We all know the popular resolutions that folks consider making each year, including that they exercise more, spend less money, and enjoy life more, etc.
Those are all great, but this year, how about adding a few about vaccines!
Why We Need Vaccine Resolutions
Why do we need resolutions about vaccines?
“You hear about people who don’t like to vaccinate their kids in the Western world, which I suppose is a personal choice, but when you’re out there, the result of your children not being vaccinated is that they’ll likely die, or be horribly maimed. So yes, I saw a real desire to have their children protected, and also a real understanding of it – I didn’t seem to come across anybody who went ‘What is it?’ Or ‘What does it do?’ They all seemed to know about it.”
Ewan McGregor on Cold Chain Mission
Not surprisingly, you don’t have to be “out there” to see what can happen if your kids aren’t vaccinated. That’s evident from all of the kids who have died during the recent measles outbreaks in Europe. And the fact that most kids who die with flu in the US aren’t vaccinated.
That’s why we need people to make these resolutions about vaccines.
Nelson Mandela was long imprisoned in South Africa for protesting against apartheid.
After 27 years in prison, he was elected president of the African National Congress (ANC) and eventually became the first elected President of a democratic South Africa.
A lesser known fact is that Nelson Mandela served as Chairman of the Board of Directors for The Vaccine Fund, which provides financial support to the Global Alliance for Vaccines and Immunization (GAVI).
“Giving children a healthy start in life, no matter where they are born or the circumstances of their birth, is the moral obligation of every one of us.
I find it heartbreaking that 3 million people, most of them children, die each year from diseases that we can prevent with simple, inexpensive vaccines. These are children who would have grown up to support their families, their communities, their nations. They would have been productive members of societies that are still developing and need their children to be healthy and strong.
By preventing these deaths, we not only would save children’s lives, but we also would help strengthen communities and contribute to the development of strong and prosperous nations.”
During his time working with the Vaccine Fund, from 2001 to 2004, he worked to get more and more kids vaccinated and protected against vaccine-preventable diseases.
“A world free of unnecessary disease would be a world more able to cope with the realities it cannot change. A world less burdened by preventable disease would be a world of more balance and greater opportunity for all. Because as a society we are only as strong as the sum of our parts, we all suffer loss when 25 percent of our global family is incapacitated, as it is today. We all lose because too many of our children will never have the opportunity to realize their talents, to share their unique gifts, to focus their courage, or to inspire their fellow citizens to shape a better world.”
Before his work at the Vaccine Fund, as President of South Africa, in 1996, Nelson Mandela launched the “Kick Polio Out of Africa” campaign at the Organization of African Unity (OAU) meeting in Yaoundé, Cameroon.
He also committed the OAU to regularly monitoring progress of the campaign, which helped decrease the number of countries with endemic polio in Africa from 34 to just 2 in 6 years!
And it was Nelson Mandela himself that was “hugely influential” in making sure the campaign worked.
“Children are our future, they are our best hope, their suffering our worst fear. Parents the world over will lie awake at night with fears and dreams in equal measure for what lies ahead for them. Our actions can help or hinder their development. With the resources that the world has at hand, it is possible to break the cycles of poverty and disease. Starting with immunization, we can reduce the inequities of our world and tackle today’s major epidemics, like HIV/AIDS, so that the next generation has an equal chance of life and health.
Guardians of health, we urge you to take up this challenge: we call on governments and civil groups, organizations of the United Nations system and nongovernmental organizations, philanthropists and responsible corporate citizens, to recognize immunization as a global public good. Meet your moral and financial commitments to the world’s children and make a greater investment in immunization.”
As we get closer to that goal of eradicating polio, we shouldn’t forget that his hard work helped us get there.
We also shouldn’t forget our “moral and financial commitments to the world’s children.”
Let’s continue his work to get them all vaccinated and protected.
What to Know About Nelson Mandela and His Vaccine Advocacy
Nelson Mandela believed in the importance of education, that children should be able to live free from violence and fear, and that they shouldn’t die from diseases that can be easily preventable with vaccines.
It shouldn’t be surprising that talk of morality comes up around the issue of vaccines from time to time.
“Scientists and clinicians confront moral and ethical choices daily and often observe a religious faith that helps guide their own personal conduct. Indeed, the religious beliefs of countless historical and contemporary researchers and clinicians have been a source of motivation to help relieve human suffering by means of immunization.”
