Vaccination is a subject near and dear to me.
As a molecular microbiologist I have spent the past two decades studying virulence and pathogenesis, the specific mechanisms responsible for the debilitating effects microorganisms like bacteria have on the human body. I continue this work in my laboratory on the University of Dallas campus with the help of several students.
In addition to my research efforts to create new and novel therapeutics against disease, I am the father of a 3-year-old son with T-cell acute lymphoblastic leukemia. He is currently in remission, but two years past his original cancer diagnosis, he is still immunocompromised.
Data collected by the World Health Organization (WHO) shows that infectious diseases represent three of the top 10 causes of deaths worldwide. If we focus on low-income countries, infectious diseases represent five of the top 10 causes of deaths, including the top three causes (1:lower respiratory infection, 2: HIV/AIDS, 3: diarrheal diseases, 7:malaria, 9: tuberculosis).
Of the top 10 lethal infectious diseases of children, there are vaccines available for eight. These eight diseases cause over 1.5 million deaths of children under the age of five worldwide each year. These deaths could be prevented if the rest of the world had access to the vaccines readily available to every child in the United States.
In the U.S., we have become complacent about infectious disease due to the overwhelming success of our vaccination programs. While vaccination rates for childhood diseases as a whole in the U.S. are above 90 percent, coverage for the flu vaccine remains low.
To be clear, influenza is a deadly disease. In the state of Texas there were 8,041 deaths due to influenza and pneumonia during the 2014-2015 flu season. Of these deaths, 41 were children under the age of four (73 percent vaccine coverage) and 6,156 were adults over the age of 65 (63 percent vaccine coverage).
Unlike other vaccines that come as a single dose or a limited number of boosters shots over the course of several years, it is recommended that you receive the flu vaccine each year. The genetic makeup of the influenza virus, a negative-sense single-stranded RNA virus with eight segments, means it has a predilection for mutation. There is no way of knowing if the antibodies generated by the previous year’s vaccine will provide protection against the new and mutated strains that emerge in succeeding years.
Because of this, the Centers for Disease Control and Prevention (CDC) and the WHO work to develop a new formulation of the flu vaccine each year. In the 2009-2010 flu season, when the predominant strain was not included in that year’s vaccine, influenza strain A/California/7/2009 (Also known as H1N1pdm09 or swine flu) caused 89 million infections and 18,300 deaths.
The modern anti-vaccine movement began in 1998 when a falsified research study driven by profit motive raised unfounded concerns about the MMR vaccine. It is now widely recognized as the greatest medical hoax of all time.
In 2016 there are still many misconceptions and false information about vaccines.
The charge that vaccines are grown in “fetal stem cells” is inaccurate, but does merit careful examination. The WI-38 and MCR-5 cell lines are embryonic stem cell lines both derived from the lungs of aborted fetuses in 1962 and 1968, respectively. The current cells for these lines are descended from those original cells and are not used for most vaccines.
Of the vaccines that do use the cell lines, there are FDA-approved alternative vaccines available in the U.S., with the exception of MMR-V vaccines like ProQuad, which protects against measles, mumps, rubella, chickenpox and shingles, the adenovirus vaccine, and the various vaccines that protect against hepatitis A.
The Pontifical Academy for Life, an academic institution under the direction of the Holy See dedicated to promoting the Catholic Church’s consistent life ethic, explored this challenging moral issue in 2005. Their review, “Moral Reflections On Vaccines Prepared From Cells Derived From Aborted Human Fetuses,” concludes that there is a moral obligation to use alternative vaccines when available and to pressure researchers and pharmaceutical companies to use different cell lines, but prioritizes health.
“[We are] morally justified as an extrema ratio due to the necessity to provide for the good of one’s children and of the people who come in contact with the children … To put the health of their children and of the population as a whole at risk … is an unjust alternative choice, which must be eliminated as soon as possible.”
The anti-vaccine movement has resulted in the reemergence of several diseases on the verge of eradication in North America. In 1938, the year the first widely distributed pertussis vaccine was developed, there were 227,319 known cases of pertussis (whooping cough) in the U.S. The following year cases were down 45 percent to 103,188. By 1976, cases dropped to 1,010 cases. Due to false claims against the vaccine, lower vaccination rates resulted in a resurgence of the disease. In 2012 there were 48,277 cases.
