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Vaccines are still our best protection against infection

With the coming of a new year–and a new administration–there have been unsettling indications that some long-standing public health policies and evidence-based healthcare recommendations may be weakened or abandoned altogether by newly appointed directors of major federal departments overseeing health, medical research, and Medicare/Medicaid.

Regarding well-established preventive care measures–including the routine administration of childhood and adult vaccines–you should be armed with facts before being sold on plans to disrupt and eliminate mandatory immunization requirements for school entry and otherwise disregard the careful scientific vetting of vaccines’ safety and effectiveness.

To help guide your decision-making, seek out our area’s knowledgeable medical professionals. They are your primary care doctors, advanced practice providers, and the specialists to whom they might refer you. Having a relationship with you and knowledge of your current health status allows those providers to make their best recommendations based on scientific evidence and your particular situation. It also allows you to ask relevant questions and to express worries that they can then address in detail.

Some parents and other adults feel that it is better to acquire immunity “naturally” than by way of vaccination, as if somehow “naturally” is safer or more effective. But realize this: in order to acquire immunity “naturally”, it is necessary to actually be infected with a virus, with all the symptoms, long term-effects, and even the potential for death that infection involves. “Natural” immunity occurs when the body’s immune system recognizes certain proteins (“antigens”) on the surfaces of viruses, develops infection-fighting substances called antibodies in response to those antigens (which can take several days), and “remembers” that response so that it can quickly fight the virus in the future. Vaccinations use those ‘same’ antigens ‘without’ the other parts of the viruses that they are usually attached to, so that the body can make the ‘same’ immune response ‘without’ getting infected.

Overwhelming evidence has accumulated over the last several decades demonstrating the effectiveness of vaccination, and the numbers are staggering. Smallpox, with 48,164 cases and 1,528 deaths yearly at the beginning of the last century, has been eradicated worldwide. Polio, a paralytic scourge until the 1950s (16,316 cases and 1,879 deaths each year) has essentially been eliminated in the Western Hemisphere. Before-and-after yearly data for other vaccine-preventable diseases are similar (measles: 503,282 down to 89; mumps: 152,209 to 606; rubella [German measles]: 47,745 to 345; tetanus 1,314 to 34; and diphtheria: 175,885 to 1).

With such dramatic success, many ask if it is still necessary to routinely vaccinate children and adults. While the worldwide elimination of smallpox has meant that ‘this’ vaccination is no longer recommended or given, effective prevention of the ‘other’ once-common infections listed above requires maintaining a high level of immunity in the general population (“herd immunity”). Since those diseases are still around, we need to make sure that the as many people as possible continue to be fully vaccinated to prevent outbreaks from occurring. Since the specific strains of circulating viruses can change every year (such as occurs with influenza and COVID-19), it is usually necessary to receive a new vaccine each year to protect against those diseases; in other cases, such as tetanus, immunity weakens over time, requiring “booster” vaccinations to remain fully protected.

While many are concerned about vaccine risks and side effects, it is clear that the benefits far outweigh the risks for vaccine-preventable diseases. With measles, for example, the side effects of the measles-mumps-rubella (MMR) vaccination introduced in 1971 are infinitesimally small, especially when contrasted with the effects of the disease. When 10,000 children get the MMR vaccine, about 3 fever-related seizures can be expected as can 0-1 cases of abnormal blood clotting, and 0.035 allergic reactions. By comparison, complications from 10,000 children getting measles infections would include 2,000 hospitalizations, 500 cases of pneumonia, 1,000 ear infections (with possible permanent hearing loss), and 10-30 deaths. (Bester, J. “Measles and Measles Vaccination”, ‘JAMA Pediatrics’, 2016).

It is reasonable to ask how we know that vaccines are safe, especially since they are usually given to healthy people. Vaccines do not get approved in the first place until they are shown to be safe and effective in rigorously controlled clinical trials involving tens of thousands of volunteers who are monitored very closely. After a successful candidate vaccine is approved, there are three separate systems that continue monitoring it to determine whether additional, very rare safety issues develop once millions more doses are given to Americans. Data from other countries can help to flag potential safety concerns independently. You may recall that during the height of the COVID-19 pandemic, U.S. safety systems rapidly detected serious blood clots in 6 people (out of 6.8 million doses given) associated with the Johnson & Johnson COVID-19 vaccine. That led to the Johnson & Johnson vaccine being withdrawn from the U.S. market.

Finally, what about autism? Studies of millions of children across the globe have clearly shown that vaccines, particularly MMR vaccines, do not cause autism. A claim to the contrary was made in the 1990s by a researcher who published a fraudulent scientific study to promote his own particular measles vaccine. That study was eventually discredited and retracted — and the researcher lost his medical license — but the false claims persisted and were amplified in the following years, sometimes by worried parents and at other times, to advance certain personal or political agendas. Extensive research and expert opinion have shown that autism is a mostly inherited disorder caused by unusual patterns of prenatal brain development (Courchesne, E. “Prenatal Origins of ASD”, ‘Trends in Neurosciences’, 2020), which occur long before the affected children receive any vaccinations. Studies that have carefully compared rates of autism across generations using standardized diagnostic criteria have also shown that rates of this disorder have remained stable across time, casting doubt about whether environmental factors or vaccine exposures are involved.

We applaud your efforts to keep your children and yourselves safe and healthy, and we encourage you to keep taking questions about preventive care to your trusted family doctors, pediatricians, and other healthcare providers who specialize in you (while politicians and the Internet may not).

Timothy M. Heilmann, MD, MHA, FAAFP, is a family physician and medical educator who served as past president of the Lycoming County Medical Society as well as of the Pennsylvania Academy of Family Physicians. He is a certified leader in clinical informatics. Barbara E. Hemmendinger, MSS, a member of the Lycoming County Health Improvement Coalition and a retired behavioral medicine educator, belongs to Let’s End COVID! a group of concerned people in northcentral PA who worked to overcome the COVID-19 pandemic through education, outreach, and mitigation.

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