Grabenstein on What the World’s religions teach, applied to vaccines and immune globulins
It is most often because some vaccines do have a “distant historical association with abortion.”
One is morally free to use the vaccine regardless of its historical association with abortion. The reason is that the risk to public health, if one chooses not to vaccinate, outweighs the legitimate concern about the origins of the vaccine. This is especially important for parents, who have a moral obligation to protect the life and health of their children and those around them.
That seems pretty easy to interpret.
They are saying we are both “morally free” to use these vaccines and that we “have a moral obligation” to get vaccinated.
What about those parents who feel like they shouldn’t have to vaccinate their kids, exposing them to the risks of vaccines, simply to “protect the herd?”
“Putting aside arguments about social good, herd immunity, discouraging free loading and preventing harm to others, vaccinating a child for the child’s sake is not just the right thing to do, but also the only thing to do.”
Ogbogu on Vaccines and the Ethics of Parental Choice
They should understand that:
they aren’t vaccinating their kids just to protect levels of herd immunity in the community – they are also providing their own kids with individual levels of immunity and protection, so it is not just about preventing harm to others
vaccines are safe, so the risks of getting vaccinated are very low
by intentionally not vaccinating their own kids, they are free-riding and benefiting from the fact that most of the rest of us do get vaccinated and do vaccinate our kids
“Giving children a healthy start in life, no matter where they are born or the circumstances of their birth, is the moral obligation of every one of us. It is heartbreaking to think that three million children die each year from diseases that we can prevent.”
“The argument relating to public goods can be added to the harm-to-others arguments. Where a public good, such as herd protection, exists we must take care not to damage it. The need to create and maintain such a good provides an additional reason, should one be needed, to argue in favour of a moral obligation for the traveller to be vaccinated in advance for infectious disease.”
Dawson on What are the moral obligations of the traveller in relation to vaccination?
And if there is a moral obligation to get vaccinated, then what does that say about those who push propaganda that scares parents away from vaccinating and protecting their kids?
“The anti-vaccine argument is wrong in both the scientific and moral sense.”
Sarah Kurchak on Here’s How the Anti-Vaccination Movement Hurts Autistic People
Dr. Vytenis Andriukaitis, the EU Health Commissioner, is the latest to call out those in anti-vaccination movements, who he says have the “moral responsibility” for the death of unvaccinated children.
“I would like to draw attention to the fact that all these movements, which use different arguments, do not understand what they are doing. It would be a shame if the families belonging to this movement were to bury their children, as happened this year in the Member States where children have died of measles.
I would like to invite those who are against the vaccines to visit families, to visit the tombs of the children of those families, and to think what they are doing. I would like to invite all these anti-aging movements to visit the European cemeteries of the nineteenth century, of the eighteenth century, beginning of the twentieth century: they will find many tombs of small children, because there were no vaccines.”
Vytenis Andriukaitis, MD (translated from Italian)
This brings to mind another challenge that was made to anti-vaccine activists just over one hundred years ago by Dr. William Osler in his essay Man’s Redemption of Man.
Dr. Osler jokingly proposed a small vaccinated vs unvaccinated study and challenged ten unvaccinated people, including “three anti-vaccination doctors, if they could be found,” to join him in the “next severe epidemic.”
Tragically, Dr. Osler wouldn’t have a hard time finding three anti-vaccination doctors today.
What to Know About the Moral Responsibility of the Anti-Vaccine Movement
Many people believe that we have a moral responsibility to protect ourselves, our families, and those around us from vaccine-preventable diseases by getting vaccinated and it is immoral to push misinformation that scares parents away from vaccinating and protecting their kids.
More on the Moral Responsibility of the Anti-Vaccine Movement
Polio is caused by one of three wild-type polio viruses.
Of course, anti-vaccine folks like to push misinformation about polio being caused by a lot of other things, from poor hygiene and eating too much white bread to having a tonsillectomy or being exposed to pesticides, like DDT.
“Williams describes the many blind alleys and false leads of the early days of polio research, when doctors, scientists, and public health officials were convinced that the disease was transmitted by bedbugs, budgies, cats, and flies, or caused by seafood, cow’s milk, jimson weed, fruit, vegetables, and DDT…”
If the polio virus doesn’t cause polio (germ theory denialism), then you can’t really expect the polio vaccine to prevent polio, now can you?
The DDT-Polio Connection?
