The debate over mandatory vaccination has raised controversies in the country. Vaccines have become renown in the past few years but it is evident that their history is longer. Vaccination has reshaped the Medicine landscape since 1978 when they were first scientifically acknowledged. Their impacts range from polio eradication in the United States in 1979, to worldwide suppression of small pox in 1980, and to the prevention of both cervical and liver cancer (World Health Organization (WHO), 2011). The influence of vaccine is so great that some scientists consider vaccination the utmost success in World Health. However, some individuals do not support these optimistic views of vaccination. Anti-vaccinationists movement, or famously known as “anti-vaxxers” including religious leaders, parents and politicians oppose childhood vaccination. The movement claims that the vaccines are ineffective, dangerous and unnecessary (WHO, 2011).We might criticize their argument but research shows that vaccination is associated with risks such as anaphylaxis, brain inflammation, death, or even chronic arthritis. However, the anti-vaccinationists seem uninformed or rather ignorant about the benefits of vaccination. Only a very small percentage of individual experience the adverse effects or reactions due to immunization. According to Centers for Disease Control and Prevention (CDC) statistics, over 320 million illness cases and approximately 730000 deaths are prevented by vaccines (2014). The World Health organization has outlined various benefits of vaccination including eradication and elimination of certain diseases, prevention of other diseases as well as societal benefits (WHO, 2011). It is certainly unreasonable for the public to pay attention to issues regarding safety of vaccination rather than the effectiveness. Considering all the prevention and elimination benefits, children should be vaccinated.
The best way to address this controversy is by analyzing the possible benefits of vaccination. Vaccine administration has benefits such as elimination and eradication of certain diseases. Eradication means that the disease is completely exterminated. Unless there exists an environmental reservoir, eradicated pathogen would hardly re-emerge except when humans vindictively or accidentally re-introduce them, allowing discontinuation of all other preventive measures (WHO, 2011). Eradication is the most ideal objective of vaccination programs but so far only Smallpox has been completely exterminated which allows global discontinuation of smallpox vaccination. Provided distinctive diagnostic tests and effective vaccines are available, infectious diseases without an extra human reservoir can be completely eliminated. Eradication necessitates population immunity in all regions of the world for a long period which is accompanied by suitable observation in place (WHO, 2011). Polio is the next targeted disease for eradication and this is still a global problem. Type 2 poliovirus has been globally eliminated by administration of OPV to children below age six but the spread of types 1 and 3 poliovirus is still a challenge in some countries. Some of these diseases can however be eliminated.
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Diseases can be locally eliminated without necessarily eradicating the causative microorganisms. Substantial progress has been made in elimination of measles in four WHO regions; indigenous transmission of the virus is significantly reduced and importation doesn’t lead to a significant spread the virus. Ninety five percent population immunity acquired through two-dose schedule, is required in order to meet the elimination objective. Increasing the levels of measles vaccination in Africa could be crucial for its eradication. In Finland elimination of measles and rubella have been accomplished which is proof that the same can be globally achieved. Elimination of type b Haemophilus influenzae is possible through well implemented programmes. Elimination of diseases that lack animal or environmental reservoirs is a realistic objective if only human vaccination is highly maintained.
Vaccination reduces the morbidity and mortality rates for both the individual and the society. If the efficacious vaccines are administered prior to exposure, the individuals are protected. Over 732,000 deaths of children born between 1994 and 2003 were prevented (CDC, 2014). A 90% vaccine effectiveness against Hib was observed in European, African, Native American and Chilean children in clinical studies. Several vaccines such as hepatitis A, Rabies Varicella could be used to protect when administered after the individual is exposed. Approximately six million deaths are prevented worldwide. It is estimated that disease incidence in the USA has decreased by 99% (WHO, 2011) which is accompanied by a significant decrease in the mortality rates. Reduced morbidity and mortality rates were observed for rotavirus in Latin America and for pneumonia in sub-Saharan Africa. Specific vaccines were used to take care individuals with the extreme need of being protected from various infectious diseases; they include the immunocompromised, pregnant women and cancer patients. In every society life is highly valued and any effort to protect life should be highly appreciated and so is vaccination.
