September 17, 2019

The Editor speaks: Vaccinations

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Colin Wilson

This week (April 20-27) is in the Americas.

Never has there been such an important week in our ever increasing “It’s XXXXXX Day/Week”.

Whist the Health Authorities across the world, with heavy emphasis on the USA, have been sleeping the Anti-vaccination Movement have been blasting their rhetoric across media platforms that are also to blame. The result is a measles epidemic that is spreading across the USA now and there is no good news it is stopping. It seems inevitable it will be here.

The recent trends by parents in Western countries to refuse to vaccinate their children due to numerous reasons and perceived fears is why. While opposition to vaccines is as old as the vaccines themselves, there has been a recent surge in the opposition to vaccines in general, specifically against the MMR (measles, mumps, and rubella) vaccine, most notably since the rise in prominence of the notorious British ex-physician, Andrew Wakefield, and his works. This has caused multiple measles outbreaks in Western countries where the measles virus was previously considered eliminated.

Wakefield is not alone.

From Cureus:

Voices such as Jenny McCarthy’s have proven to be influential, sweeping fear and distrust into parents’ minds by parading as “autism experts”. Social media and television talk show hosts, such as Oprah Winfrey, played a big role in this miseducation by giving credence to the campaign. This has caused vaccination rates to sustain a surprising drop in some Western countries. The decrease in vaccinations has led to recent outbreaks of diseases that were thought to be “eliminated”, such as measles. Still, other reasons for the anti-vaccination movement can be due to personal reasons, such as religious or secular views. A drop in immunizations poses a threat to the herd immunity the medical world has worked hard to achieve. Global communities are now more connected than ever, which translates to a higher probability of the transmission of pathogens. The only thing that can protect populations against a rapidly spreading disease is the disease’s resistance created by herd immunity when the majority are immune after vaccinations. Given the highly contagious nature of diseases like measles, vaccination rates of 96% to 99% are necessary to preserve herd immunity and prevent future outbreaks.

Origins of the anti-vaccination movement

Fear of vaccines and myths against them are not a new phenomenon. Opposition to vaccines goes as far back as the 18th century when, for example, Reverend Edmund Massey in England called the vaccines “diabolical operations” in his 1772 sermon, “The Dangerous and Sinful Practice of Inoculation” [4]. He decried these vaccines as an attempt to oppose God’s punishments upon man for his sins. Similar religious opposition was seen in the “New World” even earlier, such as in the writings of Reverend John Williams in Massachusetts, who also cited similar reasons for his opposition to vaccines claiming that they were the devil’s work. However, opposition against vaccines was not only manifested in theological arguments; many also objected to them for political and legal reasons. After the passage of laws in Britain in the mid-19th century making it mandatory for parents to vaccinate their children, anti-vaccine activists formed the Anti-Vaccination League in London. The league emphasized that its mission was to protect the liberties of the people which were being “invaded” by Parliament and its compulsory vaccination laws. Eventually, the pressure exerted by the league and its supporters compelled the British Parliament to pass an act in 1898, which removed penalties for not abiding by vaccination laws and allowed parents who did not believe vaccination was beneficial or safe to not have their children vaccinated. Since the rise and spread of the use of vaccines, opposition to vaccines has never completely gone away, vocalized intermittently in different parts of the world due to arguments based in theology, skepticism, and legal obstacles.

Anti-vaccination propaganda

While pushback against the measles vaccine due to fears of its connection to autism is the most recent example that comes to mind, there have been other instances of outbreaks of previously “extinct” diseases in modern times. One example is the refusal of some British parents to vaccinate their children in the 1970s and 1980s against pertussis in response to the publication of a report in 1974 that credited 36 negative neurological reactions to the whole-cell pertussis vaccine. This caused a decrease in the pertussis vaccine uptake in the United Kingdom (UK) from 81% in 1974 to 31% in 1980, eventually resulting in a pertussis outbreak in the UK, putting severe strain and pressure on the National Health System. Vaccine uptake levels were elevated to normal levels after the publication of a national reassessment of vaccine efficacy that reaffirmed the vaccine’s benefits, as well as financial incentives for general practitioners who achieved the target of vaccine coverage. Disease incidence declined dramatically as a result.

