A six-year-old girl is taken to her family GP by her parents. She has a fever, runny nose, dry cough, skin rashes, red eyes, and red and bluish spots on the inside of her mouth. The GP sends her home saying it was just a cold virus and bedrest will suffice. On the way home, the family stop at a restaurant for takeaway, potentially spreading the virus. A week later, the girl is severely sick and is admitted to hospital with complications such as pneumonia and inflammation of the brain. The doctors figure out she has measles, although rare in Australia, it is making a comeback. The complications proved fatal and the girl dies later that day.
The modern world has been able to eradicate or control the spread of life-threatening viruses by the implementation of vaccines. But even the word ‘vaccine’ now comes with its own baggage. Very much because of the rise in an anti-vaxx agenda. In Australia there is a Standard Vaccination Schedule, outlining which vaccines should be administered to an individual from birth and throughout their life at various stages and for different diseases. Vaccines have eradicated smallpox, saving almost 5 million lives a year. Polio could be next, with over 80% of children in the world now immunised. There are many diseases which are currently vaccine-preventable: diphtheria, tetanus, whooping cough, mumps and measles amongst others. However, recently there has been a rise in cases for vaccine-preventable diseases.
What is measles?
Measles is a highly contagious viral illness, which causes the above symptoms. Infected individuals, often unaware that they have been infected, risk spreading the disease to others and causing further outbreaks. It spreads through coughing or sneezing and can remain alive in the cough mucous and/or saliva droplets for several hours. Infection can also occur if someone touches contaminated surfaces or objects and then touches their own mouth/nose or eats before washing their hands. It’s such a contagious virus, that an estimated 9 out of 10 people will contract it simply from contact with an infected individual!
The history of measles:
The vaccine for measles, the MMR (measles, mumps and rubella vaccine), was first introduced in the USA in 1963. It was highly effective and generally very safe (with side effects including mild fever and pain at the site of injection). According to the World Health Organisation, when the rate of vaccination for measles in a population is high, more than 92% of outbreaks no longer occur; however, if vaccination rates drop, outbreaks will rise again. Measles killed more than 400 children every year before a vaccine was invented. In contrast, one adult died as a result of measles in 2015.
The last few months have seen a measles comeback. A 2019 Measles Outbreak Report, from the Australian Department of Health, highlights the increase in cases worldwide, and the fact that in Australia, the majority of measles cases are due to unvaccinated individuals becoming infected while travelling. So far, in 2019, there have been 83 measles notifications compared to 103 for the whole of 2018! There have also been a measles outbreaks in New Zealand, Japan, the US and the Philippines, where more than 200 people have died this year.
In 2014, Australia eliminated endemic measles thanks to something called herd immunity (meaning no Australian has been infected by another Australian since 2014). A once preventable disease rears its ugly head. What on earth is going on?
What exactly are vaccines?
Immunisation has been occurring for centuries. Buddhist monks drank snake venom for immunity to a snake bite, though its effectiveness is debatable.
A vaccine is a tiny dose containing:
- Fragments of bacteria or viruses, known as the antigen (non-self/ foreign substance). Once injected into a person, the body responds to the antigens by generating a protective immune reaction, which it will remember the next time it encounters the same antigen.
- An adjuvant, an ingredient which helps retain the antigen at the injection site and attract immune cells to the area to improve the immune response to the vaccine. Adjuvants include aluminium salts, aluminium hydroxide and aluminium phosphate. Aluminium is often added during the processing of foods such as bread.
- An excipient (preservatives, residuals, stabilisers, buffers, surfactants, solvents, diluents)—these are substances found in the finished product, used during the manufacturing process or the finished product to maintain quality. More info on that here.
In the past, mercury-based preservatives (thiomersal) were used in vaccines. In Australia, the only thiomersal containing vaccines are Japanese encephalitis and Q-fever. And the amount of mercury a person would get from these vaccines is less than what you would find in a can of tuna (85 micrograms of mercury a standard serve) and in a less toxic form.
How do we know that vaccines are safe?
Exploratory stage: Involves basic lab research and lasts years. At this stage, scientists and researchers explore which antigens might prevent/treat a disease
Pre-Clinical stage: The vaccine is used in cell culture/tissue culture studies before being tested on animals (usually mice and monkeys). For example, scientists may vaccinate an animal and then inject them with the target disease to test the effectiveness of the vaccine. Many potential vaccines never progress beyond this stage as they fail to yield the desired immune responses. This stage can last a few years and if found to be safe, human studies will run in three phases of clinical trials.