Vaccination reduces the severity of the disease and chances of infection. Diseases may sometimes occur in previously vaccinated persons as a result of vaccine failure or malfunction in which case, the ailment is milder. A study conducted in Germany about pertussis vaccine showed that vaccinated persons developed a milder form of whooping cough compared to the individuals who were not vaccinated. Similar findings were realized in Senegal where individuals vaccinated against Varicella exhibited fewer lesions, little fever and less complication compared to the unvaccinated persons. Additionally, vaccines reduce chances of infection. Hepatitis A vaccine for example, has shown over 90% efficaciousness in protecting individuals against asymptomatic infections and symptomatic diseases. Human papillomavirus (HPV) vaccine shows complete prevention against vaccine-type infections. This kind of protection is known as “sterilizing immunity” which may diminish in the course of time but minimizes infection consequences.
Some individuals show some reactions to vaccines and it is important for the rest of the society to be vaccinated as a way of protecting the unvaccinated. This kind of protection can either be herd protection or source dying. Herd protection occurs when a larger population proportion is immune. In Gambia for example a Hib vaccine exposure of around 70% was adequate to eliminate Hib with such results observed among Navajo populations (Adegbola et al., 2005). Measles outbreak in USA among children diminished faster as the immunity coverage increased. Herd protection is associated with diarrhea related vaccines such as cholera vaccines. The coverage required to reduce spread of a particular disease is dependent on Reproduction number (RO) which refers to the expected transmission per primary case. Diseases such as measles whose RO is high often require a high coverage rate while diseases such as Polio and rubella whose RO is significantly lower require a lower rate of coverage. Some of the diseases could be eliminated without immunity coverage of 100%. Source dying closely relates to herd protection except the fact that in source dying, a specific subgroup recognized as the infection reservoir is vaccinated and this decreases the disease in the entire population. In North Queensland, Australia, high hepatitis A incidences were observed (WHO, 2011). Immunization of toddlers up to six years significantly impacted the elimination of the disease in the entire population. Similar methodologies were applied successfully in other larger groups such as USA and Israel. The huge success of source dying validates the idea of vaccinating special groups like food handlers to reduce cases of Hepatitis A and typhoid.
Related diseases and some types of cancer can be prevented through vaccination. Vaccination protects an individual against diseases that are closely related to the targeted disease. Vaccination against influenza has been discovered to protect children from otitis media in Finland and USA (Manzoli et al., 2007). Measles vaccines protect individuals against complications such as bacterial pneumonia, malnutrition, dysentery, and keratomalacia (WHO, 2011). Hepatitis B (chronic) which is caused by infective agents, might lead to cancer of the liver. Vaccination against causative agents can also prevent cancer. In Taiwan, China, such a case was detected for Hepatocellular Carcinoma (a type of liver cancer among adults). It is also expected that the cervical cancer incidences will be reduced by the administration of HPV vaccines against serotype (16 &18) which are responsible for cervical cancer cases (approximately 70%). Decreases in precancerous lesions have already been proven among vacinees (WHO, 2011).
Other benefits of vaccination include healthcare savings. Immunization programmes need money for infrastructure, adequate staffing and vaccines. However, morbidity and mortality prevention saves a considerable amount in the long run leading to economic growth. Savings of over 10 billion US dollars have been realized through vaccination (WHO, 2011). Saving are further enhanced when more than two antigens are administered in a single dose. Vaccine combinations have an added advantage of coverage, injection safety and better compliance. Indirect savings were highest for common diseases like varicella whose morbidity and mortality rates are lowest (WHO, 2011). Before debating over the vaccination issue, people should put into consideration the money they lose trying to cure diseases they would have prevented.
Other vaccination advantages include increasing life expectancy, reducing of antibiotic resistance. Vaccination reduces the use of antibiotics which may in turn obstruct the prevalence of resistant forms. Pneumococcal vaccine among infants reduced disease caused by strains resistant to penicillin by approximately 57%.Typhoid vaccines prevent spread of antibiotic resistant strains and primary infections. The administration of vaccines against antibiotic resistant pathogens such as Staphylococcus aureus is a better solution to address the resistance threat. Vaccines also increase life expectancy by protecting individuals against diseases. Elderly persons vaccinated against influenza in USA had a 20% less risk of suffering from cerebrovascular and cardiovascular diseases and an approximately 50% less chance of mortality compared to the unvaccinated individuals (Nichol et al., 2003).In Sweden, cardiac failure and in-hospital mortality rates were significantly reduced by administering pneumococcal vaccine. The impact of vaccination is more than just a mere mention of prevention of target diseases.
