In recent years, a concern regarding both the safety and necessity of certain immunizations has been raised, since the number of new vaccines had risenover the past two decades. This is supported by Murphy (2002) who claims thata child takes 37 doses of eleven different vaccines during his first five years of life. Indeed, because vaccines are widely used and there are laws in many countries worldwide that make immunization compulsory in order to enter kindergarten and school, it is essential to pay attention to the effectiveness and side effects of the vaccines (Stratton et. al. 2003).
In order to understand this, it is necessary to lookfirstly at the history of vaccine development and its process of defending humans from catching diseases, and then at risk-benefits assessment by considering two cases either making immunization compulsory or giving parents a choice. It is argued that laws making parents obliged to immunize children should stay the same since the benefits held by immunization outweigh its risks. The history of the expansion and spread of vaccination starts with Edward Jenner from Gloucestershire, England, who did the first successful immunization in 1796 (Stern, Markel 2005).
Before this, it was noticed in Great Britain that the cases of smallpox among milkmaids, who had pockmarks on their hands after cowpox infection, were the lowest. Edward Jenner took the pus from the lesion of the hand of milkmaid Sara Nelmesand entered into the 8 year old boy James Phipps. This resulted in no illness after inoculating this boy with smallpox 6 weeks after the first inoculation. After that many scientists made their own contributions resulting in devising of vaccines against cholera in 1896, the plague in 1897, influenza vaccine in 1936 and yellow fever in 1937.
The introduction of triple Measles-Mumps-Rubella vaccine in 1969 is still representing the cornerstone of immunization pediatrics because now a single vaccine could provide immunity for three different diseases (Payette and Davis 2001). All vaccines operatein similar ways. Through inoculation the organism gets a particular amount of either live or dead microorganisms, depending on the type of vaccine, that are the causes of the pathogenic illness (The Meningitis Trust 2008). But they are weakened forms so they are not able to cause the illness. The individual’s immune system accepts microorganisms as foreign.
Those microbes enforce the human organism to create antibodies which consequently destroy and remember the microbe’s code. When the actual infection is attacking the human, the organism will recognize and neutralize it, thus eliminating it entering into cells (The Meningitis Trust 2008). Examining advantages of the immunization programs, the first and main reason forsupporting such an expensive medical strategy as vaccination is the prevention of the hugemortality and morbidity rates due to transmittable diseases. Contagious diseases have always shaped human history (Poland and Jacobson 2001).
In 1998 transmittable diseases were ranked second after cardiovascular diseases among the reasons of deaths at 13. 3 million which is 25% of the total number of deaths worldwide (Dittman 2001). They were the number one killers of both children and adults in developing countries representing 50% of deaths. But the emergence of vaccines changed the situation. Such diseases as diphtheria and Haemophilusinfluenzae type B are almost eradicated, while smallpox has been wiped out. Never before in mankind’s history wasone of the terminal illnesses stamped out. Smallpox cases stopped completely in the US and the UK by 1971.
As far as Asia is concerned, it happened by 1975. Therefore, in 1980 World Health Organization (WHO)declared total eradication of smallpox (Payette and Davis 2001). Now it is only an illness of historic interest (Poland and Jacobson 2001). Taking into account such a success with smallpox, the Expanded Program on Immunisation(EPI) was established in 1974, and it became one of the most successful public health policies. During its first twenty years of functioning,the EPI saved about 3-4 million children a year and there were 1 million less mentally handicapped and physically challenged children (Dittman2001).
Thus, the measures such as making immunization compulsory for the children is very important since by this way people can get rid of many transmittable diseases or save millions of lives. However, the altered virus or bacteria included in the vaccine still has the inherent ability to damage an individual’s brain or immune system, depending on whether vaccine combined or notand the person’s likelihood to be at risk because of his or her initial genetic and biologicalconditions.
The fact that mandatory immunization can generate complications and deaths was accepted in the USA in 1986 when the Congress developed a special system that gives compensations to the families of deceased or injured children and adults. Since then, approximately $ 1. 3 billion were allocated into the program (Murphy 2002). The weakened microbesare the reasons for the negative consequences of immunisation, its side effects. Every vaccine has adverse effects. Pless, Bentsi-Enchill and Duclos (2003, 292) define adverse reactions following a vaccines administration as “any untoward event where the causal relationship supports an association”.
It means that adverse effect is an unfavourable event happened after and caused by vaccination. There are mild, moderate and severe reactions to injections. Center for Disease Control and Prevention in the USA (2010) claims that there might follow some mild reactions afterDiphtheria, Tetanus and acellular Pertussis vaccine (DTaP): fever – about 1 child in 4, redness or swelling – 1 in 4, soreness and tenderness- 1 in 4, vomiting -1 in 50 and tiredness-1 in 3. Apart from this there are moderate reactions of DTaP vaccine such as seizureand non-stop crying for 3 hours.
