk. At the very least, it’s kind of unfair to those guys who have to clean up at accident sites along the highway with people who won’t wear a seat belt.
This is an appropriate forum for discussing the safety, efficacy, and rationale for immunization strategies currently in use in the United States. If you have heard of something, and would like clarification, please leave it in the comments/email it to me/slide an anonymous Post-it note under my office door, and we’ll open it up for discussion.