Disease_Prevention__Two_Issues_of_a_Controversy

Diana L Montclair Final Paper Professor Sandra Johnson Independent Learning Strategies November 29, 2011 Disease Prevention: Two Issues of a Controversy With all the drug warnings on television commercials, it should be no surprise that the pharmaceutical companies have made a preventative medicine which might cause lifelong side effects or worse. It also shouldn’t be surprising that the efficacy of it is unknown. This preventative medicine is compulsory for everyone in most advance countries. You have to have it and, probably already have. This is part of a long standing controversy in America and throughout most of the world, vaccines. There are questions about its effectiveness and safety, including the safety of the ingredients. While there are many other issues surrounding the vaccine controversy, this paper aims to focus on the questions of efficacy (do they really work) and safety (do they cause medical problems). Including combination vaccines (DTaP protects against diphtheria, tetanus, and pertussis) (MMR protects against measles, mumps, and rubella) there are 32 recommended doses for the first year of a child’s life with another 4 doses three months later (CDC, 2011). Eight more are recommended by the age of six, including 4 annual flu vaccines, bringing the total to 44 (CDC, 2011). Over the next twelve years it is recommended that boys receive another 5 vaccines and girls another 8 plus 12 flu vaccines (one for each year) for both. A total of 61 vaccines doses are recommended for boys and 64 for girls by the age of 18 (CDC, 2011). To understand why so many vaccines are given and where the issues of safety and efficiency come from, one must first understand what a vaccine is and how they are made. Vaccine: A History In 1796, Edward Jenner discovered a way to prevent smallpox by infecting the patient with cowpox (KVR, 2011). Naturally there were many who praised this new invention and believed it would one day wipe out the dreaded and deadly smallpox epidemics. After some vaccinated individuals either contracted the smallpox disease or died from the vaccination itself, a group of frightened people against vaccine cropped up. They claimed that vaccination was the cause and thus dangerous (Greenberg, 2010). In 1802, a pustule on the arm of a British soldier used to obtain material for the smallpox vaccine turned out to be from an infection rather than a vaccination and ended up killing 68 people who the tainted vaccine was used on (Project Staff, 2010). By 1898, adverse reactions to the vaccine became more visible further escalating the scare in light of new developments which increased the safety of vaccines, allowing the smallpox rates to continue to decline (Project Staff, 2010). In 1919, five children died with dozens more falling ill in Dallas, Texas from a contaminated diphtheria vaccine (Project Staff, 2010). In 1947, smallpox hit New York City which triggered a mass vaccination campaign that vaccinated 80% of the residents. There were only 12 reported cases of smallpox with just 2 deaths (Project Staff, 2010). In 1948, 68 children died from a diphtheria vaccination in Kyoto, Japan. (Project Staff, 2010). Vaccine: A definition Vaccines are made from weakened or killed disease microorganisms. Vaccines are “inactivated toxins; toxoids derived from microorganisms; or immunologically active surface markers extracted or copied from microorganisms” (vaccine, 2009). Vaccine substance likely contains animal or human DNA since some of the viruses and rickettsia are “grown in avian embryos, rabbit brain tissue, or monkey kidney tissue” (vaccine, 2009). Some other ingredients which are used to kill bacteria or as a preservative include formaldehyde, phenol (components of dyes, plastics, disinfectants, antimicrobials, and other drugs, including salicylic acid), aluminum and thimerosal (vaccine, 2009). Vaccines are injected into the body after preparation via intramuscularly, subcutaneously, intra-dermally, orally, or intra-nasally (vaccine, 2009). The Gale Encyclopedia of Children's Health: Infancy through Adolescence 2006 says of vaccines: “Many diseases that once caused widespread illness, disability, and death are now prevented by vaccines in developed countries.” The desired and expected effect is protection from the disease from which the microorganisms were cultivated. Today we have vaccines for Anthrax, Cervical cancer, Diphtheria, Hepatitis A and B, Haemophilus influenzae type b (Hib), Human Papillomavirus (HPV), Influenza (Flu), Japanese encephalitis (JE), Measles, Meningococcal, Monkeypox, Mumps, Pertussis (whooping cough), Pneumococcal (pneumonia) , Polio, Rabies, Rotavirus, Rubella, Shingles, Smallpox, Tetanus, Typhoid , Tuberculosis (TB), Varicella (Chickenpox) and