"In 2015 pneumococcal conjugate vaccine, as the children’s formulation is called, reached the Bangladeshis, and Saha’s research team is intently tracking its progress. If PCVs prove as effective around the world as vaccine experts hope, they promise both a greatly lowered mortality rate—that’s many thousands of small children staying alive instead of dying before they’re old enough to start school—and much less nonmortal sickness. Less of the rapid pneumonia breathing; less of the fever, the sucking chest, the rattling cough, the blue lips, the bedside watch by parents pulled away from the paid work that supports their other children. Less … suffering, I kept hearing Saha and his Bangladeshi colleagues say, as though sensing that an outsider might need help appreciating the stakes.
"Because from the vantage of a country like the United States, it can be easy to imagine that the most pressing vaccine challenge of 2017 lies in convincing certain communities of skeptical parents that they really ought to inoculate their kids. Those efforts are important, to be sure. But even more urgent—more ambitious, more complex, involving many governments and billions of philanthropic dollars—is the international collaboration to get new vaccines to children in the developing world, where to this day the suffering caused by vaccine-preventable disease is as vivid and nontheoretical as the frantic families Saha sees every day in the halls of Dhaka Shishu."
Source: Here's Why Vaccine are so Crucial, by Cynthia Gorney; National Geographic Magazine, November 2017.
(See: https://www.nationalgeographic.com/magazine/2017/11/vaccine-health-infection-global-children/)
WITH THE SUPPORT OF THE AMERICAN CANCER SOCIETY and Northwell's Oncology service line, a group of Huntington Hospital pediatricians and other child health professionals are collaborating to increase the rate of adolescents immunized with the human papilloma virus (HPV) vaccine known as Gardasil. This is one of two vaccines (the other being hepatitis B vaccine) that were specifically developed to prevent potentially fatal cancers.
As noted in this month's National Geographic, the US is among a relatively small number of countries where the problem of under-immunization is decidedly NOT about access. In fact, the CDC maps that depict immunization rates by state and locale tell a strange and interesting story: financially challenged places like Mississippi significantly outperform downstate New York, Colorado and the San Francisco Bay Area when it comes to immunizing children. For that matter, the vaccination rate in poverty-stricken Belize is far higher than in the US overall.
The reasons are not mysterious. The phenomenon of "vaccine reluctance" has been so well studied that national meetings of our professional societies routinely include symposia on the topic, and research studies on how to combat it increase in number every year.
At its core, vaccine reluctance represents a movement - a backlash - that calls into question both the science of vaccinology and the motives of the many organizations, from the WHO to the CDC, IDSA, AAP, AAPF and many others that seek to educate the general public about the following facts:
1. Vaccine-preventable diseases continue to pose a threat to children and adults.
2. Vaccines are among the safest pharmaceuticals on the market.
3. The list of known, severe vaccine side effects has almost nothing in common with the list of fearsome (but mythical) side effects that are highlighted on dozens of "anti-vax" websites, and instill in thousands of parents...not certainty about the issue, but just enough doubt to cause serious damage to our national program of immunization.
What are the main drivers of this retreat from a preventive strategy that has been called the most important contribution of the 20th century? One is certainly the very success of immunization in making previously dreaded diseases less visible, among them: diphtheria, with its throat pain, fever and suffocating airway obstruction; measles - highly contagious, red eyes, cough, fever and rash, resulting now and again in pneumonia or brain infection; and pneumococcus - agent of plain vanilla middle ear infection, but also of death-dealing sepsis, and bacterial meningitis.
Additionally, human nature is such that giving a health infant something that could make them even a little sick, or that carries even a very, very small risk of more serious harm, seems like a bad idea, even if those harms or risk are outweighed by the risks of NOT immunizing, by a large margin.
Perhaps the most potent influence on our nation's vaccine program is the social/cultural/political trend toward a kind of libertarianism that is distrustful of government, authority figures and mandates. As Senator Rand Paul (a physician) has stated, "I think this is a question of freedom...the government doesn't own your children...parents own their children." To the extent that science itself is seen as just one voice in the marketplace of ideas, it is no more surprising that the guidance of infectious disease experts would be dismissed as would the conclusions of climate scientists. We are, after all, living in an era of "alternative facts."
The Huntington team convened for the first time earlier this month, to define our goals and the way forward. Several studies have tried to determine what interventions lead to higher immunization rates and which do not. It seems that more information doesn't necessarily improve this outcome; at least one published study found the opposite effect, when an informational strategy was applied to a previously vaccine-reluctant group of parents. Neither does a shared decision-making model.
In fact, the most interesting study of the last few years found that the patients of clinicians who took a "presumptive" approach were more likely to be immunized that those who took a more tentative, "collaborative" stance. (The latter group would generally open the conversation with some version of 'how do you feel about immunizing Alice with the HPV vaccine today?' The 'presumptive' clinician, on the other hand, is likely to conclude the visit with 'I'm going to order a lipid panel for Alice, and she's due for her first dose of HPV vaccine today. The nurse will be in with that in a few minutes. What questions do you have?')
I'll keep you posted on our progress.
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| WHO poster depicts disease burden of HPV and the vaccine program that prevents it |