There actually is a bit of a connection between polio and DDT, but not the one anti-vax folks think.
No, DDT didn’t cause polio.
“Between the end of World War II and the early 1950s, researchers, municipal officials, and individuals from Georgia to California employed DDT to stop polio by killing flies, a suspected but debated actor in the disease’s transmission.”
Conis on Polio, DDT, and Disease Risk in the United States after World War II
Yes, many towns would routinely spray with DDT after a polio epidemic came to town because they didn’t yet know what did cause polio.
For example, in May 1946, “sections of the city were blanketed” with DDT as they sought to stop the source of a polio epidemic in San Antonio, which they thought might be a “tropical mosquito.”
See the connection now?
Polio first. DDT spraying after.
This idea is especially easy to see when you understand that there were many polio outbreaks and epidemics in the late 19th and early 20th century, well before DDT was discovered to be an effective insecticide in the early 1940s.
And the spraying mostly stopped before the polio outbreaks stopped.
In 1951, although he wasn’t yet sure how the polio virus spread, Dr. Sabin did know it came from “human feces derived from patients and healthy carriers,” and he declared that there was “general agreement that there is no justification for initiating emergency insect control measures in the hope of stopping a poliomyelitis epidemic.”
“It is perhaps an established epidemiological principle that epidemiological probability must be compatible with bacteriologic (or virologic) possibility, particularly when the epidemiological probabilities lend themselves to several alternative explanations.”
Albert B Sabin, MD on Transmission of Poliomyelitis Virus
And even before that, the Editorial Board for the American Journal of Public Health, in 1946, said that “While municipal cleanliness and sanitation are always highly desirable, there is no reason to believe that improved methods of sewage treatment and disposal, more rigid standards for the purification of water supplies, or the dusting of DDT over a city from aeroplanes will have any measurable effect on the incidence of infantile paralysis.”
Also remember the other big reason that we saw DDT spraying in the United States – the elimination of malaria.
“The National Malaria Eradication Program, a cooperative undertaking by state and local health agencies of 13 southeastern states and the CDC, originally proposed by Louis Laval Williams, commenced operations on July 1, 1947. By the end of 1949, over 4,650,000 housespray applications had been made.”
CDC on Elimination of Malaria in the United States (1947 — 1951)
Did the spraying of DDT to eliminate the flies that transmit malaria in the southeastern United States correlate with extra cases of polio?
There were big outbreaks in New York, Indiana, Ohio, and many other parts of the country that didn’t spray DDT to help fight malaria.
“The peak year for use in the United States was 1959 when nearly 80 million pounds were applied. From that high point, usage declined steadily to about 13 million pounds in 1971, most of it applied to cotton.”
EPA on DDT Ban Takes Effect
Did we stop spraying with DDT in the early 1950s because it was banned and is that why we stopped seeing so much polio?
The peak year for DDT use was in 1959. Surprisingly, we don’t see that peak on any anti-vaccine graphs in 1959…
What was the peak year for polio cases? It wasn’t 1959 or 1960, as you would expect if there was a link between DDT and polio.
Although the use of DDT decreased after 1959, it was used until it was “banned” in 1972, and even then, there were exceptions for public health uses.
The polio virus causes polio.
Or at least why did we start seeing so many more cases in the late 18th through the mid 19th century, until it was controlled with our polio vaccines?
“…contrary to the prevailing “disease of development” hypothesis, our analyses demonstrate that polio’s historical expansion was straightforwardly explained by demographic trends rather than improvements in sanitation and hygiene…”
Martinez-Baker et all on Unraveling the Transmission Ecology of Polio
One rather simple and elegant explanation is that we started to get too clean, the “disease of development” hypothesis.
Improved hygiene and sanitation helped delay when kids would get polio. Remember, polio is spread by contaminated food and water through fecal-oral transmission.
So instead of routinely getting it when they were newborn babies or young infants, when they still had some protection from maternal antibodies, they got it later when they had no immunity. So polio essentially changed from an endemic disease, or something that everything got, to an epidemic form.
Dr, Julie Gerberding was the director of the Centers for Disease Control and Prevention from 2002 to 2009, when she was replaced by Tom Frieden.
Julie Gerberding, MD, MPH
A medical doctor with a Masters in Public Health, who had done a fellowship in clinical pharmacology and infectious diseases, she was well trained for the notable issues she faced during her tenure include anthrax bioterrorism, avian flu, SARS, natural disasters, and concerns about autism and vaccines.