Yellow fever (CDC, 2011). Anti-vaccine groups such as WAVE and ThinkTwice Global Vaccine Institute have raised important questions which initiated a profound look at vaccines. Unfortunately the information can be interpreted in different ways. Vaccines are ineffective An article in 1887 attempts to prove that vaccine does not work by giving alarming numbers of people contracting wild smallpox after being vaccinated (Dunbar and Sloan, 1887). Many diseases that vaccines claim to protect against once had a scary mortality rate or were permanently disabling. Organizations such as the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and Immunization Action Coalition believe that vaccines are effective and necessary for the wellbeing of society. Others, such as World Association for Vaccine Education (WAVE), ThinkTwice Global Vaccine Institute, and National Vaccine Information Center have a completely different view. The largest argument against vaccine efficacy today is that disease mortality rates were already on the decline before their respective vaccine was released. Anti-vaccinationists accuse authorities such as the CDC of manipulating statistical numbers in an effort to convince the public that vaccines are effective in preventing disease. These organizations claim that vaccines are what are responsible for the mortality rate decline of many vaccine preventable diseases. The anti-vaccination groups point out that the information the CDC neglects to give is what years the MR actually began to significantly decline and what years the respective vaccines were released. The vaccines for Diphtheria, Tuberculosis, Pertussis, Influenza, pneumococcal and Measles were released or licensed in 1920, 1921, 1939, 1940’s, 1945 and 1963 respectively (Project Staff, 2010). These diseases experienced a swift decline in their mortality rates for years prior to their respective vaccines being released (Bystrianyk 2010) (Armstrong, Conn & Pinner, 1999) (Bradshaw, Smith, Blanchard, 2008). It is statistics like these that lead many anti-vaccinationists to believe that vaccines have done little or nothing to save us from diseases. So while it is accurate to say that the mortality rates are significantly lower in 2000 than in 1900, I believe that it is inaccurate to attribute the cause of that decrease solely to vaccines. The thinking behind this idea is that if vaccines were solely responsible we would have seen the decline after vaccines were introduced, not before. Anti-vaccinationists explain the decrease of the mortality rates of many diseases from the late 1800’s until their vaccines were released. Many anti-vaccine groups, such as Vaccination Liberation, claim that it was not vaccines but advancements in society which have nearly removed the mortality rate of many diseases that are vaccinated against today (Vaccination Liberation, 2011). The statistics noted above help give the idea that it was other environmental changes that were responsible for the decline. Vaccination Liberation and other anti-vaccination groups suggest that the true cause of decline was increased sanitary conditions, clean water supply, better nutrition and advanced medical treatments. Some of the unsanitary conditions which prevailed until around the last quarter of the 1800’s include manure in the streets, community privies, dirty fogs from burning black coal, household waste and feces dumped into nearby cesspools or rivers if not directly in the streets, garbage piled up in the streets without regular collection, and a lack of clean water supply or drainage (sewage) (Salisbury, Kersten, 2011). Some medical advances include the decline of bloodletting from the 1800’s - 1920’s (Lawrence, 2008) and somewhere around the turn of the century an effective fever reducer (aspirin) became widely available (Andermann, 1996). It was then as well that medical science largely made a connection between disease and personal hygiene. Bathing on a regular basis and brushing of the teeth finally became common practice (Cumo, 2011). These living conditions and medical advances began changing in the latter part of the 1800’s long before vaccines were released barring that for smallpox. Anti-vaccination groups believe these environmental changes could largely explain the decline of diseases and their mortality rates in the early 1900’s. Vaccines are effective Vaccine itself is effective as long as it is done right (Unknown, 1870). Organizations such as the CDC believe that vaccines have rid the public of many diseases and their mortality rates. They feel that if we stopped vaccinating then those diseases would have a full return. Even small reductions in vaccine uptake have seen epidemics. In 2007 there were outbreaks of measles in unvaccinated individuals in Pennsylvania, Michigan, and