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Vaxxers and anti-vaxxers

I wrote the bones of this a year ago. But then we knew nothing of Covid-19, and we would not have believed what was about to arrive. Now, with all we have suffered, and with a Covid-19 vaccine arriving, maybe this is much more relevant.

The cow might have saved more lives than any other animal. Probably tens of millions. Through the healthy benefits of milk? Nutritious protein? Keeping grass short to ward away snakes? No, none of the above. It has been through milkmaids.

In 1796 a physician working in Gloucestershire heard it rumoured that milkmaids did not contract smallpox, whereas in other individuals it was rife. His name was Edward Jenner, and he had an inspired thought. Cows contracted cowpox, a mildly eruptive viral disease of their udders caused by the vaccinia virus, part of the genus Orthopoxvirus. The virus is zoonotic, meaning that it is transferable between species, such as from cows to humans. The cowpox virus is closely related to variola, the causative virus of smallpox. Jenner noted that it was true that the milkmaids who had contracted cowpox, resulting in a mild illness, did not subsequently contract smallpox. Dr Jenner needed to test a theory.

At that time smallpox had an overall mortality rate of 30% and was naturally greatly feared by the population. It was therefore with ease that he persuaded a local mother to allow him to inject a small amount of cow serum into her 8 year old son. Not only did he survive this highly irregular onslaught, but he was then found to be resistant to the wave of smallpox sweeping the community. Others underwent the same injection, with identically protective effects. Dr Jenner used the Latin word for cow, vacca, to name his ingenious new technique. Thus ‘vaccination’ was born, and the humble cow was its genesis. Centuries later, vaccinations have saved tens of millions of lives.

The Jenner Institute in Oxford has just developed it’s Covid-19 vaccine with characteristic determination and expertise.

Cowpox is now rare, with one case in the last 15 years on the Welsh – Cheshire border in June 2018. And smallpox is virtually extinct worldwide. But measles remains, and here lies a sorry tale that has relevance to Covid 19.

Measles is a contagious viral disease that can cause viral meningitis, blindness and permanent severe brain damage. A vaccine was introduced to the UK in 1968, but uptake was slow. In 1980, 2.6 million people died of measles throughout the world. According to the WHO, by 2014 global vaccination programs had reduced this number to 114,900 deaths, an amazing achievement.

This means that the measles vaccination prevents over two million deaths a year globally. The World Health Organisation estimates that many more lives could be saved globally if vaccination rates improved. In many poor countries parents queue with their infants for hours for vaccinations. In DRC last year there were 6,000 deaths due to measles, as a result of no national vaccination programme. Yet in the West, uptakes are dropping as confidence in the safety of vaccines falls.

That Western parents have become suspicious of vaccinations is of immense concern. Measles is a serious illness, and complications are more common in children under the age of 5. They include blindness, encephalitis, severe diarrhoea and related dehydration, ear infections and severe respiratory infections such as pneumonia. Severe complications can be fatal. So what lies behind this any-vat trend? Perhaps there are three main issues that have an influence over some parents’ minds.

The first is the persistence of concern that perhaps Andrew Wakefield really did know something, and the medical establishment has carried out a cover up. He was the former doctor who claimed in 1998 to have found a link between measles-mumps-rubella (MMR) vaccination and autism. But let’s look at his work. Wakefield drew the association between the MMR vaccine and autism based on a study involving only 12 children. And many children have autism and nearly all have been given the MMR vaccine. So forming an association between the two based on 12 cases is patently ludicrous. In discrediting the combination MMR vaccine he was suggesting parents should give their children single shots over a longer period of time, and that the load of all three was too much. Incidental to this was that more money would be made from three separate vaccines by certain companies within the vaccine producing industry. Furthermore, and most shockingly, he was paid £435,643 in fees, plus £3,910 in expenses by lawyers trying to prove that the MMR vaccine was unsafe. The payments were part of £3.4m distributed to doctors and scientists who had been recruited to support the change to three separate vaccines. A lawsuit was taken out against MMR manufacturers.

