A Balanced Understanding of Vaccination

Why do we live so long?  If you question the value of vaccines then please read this:

In 1800 the average lifespan was about 30 years old.  By 1900 that number increased to 47 but by the turn of the 21^th century life expectancy increased to a whopping 77.  What were the primary contributors to this increase in longevity?  We may thank the advent of antiseptics, antibiotics, and vaccines.  Modern medicine has not nearly had the impact on human health as these fortuitous discoveries.

Prior to the discovery of antiseptics entire generations were wiped out by plagues that likely, were caused by infectious agents such as influenza, cholera and typhus.  Alexander Fleming’s discovery of Penicillin, and the introduction of the first Small Pox vaccine by Edward Jenner, ultimately vanquished the kiss of death for those impacted by these bacterial and viral infections.  This blog will largely focus on current concerns regarding vaccination.  Efficacy and outcomes of antibiotic use will be addressed in a future blog. 

The first vaccination campaigns were met with broad cooperation.  Young people today may be amused by the depiction of Polio in the movie Forest Gump but make no mistake, a Polio infection is no laughing matter.  Poliomyelitis is a disease caused by infection with the poliovirus that initially presents with minor symptoms such as fever and headache but ultimately, may lead to complete muscle paralysis.  During an outbreak in the early 1950’s iron lungs were used to help the infected breathe.   The discovery of a vaccine that could irradiate this infection was met with global support and as result, Polio is almost completely eradicated.

So what exactly is propelling our fear of vaccines?  It appears that after many decades of reduced bacterial and viral infection our immune systems have let down their guard.  Our killer T cells and natural killer cells simply are not the stealth fighters that they used to be.  Although we are no longer susceptible to infectious disease we are MORE prone to immunological and immune-based diseases such as allergies and asthma, along with inflammatory bowel diseases, rheumatoid arthritis, psoriasis, and even Multiple Sclerosis (MS).  Lately, I have noticed a perceptible uptick in diagnosis of Lupus (aka Lupus erythematosus), an autoimmune disease caused by a hyperactive immune system that attacks normal, healthy tissues.  These diseases tend to be chronic, and not as pronounced as infectious disease, but diagnosis rates are growing at an alarming rate with no abatement in sight.

During the fledgling days of vaccination campaigns our immune systems were primed to respond exactly as predicted to vaccine exposure.  Almost every individual immediately mounted an active immune response that would prevent future infection upon viral exposure.  However, as our immunity has evolved so has our response to vaccines.  This is particularly apparent in infants whose developing immune systems are largely dictated by the health of the Mother.  If Mommy does not pass on a healthy immunity to baby then some infants with undiagnosed immune deficiencies may respond adversely to a vaccination.  The response may be triggered by the vaccine itself or by a non-active ingredient, both of which are perceived as foreign.

This relatively recent observation calls for more research to better understand the biological response to vaccines so that we can conclusively demonstrate cause and effect.  It would be a pity to see even a minor reversal in viral infection rates due to our lack of understanding of Immune Biology.  I fully empathize with parents concerned about adverse events related to vaccination.  These are not trivial yet are not fully understood.

In the meantime, I would like to emphasize the benefits of vaccination for those with a healthy immune system.  The herd immunity theory dictates that the more healthy people that are vaccinated the less likely the unvaccinated people will become infected.   Furthermore, it is important to keep in mind that response to new viral infections will be very different from what we have seen in the past.  Once new infections become increasingly more common, our response to these infections may not mirror what we have seen in the previous century.  So many people, baby-boomers in particular, remember acquiring measles, mumps and chicken pox and thinking-no big deal.  Since viral infections, other than influenza, are a relatively rare occurrence, we have no idea how the current immune system will respond.  If the current response to influenza* is any indication, then a new round of viral infections will not be pleasant.  Keep in mind also, that in the previous century most Moms stayed home and took care of their sick family.  Today, these exposed Moms and Dads will return to work possibly carrying infection to their place of employment.  Managing outbreaks is sure to be a challenge.

So what is the solution to vaccination?  As a healthy adult and parent I fully endorse vaccination of myself and my family.  The very young, the very old and the immunocompromised deserve special consideration while we support research to understand the root cause of adverse outcomes of vaccination.

* The CDC estimates that from the 1976-1977 season to the 2006-2007 flu season, flu-associated deaths in the US ranged from a low of about 3,000 to a high of about 49,000 people.