Texas (Hunt, Lurie, et al., 2008). Another measles outbreak in 2008 in San Diego, California found 12 cases and none were vaccinated (Hassidim, Waters-Montijo, et al., 2008). Another 13 unvaccinated people were infected in an outbreak in 2011 where 8 were hospitalized (MMWR 2011). In 2010, California experienced its worse epidemic of pertussis (whooping cough) in over 50 years which saw over 9,000 cases with 10 casualties (Sydney, 2011). The epidemic finally came to an end only after a mass vaccination campaign ensued. It is outbreaks and epidemics like these that lead many physicians and the CDC to believe that vaccinations are absolutely effective and that if vaccination stopped, diseases would make a complete comeback and deadly epidemics would return. Vaccines are safe While pro-vaccinationists don’t claim that vaccines are 100% safe, nothing is, they do claim that vaccines are safer than the diseases they protect against. Vaccines are tested at great length by highly qualified scientists and researchers. They then go through rigorous testing through the FDA (U.S. Department of Health & Human Services, Food and Drug Administration 2009). By the time a vaccine is licensed and released to the public, it has usually undergone years of research and studies. The Pro-vaccination groups recognize that some may have a severe allergic reaction to a vaccine (as some can have allergies to peanuts) and note that the occurrence of this is rare. Also, since the decline of diseases which are vaccinated against, the life expectancy of an individual has increased by many years (Andre, Booy, Bock, Clemens, Datta, John, et al, 2008). Not only do we enjoy longer lives, but we also enjoy a better quality as well. Life quality increased through the lack of getting sick as often or as severely. Some of the diseases would last up to six weeks or longer and in some cases require hospitalization or worse. All the diseases that are vaccinated against had a mortality rate far greater than any vaccine has been accused of. As a side note, it is interesting that one study I found concludes of childhood diabetes that “regular vaccination has a preventive effect” (Šipetić, Vlajinac, et al., 2003) while another claims that vaccines increase the risk of developing childhood diabetes (Classen, 2009). While it is apparent that more in-depth studies are warranted, those without bias might be difficult to come by. Conspiracy theory There are some anti-vaccinationists who believe that the business of vaccines is actually fraudulent. They tell conspiracy stories that the government and vaccine companies are lying to the people either for financial gain or population control or some other reason. Some anti-vaccinationists, including Robert F. Kennedy Jr., claim that the CDC and Pharmaceutical companies have plotted against the people for money (Kennedy Jr., 2005). Another accusation was against Governor Perry for making a vaccine mandatory for teens in exchange for financial backing from the pharmaceutical company that produces that vaccine (Editorial Desk, 2011). One attorney even stated that “no government agency within the executive or legislative branches can be depended on to protect our children” (Holcomb, 2008). They use such stories to sway people to believe that there is a cover-up and vaccines either don’t really work or are harmful. In my opinion, it doesn’t make sense to cover-up something that causes great debility and deaths in so many people in the country without removing the product. Such a thing would actually cost the government and vaccine companies far more money than they currently make through loss of work and medical care and expenses. Vaccines are dangerous Many anti-vaccinationists believe that vaccines do more harm than good. Some of the great many lifelong disorders that have been blamed on vaccines include infant deaths (Miller and Goldman, 2011) (Aaby, Ibrahim, et al., 2006), asthma (McDonald, Huq, et al., 2008), diabetes (Classen, 2009), rheumatism (Ray, Black, et al.; Vaccine Safety Datalink Team, 2011), and neurological and ASP disorders (Burton, 2002). Many also believe that the current immunization schedule is too dense for an infant and small child to withstand (Blaylock, 2008). The claim is that the immune system becomes “overloaded” with too many viruses and toxins at once and such a young immune system cannot possibly withstand or overcome such a slaughter. I think that at first glance this makes sense, but then we must consider that many thousands of infants who were immunized every year have grown up to be very healthy (CDC). There again, not all infants are born equally, each have a different chemical make-up and some cannot with stand what others can. Anti-vaccination groups claim that another danger is of