Why Are More Children Not Being Vaccinated?
07 May 2019
According to UNICEF, Edward Jenner demonstrated the value of immunization against smallpox in 1798. Nearly 200 years later, in 1979, smallpox was eradicated from the world through the widespread and targeted use of the vaccine.
Ever since, many more kinds of vaccines have been administered to children all around the world, which clearly shows its effective use in eradicating many deadly diseases. Many years of research have also demonstrated the safety of these vaccines. Yet, we see an alarming increase in the so-called anti-vaccination movements among young, albeit educated parents.
Malaysia’s National Immunisation Programme (NIP), introduced in the mid 50’s, provides the majority of our children with a herd’s immunity advantage. This concept occurs when a significant portion of a population provides a measure of protection for individuals who have not developed immunity. Fortunately, our uptake of vaccinations is still considered one of the best in Southeast Asia region. However, we as paediatricians would like to see more optional vaccines such as pneumococcal, rotavirus and chicken pox vaccines being included into the national immunisation program (NIP), just as in many developed countries.
That being said, there are increasingly more reported news about groups of parents who are actively campaigning through social media by posting up unsupported evidences that the immunisation programme is a "new world" conspiracy between the vaccine company and health care providers. I need to stress the point here that we as healthcare providers have no profit sharing at all with any vaccine company and our main concern as paediatricians both in government and private hospitals is to prevent infections and hopefully eradicated them through vaccination.It is even more frightening when a very popular public figure publicly announces herself as a proponent of not vaccinating her children, as she strongly believes vaccinations made her son autistic.
Let’s look at where and how these anti vaccination ideas and theories stem came from. The two most recent controversies revolve around a particular ingredient used in vaccines and the MMR-autism linkage. In 1999, a mercury-based preservative, thiomersal, was phased out of vaccines. This has sparked confusion and controversy that thiomersal contributes to autism. However, autism incidence rates continue to increase steadily even after thiomersal was removed from childhood vaccines, hence refuting this alleged linkage. A more serious claim surfaced in the UK in 1998 when a prestigious and well-known medical journal, The Lancet, published a paper by Andrew Wakefield reporting that there is a link between the MMR (measles, mumps, and rubella) vaccine with autism.
Not long after, several health agencies have all concluded that there is no evidence of an association between the two. It was later found out that Wakefield had received funding from litigants against vaccine manufacturers. It was also reported that his research methodology was questionable as patient data was manipulated in order to create the appearance of a link with autism. This conflict of interest plus the fraudulent research have resulted in the withdrawal of Wakefield’s paper from The Lancet and revocation of his medical license. Surprisingly, even with such a public retract on his study, many parents still hold on to their misguided beliefs. But a more serious effect that resulted from this unethical claim was the decline in vaccination rates, and in turn putting hundreds of children at risk. Vaccination rates in the UK plummeted to 80% in the years following the study, and the measles, which vanquished in the UK in the 1990’s, came roaring back to endemic levels within a decade. With that, came the world wide effect where parents of the 21st century start developing misperceptions and misinterpretations towards the true value of immunisation. It is not uncommon to encounter parents with predetermined mindsets on their objection in vaccinating their child.
As a paediatrician, I occasionally encounter parents who strongly object in vaccinating their children. No amount of explaining or advising seems to be able to make the strong advocates to budge. While it is important for us to respect the personal choice of these parents, the medical community hopes that these parents know that it is not ethical to advocate their dangerous claims to other parents who are open to or indecisive about vaccination. By rejecting the national baby immunization programme, these parents are endangering not only their children but can inadvertently cause an epidemic.
Active immunisation works by stimulating our own body’s immune system with vaccine, which is made up of weak virus or bacteria so that when the real infection happens, the person’s immune system will recognise it and immediately produce the antibodies needed to fight it. Passive immunity is provided when a person is given specific antibodies to a certain disease rather than producing them through his or her own immune system. This type of immunisation is usually given to immuno-compromised patients such as premature babies, children and adults infected with HIV or patients who are undergoing chemotherapy.
Why are anti-vaccination groups seen propagating myths about vaccination, and at the same time fanning fear among otherwise reasonable parents? Many still hold onto the mistaken belief that autism is caused by receiving childhood vaccines. Parents should get themselves informed by conducting thorough research from credible sources before coming to a conclusion on whether to immunise their children. Autism cases - the main issue in vaccine controversy – are on the rise due to probably more parental awareness and doctors are getting better and faster at diagnosing the characteristics of autistic spectrum disorder.
It is very easy to link vaccinations to autism because vaccinations are given around the same time that a child starts developing behavioural milestones. However, this disorder is a variant or spectrum of behavior that happens in mankind where the cause is still unknown; but one definite fact about autism is that it can never be acquired either from eating a certain diet, environmental pollution or vaccination. Medical and scientific evidence surrounding vaccinations demonstrate that the overwhelming life-saving benefits of vaccination far outweigh the rare adverse effects of vaccination. Ingredients used in vaccine preparations are safe even though some may cause minor side effects, such as low grade fever, transient pain/soreness and swelling at the injection site. These common side effects are usually tolerable and manageable. Severe allergic reactions are extremely rare and usually happen within few hours after vaccination. If a child becomes sick-looking, refuse to feed, or is less active following vaccination, parents should then bring the child back to the hospital or clinic immediately.
Vaccines are continually monitored for safety, and like any medication, go through all phases of clinical trials to test for side effects and efficacy before being finally used by public. Vaccines, just like any medication, too can cause side effects. However, a decision not to immunise a child involves risk and could put a child and others who come into contact with him or her at risk of contracting a potentially deadly disease. It is therefore important to differentiate between unfounded concerns and evidence based facts. I personally hope that parents will consult their local paediatricians or general practitioners about the importance of vaccinating their children before deciding to take a risky decision of not vaccinating them which may predispose them to potentially serious infection that may lead to life threatening diseases, severe long term complications or even death. As the old saying, prevention is certainly better than cure. So be wise and responsible parents that make the right decision
for your children's sake.
