UHA Worksite Wellness

Immunizations: A Controversy That Lingers

Written by George McPheeters, MD, FACS on July 20, 2015. Posted in Healthcare, Featured2, Post

There is a recurring "controversy" about the safety and utility of immunizations, particularly in children. Uncertainty about the safety and value of vaccinations distracts families and physicians, creates tension, and puts the population at risk. Immunization has not only proven effective over the long-term, it has directly contributed to saving the lives of thousands of people.

Epidemics: Recent History Too Soon Forgotten

Few Americans (and fewer residing in the geographically isolated Hawaiian islands) have lived through a true infectious epidemic – but that does not diminish the tragic and lasting effects epidemics have had on our nation or the world. Eleanor Nordyke, Hawaiian author and historian, estimates that 10% of natives died in the span of only a few years in the mid-nineteenth century as a result of measles, whooping cough and influenza. Less than 100 years ago, almost a third of our nation’s population was stricken with the flu. Over 500,000 Americans died during this global outbreak that affected half a billion people worldwide.

Though these tragedies occurred a relatively short time ago, most of us find it difficult to imagine living through an epidemic or suffering personally from these dreadful diseases. But the disease itself is only part of the process of pain and disruption; life as we know it would stop in a true epidemic. Doctors, nurses, agents of law enforcement and food distribution would be adversely affected.

Thankfully, we have the ability to prevent many diseases that could cause epidemics. Hygiene, nutrition, and childhood immunization have saved countless lives and prevented profound amounts of human suffering.

Historic Skepticism Dwindles as Vaccinations Prove Effective and Safe

Anti-vaccination has historic roots. Around 1798, Englishman Edward Jenner discovered the smallpox vaccine and it was immediately met with detractors. Because the vaccine was derived from cows, contemporary critics disseminated drawings of children with cows' horns.

Yet, inoculation quickly became recognized for the life-saving preventative treatment that it is. In 1853, some 5,000 Hawaiians died of smallpox. Only a year later, King Kamehameha IV ordered vaccinations for all Hawaiians.

One hundred years ago, the Supreme Court upheld the right of a state to require a fine if immunization was refused and up until the past few years, most states required childhood vaccinations.

Inoculation gained popularity and proved an effective method to stop the unnecessary pain and suffering caused by preventable diseases.

Today’s Controversy Around Vaccinations: No Evidence to Substantiate Fears

Today’s anti-vaccination movement ignited in 1998 when a now-retracted paper suggested a link between vaccinations and autism. The supposed link has been completely discredited and the author, Dr. Andrew Wakefield, lost his medical license.

Despite the overwhelming lack of scientific evidence, the movement has steadily gained traction and in parts of the U.S., vaccination rates have dropped significantly. This fact is almost certainly related to the outbreaks of measles, meningitis and California’s 2010 outbreak of whooping cough. In the latter instance, at least 10,000 people became infected and 10 infants died, all of a preventable disease.

Just a few months ago, outbreaks of measles and meningococcal meningitis occurred in the U.S., with substantial publicity. The National Vaccine Information Center (which opposes routine preventive immunization) called it a "phony crisis" (as reported by David Oshinsky in the Wall Street Journal). Yet 178 people from 24 different states have contracted measles in 2015 alone – hardly a “phony crisis,” but rather evidence of how, with inoculation, these diseases can spread rapidly across great distances.

Inoculation was at first met with skepticism. But in light of the horror of some diseases, vaccination was widely adopted – to great effect. Hence we find that Tetanus, a life threatening and genuinely terrifying disease, is 95% less common now than in 1940 and causes death 99% less frequently now than then. Polio (or "infantile paralysis") remains a serious problem in some countries but has been wiped out in our country as a result of vast immunization campaigns. So, some 200 years later, many of these illnesses have been eradicated. With the majority of the population vaccinated, almost all people (vaccinated or not) are protected, because an epidemic cannot begin. This phenomenon, known as “herd immunity,” is now at risk as anti-vaccination holds popularity – despite the misinformation circulating.

Exactly How Effective and How Risky Are Vaccines?

Vaccines are not completely perfect at preventing all of the diseases for which they are given, and there are a small number of occasionally serious risks associated with them. However, the benefits far outweigh the minimal risks and the vast majority of "adverse events" are coincidental, not causational. For instance, children are immunized at the same ages when neurological disorders such as autism are likely to manifest. The myth persists though there is no scientific evidence to suggest that inoculation in any way causes these disorders.

Some vaccines do carry rare risks. For example, the DTaP vaccine (for diphtheria, tetanus and pertussis), can cause a serious – but treatable – condition in about 1 in 15,000 people. But it prevents a disease that can cause death in 1 in 20 people. The vast majority of the side effects are minor: discomfort at the injection site and sometimes a low grade fever. These negligible issues are well worth the overall benefits of inoculation, not just for our own families, but for our communities.

We all know that medical recommendations can change, but preventive immunizations have truly stood the test of time. Anyone reading this could easily have died or been very seriously affected by terrible diseases for which preventive immunizations have offered lifelong protection.

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George McPheeters, MD, FACS

UHA Chief Medical Officer

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