A hundred years ago, the benefits of getting vaccinated were obvious to almost everyone. We lived in a world where children commonly died of diphtheria, most of us knew someone who was crippled with polio, and measles hit every household at least once.
Today, in Canada, diseases that were once the leading cause of death world wide, cause only 5 percent of deaths . Polio and diphtheria have almost disappeared, and most of the younger generation in North America, have never seen measles before!
This dramatic change has come about through vaccines. All the diseases we immunize against are still around. But we rarely get them because we are protected by our immunization programs.
The vaccine paradox
The very success of our immunization programs has proven to be their Achilles heel: As generations grow up in the absence of vaccine-preventable diseases, there is no longer the same stimulus to seek protection. People who can't remember ever having seen a case of measles in the current generation now focus on the side effects of the vaccines themselves and question the validity of the very programs that seek to protect them. And these skeptics tend to be well-educated and savvy people, who refuse to be dismissed by their doctor's "you should vaccinate, because we say so."
Many (probably most) people who raise concerns about vaccinations are parents. Parents have a low tolerance to risk when it comes to their children: Their child is healthy, why take a chance of causing an unpleasant, even dangerous side effect?
According to a 2001 national survey, 38 percent of parents with children less than 7 years old are not completely sure that immunization is beneficial, 82 percent actively seek the most recent information, and 45 percent go to the Internet for health information. Another survey found that 25 percent of parents are concerned that immunizations may weaken a child's immune system, 23 percent believe that children get more immunizations than necessary, and 19 percent believe that immunizations are not always proven safe before being approved for use.
To combat statistics such as these, Canada's public health providers are working hard to spread the news: Vaccines work, they're safe, and we need them to keep our communities healthy.
"Vaccines are not perfectly safe. They're only extremely safe."
No one in the field of public health takes the safety of vaccines for granted. And acknowledging the risks and helping people to see the risks in perspective is part of the job of our health providers.
Minor side effects from vaccines are common, typically tenderness, swelling, and redness at the site of the injection. Occasionally a mild fever and irritability results.
Serious side effects, such as severe allergic reactions, are extremely rare, and occur in Canada less often than once per million doses of vaccine.
Vaccines and autism
After a child becomes seriously ill, especially from a disease or syndrome with still unknown causes, it is not uncommon for parents to try to link the illness to something that happened in the child's life that might have brought it on. Vaccines, in recent years, have sometimes become the scapegoats in such searches and the putative link between the MMR (measles, mumps, rubella vaccine) and autism is one such example.
The controversy arose after a study was published in Lancet , the well-known British medical journal that hypothesized that the MMR vaccine caused bowel problems, which in turn caused autism. The study (based on a review of 12 case studies of vaccinated autistic children with bowel problems) fueled the fears of many parents. Vaccination rates decreased, measles cases increased. (The editors of Lancet have since disavowed the study after learning that the author had received payment while doing the study by lawyers planning to sue vaccine makers.)
Subsequent studies have failed to unearth a connection between MMR and autism. The one cited the most frequently involved more than 530,000 children and it found that "the risk of autism was similar in vaccinated and unvaccinated children." These studies have led most scientists and doctors to believe that fears about vaccines and autism are unfounded.
In Canada, each new vaccine must first undergo laboratory and field testing and pass a rigorous licensing procedure by the federal government before it is introduced. After the vaccine has been approved, every vaccine lot (batch) is tested for safety and quality and the vaccines are continuously monitored for side effects. Severe reactions are reported to the Vaccine-Associated Adverse Events Surveillance (VAAES) Section in Health Canada.
When vaccine rates drop, vaccine-preventable diseases return
The reduction of vaccine-preventable illnesses has come about directly through immunization programs, which rank up there with clean drinking water as measures that have had the strongest impact on the reduction of human disease - greater even than antibiotics.
Arguments that improvements to sanitation and living conditions are more responsible are countered by examining what happens when immunization programs are cut back: A drop in vaccinations against pertussis in Britain in 1974 was followed by a pertussis epidemic that affected 100,000 people and killed 36 in 1978. Japan, Sweden, and Russia (to name just a few well-off countries that have tried reducing their immunization programs) have all had similar recurrences of once controlled diseases.
Diseases travel without passports
Some people wonder why, if a vaccine-preventable disease is rare in Canada, they or their children need to be vaccinated against it. The answer to that is clear: Travellers sometimes carry diseases from country to country, and if we in Canada are not protected then the disease could once again rear its mcgly head. A recent example of what can happen concerns polio, which had been under control in Canada since polio vaccines were introduced in the fifties. In 1978-79, polio broke out in certain closed communities in western Canada, whose members do not accept routine immunization for religious reasons. Eleven cases of paralytic polio were subsequently reported in British Columbia, Ontario, and Alberta, and 10 in the United States. The virus was found to have been imported from similar closed religious communities in the Netherlands.
How much is too much?
Another concern voiced by parents reluctant to immunize their children relates to a fear that our immune systems are being overloaded by the 16 to 22 or so vaccines that we now receive as children. Researchers have estimated, however, that each of us has the ability to respond to 10,000 vaccines at any one time. And that the vaccines currently included in the national immunization recommendations would use up less than 0.1 percent of our immune system's capacity.
You have a right to say no...
In Canada, immunization is not mandatory because the Canadian Constitution protects our right to say no in this matter. It is, however, legal for schools to exclude unvaccinated children from school during outbreaks of vaccine-preventable diseases. In 3 provinces (Ontario, New Brunswick, and Manitoba) children require proof of immunization for school entrance, although exceptions are permitted on medical and religious grounds and reasons of conscience. Parents must sign documents attesting to this.
But before you say no...
Parents need to discover for themselves that there is much more risk involved in driving their child to the doctor's office to get a vaccination than from a vaccine itself.
Inform yourself properly about vaccines. Be aware that the Internet contains a preponderance of negative views that are unfounded but superficially very persuasive. Look carefully at the data that underlie the arguments. Visit the library and look up the studies for yourself. And, of course, consult your family doctor and pharmacist; they will respect your concerns and try to allay your fears with additional information, if necessary.
For more information :
Canadian Coalition for Immunization Awareness & Promotion
Public Health Agency of Canada