Phase 1: The vaccine is given to a small number, usually between 25–50, healthy adults to assess its safety
Phase 2: If the vaccine is successful in Phase 1, it will be given to hundreds of people to determine its effect on their immune responses, the effective dose or doses and whether there are any side effects. People who undergo Phase 2 are ones who are more likely to get the disease.
Phase 3: If the vaccine passes Phase 2, it will be given to thousands of people to test its protective effects in large populations and check for other uncommon or serious side effects.
EVERY vaccine given to children in Australia must pass all three phases before being registered for use by the Therapeutic Goods Administration (TGA) (similar to its American sister the FDA – Food and Drug Administration). On top of this, there are also systems in place to track and monitor vaccine safety.
Do vaccines have side effects?
Vaccines are generally safe. However, some side effects include:
- Pain, swelling and redness at the injection site
- Mild fever
- Muscle and joint pain
A rare but serious side effect is an immediate allergic reaction occurring in less than one in a million cases, which can be treated by healthcare professionals.
Many diseases are preventable by vaccines. These include: diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella, hepatitis A and B, influenza, pneumococcal infections, rabies, cholera, meningococcal disease, tuberculosis, typhoid etc. Between 1926 and 2005 in Australia, deaths caused by these diseases were almost completely eradicated. (See the graph below).
Image source: The Conversation
Vaccines and autism, what’s up with that?
A paper published in 1998, by Andrew Wakefield made the first claim that the MMR vaccine is linked with autism. However, later on it was discovered that the study was unethical, dishonest and was fraudulent. Apparently, Wakefield was being paid by attorneys to file lawsuits against vaccine manufacturers. Since then the researchers and findings of this study have been discredited and the paper retracted. Wakefield has been stripped of his clinical and academic titles. From that point vaccination rates plummeted and there was a rise in people who did not believe in vaccination, AKA anti-vaxxers.
Many studies after this point, tried exhaustively to determine the possibility of a link between MMR and autism, however, no such reputable or relevant study could ever confirm Wakefield’s findings. Instead many studies have found the opposite, that there is, in fact, no link, zero, zilch, nada between MMR and autism. One of the largest and more recent studies published on the MMR vaccine and Autism, involving 657,461 children and lasting more than a decade, found no support that the MMR vaccination increased the risk for autism. A list of similar studies can be found here.
Children typically start showing symptoms of autism by 12 to 18 months of age or even earlier. Many parents are unaware of ‘early’ signs of autism and don’t start thinking about it until their child starts talking. Most children with autism are not diagnosed until after age 3, even though health care professionals can often see developmental problems prior to that age. Interestingly, it is around the 12- and 18-month period that certain vital vaccinations take place such as the MMR vaccine. Some people assumed that there were links between MMR vaccination with autism as the MMR vaccine is given around the same time that autistic symptoms are commonly being identified by parents. Correlation is not causation. The cause of autism is unknown, however, it is believed to be mainly due to genetic (including pre-natal factors) and then environmental factors.
Should people be forced to vaccinate?
This is a tough situation as it is a fine balance between freedom of choice and community responsibility.
If you decide you never want to go to the dentist or refuse to wear your seatbelt while driving, you are putting yourself at risk, the direct impact on the health of others is zero (mostly). However, with vaccines, if you don’t get vaccinated, then catch a disease and spread it through school, work or public places, you are affecting countless others’ health. If enough people in a community are vaccinated, herd immunity is achieved. Herd immunity makes it tricky for infectious diseases to spread as more people are protected. But what happens when people opt-out of vaccinating?
In Australia, children must meet immunisation requirements in order to receive the Family Tax Benefit (FTB) from the government. The government can check these details via Medicare. Should vaccination be a condition of accessing financial aid, education or employment? If so where does it end? And if it is not enforced, what does it mean for community health and infectious diseases? Diseases that have the potential to infect and wipe out large numbers of humans.
Vaccines, like other medications, can have side effects. However, all vaccines in use provide benefits which far outweigh their risks. Experts weigh in on the great debate and you can read more on that here.
For now though, it may be worth doing your own research (reputable journal articles of course not mummiesagainstvaccines.com) and educating yourself, as this public health issue gains more momentum.
On a side note, there has been a massive spike in the number of influenza cases in WA this year. There have been at least 29 deaths reported so far. Scarily, in the past 6 MONTHS, more West Aussies have died from the flu compared to the WHOLE of 2018. This outbreak has prompted massive demand for flu vaccines, useful especially for young children and the elderly as their immune system are not as able to withstand the virus. You can check at your local pharmacy or GP for more information on getting vaccinated against the flu virus.
Image source: ABC News