Common Vaccine Controversies and their Impact

1 Common Vaccine Controversies and their Impact on Vaccine Uptake Introduction The medical health fraternity believes that the discovery of vaccines was mainly triggered by the need to enhance and also give people, particularly young children, an enhanced chance of survival during their early stages of life (Cave & Mitchell 2001). Vaccines along with vaccination are considered the greatest medical achievements human beings have ever made.

The role played by vaccine, however, cannot be overestimated or underestimated. It has resulted in substantial reduction of deadly health conditions such as polio and measles. Nonetheless, a great deal of controversies has emerged over the years with regard to the safety of vaccines.

Vaccine controversies can in simple terms be described as differences of opinion over the efficacy, morality, and ethics as well as safety of vaccines.

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2 For instance, in addition to opponents arguing that vaccination is a good example of experiments carried out all over the world using young children as subjects, they also claim that vaccines do not have the capacity to bring about the intended outcome (Nettleton 2006). They also point out that vaccines subject the health of a large number of people to great risk and as a result human beings should not rely on vaccines for prevention of diseases, but rather on safer modalities such as sanitation and high levels of personal hygiene. Opponents also argue that vaccination is a compulsory practice that infringes the rights and religious principles of the people. In order to ensure that vaccines and vaccination are globally accepted, all issues bringing about controversy should be amicably resolved (Romm 2010).

Scientific and medical studies have revealed that the benefits of eradicating suffering and potential deaths, which may emanate from certain diseases, by far outweigh all possible adverse consequences associated with vaccination (Gervais 2012). Even though vaccines may result in some adverse effects, their efficacy and success may be increased if the public is made to develop confidence in their safety (Chatterjee & O’Keefe 2010). Arguments by opponents that most of the adverse health conditions people suffer from are a consequence of vaccines used during early the stages of life have been proven baseless through extensive research and cannot be used as evidence against vaccines and vaccination (Chen & DeStefano1998). The main question posited by these arguments is whether vaccination should be stopped or not. In consideration to the safety and cost-effectiveness of vaccines, this article reveals that far from being obsolete, vaccines and vaccination continue playing an imperative role in global immunization.

History of vaccines

3 Medical history has it that prior to the discovery of vaccines children were dying in large numbers even before their first birthday. The mortality rate of children in the UK, for instance, was estimated at 20%. Infant mortality was far much lower in other pars of the world. This rate, however, was remarkably reduced after the discovery and introduction of vaccines in the health care system (Chatterjee & O’Keefe 2010). The discovery of vaccines is presumed to be one of the major landmarks in the medical history, mainly since it resulted in the saving of lives of millions of children. Continued research on this subject has resulted in the discovery of more than 30 vaccines for various diseases (Stern & Markel 2005). Some of the key medical benefits associated with vaccination include suppression of smallpox in the year 1979, reduction by more than 70% in the number of children suffering and dying from diseases such as whooping cough, tuberculosis, measles, and diphtheria among others (Link 2005). Vaccines also resulted in the control of diseases such as measles and smallpox, which were a major medical menace in the past.

Medical health records reveal that more than 3 million deaths that occur in the world today are as a result of diseases that can be controlled by vaccines (Link 2005). Most of these deaths occur as a result of negligence of the people involved in taking care of young children.

Even though vaccines epitomize one of the greatest assurances available for the prevention of a wide range of diseases, a large proportion of the people in different parts of the world have not yet accepted this medical practice. Despite campaigns being conducted globally with reference to the importance of vaccination, there are still some people who advocate against it, thereby generating a heated controversy towards this noble practice (Stern & Markel 2005).

Controversies Associated with Vaccination The DPT vaccine controversies

4 Despite the medical breakthrough as well as the success stories published globally as a result of extensive use of the DPT and other vaccines, there are numerous controversies surrounding its use. Most of the issues associated with these vaccines arise from social, biological and cultural reactions (Gervais 2012).

The safety of vaccines has been subjected to numerous discussions which have over shadowed the medical achievements recorded over the years. As stated by Gervais (2012), controversial debates have shifted fear from those posed by ailments to the fear of the safety of vaccines. Nonetheless, researchers make it clear that vaccinations present the people with one of the most viable modes to the prevention of numerous diseases that can easily result in death.

