Immunisations have been in the news this week the Republican candidate Donald Trump blamed vaccines for autism. ‘ two years old, beautiful child went to have the vaccine and came back and a week later, got a tremendous fever, got very, very sick, now is autistic.” It was also reported that 2 children in Ukraine have been found to have developed Polio. The immunisation rate of polio has fallen in the Ukraine because of the war. We are tantalisingly close to eliminating polio and this is a major setback.
Immunisation may be the most important and life-saving medical invention, arguably saving more lives than antibiotics. A handful of Spanish invaders were able to conquer South America because the majority of natives died from the diseases they introduced [some areas decimated – reduced to 10%]. The 1st World War was responsible for more deaths than any war in history but the Spanish Flu, towards the end of the war in 1918 killed far more – an estimated 50 to 100 million people [3 to 5 percent of the world’s population]. Bill Gates [of Microsoft] has in his wisdom poured billions into vaccinations, via GAVI, as it is one of the best ways to prevent needless deaths and disability. The medical view is clear. There is overwhelming evidence that immunisations are relatively safe procedures that protect populations effectively against the risk of serious disease. When I was young my sister’s best friend’s brother was brain damaged because of measles. It is undoubtedly one of the major causes of the increase in life expectancy in the 20th Century. Bill Gates, with his intelligence, has chosen to invest much of the millions he made in GAVI, which researches into and provides vaccines world-wide. New vaccines are being added all the time for example rota virus and Meningitis B.
There have been numerous scare stories about immunisations as any search on the internet will show. The last major scare involved Andrew Wakefield who appeared to show a link between the MMR vaccine and autism and a bowel disease [Crohn’s Disease]. It was later revealed that much of his research [which involved risky procedure on children] had been fabricated and he had been paid hundreds of thousands of pounds by lawyers acting for anti-vaccine court cases. The dip in vaccine uptake undoubtedly led to deaths.
However although the risk of harm is very low there are small risks involved. Vaccines like other medical treatments such as antibiotics are not 100% safe, 100% of the time. The risk of most vaccines is comparable with that of crossing roads; for example being seriously affected by measles is about 1/10 of the life time risk of getting struck by lightning [see http://besthealth.bmj.com/x/static/514517/decision-support.html%5D
Reduced uptake of vaccination results in more cases of the disease. If vaccination rates fall below 95% there will be a loss in what is termed ‘herd immunity’. Herd immunity occurs when the vast majority of a population is so resistant to an infection that that infection is undetectable in that population. Those who can’t be vaccinated for medical reasons or those with reduced immunity such as cancer patients are thus protected from the illness. In the USA it is compulsory to show that a child has been vaccinated when it attends school because a non-vaccinated child can be a source of an infectious disease.Donald Trump and other Republican candidates want to change this.
Vaccinations are an emotive subject for many who are anxious not to take any risks with their health of their children. An injection intrinsically seems to cause much more fear than a tablet and as a profession I do not think we explain risks well. Risks are unavoidable in life and the risks from vaccinating are small, certainly smaller than the risk from large numbers not being vaccinated. We need to celebrate the success of vaccinations. They are a vital weapon in our armoury against infectious diseases. A century ago most people died from infectious disease, this thankfully is rare because of antibiotics and vaccinations. As antibiotic resistance grows vaccinations will become even more important
Should we make vaccinations compulsory? They protect a population best when there is herd immunity and the only disease eliminated by vaccination was smallpox which was backed by compulsory vaccination. However patients have autonomy, the right to refuse treatment and refuse treatment for their children. To deny them this would certainly harm the doctor- patient relationship. So, as long as we are not dealing with an illness such as smallpox or SARS I think on balance it is better to leave the law as it is and put more effort into persuasion which is so much harder when we have a popular ignoramus such as Donald Trump.