Concerns about the Safety of Vaccines

Until just a couple of centuries ago, infectious scourges roused fear into the minds of all people. Just over a hundred years ago, the infant mortality rate was at a mind-boggling 20 percent. In a time before effective vaccines, diseases like smallpox, diphtheria, measles, whooping cough, and more were some of the most common childhood killers. Fortunately, in developed and industrialized nations today, vaccines are widely available and affordable. As a result, these diseases have been contained and even in some cases, eradicated, saving millions of lives and bringing peace to many minds. Surely, one could claim that vaccinations are one of the greatest achievements mankind has made. Unfortunately, many today refuse to vaccinate their children due to a variety of reasons. After understanding how vaccines work and the myths and facts that are associated with vaccines, one can see that not being vaccinated creates a public health threat and can have severe consequences for many. Due to this fact, children attending public school should be required by law to be up to date on all of their vaccines unless they are unable to for medical reasons. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.24.3.611

        In 1796, the world's first small pox vaccination was performed. After noticing that milkmaids who had been infected from cowpox were immune to outbreaks of small pox, Edward Jenner conducted a clinical trial. He discovered that when he took pus from a cowpox lesion and introduced it to an eight-year-old boy, he did not catch small pox when it was directly introduced to him six weeks later. This trial became the scientific basis for vaccinology and a century later the rabies vaccine was introduced and a century after that the polio vaccination trials began. These experiments were extremely effective and saving hundreds of lives, but how did they work? https://www.healthaffairs.org/doi/full/10.1377/hlthaff.24.3.611

        The human immune system is a complex network whose sole purpose is to fight off infectious microbes. Multiple specialized cells find, target, and destroy these microbes. Every cell has a unique marker, or antigen, on it and white blood cells called macrophages use these antigens to distinguish which cells are part of your body and which ones are harmful invaders that need to be destroyed. Macrophages digest most of these invasive cells, but carry the antigens back to the lymph nodes and display them on their surface so that other specialized cells called lymphocytes, can recognize them. There are two major kinds of lymphocytes, T cells and B cells. Offensive T cells kill human cells that have been infected by the microbe and defensive T cells secrete chemicals that help direct the other immune system cells. B cells make important antibodies. Antibodies work by attaching to the microbe's antigen and then coating the microbe making it unable to function. Antibodies and antigens fit together like a puzzle. Each antibody can only fit with one antigen so the immune system keeps millions of antibodies on hand so that it is prepared against foreign invaders. About 50 million B cells are circulating in one teaspoon of human blood. Once attached to antigens, antibodies signal macrophages to come and destroy the microbe. Once T cells and antibodies eliminate the microbe faster than it can reproduce, the immune system is winning. The virus begins to disappear from the body. Once the disease is gone, B cells and T cells are converted into memory cell. Memory B cells can quickly make more antibody if needed. Memory T cells can divide and grow into a fighting army. If the body is re-exposed to the same infectious microbe, the immune system can quickly respond and stop the infection because it is able to quickly recognize the virus.  https://www.niaid.nih.gov/research/how-vaccines-work

        Vaccines are effective because they mimic natural infection. They contain a weakened form of the virus that does not reproduce very well. The human body is not able to determine that the vaccine viruses are in a weakened state and so they treat these viruses as if they are dangerous. The immune system responds and the vaccine virus is quickly eliminated. The mock infection disappears and humans are left with a supply of memory T and B cells that are ready at a moment's notice should the true aggressive form of the virus enter the body at a future date. Although this process makes scientific sense, there are many parents who elect to not vaccinate their children for a variety of reasons. It is important to explore these reasons and decide whether or not parents of children have misconceptions about vaccinations, their side effects, their benefits, and so on. lhttps://www.niaid.nih.gov/research/how-vaccines-work

        One of the most common reasons why parents choose to not vaccinate their children is for religious reasons. Unfortunately, the number of children not vaccinated for this reason is increasing and in communities where there is a higher percentage of those who are not vaccinated for religious reasons, there are more vaccine preventable outbreaks. When a parent refuses on religious ground, most claim that it is not because they are ignorant but rather that they have a very strong internal conviction that it is fundamentally wrong to vaccinate their children. Due to the fact that they have such a strong conviction, it is often difficult for medical practitioners to persuade these parents to vaccinate their children and help them change the views they have against vaccination. One of the scariest parts of religious exemption is the fact that these families often refuse all of their vaccines rather than just certain immunizations. Many worldwide religions have stated positions regarding vaccines and whether or not they should be used. Looking at some of the mainstream religions worldwide presents some very interesting information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869767/