One thing in particular that anti-vaccine folks continue to bring up is the mistaken idea that Dr. Gerberding actually said that vaccines cause autism on CNN following the Hannah Polling case.
GUPTA: And one of those 4,900 cases was the case of nine-year-old Hannah Polling, which has been making a lot of news lately. Luckily, we have the director of the Centers for Disease Control and Prevention, Dr. Julie Gerberding here.
We’re talking a lot about autism, as you know. I should remind people that the — my understanding is the federal government conceded that vaccines caused her autism like symptoms. First of all, is there a difference? I mean, does she have autism or autism like symptoms? What’s the difference?
JULIE GERBERDING, DR., CDC DIRECTOR: Well, you know, I don’t have all the facts because I still haven’t been able to review the case files myself. But my understanding is that the child has a — what we think is a rare mitochondrial disorder. And children that have this disease, anything that stresses them creates a situation where their cells just can’t make enough energy to keep their brains functioning normally. Now, we all know that vaccines can occasionally cause fevers in kids.So if a child was immunized, got a fever, had other complications from the vaccines. And if you’re predisposed with the mitochondrial disorder, it can certainly set off some damage. Some of the symptoms can be symptoms that have characteristics of autism.
GUPTA: Yes, I have a two-and-a-half-year-old and a one-year-old as you know. And you know, you know, you think about this all the time. Are we ready to say right now as things stand that childhood vaccines do not cause autism?
GERBERDING: What we can say absolutely for sure is that we don’t really understand the causes of autism. We’ve got a long way to go before we get to the bottom of this. But there have been at least 15 very good scientific studies on the Institute of Medicine who have searched this out. And they have concluded that there really is no association between vaccines and autism.
As many people are aware, Hannah Polling was awarded compensated for a table injury in Vaccine Court. She was not awarded compensated because vaccines caused her to be autistic.
And Dr. Gerberding certainly did not admit or say that vaccines cause autism. You can read that into her statements during the CNN interview if you like, but that isn’t what she said.
She also did not resign “in shame from her post under the Obama regime as director of the CDC in 2009 to return to Merck’s vaccine division.”
As often happens when a new president is elected, President Obama simply brought in a new team to the CDC and many other agencies after he was inaugurated on January 2009.
And while she did become the president of Merck’s vaccine division, it wasn’t a return. She had been at the CDC since 1998 and before that, she directed the Prevention Epicenter at the University of California at San Francisco (UCSF).
Dr. Gerberding is currently the Executive Vice President and Chief Patient Officer, Strategic Communications, Global Public Policy, and Population Health at Merck, where she also has responsibility for the Merck for Mothers program and the Merck Foundation.
What To Know About Julie Gerberding
The first woman to lead the CDC, Dr. Julie Gerberding is an infectious disease expert with a Masters in Public Health who is now the the Executive Vice President at Merck. She never said that vaccines could trigger autism while on CNN or anywhere else.
Licensed in 2006, it has been recommended that all seniors who are at least 60 years old get Zostavax, the shingles vaccine.
When given as a one time dose, it can help reduce your risk of developing shingles by 51% and risk of developing post-herpetic neuralgia (PHN) by 67%. That protection will last about five years.
Since you can get shingles more than once, you can get the shingles vaccine even if you have already had shingles.
Myths About the Shingles
A lot of people don’t understand shingles (herpes zoster).
What is shingles? It is a reactivation of the varicella zoster virus, which also causes chicken pox. Although we don’t know why, it is clear that in some people, instead of staying dormant, the chicken pox virus can reactivate from the dorsal root ganglia of a spinal nerve.
Is shingles contagious? Yes, but other people exposed to shingles won’t actually get shingles, instead, they can get chicken pox (if they are not immune).
Can you catch shingles? No, but you can catch chicken pox (if you are not immune) from someone that has shingles.
Can kids get shingles? Yes, you can get shingles at just about any age, but the risk increases as you get older, which is why the elderly are most at risk.
What does herpes zoster have to do with genital herpes? Nothing. Shingles got the name herpes zoster before it was known that it was caused by the chicken pox virus (varicella zoster).
Can you get shingles if you have never had chicken pox? Yes, if you have had the chicken pox vaccine, although the risk is much less than after a natural chicken pox infection with the wild-type chicken pox virus. In fact, so far, it has been shown that vaccinated children have a moderately decreased risk of getting shingles after being vaccinated with the chicken pox vaccine.