Before the development of a vaccine in 1963, estimates of measles cases in the U.S. were as high as 4 million a year. There were fewer than 100 cases in 1998, the year marking the beginning of the current anti-vaccine movement. In 2014 and 2015, there were 667 cases and 189 cases respectively, including 125 cases between Dec. 8, 2014, and Feb. 8, 2015, directly associated with an outbreak at Disneyland in California.
Among the 110 California patients, 45 percent were unvaccinated and 43 percent had unknown or undocumented vaccination status. Twelve of the unvaccinated patients were infants too young to be vaccinated. Among the 37 remaining vaccine-eligible patients, 67 percent were intentionally unvaccinated, and one was on an alternative plan for vaccination. Identification of the particular strain in this outbreak indicates it was caused by someone who visited the Philippines, which was experiencing a large outbreak at the time, before coming to the park.
In 2013 a measles outbreak was linked to a church in Fort Worth after a parishioner returned from a mission trip in Indonesia. Twenty-one churchgoers became ill. Of those, 16 were documented as unvaccinated. In both of these cases, vaccinated individuals also were infected.
Herd immunity occurs when the vaccination of a significant portion of a population (or herd) provides a measure of protection for individuals who have not developed immunity. Herd immunity begins to break down below 90 percent, which is why we continue to see measles outbreaks in anti-vaccine communities.
Measles is not the most lethal infectious disease, but it is the most contagious. For every one person with measles, we expect them to infect 18 others.
Unfortunately, we cannot rely on herd immunity to protect our communities. Infectious agents are living organisms that evolve and adapt. Antigenic and genetic drift is not limited to the flu. Infectious agents can change over time in ways that our immune system may not recognize, even if we were previously vaccinated.
Infected individuals serve as incubators for disease and provide selective pressure to make infectious agents stronger and deadlier. The more unvaccinated individuals in our communities, the more we are all at risk.
There are many legitimate health concerns when it comes to vaccines. The Institute of Medicine of the National Academies of Science conducted a committee review, producing the manuscript “Adverse Effects of Vaccines: Evidence and Causality.”
The panel reviews every peer-reviewed scientific journal article noting an adverse effect of any of the childhood disease vaccines. Most prominent are allergic reactions and mild toxicity, which in most cases means redness and soreness. In extreme cases this can lead to febrile seizure or anaphylactic shock. Risk of febrile seizure, convulsions induced by a fever over 100.4 F, is approximately 0.0003 percent.
While terrifying to witness, febrile seizures do not cause permanent damage, lasting harm or increased susceptibility to developing seizure disorders. In fact, the diseases the vaccines protect against can also cause febrile seizure, and studies have indicated that a child’s overall risk for febrile seizures is lower when vaccinated.
The risk of anaphylactic shock is lower than one in 1 million. Patients with concerns due to specific allergies should speak with their medical provider about alternative vaccines and plan to receive vaccinations under supervision in a medical office.
As a professor I encourage students in my Microbiology, Immunology, and Disease and Society courses to learn more about the immune system, read the manuscripts I mentioned earlier and promote vaccination.
As parent, I think about the health and safety of my own children. There are several members of the UD community who are immunocompromised or, like myself, have immediate family members who are. They include faculty, staff, students, their children, their parents and their siblings.
Anti-vaxxers present a very real danger to all of us. Coming to work or attending class should not mean we have to endanger ourselves or the ones we love.
Please read the following if you would like to learn more:
Pontifical Academy for Life. (2006). Moral Reflections on Vaccines Prepared from Cells Derived from Aborted Human Fetuses. The National Catholic Bioethics Quarterly, 6(3), 541-550.
Stratton, Kathleen R. Adverse Effects of Vaccines: Evidence and Causality. Washington, D.C.: National Academies, 2012. Print.
Deer, B. “How the Case against the MMR Vaccine Was Fixed.” BMJ 342 (2011): C5347.