The campaign led by Wakefield, caused immunisation rates to slump immediately from 92% to 78.9%. His theory was subsequently found to have been based on fabricated data, and has been decisively and internationally debunked. The National Autistic Society says: “There is no link between autism and the MMR vaccine. We believe that no further attention or research funding should be unnecessarily directed towards examining a link that has already been comprehensively discredited.” And despite this resulting in Wakefield being struck off the General Medical Register, the fear that he sowed lingers on. So it’s totally understandable that the Health Secretary has refused to rule out the banning of unvaccinated children from schools, as countries such as France, Italy and the US do.

The second, more recent cause of MMR vaccine aversion is the proliferation of immunisation misinformation online. According to a recent study, half of parents of children aged under five in Britain have been exposed to negative messages about vaccines on social media. I searched FaceBook recently, and there is actually very little ‘anti-vaxxer’ material on public display, as it is mostly in private groups. This is probably because the majority of parents are positive about MMR, and would be critical of any parents they know who openly declare to be anti-vaxxers. But in Europe the number of measles cases rose to 82,000 in 2018, 15 times higher than in 2016. More than 70 people died of measles across Europe in 2018. In the UK we saw a rise from 91 cases in 2015 to almost a thousand in 2018.The number of children receiving the five-in-one jab, which protects against whooping cough and other illnesses, has reached a ten-year low among one-year-olds. And the number of children under two who were given the MMR vaccine, for measles, mumps and rubella, dropped from 91.2 per cent in 2017-18 to 90.3 per cent in 2018-19. The World Health Organisation (WHO) target for population immunity is 95 per cent.

The third reason is simply that many parents do not understand how potentially dangerous these illnesses are. Mumps in an adult male, for example, can result in infertility. And influenza is dangerous. There were over 50,000 excess winter deaths in England and Wales in the 2018-19 winter, the highest recorded since 1975/76, according to data released by the Office of National Statistics (ONS). The increase is thought to be a result of the prevalence of flu that season, alongside ineffectiveness of the flu vaccine and colder than usual temperatures, according to the ONS. They estimate 20,000 were directly due to influenza. While relatively rare, some children die from flu each year. Since 2004-2005, flu-related deaths in children reported to CDC during regular flu seasons have ranged from 37 to 188 deaths per annum.

And now Covid-19 has hit us so badly, with it’s own vaccination programme just around the corner. How will people respond? Initial surveys have shown a troubling percentage of people unwilling to have the vaccine. A survey by University College London of 70,000 people in late September 2020, found that only half (49%) considered themselves “very likely” to get vaccinated once there is a Covid vaccine and 10% said they were “very unlikely”. There were considerable anxieties about the side-effects of the vaccines we already have. More than half (53%) believed to varying degrees that vaccines can cause unforeseen effects. Nearly a third (30%) believed there could be future problems for adults or children that were as yet unknown. More than a third (38%) thought natural immunity – from having the infection and recovering – was better than immunity from vaccines. A small minority (4%) said they did not believe vaccines offered protection.

The reality is that any side effects are found in the very large scale Phase 3 trials, and that, once vaccinated without a significant side effect, long term side effects do not occur.

What can we conclude is to be done? Maybe the purging of FaceBook? Sadly their responsiveness to date, though better than it has been, is not inspiring. Maybe some solid public education might help, such as vaccine-supporting broadcasts on TV. Certainly we need greater health visitor and practice nurse contact with worried parents. There is evidence that poor access to advice is a factor in poor vaccine uptake. But eventually, if all else fails, we may need to move toward mandatory vaccination: no vaccination certification means no schooling or flying, for instance. Has it worked elsewhere? It is probably too early to tell. But let us understand: Covid-19, influenza and measles are all more contagious than Ebola, tuberculosis or flu. They have limited specific treatments and can be picked up from the air or from surfaces for many hours after an infected person has come and gone.

In the same way that people transmit viruses, they can also transit truth. It maybe time for these of us who believe in vaccines to speak out more persuasively and coax the doubters to see reason. Spread the good news!

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