We're scaremongers! says the WHO

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we never had millions of deaths before vaccines

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EXCELLENT LONG ARTICLE

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UNIVERSAL IMMUNIZATION

Medical Miracle or Masterful Mirage

By Dr. Obomsawin

Sheri

http://www.who.int/bulletin/volumes/86/6/08-030608/en/index.html

No vaccine for the scaremongers

Millions of deaths are prevented by vaccination

every year, yet public anxieties and vaccine

scares that ignore rigorous science continue to

hamper immunization programmes. Jane Parry reports.

WHO

Dr Jonas E Salk, who developed the first vaccine

against poliomyelitis in 1955, gives a boy a

polio vaccine shot during the mass innoculation

trial in Pittsburg, Pennsylvania, in the United

States of America (USA). Salk developed his

successful vaccine around the time of the Cutter

incident, when thousands of people in the USA

developed polio after being given vaccine

containing live virulent polio virus from Cutter Laboratories.

For most children in the developed world,

immunization against a range of infectious

diseases is a form of health protection often

taken for granted. These children benefit from

vaccines against more than 20 diseases, while new

vaccines continue to be developed, most recently

for rotavirus and human papillomavirus.

In developing countries, however, getting routine

vaccinations to the people who need them remains

a key public health challenge, with the lack of

health-care infrastructure, high costs and delays

between their introduction in developed countries

and their rollout in the developing world cited as the main barriers.

Despite these barriers, global vaccination has

evolved as a result of rigorous scientific

research. According to the World Health

Organization (WHO) and the United Nations

Children’s Fund’s (UNICEF) 2007 Immunization

Summary, more than 2.5 million deaths a year are

prevented in all age groups owing to vaccination

against four diseases – diphtheria, tetanus,

pertussis (DTP) and measles. Global coverage of

infants with the DTP vaccine reached 79% in 2006,

up from 20% in 1980, while the uptake of several

under-used vaccines, including hepatitis B,

rubella and yellow fever, is increasing.

Smallpox has long been hailed as the ultimate

vaccination success. It was declared eradicated

in 1979, the only disease affecting humans to be

eliminated deliberately. Polio has been

eradicated in WHO’s American, European and

Western Pacific Regions, while the number of

countries where polio is deemed a serious public

health problem has dropped from 125 in 1988, when

the eradication drive was launched, to only four

– Afghanistan, India, Nigeria and Pakistan – where the disease remains endemic.

There have been many other successes, such as the

99% reduction in the incidence of bacterial

meningitis caused by Haemophilus influenzae in

the United States of America (USA) which

introduced vaccination against the disease in

1988, according to its Centers for Disease

Control and Prevention. The Republic of Korea,

with 99% vaccination coverage for measles,

declared the killer disease eradicated in 2006.

Despite these successes, vaccine anxieties

continue to periodically impede this highly

effective public health measure. In certain

industrialized countries, most notably the USA,

public concern has shifted its focus from the

diseases vaccination can prevent, to the risks of

the vaccines themselves. The Internet has become

a significant channel for anti-vaccination views.

The popular video-sharing web site YouTube offers

a plethora of anti-vaccination clips. The

Internet has also become a forum for alternative

medicine practitioners to present their

anti-vaccination ideas and promote alternative products.

While parents in developing countries have, for

example, first-hand experience of measles and

welcome vaccination against it, the uptake by

parents for the combined measles, mumps and

rubella vaccine in many developed countries has

yet to recover almost 10 years after a study

linking it to autism, even though the original

study has long since been discredited and there

is overwhelming scientific evidence that refutes the link.

A similar scare linking the mercury compound

vaccine, thiomersal, to autism led to its

elimination from most USA and European vaccines

that contained it, despite the lack of scientific

evidence to support this measure. Indeed, five

large-scale studies failed to find a link between

thiomersal and autism, and, according to some

studies, the incidence of autism has risen after

discontinuation of thiomersal use in vaccines.

