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Prepare for vaccine questions
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“Why are we hearing so much about problems with vaccines now?”
This question implies that there are new or more problems with vaccines than in the past. Alternatively, there is no increase, but we are hearing about it more. It might be reassuring to both parents and pediatricians to learn that many of these “problems” are not new nor are they always “problems.”
The opposition to smallpox immunization dates back about 300 years. Cotton Mather urged Dr. Zabdiel Boylston to immunize against smallpox. He first vaccinated his own son and some others against this disease in the face of a devastating epidemic and subsequently came under verbal and physical attack. Mather, a clergyman, had learned about smallpox inoculation from an African slave, Onesimus.
The opposition claimed that “for a man to infect a family in the morning with smallpox and to pray to God in the evening against the disease is blasphemy;” that smallpox is “a judgment of God on the sins of the people”’ and that “to avert it is but to provoke him more;” that inoculation is “an encroachment on the prerogatives of Jehovah, whose right it is to wound and smite.” (jameslindlibrary.org)
Sound familiar — as in AIDS as a punishment for gays? The later introduction of vaccination was met with the claim that children vaccinated with cowpox would “develop horns and their human character would undergo transformation” (BMJ. 1963; 1368).
It is well to remember that the medical community discontinued smallpox vaccination when the reactions to this procedure were judged more dangerous than the threat of smallpox. Henry Kempe stood up at a national pediatric meeting and declared he would not vaccinate American children any longer, and the medical community agreed and followed suit. As is true of all vaccines, the benefits are weighed against the risks. At that time, the risks were deemed greater. When the threat of smallpox as a biological weapon emerged, this equation again needed to be reassessed.
Pertussis vaccination
About 25 years ago, there was a reaction globally against the use of whole cell pertussis vaccine (wP). At this time, the number of cases had declined from hundreds of thousands a few decades previously before the vaccine was introduced to a few thousand. It has now increased to more than 20,000. The reaction to the vaccine occurred because the disease no longer was visible but the reactions were. The vaccines, which had been changed little since their introduction 40 years previously, produced severe local reactions and some bad systemic reactions, including convulsions in 1,750 vaccine recipients, usually accompanied by a generous fever. It was not much of a stretch to try to blame permanent neurologic damage, SIDS or infantile spasms on the vaccine, all of which were subsequently disproved.
In the meanwhile, vaccine rates dropped in the United Kingdom, Japan and Sweden. In the latter two, wP was suspended or discontinued. Unfortunately, proof that the vaccine really worked was forthcoming in massive epidemics and deaths in these countries. In the United States, fear was spread by the media and the lay press but the disease did not get out of control as it had in other countries.
The health establishment in the United States was culpable for the pertussis crisis. I did some calling around at the time to find out whether there were other vaccines in the pipeline. Not only was there nothing in the United States, but also animal models were poor and protective correlates were and remain unknown. Understandably, vaccine manufacturers wanted to invest in products that sold for 10 times that of pertussis vaccine.
U.S. manufacturers were reluctant to get into the pertussis market partly because of potential lawsuits. As one of their representatives told me at the time, they make more money from underarm deodorants and do not get sued. The lawsuits pending at the time were for many times the annual sales of wP. The number of manufacturers shrunk from seven to two.
In the meantime, Japanese researchers had been working on acellular pertussis vaccines (aP), which proved to be less reactive and thus more acceptable. Since there were not protective correlates, massive field trials taking years to complete, comparing various acellular vaccines with wP in some cases, were undertaken in Europe. Out of this came some aP, which were eventually licensed in the United States.
One of the outgrowths of this crisis was the “National Childhood Vaccine Injury Act.” Although most of us associate this with a prompt and fair compensation of victims of vaccines, the other virtues are often forgotten. We have committees to oversee the conditions for compensation and to monitor the state of vaccine development. We also have in place the Vaccine Associated Events Reaction System (VAERS) and other mechanisms to monitor vaccine safety post marketing.
The recent flap over autism and over mercury in vaccines is one of a number of “crises” we have been through over the centuries, and it is not likely to be the last. Lawyers, who are more creative than vaccinologists, claimed that suits about mercury were not covered by the Act, as it was not a component of vaccines. Certain vaccines that have been linked with autism have recently been “exonerated” by recent decisions of the special masters who administer the vaccine compensation program. It is unlikely to be the last challenge or the last vaccine “crisis.”
In looking back, we can say that humility is in order. We must listen to parents and be prepared to answer their concerns about the vaccines their children are to receive. Vaccinology is an evolving field that requires constant monitoring of the vaccines in use, the diseases they are intended to prevent and the search for new and improved vaccines.