Vaccinations are also considered effectual as well as the principal reasons underlying the reduction of infectious diseases. The heated debates surrounding vaccines result from the basis on which vaccination is supposedly grounded (Petersen 2011).

Ethical reasons, as pointed out by Petersen (2011), are also presumed to be major contributors to the controversies surrounding vaccination. Most of the ethical issues that bring about vaccination controversies are centered mainly on informed consent, disparities in access, research, and testing in addition to mandates. Advocates against vaccines point out that more than 100,000 people may suffer from various forms of injury or meet their outright death as a result of vaccination. They base their criticism on the safety of vaccines on these statistics. Even though health care professionals and manufacturers of vaccines acknowledge the fact that there is a possibility of vaccines causing injuries and also death (Chen & DeStefano 1998), they make it clear that such eventualities are negligible. Health records reveal that only a small proportion of adverse cases are reported as a result of vaccines.

5 Advocates against vaccination argue that quite a number of psychological disorders and other adverse nervous system disorders started rising as a result of extensive use of vaccines.

Strong critics against this practice associate disorders such as autism, criminal behavior and deficit disorder to the use of vaccines. Claims have been made that continued use of vaccines may turn young children, who would otherwise have lived a healthy productive life into persons who are psychologically unstable, mentally retarded, autistic, epileptic, and career criminals (Petersen 2011). They also opine that the use of vaccines tremendously reduce the effectiveness of the immune system, thereby giving rise to allergies and infections (Morrow et al. 2012).

Critics also base their arguments on evidence generated from various studies which posit that vaccination may lead to asthma.

Arguments have also been made that even though some health organizations claim that there are no conclusive findings as far as long term effects of vaccination are concerned, there are reports revealing children who became convulsive due to vaccination. It has been reported that over 18,000 children per year suffer from some form of neurological reaction which may last for at least two days from the day of injection with certain vaccines such as DPT (Fairhead & Leach 2012). It has also been revealed that more than half of these children may suffer permanent damage or even die as a result of DPT vaccination. DPT has also been associated with an array of skin conditions (Morrow et al. 2012). Most of these skin disorders have been shown to be more severe as compared to the diseases they were initially intended to prevent and may subject a child to intense suffering. According to critics, this may subject the health of the child to a risk greater than the disease the vaccine was originally intended to manage. Some of the adverse conditions that are believed to emanate from the use of DPT and other forms of vaccine include autism, arthritis, cancer, diabetes, kidney diseases, and sudden death in extreme cases.

6 Other conditions associated with DPT vaccine include neurological disorders, miscarriage, and autoimmune diseases. Even though DPT may produce some unwanted effects, health care professionals make it clear that these are normal reactions that subside after a period of time. It is normal for the human body to react to foreign substances including vaccines and therefore basing the movement against vaccines on these mild reactions, as stated by health care professionals, is medially not valid (Goodman et al. 2006).

The MMR vaccine The other vaccine that has been subjected to rigorous debate is the measles, mumps and rubella vaccine, also abbreviated as the MMR vaccine. This vaccine was developed in the 1960s by a renowned scientist, Maurice Hilleman. The MMR vaccine, which is actually a mixture of 3 live attenuated viruses, is administered through injection. The first dose of this vaccine is administered to children who are about one year of age (Goodman et al. 2006). Children receive the second dose when they attain five years of age and this is actually done to boost the immunity of children who failed to develop immunity following the first dose. Even though the vaccine has been in use since its introduction in the health care system in the 1970s, its efficacy as well as possible side effects has been in scrutiny all over the world (Nettleton 2006).