Their incidence rates are 1 out of 14,000 and 1 out of 1,000 respectively. Finally, severe side effects are presented by long-term seizures or coma and permanent brain damage (Center for Disease Control and Prevention 2010). However, severe reactions are so rare that it is difficult to say whether DTaP vaccine caused the reaction and the rate of these reactions does not given. But in recent years a concern over vaccination safety raised due to association of vaccines with severe illnesses that weren’t related before to the immunisation side effects.
For instance, parents are still confused about the link between Measles-Mumps-Rubella vaccine and autism. A number of scientists have determined that autism is the side effect of MMR vaccine. The University of California(2002, 2)defines autism as “a neurological or brain disorder that profoundly affects a person’s ability to communicate, form relationships with others and respond appropriately to the environment”. Also it is characterized by repetitive behaviours, abnormal movement and sensory dysfunction.
Connection between MMR vaccine and autism should be carefully investigated because of two reasons. Firstly, in California the rate of the autism incidence increased by 273% during the period between 1987 and 1998 (Byrd et. al. 2002). A trend of autism increase refers to the other parts of the world, however in different percentages. Secondly, autism is an exhausting disease. It is very difficult for families of autistic children to tackle and afford this problem, since many people that are ill with autism stay dependent throughout their whole live.
Special education for such children costs about $30,000 per year and the annual cost of care in residential schools is $80,000-100,000 (Immunisation Safety Review 2004). The link between the MMR vaccine and autism is possible for three reasons. First, this link is based on the fact that autism might be equal to the mercury poisoning (Bernard et. al. 2001). Mercury is a neurotoxic material and also source of serious health problems (Redwood, Bernard and Brown 2001). MMR vaccine contains a thimerosal preservative.
Thimerosal is a substance consisting of 49. 6% ethyl mercury (Bernard et. al. 2002). It has been found not only in the MMR vaccine, but also in the most of Hepatitis B, influenza type B and Diphtheria-Tetanus-Pertussis vaccines. Only in 1999 it was demonstrated that infants were taking an amount of mercury much higher than they should be. According to the Centers for Disease Control the threshold of exposing to the mercury is 1? g per year, however the amount of mercuryin infants is 237. 5 ? g during the first 18 months. Bernard et. al. 2001) state that traits of the mercury poisoning and autism such as shyness, desire to be alone, mood swings, aggression, difficultieswith explicit speech, hand dithering and mild or profound hearing problems are similar. They mention that mercury poisoning at the very beginning is usually incorrectly determined as psychiatric illness. The second support of the autism and MMR link isthat the time when autism was firstly observed coincides with the time when thimerosal was added as ingredient to the vaccines. Autism was found in 1943 in children born in 1930.
Thimerosal was added into vaccines in 1930 (Bernard et. al. 2002). Furthermore, from Figure 1 the concentration of mercury changes in the hair of infants during two first years, it can be clearly seen that this number peaks at the age of 59 days, 107 days, 180 days and 540 days. It is the time when children get their MMR vaccines at 2, 4, 6 and 18 months (Redwood, Bernard and Brown 2001). Those peaks show that children are exposed to the large doses of mercury during a single visit to the doctor, not small portions daily over a long period of time.
Thus, thimerosal has the potential to increase the quantity of mercury in infants that exceeds the guidelines. If it does not contribute directly to the emerging of autism, it is inducing autistic symptoms among already ill children (Bernard et. al. 2001). Figure 1: Infant/child of 95th percentile body weight (no excretion first 6 months) (Redwood, Bernard and Brown 2001). The last aspect defining the autism and MMR vaccine side effects link is the significant number of autism incidences after vaccination.
Studies conducted by Makela, Nuorti and Peltola (2002) examined this link by analysing the numbers of autism hospitalizations after MMR vaccinations. They observed in Finland 535, 544 1-7 year old children that were vaccinated for MMR between 1982 and 1986 andrecorded 712 hospitalizations after vaccination. Among them there were 352 cases of autistic disorders. Therefore, autism can be considered as one of the adverse effects of MMR vaccine, since the MMR vaccination influenceschildren in the same way as the mercury poisoning.
By identifying the link between the MMR vaccination and autism, people cannot be sure that all other existing vaccines are safe. As it was mentioned before, not only MMR contains thimerosal but also Hepatitis B, influenzae type B and diphtheria-tetanus-pertussis vaccines. So while parents are obligatory to immunize their children, they have no opportunity of preventing exposure of their children to the mercury poisoning. If further the case of compulsory immunizations is considered, another significant disadvantage of this policy is that lawsdo not require vulnerable children to be determined.
The government sticks to the policy of “one-size-fits-all” and passes strict and hard rules to make everybody get vaccinated. For example, a study by Wilson et. al. (2009)shows that whole cell pertussis vaccine can cause Sudden Infant Death Syndrome (SIDS) for some groups of children. SIDS can be defined as deaths of infants which causes are uncertain (Stratton et. al. 2003). According to Wilson et. al. (2009), association of pertussis vaccine and SIDS can take place only in the group of children with inborn metabolism problems.