Anti-vaccination scares can have lasting, harmful

effects. Pertussis (or whooping cough)

vaccination was halted in Japan in the mid-1970s

owing to public concerns over adverse

neurological effects. At that point, Japan had

brought the disease under control after

introducing immunization in 1947. Pertussis is a

highly contagious respiratory disease and one of

the leading causes of vaccine-preventable deaths

worldwide, causing 300 000 deaths a year,

predominantly among unvaccinated or partially

vaccinated infants, who go on to suffer vomiting, dehydration and malnutrition.

Dr Sniadack, medical officer with the

Expanded Programme on Immunization in WHO’s

Western Pacific Regional Office, says: “With less

than 10% coverage among infants in 1976, [there]

followed a resurgence of pertussis cases. A

pertussis epidemic involving 13 000 cases and 41

deaths occurred in 1979. Pertussis incidence

returned to very low levels with the introduction of DTP vaccinations in 1981.”

France still has low rates of hepatitis B

vaccination compared with other countries in

Europe as a result largely of misinformed public

opposition to the vaccine. Dr Zuber,

group leader of the WHO vaccine safety team,

says: “From all the data we have, hepatitis B is

as benign as any other vaccine but it has been

associated in rumours with autism, multiple

sclerosis and leukaemia. All the solid

epidemiological studies have not been able to

confirm any hint of an association.”

The Internet has become a significant channel for

anti-vaccination views. The video-sharing website

YouTube offers a plethora of anti-vaccination clips.

An 11-month hiatus in the immunization campaign

in Kano and other northern Nigerian states in

August 2003 resulted in a resurgence of polio,

which then spread to 13 other African countries,

and from the Sudan to Saudi Arabia and Yemen, and then on to Indonesia.

Dr Bardan Jung Rana, medical officer with WHO’s

Expanded Programme on Immunization in Jakarta,

says: “After a 10-year interval of no polio

cases, on 21 April 2005, the National Polio

Laboratory in Bandung reported a wild poliovirus

isolate. Genetic analysis of the virus showed it

to be similar to recently isolated viruses in

Saudi Arabia and Yemen. After the detection of

the case, Indonesia conducted two rounds of

mop-up in the three provinces surrounding the

case and followed it up with five National

Immunization Days (NIDs) and three Synchro-NIDs.”

While most anti-vaccination scares are not

supported by scientific evidence, public concern

about the safety of new vaccines is

understandable. American infectious diseases

expert and vaccinologist Dr Offit traces

public distrust of vaccines to the so-called

Cutter incident during the 1950s, when thousands

of people in the USA developed vaccine-induced

polio as a result of being given vaccine

containing live polio virus from Cutter

Laboratories. In his 2007 book entitled The

Cutter Incident, Offit recalls that of 220 000

people infected – including about 100 000

children – 70 000 developed muscle weakness, 164

were severely paralysed and 10 died.

Dealing with vaccine anxieties requires a

multi-pronged approach, including engagement with

governments in affected countries and

disseminating scientific evidence on vaccine

safety, Zuber says. He cites the successful

response to opposition to vaccines in Nigeria.

“WHO met with the national authorities and other

local leaders. They listened to their concerns,

which were based on a fear about vaccine safety.”

However, the authorities were eventually

reassured and acceptance of the vaccine was

re-established following intensive dialogue.

As with disease itself, the prevention of

anxieties about vaccines is better than cure. It

is the task of WHO’s Global Advisory Committee on

Vaccine Safety to address the misinformation that

undermines vaccination efforts by constantly

monitoring and reviewing vaccine safety and

providing accurate information on any adverse

events. The committee’s 14 members, recruited for

three-year terms to offer expertise in a range of

related fields, including epidemiology,

pharmacology, infectious disease and drug

regulation and safety, are also charged with

providing scientific recommendations on

vaccination. The committee, along with other

members of the health and development community,

have played a major role in tipping the balance

in favour of reliable information. WHO’s Vaccine

Safety Net lists web sites that contain vaccine

safety information and are considered credible.

Zuber says: “Immunization programmes are already

extremely successful but the potential impact is

even greater. It would be technically possible to

prevent a further four million deaths each year

due to influenza, pneumococcus, rotavirus,

rabies, cholera, typhoid, epidemic meningitis and

Japanese encephalitis. All of these diseases are

significant health issues but they all have safe, effective vaccines.”

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Sheri Nakken, former R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

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