Oct. 26 2015

The Vaccine Conundrum

Conference Asks: Are Immunization Programs Victims of Their Own Successes?

When vaccines work, nothing happens. To some extent vaccines have become victims of their own successes, explained Paul Offit, a pediatrician and infectious disease expert, at a recent symposium on vaccines hosted by the Mailman School Department of Epidemiology.

Unlike 60 years ago when diseases like measles and polio were commonplace and the discovery of vaccines celebrated, Offit said, vaccines today are essentially a “matter of faith.”

This situation has led some parents to skip inoculations for their children, leading to outbreaks. Earlier this year, a case of measles at Disneyland spread across six states and infected 147 people. In the aftermath, Offit said, even some doctors who had been vocal about purported risks of vaccines were now giving more measles vaccines than ever before “because parents were scared of measles.”

Vaccines date back to the 1790s when English physician Edward Jenner successfully immunized people against smallpox by injecting them with pus from a cow infected with a similar disease. As Stephen Morse, professor of Epidemiology, noted, the word “vaccine” derives from the Latin vaccinus, meaning “from cows.”

Smallpox was responsible for an estimated 300-500 million deaths in the 20th Century alone. But, after a vigorous inoculation campaign, the disease was finally eliminated in 1980. As Morse noted, smallpox remains the only infectious disease to be completely eliminated through human intervention. Inoculation programs have also brought rates of rubella, polio, and diphtheria infection down to negligible levels in most countries.

The fight against global infectious disease, however, is not over. Bird flu, Middle East Respiratory Syndrome Coronavirus (MERS) and, most notably, Ebola have emerged or flared up in the last decade or so. Combating these diseases relies on scientific ingenuity to develop vaccines and a society that embraces vaccination. “With microbes, it’s our wits versus their genes,” Morse said.

Fear of vaccines is nearly as old as vaccines themselves. A British political cartoon published in 1802, for example, shows recipients of smallpox inoculation morphing into cows. One hundred year later, the Anti-Vaccination Society of America published flyers and actively recruited followers. Some of the earliest anti-vaxxers were ministers who warned that God sends illness as a punishment for sin and any interference by humans borders on blasphemy: diseases, they maintained, should be allowed to run their course.

The latest iteration of anti-vaccine rhetoric isn’t rooted in fire-and-brimstone, but may be just as difficult to uproot. The 1998 vaccine-autism connection, based on one poorly designed (now retracted) study in The Lancet, is persistent.

“There aren’t two sides to this story,” Offit assured the audience. “Vaccines simply don’t cause autism.”

Media coverage of outspoken celebrities’ opinions on the matter, most notably, a focus on Jenny McCarthy’s misdirected outrage over her son’s health problems, has pushed the anti-vaccine movement into the popular consciousness in recent years, Offit said. Unfortunately, in the interest of balanced journalism, or perhaps higher ratings, the news media has highlighted anecdotes and given science rather short shrift, he said.

“Media’s job is to entertain,” Offit said. “As long as people enjoy ‘vaccines cause autism stories,’ we’ll have them.”

Whether and to what extent vaccines are compulsory is worthy of serious consideration. In the view of Ronald Bayer, professor of Sociomedical Sciences, “a very small number of people should be allowed to forgo vaccines,” including those with weakened immune systems.

Vaccinating children not only protects them, but the kids they interact with at school every day. “The unvaccinated are free-riders, which [also] violates justice,” Bayer said.

Offit, who co-invented the lifesaving RotaTeq vaccine that protects against rotavirus, maintains that vaccines are vastly underappreciated considering how many lives they’ve saved.

“Vaccine inventors were once celebrated with ticker-tape parades,” he lamented. “Now they get hate mail.”

By Kathryn Gerlach,
Assistant Manager for Communications, Epidemiology