        All mainstream religions besides the Dutch Reformed Church do not have any formal anti-vaccine doctrine as part of their religion. Catholics have expressed concern about the use of aborted fetal tissue that is used to manufacture some vaccines, however, this has not led to any formal restrictions for any vaccines. Muslims and Jews are prohibited from eating pork which is the basis for the gelatin in some vaccines. However, in Islamic tradition, those who receive these vaccinations based on the law of necessity, are not found guilty if there was no other alternative. Since vaccinations are injected and used for medical purpose rather than being eaten for the purpose of diet, vaccines are permitted. Similarly, Jews emphasize the community over the individual when it comes to disease prevention and so they support vaccinations in order to have disease prevention in their communities. https://www.ncbi.nlm.nih.gov/pubmed/23499565

        This information is interesting because it seems to contradict the statistic that the majority of vaccine refusals are based on religious ground. The animal-derived gelatin as well as aborted human fetus tissue can pose a concern for the most orthodox and extreme members of the religions mentioned above. However, only a small percent of members belong to these sects or have extreme bishops, priests or rabbis that would vocalize against vaccines. Additionally, probably only a small percent of these children are even attending a public school. It seems as though religious exemption may just be an excuse used by many who refuse vaccines because they are uneducated or have heard negative things about vaccinations from someone else. 47 of the 50 United States allow vaccine exemption on the grounds of religious reasons. It would be very easy for many people to avoid vaccinations using the pretense that they are doing so under religion. https://vaccines.procon.org/view.resource.php?resourceID=003597

        Another common reason why parents refuse or delay vaccines for their children is personal or philosophical reasons. Fewer states allow philosophical exemption and some of these states require that parents meet with a health care professional to discuss the benefits of immunizations if they use this exemption. Although contrary to intuition, some parents feel that there are benefits to contracting these preventable diseases because it will build a stronger immune system. Others believe that receiving natural immunity by acquiring the disease is better than becoming immune through a vaccine. Some believe that the diseases that children are vaccinated for today are no longer prevalent enough for their child to be at risk of catching. They believe that there are more benefits that come from not receiving vaccines than for receiving them. Some think that if they are helping their children live healthy diets and active lifestyles, that they will be better able to avoid contracting these diseases even without getting vaccinated for them. Others do not see the diseases that are vaccinated for as dangerous and life-threatening and that if their child did contract one of these diseases that it would be easily curable. Many personal reasons stem from parents who are uneducated or ignorant about vaccines, how they work, and the diseases they prevent. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869767/

        All of the personal beliefs stated above are derived from misconceptions that parents have about vaccines. It is important that medical providers clear these misconceptions that parents have. If parents were aware of how vaccines work, they would know that there is no difference between immunity built by vaccines and immunity built by actually acquiring a disease because the immune system responds the same way in both cases. Education about the various vaccine-preventable diseases would inform parents that these are highly contagious diseases that are very life threatening which is why vaccines have been created for them. Some are not easily curable because they are viral so no antibiotics can be taken for them. Having a true understanding of herd immunity is also important for these parents who think they are safe because everyone else is being immunized.

        Herd immunity is one of the most important reasons that everyone should be vaccinated. The idea of herd immunity is that when enough people are vaccinated in a community, the disease cannot travel as easily from person to person because those who are vaccinated cannot contract the disease and additionally, they are less likely to spread it. This means that it is very unlikely that those who are not vaccinated will not contract the disease. While herd immunity protects everyone, it is extremely important that a very high percentage of the community is immunized in order for herd immunity to work. Depending on how contagious a disease is, more of the population must be immunized in order for herd immunity to work. This percent can range anywhere from 85 to 95%. Many depend on herd immunity such as those who have a compromised immune system, those who are medically unable to receive vaccines, elderly people, newborn babies and young children that have not received all of their vaccines yet and those who receive faulty vaccines. These individuals are all at a higher risk for contracting these vaccine preventable diseases and make up enough percent of the unvaccinated that it is so important that everyone else is vaccinated. Due to the fact that a slight drop in the number of vaccinated individuals in a population can cause a large drop in the effectiveness of herd immunity, it is not a reliable way of protecting children because it is indirect.  This idea can be seen in the graphic below: https://www.ovg.ox.ac.uk/news/herd-immunity-how-does-it-work

https://fred.publichealth.pitt.edu/proj/measles/results.php

        Maybe the most frequent reason for refusing vaccinations are concerns about the safety of vaccines. Most of these fears rise from the media or things they have heard from others. Every person, educated or not, has their own opinion about vaccines and this can directly influence other people's opinions. Some parents are concerned about vaccines causing autism. Others worry that bombarding children with so many vaccines at a young age can overwhelm their immune systems and these parents will often delay their child's immunizations. Some worry about side effects of vaccines and fear they are greater than what they have been told by their physicians. Fear is a great influencer and this is why it is important that there is trust between practitioners and parents. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869767/

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