Childhood vaccination rates fell for eight out of the twelve vaccines routinely administered in England during 2017/18, when compared with 2016/17. There have been several well-publicised outbreaks of measles in various communities in the United States, even though measles was declared eliminated by the Centers for Disease Control in 2000. These are among the effects of a growing anti-vaccination movement in the Western world.
Mass vaccination was hailed as one of the major advances of public health medicine in the 20th century. Not only was smallpox eradicated by 1980, but many other potentially lethal or disabling diseases such as diphtheria, polio and and tetanus became rarities in the Western world. The aim was not only to protect individuals but also to provide herd immunity for the entire community.
But things are changing. The anti-vaccination movement has come to the forefront in recent years, with many online websites, social media, books and films all playing a part. Vaccine hesitancy is a new phenomenon, involving ‘the delay in acceptance or refusal of vaccines’ in the words of the World Health Organisation, which included it in a list of top-ten international public health problems in 2019.
Vaccines consist of either live but weakly active (attenuated) or killed bacteria or viruses. Some vaccines incorporate adjuvants, usually aluminium salts, to enhance the immunological response of the body to the bacterial or viral antigen, or foreign protein, being administered. The idea is to encourage the body to produce antibodies in response to the antigen and thereby develop immunity to subsequent infection.
Concern about vaccines is not new. Anti-vaccination views have been around ever since Edward Jenner introduced vaccination in 1796. There have been some high-profile events and campaigns along the way. For example, in 1955, Cutter Laboratories in California developed a live polio vaccine which killed ten people and paralysed a further 192. In the 1970s and 1980s, concerns were raised in the UK about the neurological complications of DPT (diphtheria, pertussis and tetanus) vaccination. This led to the formation of the Association of Parents of Vaccine Damaged Children.
An hour-long documentary, DPT: Vaccine Roulette, was broadcast on WRC-TV in Washington DC on April 19 1982. This led to the formation of Dissatisfied Parents Together in 1982, which changed its name to the National Vaccination Information Center (NVIC) by the early 1990s.
In 1998, a now retracted and discredited paper was published in The Lancet, a prestigious British medical journal, which linked autism with the MMR (measles, mumps and rubella) vaccine. The lead author, Andrew Wakefield, went on to receive the Courage in Science Award from the NVIC in 2000, but was eventually struck off the UK medical register by the GMC in 2010 for unethical practice related to his autism study.
The anti-vaccination programme has gained in credibility in recent years through celebrity endorsement, supported by many anecdotes of alleged vaccine damage in children. It is claimed by anti-vaxxers that naturally acquired immunity gained through exposure to infections is preferable to that gained through vaccines. Many vaccines are alleged to contain “dangerous” additives. Some diseases are considered mild and felt not to require protective vaccination. Vaccines are believed to cause autism, attention deficit disorder, inflammatory bowel disease, diabetes, multiple sclerosis and other chronic diseases. Concerned parents also claim the desire to make personal choices when deciding to allow their children to be vaccinated.
International scientific consensus is almost unanimous in its support for continued vaccination. This has led to accusations of a collusion between the “medical establishment” and “big pharma”-the global pharmaceutical industry. It is believed that profit-seeking behaviour has led to deception about the safety of vaccines, and there is in addition a lack of faith in the effectiveness of the regulatory bodies.
Vaccines do cause adverse reactions or side effects, but the large majority of these are local reactions-pain, swelling and redness at the injection site- or minor flu-like symptoms. Serious adverse reactions such as severe allergic reactions (anaphylaxis) to the vaccine and serious neurological complications, including seizures and permanent brain damage, are exceedingly rare. Many governments have set up no-fault compensation schemes for those people who have suffered serious adverse effects of vaccination.
The overwhelming evidence favours vaccination, when one considers a trade-off between the effects of preventable disease and the side-effects of vaccination. Furthermore, a 95% immunisation rate may suffice to provide so-called herd immunity for entire communities in which the majority of people are vaccinated,
An emotionally charged and highly polarised public debate is, however, likely to lead to further outbreaks of vaccine-preventable illness in the short term, as many people remain unconvinced of the benefits of vaccination. The perceived need to protect the wider public may in turn lead to premature legislation introducing compulsory vaccination, which is unlikely to be the best way forward. Making vaccination mandatory may even turn out to be counter-productive, as coercion is frequently considered an infringement of personal rights and choices. Better access to vaccination and better information about its benefits are far more preferable in the first instance.
Ashis Banerjee (vaccinated adult, with vaccinated child)