the vaccines causing that disease which they are supposed to protect against. This idea that they can cause the diseases they protect against began when vaccine was first introduced and vaccinated people were getting sick with smallpox (Dunbar, Sloan, 1887). This notion was again strengthened when it was discovered that the oral polio vaccine (OPV) caused paralysis in a small percentage of children (Yash, 2008). To further escalate this fear, many side-effects of vaccines are the same symptoms of the disease, though to a much milder degree. In addition to this, most people know that a vaccine is the disease itself, either in a weakened form or a dead one. Another fear people have had for many years is that of manufacturing (McCranie, 1873). While there are strict guidelines for making and storing vaccines, we have to factor in human error. In 1955, two of the eight lots of polio vaccine released contained live polio virus, they “forgot” to kill the virus (Tenpenny, 2004). At least 40,000 people developed abortive polio, 164 were paralyzed permanently and 10 died (Tenpenny, 2004). Another scare story comes from recent times where it was reported that vaccines were kept at room temperature for extended periods of time rendering them ineffective (Bradsher, Wang, 2010). Children received this vaccine believing they were protected. Of course people will consume cereal or over the counter medicine without considering that it might have been exposed to something during manufacturing (remember the Tylenol recall'). It is my opinion that this is no different except that vaccines are mandatory. Dangerous additives There is another fear other than mistakes during manufacturing, potential mishandling and the vaccine schedule being so dense. The biggest fear of vaccines is the ingredients. Here is where the voices of the anti-vaccinationists ring loudest. First in print in the Lancet in 1987, Wakefield accuses an additive called thimerosal which comes from a known poison, mercury. What he accuses it of is autism. With autism rates skyrocketing at that time, many feared vaccinating their children. Even after Wakefield’s article was retracted and debunked, many parents remained fearful. While it was possible that he might have been completely wrong, people just didn’t want to take a chance, just in-case. Since then there have been a huge amount of studies done in regards to that ingredient causing neurological disorders in children. It is interesting to note that while there have been many studies of the possible connection of autism and thimerosal, pro-vaccinationists have found no causal relationship (Madsen, Lauritsen, Pedersen, et al., 2003), (Schechter, Grether, 2008), (Heron, Golding; ALSPAC Study Team, 2004) while anti-vaccinationists have (Congressman Burton, 2002) (Newschaffer, Falb, Gurney, 2005). This leads me to believe that all such studies are bias according to the beliefs of those conducting the studies. The anti-vaccinationists claim there are other potentially dangerous ingredients in the vaccines. After thimerosal was seriously reduced or removed from many vaccines, autism rates continued to soar. While thimerosal was gradually being removed, aluminum was being phased in. This and the growing of vaccine viruses in human DNA have begun to receive a lot of attention from the anti-vaccinationists. They now claim that the aluminum and/or the human DNA in the vaccines today are causing neurological disorders. New studies are commencing to find an autism connection to the aluminum or human DNA in vaccines. One study printed in the November 2011 issue of Journal of Inorganic Biochemistry showed a possible correlation between the aluminum adjuvant in vaccines and Autism spectrum disorders (Tomljenovic, 2011). In 2010 a Computational line fitting methods analysis was performed using data from the U.S. Department of Education, the California Department of Developmental Services the Environmental Protection Agency (EPA). This study indicates a great possibility that the human fetal cells containing residual human DNA and cellular debris in the production of vaccines are the cause of the rising Autism epidemic (Deisher, 2010). Conclusion Many people became frightened after some either fell ill or died from vaccine and claimed that it was very dangerous (Greenberg, 2010). Still it became compulsory. Today we have vaccines for 21 different diseases and in the U.S. there are 32 recommended doses of vaccine for a child’s first year (CDC, 2011). While some organizations claim that vaccines are responsible for the decline of disease mortality rates, they couldn’t have been solely responsible for the decrease since the MR’s of many diseases were already on a serious decline long before their vaccine was released (Bystrianyk 