International health care organizations strongly refute claims that vaccinations expose children to a higher health risk as compared to the diseases themselves. These organizations make use of relevant medical documents to support their positions. They, for instance, point out that almost a 100% of those who receive the MMR vaccine develop strong immunity towards these diseases (Romm 2010). Children who receive these doses benefit from lifetime protection against measles, mumps and rubella. Credible sources make it clear that all those who argue that vaccination is a potentially harmful practice present the public with biased and misleading

7 information (Stanton 2004). These sources make it clear that no tangible evidence has been produced to reveal the negative intensity of using vaccines. The notion that vaccines have resulted in a remarkable reduction in the number of deaths emanating from diseases such as measles and polio offer a solid ground on which medical practitioners can base their support for vaccination.

Medical history has it that prior to the introduction of vaccines and vaccination in the UK, infant mortality rate was approximately 20% (Stern & Markel 2005). This rate was completely averted by the introduction of vaccines, an aspect that resulted in vaccines being presumed to be not only the key means through which a large number of diseases can be prevented, but also a major step towards averting millions of possible deaths. Although there have been claims that there was a drastic reduction in the number of deaths resulting from measles and other infectious diseases in the 1920s, before most of the vaccines were discovered, it is important to note that quite a number of factors including enhanced sanitation, may have contributed to this reduction in mortality rate.

In a manner similar to the DPT, anti vaccine advocates argue that that MMR has the potential to result in adverse psychological effects. Among the adverse conditions associated with the MMR vaccine is the development of autistic symptoms. Fear associated with the development of these symptoms was aggravated by a 1998 UK publication by Dr Andrew Wakefield which pointed out that there is a high possibility of developing autism following injection with MMR vaccine. In his publication, Wakefield argued that several children had developed intestinal symptoms and autistic disorders as a result of being vaccinated with MMR. It was also pointed out in this publication that MMR vaccine resulted in inflammation of the

8 gastrointestinal tract, an aspect that led to infiltration of toxic substances to the bloodstream. His theories received unlimited support from parents of autistic children (Godlee 2011).

The fears generated by these claims resulted in a drastic reduction in the number of children being vaccinated in various places around the world. In the United Kingdom, for instance, the rate of vaccination drastically dropped from 92% to 80% (Gangarosa 1998). The situation was worsened by increased publications in the media concerning these claims.

Claims by Dr. Wakefield and his team generated the need to carry out more research. An article published in The Lancet, one of the respected British medical journals, refuted most of the claims made by Dr. Wakefield. This followed a fitness to practice case filed by the UK’s General Medical Council against Wakefield and his team, which found them guilty of a wide range of medical contraventions. For instance, even though Dr. Wakefield was aware of test results which discredited his theories, he did not publish them. It is unfortunate that despite Dr. Wakefield’s publications being discredited, his claims left a large proportion of people groundlessly suspicious of the efficacy of the MMR vaccine (Seppa 2010). Lack of confidence in the MMR vaccine resulted in the resurgence of diseases such as mumps and rubella, an aspect that adversely impacted on public health.

Studies from recognized health care organizations have found out there are no links between MMR vaccine, autism or intestinal disorders (Plotkin 2009). These conclusions culminated in the discrediting of Dr. Wakefield’s claims, thereby leading to restoration of the publics’ confidence towards vaccination. Studies, according to The University of Waikato (2012), make it clear that despite MMR being used for years all over the world, the rate of autism remains significantly minimal. The statement that “MMR is not a risk factor to development of

9 autism,” is not a medical conspiracy, but it reveals unprecedented volume of medical research (Plotkin 2009).

Even though the whole world has been made aware of the benefits associated with vaccines and vaccination, it is a wonder that a large number of parents still refuse to take their children to health care facilities for vaccination (Fairhead & Leach 2012). It has been revealed that parents refuse to have their children vaccinated due to fear that vaccines might lead to adverse reactions in infants. Regardless of the fact that infants are vaccinated for purposes of protecting them as well as the community at large against infectious diseases, it is worrying how possible adverse effects of vaccination are pointed to infants alone and not to the whole community as well (Fairhead & Leach 2012). This brings rise to another reason surrounding ethical controversies. As posited by Romm (2010), is important to note that although parents have the right to decide whether to have their children vaccinated or not, the government has bestowed medical authorities with the mandate to ensure that all children are vaccinated against all infectious diseases. Research has revealed that adverse effects associated with vaccine preventable conditions are prevalent in those who as a result of their own idiosyncrasies refuse to undergo any form of vaccination (Salmon & Omar 2006). Health care professionals term this refusal as a great risk to not only the health of the person in question, but also to the health of others.