Disorders of metabolism are genetic defects observed in 1:10,000 to 1:30,000 in population. Those children after vaccination can undergo metabolic crisis. The possibility of deaths in the case of a metabolic crisis is 25% (Wilson et. al. 2009). Thus, SIDS might be caused by whole cell pertussis vaccine. The largest positive side of giving parents a choice is that they can through examining unique organism of a child identify whether shots should be taken or not. In the case of whole cell pertussis vaccine children with the metabolism problems are highly recommended not to be vaccinated.
However, regardless ofpeople realizing the threat of vaccines, government also cannot allow parents the freedom of not havingtheir children immunized since the consequences of interrupting or delaying vaccine coverage will be tremendous. There is no evidence that if people stop vaccinating there will be the same low rate of diphtheria, measles, mumps, rubella, pertussis and other infectious illnesses. This rates observed currently are only the fallouts of the mass vaccination campaigns. However, many parents takefor granted the decline in the cases of the transmittable diseases.
For example, Jacobson, Targonski and Poland revealed that 37,2% of 391 parentsrefused inoculation since there was no risk of disease to their children (2007). Similarly, 20,9% of parents had an opinion that the diseaseswere not dangerous. Thus, there is a misconception that some infectious diseases do not exist and hence do not present a threat to people. A low coverage of shots may lead to unexpected outbreaks. Such cases have taken place. For instance, in Japan in 1975 protests resulted in the low coverage and a pertussis epidemic broke outresulting inhundreds of deaths (Dittmann 2001).
A similar situation of emerging protests observed in the UK when the immunization rate decreased from 75% to 25% in the mid-1970s. A 1996 outbreak of poliomyelitis in Albania brought about 139 cases with 16 deaths (Ditmann 2001). However, two mass immunisations across the whole country terminated epidemic with the international aid. Overall, such campaigns are run in order to create the herd immunity. The herd immunity implies possibility of stating that entire population is protected by immunizing only some determined per cent of it, usually it varies between 85-95% (Stern and Markel 2005).
If this number goes down, then the risks of re-emerging infectious diseases will be high. Not making parents obliged to immunise children threatens the herd immunity. Apart from the threat to the herd immunity of people, another disadvantage of giving a choice to the parents is that severe health problems occur also when suffering from infectious diseases. It is well-established that measles can cause neurologic disorders and themeasles vaccine also contributes to it. These disorders are meningitis, encephalitis,subacutesclerosingpanencephalitis (SSPE), pneumonia and convulsions (Makela, Nuorti and Peltola 2002).
Figure 2 gives information about expected adverse effects after immunisation versus during measles disease. Possibilities of five different severe side effects of two cases are given in the rate per 100,000 cases. Then, if 10mln children were considered, in the case of non-immunizing them, 9mln children would have the measles. Approximately 90% of non-immunized children will contract the disease (Health Protection Agency 2006). According to the table, examining the encephalitis rate, 36,000 children out of 9mln would have encephalitis.
On the other hand, if they were vaccinated, only 10 children would suffer from encephalitis. This is the huge difference. It is the same forother four potential adverse effects. Therefore, the risks after immunisation are much smaller than if the child would be ill by transmittable diseases. Figure 2: Estimated risks of complications following measles vaccine compared to complications of natural measles (Dittmann 2001). ComplicationNatural measles complication rate per 100 000 casesMeasles vaccine complication rate per 100 000 cases Encephalitis/encephalopathy SSPE Pneumonia
Convulsions Death50-400 (0. 05-0. 4%) 0. 5-2. 0 3800-7300 (3. 8-7. 3%) 500-1000 (0. 5-1%) 10-10 000 (0. 01-10%)0. 1 0. 05-0. 1 – 0. 02-190 0. 02-0. 3 To conclude, mild, moderate and severe adverse events develop after immunisation. Also some illnesses have been discovered to be connected to the vaccines. To give an example, autism is the side effect of thimerosal-containing vaccines, and DTaP shot causes SIDS among children with metabolic disorders. But benefits of vaccines as safe guardians of millions of lives still remain enormous, because severe side effects are very rare.
Severe side effects when suffering from the infectious diseases are more than the adverse reactions after immunisation. For example, considering 10mln children and comparing risks of encephalitis during immunisation against measles and during measlesitself, first number is 3600 times less than the second one. Therefore, the benefits of immunisation outweigh its risks. Also, there is no opportunity to totally stop mass immunisation, in spite of emerging severe side effects, since it is highly likely that the herd immunity of whole country’s population will be under threat.
Infectious diseases have not been eradicated. Their incidences have only declined. It is suggested that every child and parent is able to get consultation and help from their physicians about possible delays in the uptake of shots in order to get vaccine experiencing only mild side effects. Overall, it is essential that immunisation side effects investigation is highly prioritised in order to make them safe. Moreover, people should not stop carrying out a research in the sphere of preventative therapy since there are many deadly illnesses as malaria and HIV that can be wiped out as smallpox.