Are we seeing more cases of shingles in adults because kids get the chicken pox vaccine now? No. While an interesting theory, it has been shown over and over and over that the chicken pox vaccine is not creating an epidemic of shingles. Studies have shown that shingles cases were rising before we started giving the chicken pox vaccine and they have been rising in countries that don’t even protect children with the chicken pox vaccine. The two are not connected.
Myths About the Shingles Vaccine
A lot of people also don’t understand the shingles vaccine.
They especially don’t seem to understand that it is same live strain of virus that is in the chicken pox vaccine, only with higher virus titers (it is more potent).
Why is it just for seniors who are at least 60 years old? That’s the age that it works best and since the immunity is not life long and it is given as just one dose, experts felt that would be the best time to get it. You can get it later though. You could even get it earlier, as early as age 50 years. Can you get it even earlier? You might consider getting the vaccine off-label at an earlier age if you have already had one or more severe cases of shingles, but it is only routinely recommended for people who are at least 60 years old.
Can you get the shingles vaccine if you have never had chicken pox? No, you should get the chicken pox vaccine instead. But keep in mind that most adults born in the pre-vaccine era, especially if they were born before 1980, are presumed to have had chicken pox already, even if they don’t remember it. Talk to your doctor if you really don’t think you have though.
“If you see a turtle sitting on top of a fence post, it didn’t get there by accident.”
President Bill Clinton
Does the shingles vaccines cause shingles? No. Since it only reduces your risk of developing shingles by 51% and the duration of protection is about 5 years, there is certainly a chance that you could get shingles even after having the vaccine, but the shingles vaccine doesn’t actually cause shingles.
Is it worth getting vaccinated against shingles? It is if you want to try and avoid getting shingles! And even though the vaccine isn’t perfect, it is safe, and “In general, with increasing age at vaccination, the vaccine retained efficacy against severity of zoster better than against zoster itself.” So even if you do get shingles later on, it should be a milder case.
Why do some folks think that the shingles vaccine can cause shingles? In 2014, the package insert for the shingles vaccine was updated to mention that shingles could be a side effect after getting the vaccine. It was added to the Adverse Events section of the package insert, where “these reactions are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to the vaccine.”
Vaccines are monitored for safety even after they are approved by the FDA, so it is not a surprise that the package insert would be updated like this.
Since they reportedly found the vaccine strain of the virus (VZV-Oka), the implications are pretty clear. But that likely just means that they got the shingles vaccine without having any immunity to chicken pox. After all, if they were immune to chicken pox from a past infection, then they would have had wild-type virus (VZV-WT) in their shingles lesions, not vaccine strain virus. And then, just like someone who got the chicken pox vaccine could still get shingles, these folks got shingles.
“The absence of VZV-Oka in samples from cases of HZ in zoster vaccine recipients indicates either that VZV-Oka rarely, if ever, establishes latency in sensory ganglia already latently infected with VZV-WT, or that if VZV-Oka does establish latent neuronal infections in VZV seropositive vaccine recipients, it rarely, if ever, reactivates to cause HZ. ”
Ruth Harbecke, et al on A Real-Time PCR Assay to Identify and Discriminate Among Wild-Type and Vaccine Strains of Varicella-Zoster Virus and Herpes Simplex Virus in Clinical Specimens, and Comparison With the Clinical Diagnoses
That still wouldn’t mean that the shingles vaccine caused shingles though. Remember, we know that “Among vaccine recipients, the attenuated Oka/Merck strain of VZV included in varicella vaccine also can establish a latent infection and clinically reactivate as zoster.” Again, that means you can get shingles after getting the chicken pox vaccine.
So the shingles vaccine could theoretically have caused a latent infection that reactivated = shingles.
But doesn’t that mean that the shingles vaccine caused them to have shingles. Maybe indirectly, but then it also gave them immunity against chicken pox. It has been shown that the shingles vaccine can safely provide immunity to adults who never had chicken pox before.
It’s not an accident that some people think that the shingles vaccine can cause shingles though and are maybe even afraid to get it. Like most anti-vaccine misinformation, this myth is spread on the Internet, this time with the help of personal injury lawyers.
What To Know About the Shingles Vaccine
The shingles vaccine is a safe way to decrease your risk of developing shingles and post-herpetic neuralgia, and it doesn’t directly cause shingles.