The process of research and testing of MMR vaccine and other vaccines is also surrounded by conflicting issues. Advocates against vaccination argue that this process call upon the efforts as wells knowledge from more than one individual, medical practitioner and also health organizations. As a result, chances of these individual entities bringing in conflicting ideas which may lead to ethical controversies are high. It is however, important to note that these

10 entities are legally constituted to fulfill the principle objective of safeguarding the health of the people (Goodman et al. 2006).

Despite controversies, it should be noted that the medical benefits associated with vaccination using the MMR vaccine are innumerable. It has been revealed that vaccination of more than 95% of the people in a population results in herd vaccination (Nettleton, 2006). Health care practitioners have been on the frontline campaigning for vaccination of young children to protect them from contacting infectious and highly communicable diseases. As a result, the numbers of children being vaccinated not only in the UK but also in other parts of the world have increased drastically over the recent past.

Impact of vaccine controversy on vaccine uptake Controversial discussions and publications related to vaccines are believed to have tremendously impacted on the success of immunization campaigns. Research has revealed that uptake of vaccines has over the years been prejudiced by the perception of the people towards their safety. The controversy surrounding the use of MMR vaccines in the United Kingdom in the year 1998, for instance, resulted in a drastic reduction in the number of children being immunized (Gangarosa 1998). The negative publicity surrounding thimerosal, one of the main preservatives of vaccines which have been in used since the 1930s, led to a drastic reduction in the number of health care facilities administering vaccines for hepatitis B (Baker 2008). Reports documented by the Centers For Disease Control and Prevention (2010) reveal that though claims that thimerosal has the capacity to lead to adverse health consequences were mere misconceptions, they resulted in a 43% drop in the number of hepatitis B vaccinations carried out in the UK (Ball, Ball & Pratt 2001). Fear of thimerosal resulted in additional reduction in the number of infants being vaccinated between 2003 and 2008. Respondents in surveys carried out

11 in the year 2008 believed that their children were actually safer if they were not vaccinated as compared to when they received vaccinations (Centers for Disease Control and Prevention, 2010). Health care professionals believe that if the fear of vaccines is not contained it might result in overshadowing some of the remarkable achievements vaccination has presented to the world (Ball, Ball & Pratt 2001). It is important to note that the fear of vaccines is real and that an increase in controversy towards vaccines has the potential to spread fear to the most remote parts of the world (Stehr-Green, et al 2005). There exists a thin line between acceptance that vaccination contributes to significant reduction in infant mortality and development of adverse effects of vaccination. The atypical quality of vaccines together with the fear surrounding their safety and development provides another reason why this debate is hard to overlook.

Comparative studies to determine the effects of anti-vaccine campaigns between countries where DPT vaccine was maintained and countries where vaccination programs were tremendously disrupted by anti-vaccine movements revealed that pertussis incidence was more than ten times higher in countries where vaccination programs were compromised by anti-immunization movements (Gangarosa 1998).

Conclusion It can therefore be concluded that even though vaccines comprise one of the most efficacious disease prevention strategies, their use has been subjected to misguided controversy that result in a reduction in their acceptance in various parts of the world. One of the main arguments by opponents is that vaccines result in adverse side effects that are dangerous both to infants and adults. However, despite numerous arguments to discredit the use of vaccines, the perception that vaccines and vaccination have resulted in remarkable reduction in infant mortality is a fact that cannot be refuted. Not only have vaccines helped in the preventing

12 uncontrollable spread of diseases, but they have also helped prevent the loss of lives for millions of infants. Therefore, the answer to the fundamental question whether vaccination should be stopped or not is NO. Even though vaccines are not a guarantee to disease free childhood, it is irrefutable that they serve to improve the chances of childhood survival. Research, development and testing of vaccines are carried out under strict guidelines thereby increasing their safety and efficacy. It has been revealed that far from being obsolete, vaccines and vaccination continue playing an imperative role in global immunization.

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