Kat von D, celebrity tattooist and make up entrepreneur, triggered a huge backlash a short while back when she and her husband announced that they wouldn’t be vaccinating their unborn child. I have to admit, I was shocked. Surely sensible-seeming people don’t just flout the fact that because of vaccines, diseases such as polio, scarlet fever, and diphtheria are no longer a constant and horrific threat to children? So why would you want to put your child, and other people’s children, at risk?
In a later statement, she clarified:
‘We are not against vaccines. Just because we have hesitancies and valid concerns about injecting our baby with specific chemicals and toxins does not mean we are anti anything. As a soon-to-be-parent [and especially as a first-time-mom] I do feel it my responsibility to have questions, and to listen to my motherly instinct to question things, and do my research. What we have found is that sometimes it isn’t always so black and white. While we believe medications, including vaccines, are not all bad — we also can’t dismiss the fact that some may not be good for everyone.
‘There are plenty of studies that show some vaccinations can work wonders. And there are also studies that show some people [including mothers, and babies] may be more susceptible to vaccine injuries more than others. ’
So, not anti-vax, but as it turns out, an example of a growing group of parents who are questioning the safety or the need for vaccines. Unfortunately, as is already being seen with new outbreaks of mumps and measles, as vaccination rates drop, infection rates rise. So why has this come about?
What actually is a vaccine?
A vaccine is a preparation of a dead, weakened, or synthetic version of a disease-causing agent (virus or microorganism), its toxin, or its surface proteins that once ingested or injected causes an immune response. By introducing this safe version of a disease to the immune system, it will generate antibodies that will be able to recognise the disease again in future and fight it off.
Discussions of vaccinations normally begin with the story of Edward Jenner taking scrapings from a milkmaid’s cowpox pustules and inoculating a young boy to protect him from the far more serious small pox, after noticing that milkmaids seemed to be immune from a disease which killed three in ten people who caught it.
As is typical with history, Jenner actually wasn’t the first to try this, just the first to publish his findings. However, from this humble beginning has sprung a huge business. Smallpox has now been eradicated and what were once common childhood illnesses such as measles, mumps, polio and diphtheria are rarely seen in developed countries. However, that doesn’t mean that they don’t still pose a threat.
The everyday threat of childhood disease
In 1956 one of the last epidemics of polio hit Cork in Ireland, just before the vaccine was introduced. Thankfully there were few fatalities, but children were left paralysed and crippled in its wake. In one to two percent of cases, polio affects the nerves, leading to paralysis of the arms, legs or diaphragm. In the last case, patients had to be encased in an iron lung respirator to keep them alive. Half of those with paralytic polio were left with permanent paralysis. Due to vaccination, there hasn’t been a case of polio in the UK since the mid 80s.
National statistics for the UK show that in 1915, 55,607 one-to four-year-olds died, mainly from infectious diseases. By 2015 this number had plummeted to 460. Mass vaccination of polio, diphtheria, tetanus, whooping cough, measles, mumps and rubella meant that these diseases were almost wiped out in the 20th Century, which, along with better diets and medical care, led to this vast reduction in child mortality.
According to WHO, the measles vaccination prevented 20.4 million deaths in 2000-2016. However, despite there being a vaccine, mass outbreaks still occur. Measles, a highly contagious virus, can lead to blindness, brain damage and pneumonia. Fatality rates can be as high as 28%. But measles is still a problem even in countries with a good vaccination programme. In May 2018, Public Health England announced outbreaks of measles across England, associated with travel to and from Europe where there are large ongoing outbreaks. So when the majority of children and adults should have been vaccinated, why are people still vulnerable?
The MMR autism controversy
In 1998, The Lancet published an article called ‘Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children’. This now-retracted paper was a study of 12 children that linked the measles, mumps and rubella (MMR) vaccine with the sudden onset of inflammatory bowel disease and what the lead author Andrew Wakefield called ‘regressive autism’ where language and basic skills were said to have been lost.
And it was completely, catastrophically wrong. A fraud investigation by journalist Brian Deer, working for The Sunday Times, found that Wakefield had been paid to provide evidence against the MMR vaccine by a lawyer who wanted to raise a speculative class action lawsuit against the drug companies manufacturing it. Wakefield, it turned out, had also filed a patent for his own single measles vaccine, which would only sell if the triple vaccine was no longer used.
Touring US autism conferences, he linked MMR with ‘an epidemic of autism’, triggering a massive backlash against not only the MMR vaccine, but all vaccines. Despite proof that Wakefield modified or lied about the medical histories and descriptions of the children in the study, leading to him being struck off of the medical register and his paper being removed from The Lancet, and subsequent studies including this one of 95,000 children observing ‘no association between MMR vaccination and increased ASD risk’, the link between MMR and autism has unfortunately stuck in the public’s perception of vaccines.
The anti-vax movement
‘Hecklers were issuing death threats to spokespeople, people who simply related the scientists’ findings. What happens when the facts of bioscience are relayed to the public and there is disbelief, lack of trust? Where does that lead us?’ These questions were asked by Sharon Kaufman, a medical anthropologist at the University of California, who investigated the growing divide between scientific evidence and parents’ attitudes towards risk and vaccinations.
Research has shown that the number of parents refusing to vaccinate their children is increasing. The reasons for not vaccinating seem to cover a varied mix of a lack of trust in the government and health care services, false medical information like the MMR scare in the UK and a mercury scare in the US, a belief that because these diseases are no longer common their child won’t catch it and therefore doesn’t need to be immunised, thinking that their child’s immune system will become overburdened, and fear of harmful side effects or the long-term impact.