The anti-vaccination movement was most strongly rejuvenated in recent years by the publication of a paper in The Lancet by a former British doctor and researcher, Andrew Wakefield, which suggested credence to the debunked-claim of a connection between the measles, mumps, and rubella (MMR) vaccine and development of autism in young children. Several studies published later disproved a causal association between the MMR vaccine and autism. Wakefield drew severe criticism for his flawed and unethical research methods, which he used to draw his data and conclusions. A journalistic investigation also revealed that there was a conflict of interest with regard to Wakefield’s publication because he had received funding from litigants against vaccine manufacturers, which he obviously did not disclose to either his co-workers nor medical authorities. For all of the aforementioned reasons, The Lancet retracted the study, and its editor declared it “utterly false”. As a result, three months later, he was also struck off the UK Medical Registry, barring him from practicing medicine in the UK. The verdict declared that he had “abused his position of trust” and “brought the medical profession into disrepute” in the studies he carried out.

Repercussions of declining vaccination rates

The damage, however, was already done and the myth was spread to many different parts of the world, especially Western Europe and North America. In the UK, for example, the MMR vaccination rate dropped from 92% in 1996 to 84% in 2002. In 2003, the rate was as low as 61% in some parts of London, far below the rate needed to avoid an epidemic of measles. In Ireland, in 1999-2000, the national immunization level had fallen below 80%, and in part of North Dublin, the level was around 60%. In the US, the controversy following the publication of the study led to a decline of about 2% in terms of parents obtaining the MMR vaccine for their children in 1999 and 2000. Even after later studies explicitly and thoroughly debunked the alleged MMR-autism link, the drop in vaccination rates persisted.

As a result, multiple breakouts of measles have occurred throughout different parts of the Western world, infecting dozens of patients and even causing deaths. In the UK in 1998, 56 people contracted measles; in 2006, this number increased to 449 in the first five months of the year, with the first death since 1992. In 2008, measles was declared endemic in the UK for the first time in 14 years. In Ireland, an outbreak occurred in 2000 and 1,500 cases and three deaths were reported. The outbreak was reported to have occurred as a direct result of a drop in vaccination rates following the MMR controversy. In France, more than 22,000 cases of measles were reported from 2008 – 2011. The United States has not been an exception, with outbreaks occurring most recently in 2008, 2011, and 2013.

Perhaps the most infamous example of a measles outbreak in the United States occurred in 2014-2015. The outbreak was believed to originate from the Disneyland Resort in Anaheim, California and resulted in an estimated 125 people contracting the disease. It was estimated that MMR vaccination rates among the exposed population in which secondary cases have occurred might be as low as 50% and likely no higher than 86%. Physicians in the region were criticized for deviating from the CDC’s (Center for Disease Control and Prevention) recommended vaccination schedule and/or discouraging vaccination. As a result, California passed Senate Bill 277, a mandatory vaccination law in June 2015, banning personal and religious exemptions to abstain from vaccinations.

SOURCE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122668/

As can be seen from the above, many parents have ignored the sound advice and listened to the social media platforms because we have another epidemic on our hands. At last there are signs that some of the popular media platforms are taking down the anti-vaccination movements demonization of vaccinations. It is about time, and they are only doing it now because they are frightened they be involved in law suits.

I leave you with the concluding sentences from the source paper above:

“ …to combat the anti-vaccination movement, there must be a strong emphasis on helping parents develop trust in health professionals and relevant authorities, educating them on the facts and figures, debunking the myths peddled by the anti-vaccination movements, and even introducing legislation that promotes vaccination, if not mandating it.”

NOTE: See also iNews Cayman story published today “Vaccination Week in the Americas 2019″.

The story includes a Message from our Minister of Health, Hon. Dwayne Seymour in which he announces:

“This Saturday, 27 April, public health authorities will take a further step further towards protecting our community. They have organised a special immunisation clinic at the Public Health Department at the Cayman Islands Hospital, from 9 a.m. to 1 p.m. where parents may bring all children needing vaccinations, including those with missed or outstanding doses.”
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