The decline of vaccination: a short overview


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The word vaccine came from the latin vaccīnum which comes from cca (meaning cow) because the first successful vaccine ever made was created in 1796 by Edward Jenner from cowpox against human smallpox-virus. On 8th May 1980 World Health Assembly declared “the world and its peoples have won freedom from smallpox”1; it’s hard for many of us to appreciate now what terrible affliction this viral infection once was, in the mid-1960s still causing 15 million cases a year and killing nearly as many as AIDS today.

Vaccines have saved countless lives, lowered the global incidence of polio by 99% and reduced illness, disability and death from diphtheria, tetanus, whooping cough, measles, meningococcal A meningitis and others diseases. There’s broad evidence showing the benefits of immunization as one of the most successful and cost effective health interventions in the history of Medicine, avoiding hospitalization, expensive treatment, disability and death.

Nowadays, vaccines save 3 million lives every year and they protect all of us from many different communicable diseases; however, 1,5 million lives could be saved if the rate of vaccination is improved.

During these last few years we observed a decline in the rates of vaccination and a re-emergence of infectious diseases in high income countries; where we usually think they don’t exist anymore. Vaccines do not only protect those who accept it, but also reduce the disease among unvaccinated individuals in the community through herd immunization, which occurs when a sufficient proportion of the group is immune. The decline of disease incidence is greater than the proportion of immunized individuals because the spread of the infectious agent is reduced. This is extremely important because it gives protection to vulnerable people such as new-born babies, elderly people and those who are too sick to be vaccinated.  However, in the last years we witnessed some preventable deaths in high-income country such as two babies killed by diphtheria and 2 measles outbreak one in Germany and the Disneyland outbreak that was partially attributed to a low vaccination rate2, 3.

These are some of the reasons for this fall in vaccination rates: paradoxically, when the incidence of infectious disease decreases due to successful preventive measures such as vaccination, the fear of the disease is often replaced by the fear of the consequences of the intervention itself so ultimately, when vaccines are successful, they become their own worst enemy” 4

Since our generation has (thankfully) forgotten the severity and consequences of many diseases, we should educate and raise awareness in order to shape vaccine acceptance behavior in younger generations. Why do we need to invest in education? Vaccination lacks drama: lives saved by vaccination are statistics, it’s tough to become emotionally attached to a number. It is not an hot news topic when compared, for instance, to a hypothetical story about an surgeon who saved a life thanks to a new high-tech procedure. Furthermore, from our comfortable home, we open a web page and it feels like we unlocked a “Pandora’s Box of XXI century”, in which we are flooded with data and information, often inaccurate and deceptive, being more and more difficult to find true reliable sources. Such easy access to information (and misinformation) fuels anti-vaccine movements that create a new challenge for public health advocates, that must address such questions and concerns.

Finally, the debate on vaccination also needs to shift from anti-vaccination movements to the striking inequities that remain in access to vaccination. Globally 5.9 million children under the age of 5 died in 2015, more than half of these early child deaths are due to conditions that could be prevented or treated with access to affordable interventions like vaccines. To tackle down this situation in May 2012 WHO approved the “Global Vaccine Action Plan” with a main objective:  deliver universal access to immunization by 2020”. This document states: “The success of this ambitious global plan will be one of the most enduring legacies for today’s children and the generations who follow them.”5

Ultimately, we have to raise awareness that vaccines are safe and they’re one of the biggest triumphs in our history and facilitate universal access to vaccines of proven efficacy.

 

Image:

Peter Salk gets a polio shot from his father, Jonas Salk, in the spring of 1953, as his mother looks on. Image retrieved from here.

 

QUOTES

  1. World Health Organization, Resolution WHA33.3 (8 May 1980)
  2. “Substandard Vaccination Compliance and the 2015 Measles Outbreak” Maimuna S. Majumder, MPH1,2; Emily L. Cohn, MPH2; Sumiko R. Mekaru, DVM, PhD2; Jane E. Huston, MPH2; John S. Brownstein, PhD2,3. JAMA Pediatr. 2015;169(5):494-495.
  3. Interwiew with Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases http://www.pbs.org/newshour/bb/completely-avoidable-vaccine-saved-victims-disneyland-measles-outbreak/
  4. Jana, L. A., & Osborn, J. E. (2013). The History of Vaccine Challenges: Conquering 
Diseases, Plagued by Controversy. In Vaccinophobia and Vaccine Controversies of 
the 21st Century (pp. 1-13). Springer New York.
  5. World Health Organization, Resolution WHA33.3 (8 May 1980)

 

FURTHER READING

  1. On the measles outbreak in Florida http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6414a1.htm
  2. About the outbreak in Germany (and a comparison with USA) https://www.washingtonpost.com/news/worldviews/wp/2015/02/07/germany-is-battling-a-measles-outbreak-that-is-10-times-worse-than-the-one-in-the-u-s
  3. Detailed situation in Europe http://ecdc.europa.eu/en/healthtopics/measles/epidemiological_data/Pages/measles_surveillance_reports.aspx
  4. WHO global vaccines action plan http://www.who.int/immunization/global_vaccine_action_plan/en/
  5. On misconceptions about immunization: http://www.who.int/vaccine_safety/initiative/detection/immunization_misconceptions/en/
  6. The Paradox of Disease Prevention. Celebrated in Principle, Resisted in Practice Harvey V. Fineberg, MD, PhD1. 2013;310(1):85-90.
  7. Pitfalls of Population-Based Preventive Medicine. Seth J. Baum, MD 2013;310(20):2201-2202
  8. Sick Individuals and Sick Populations. GEOFFREY ROSE in Int. J. Epidemiol. (1985) 14 (1): 32-38.
  9. Commentary: The prevention paradox in lay epidemiology—Rose revisited. and Carol Emslie. Int. J. Epidemiol. (2001) 30 (3): 442-446.
  10. WHO global vaccines action plan http://www.who.int/immunization/global_vaccine_action_plan/en/

 

 

 

 

 

 

 

 

 

20160906_130510 Saverio Pancetti is a medical student at University of Perugia (site of Terni), Italy. He was representative of students for two mandate before discovering his true passion for Public and Global Health.

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