One in four Americans still think that vaccines cause autism. Autism rates have risen steeply from the 1990s when this disorder first began to be tracked, linked to a better understanding and increased diagnosis as well as the removal of Asperger’s Syndrome as a separate diagnosis in 2013. However, parents who see environmental factors being responsible for rising autism rates blame the increasing number of vaccines being given to children.
As well as false ‘facts’, it has been suggested that vaccines are a victim of their own success. As the measles vaccine has been used for over 50 years, there is a generation now having children who are very unlikely to have had experience of the disease. One poll showed that three-quarters of Americans aged 65 or older have had measles, compared to just 4% of adults under 30.
Trust also seems to be a major issue, with a massive drop in people’s trust in institutions from 77% in 1964 to 24% in 2014. This, coupled with people becoming far more likely to self-diagnose using the internet, placing less trust in their doctor, and becoming less connected with their communities, means that increasing numbers of parents are deciding that, essentially, they know better than medical professionals. As herd immunity relies on 90% vaccination, both negative attitudes against vaccination and the ambivalent opinion that other people are getting their children vaccinated so they don’t have to bother means that outbreaks – which are already happening – will occur more frequently.
The fence sitters
In the middle of vaccinate/don’t vaccinate debate are the ‘fence sitters’ or ‘vaccine hesitant’ parents, who, according to a C. D. Howe Institute report, are actually in far greater numbers, and therefore more responsible for declining vaccination rates, than anti-vaxxers. Fence sitters are parents who may vaccinate their child against some diseases, but fail to complete the full course of immunisations, with reasons such as complacency, the costs associated with time off work, and significant misconceptions about the costs and benefits of immunisation.
The authors of the report argue that ‘arguably too much attention and energy are spent trying to engage [anti-vaxxers]’ and that rather than resorting to compulsory vaccinations, more targeted early interventions would show a greater uptake amongst fence sitters.
Evidence of vaccine injury and mortality
A fear some parents have is that the vaccines would have serious or lethal side effects. As much evidence that there is for the benefits of vaccination, there are studies which have shown a negative impact.
For example, one study of child mortality following the use of the DTP (diphtheria, pertussis [whooping cough], and tetanus) and oral polio vaccines in a community in Guinea-Bissau in the early 1980s showed that ‘all-cause infant mortality after 3 months of age increased after the introduction of these vaccines’. The type of vaccine used (whole-cell pertussis) is still being used in developing countries, whilst in Western countries the more expensive, but safer, acellular vaccine replaced it in the 1990s.
Yes, there is some risk with all vaccines, as can be seen in these fact sheets from WHO listing the chances of mild and severe reactions for all the different immunisations used. However, the risks from catching the disease are much higher than the risk posed by the vaccination. For example, one in 50 people vaccinated with Hib meningitis report a fever, whereas amongst those who catch the disease about 1 in 20 patients die and 1 in 4 survivors have permanent brain or nerve damage.
What next?
Immunity is a ‘game of numbers,’ Dr. Tim Lahey, a professor at the Dartmouth Institute for Health Policy and Clinical Practice, is quoted as saying in this CNN article, where the ‘way to win is to get as many people as possible immunized so that it just disappears from the population.’ Suboptimal vaccine coverage, says the European Centre for Disease Prevention and Control, has led to 14,000 cases of measles in Europe between January 2016 and June 2017.
In this annual survey, which monitors attitudes towards vaccination, the authors have found that ‘countries with high levels of schooling and good access to health services are associated with lower rates of positive sentiment, pointing to an emerging inverse relationship between vaccine sentiments and socio-economic status.’ So how do governments increase vaccination rates when increasing numbers of well-educated people are deciding not to?
Some countries have opted for bans or fines. In July it was announced that Australia will further enforce its ‘No Jab, No Pay’ rule, where family tax benefits will be decreased for each child who does not meet immunisation requirements. France has now made 11 vaccines compulsory for children, and all 50 US States require children to be vaccinated before they can be allowed in nurseries and school. Last year Italy went one step further and additionally fined parents who refused to vaccinate their children; a decision that was recently reversed after political pressure.
Currently vaccinations are not mandatory in the UK, but there have been calls to the British Medical Association to re-examine the advantages and disadvantages. Is mandatory vaccination the best step? ‘Sometimes in the conversation around vaccines, people can react against the incentive and develop resentments, says Lahey. ‘They can feel like being encouraged to get immunizations gives them a loss of control.’ However, Farah Jameel, the London GP who called on the BMA to look into mandatory vaccination, says: ‘Parents who willingly choose not to vaccinate their children, despite the safe evidence base, are displaying negligent behaviours that are in some cases seriously harming the health of children, who have no say or control over this decision, and in extreme situations costing lives.’
It seems that the main issue here, rather than vehement anti-vaxxers, is how to promote the safety and necessity of completing the full suite of childhood vaccinations amongst the far larger group of parents who have concerns or are apathetic towards diseases which they don’t consider to be a risk. Unfortunately, if the downward trend for vaccination continues, outbreaks like these will become far more common, as will the associated deaths and serious injuries caused by diseases we thought could be eradicated.
Interested in reading more? Click here for my article on how the Ebola epidemic was halted by the invention of a vaccine.
Hypervelocity Science 
“…Italy is going one step further and additionally fining parents who refuse to vaccinate their children.”
This part of the article is wrong (see http://time.com/5360823/italy-anti-vaccine/). I wonder what other parts are incorrect.
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The law was in place until last month so is still pertinent. The article has been updated.
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