The Vaccine for Children (VFC) program which was launched in 1993 recorded the highest statistics on the benefits of immunization among children. The VFC program was formed in response to the rebirth of measles of measles with the aim of ensuring eligible children were safe from diseases that can be prevented through vaccination. Health model predicted that between 1994 and 2013, vaccination would prevent approximately 732,000 deaths, 21 million hospitalizations, and 322,000,000 illnesses (Centers for Disease Control and Prevention (CDC), 2014). Vaccination would result to direct net savings of $295 billion and approximately 1.8 trillion society savings (CDC, 2014). Notably, immunization has improved the children’s health in the US. Measles was the most hazardous disease during the VFC era and immunization led to a significant reduction in the illness, deaths and hospitalization cases; in particular 70.748 million illness cases were prevented, 8.87 million hospitalizations, and approximately 57300 deaths (CDC, 2014). Rotavirus vaccine which was implemented in 2007, has prevented 11.968 million illnesses, 327,000 hospitalizations and approximately 100 deaths (CDC, 2014). These are just some statistical facts on the success of immunization since VFC program started and the impact it has brought to the health sector. Immunity coverage has rapidly increased and among older children the coverage is currently above 90%. The ability of VFC program to eliminate financial hindrances that would have affected vaccination has greatly contributed to this achievement. The sustained high coverage has eliminated most vaccine-preventable ailments.
Despite the availability of reliable statistics on the benefits of vaccination, some individuals still rely on the internet posts whose information heavily rely on the personal perception of the anti-vaccine activists . In this era we cannot afford to be ignorant about the impact of the internet toward the decisions made by the public. A study conducted to compare the effect of narratives and statistical information showed that the influence of narratives on risk judgement can override the statistical facts (Betsch et al., 2011). Activists who are against vaccination do not essentially use the facts but rather use their own perception of vaccination risks to influence people’s decisions on whether or not they should vaccinate their children. The only possible way vaccination can be ruled ineffective is only if the activists provide us with evidence that the number of risks due to vaccination is higher than the number of illnesses, hospitalizations and deaths all put together. Vaccines are just like any other drug and some of the effects such as allergy reactions and headaches cannot be used to overrule the benefits of vaccination. Furthermore only a small proportion of individuals actually experience the adverse reactions due to vaccination and often doctors are trained to handle these cases. Interestingly, these individuals can be protected if the other societal members are vaccinated against the disease; herd protection. Some other diseases such as cancer whose cure is yet to be found can be prevented simply by vaccination. Human papillomavirus (HPV) is one such disease that can be vaccinated in order to prevent cervical cancer. Anti-vaccine activists should consider revisiting some of these facts and change their mentality before they feed the public minds with nonfactual claims.
In conclusion, the vaccine “war” is not necessary and activists should consider facts about vaccination rather than mere narratives. Vaccination, benefits both the individual and the society at large. In addition to protecting the individual against the targeted diseases, vaccination also prevents diseases such as cancer. The life expectancy of an individual can also be increased and the mortality rates reduced if vaccination is made compulsory. We cannot assume the fact that some individuals experience adverse reactions and allergies after vaccination but it is evident that such cases could be prevented if a high percentage of the society is immunized. Activists are actually using the wrong approach of protecting individuals against vaccination risks. Instead they should focus on advising the unaffected public to be vaccinated. Children should therefore be required to be vaccinated.
References
Adegbola R, Secka O, Lahai G, Lloyd-Evans N, Njie A, Usen S, et al. Elimination of Haemophilus influenzae type b (Hib) disease from the Gambia after introduction of a Hib conjugate vaccine: a prospective study. Lancet 2005; 366: 144-50
Betsch, C., Ulshöfer, C., Renkewitz, F., & Betsch, T. (2011). The influence of narrative v. statistical information on perceiving vaccination risks. Medical Decision Making , 31 (5), 742-753.
Centres For Disease Control and Prevention (2014). Benefits from Immunization During the Vaccines for Children Program Era — United States, 1994–2013. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a4.htm Accessed July 11 , 2019
Manzoli L, Schioppa F, Boccia A, Villari P. The efficacy of the influenza vaccine for healthy children: a meta-analysis evaluating potential sources of variation in efficacy estimates including study quality. Pediatr Infect Dis J 2007; 26: 97-106.
Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccinations and reductions in hospitalisations for cardiac disease and stroke among the elderly. N Engl J Med 2003; 348: 1322-32
World Health Organization (WHO). (2011). Vaccination greatly reduces disease, disability, death and inequity worldwide. Retrieved from https://www.who.int/bulletin/volumes/86/2/07-040089/en/ Accessed July 11, 2019