2010) (Bradshaw, Smith, Blanchard, 2008). This decrease was more likely caused by other environmental factors such as increased sanitary conditions, clean water, better nutrition and advanced medical treatments (Salisbury, Kersten, 2011) (Lawrence, 2008) (Andermann, 1996) (Cumo, 2011). However we cannot completely discredit vaccines as even a small reduction in its uptake has seen outbreaks and epidemics (Hunt, Lurie, et al., 2008) (Hassidim, Waters-Montijo, et al., 2008) (MMWR 2011) (Sydney, 2011). I believe this shows that while other advancements have more to do with the decline of the mortality rates, vaccines are more likely the reason that these diseases are not seen much today. You could look at it as though vaccines decreased the disease mortality rates, but only in a sense that they decreased the incidence rates. Some of the current vaccine fears are that of the schedule being too dense for an infant (Blaylock, 2008), mistakes in manufacturing and handling (McCranie, 1873) (Bradsher, Wang, 2010) , causing the disease they are supposed to protect against (Dunbar, Sloan, 1887) (Yash, 2008) and the ingredients which have been blamed for many lifelong disorders (Miller and Goldman, 2011) (Aaby, Ibrahim, et al., 2006) (McDonald, Huq, et al., 2008) (Classen, 2009) (Ray, Black, et al.; Vaccine Safety Datalink Team, 2011) (Burton, 2002). To further fuel the fire, some tell tales of conspiracy (Kennedy Jr., 2005) (Editorial Desk, 2011) (Holcomb, 2008). Even the pro-vaccinationists don’t claim 100% safety. They say that although very rare, some may have a severe allergic reaction as one might have to peanuts. They do however claim that the life quality and expectancy of people has increased by many years since the advent of vaccination (Andre, Booy, Bock, Clemens, Datta, John, et al, 2008). This is probably only partially true in the sense that they decreased disease incidence rates. We also have to take into consideration the additional environmental changes such as other advancements in society (Salisbury, Kersten, 2011) (Lawrence, 2008) (Andermann, 1996) (Cumo, 2011). The largest part of the vaccine controversy is that of them possibly causing autism. While it seems reasonable with all the evidence that it is a possibility, other environmental changes must be considered. Changes in the diets in advanced countries for instance, should be looked at as well as the increased exposure to electronics and radiation waves. Prior to my investigations here-in, I was of the mind that vaccines did more harm than good and I didn’t want my grandchildren exposed to any of them. Today I feel that my grandchildren would be better off with some of them providing they are spread out rather than using the current recommended condensed schedule. Although Ben Franklin was a huge advocate of vaccination, he didn't have one of his sons vaccinated for fear that it might cause him harm as this child was not a healthy one. Sometime later, the son contracted the smallpox and died. Franklin was very remorseful that he was reluctant to give his son the vaccine. He wrote: “In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.” (Franklin, 1850) (Emphasized by Montclair, D.) Many parents who choose not to vaccinate make that choice for fear of the potential dangers, as Franklin did. They don’t want to have to regret vaccinating their children due to it possibly causing autism or worse. Like Franklin, unfortunately, some might regret not vaccinating them such as some of the parents of children who have recently died of purtusis (whooping cough). Parents should take heed of Franklin’s experience and advice “… that the regret may be the same either way, and that, therefore, the safer should be chosen” (Franklin, 1850). Questions have to be asked. One should decide what the safer choice for their family is only after a full investigation of the facts and figures from reliable sources. Once a decision has been made, stand your ground and never regret your choice, no matter what happens. Encourage others to get reliable information as well but don’t judge if the safer choice for them is different from yours. References: 1. CDC. (2011). 2011 recommended immunizations for children from birth through 6 years old. Retrieved from Centers for Disease Control and Prevention website: http://www.cdc.gov/vaccines/spec-grps/infants/downloads/parent-ver-sch-0-6yrs.pdf 2. CDC. (2011). 2011 recommended immunizations for children from 7 through 18 years old. Retrieved from Centers for Disease Control and Prevention website: http://www.cdc.gov/vaccines/who/teens/downloads/parent-version-schedule-7-18yrs.pdf 3. Greenberg, H. (13 April, 2010) Vaccines: Medicine for the healthy. Stanford Mini Med School. Stanford's School of Medicine. 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