Vaccines, Herd Immunity and “Wholesomeness” Explained

 

I am pro vaccination.

 

This shouldn’t come as a shock to you – at least I don’t think it should.

 

After posting on Instagram recently about childhood vaccination I had several direct messages that bluntly questioned my “wholesomeness.” One person actually wrote “you’re not very wholesome are you?” in response to me discussing the meningococcal B vaccination for children. When I was scrolling through the comments I thought “wow you’re questioning my wholesomeness? That’s a big call.” I was a touch offended to be honest. Do people equate “wholesome” with homeopathic natural remedies? If I prescribe a tablet to manage someone blood pressure (to prevent stroke and heart attacks) or antibiotics to treat their urinary tract infection am I somehow no longer “wholesome”?

 

 

Firstly, I’m a general practitioner who practises evidence based medicine. For those of you who just looked at that sentence and thought “she does what?” I don’t blame you! Essentially I, like most of my colleagues, rely on the evidence to direct our clinical practice – the years of studies that included thousands of people to tell us how we should safely clinically practice to help patients and prevent harm. Despite the wonderfully catchy tune of “Rock a Bye a Bear” – The Wiggles are extremely unlikely to fix your blood pressure so this intervention doesn’t fit into the category of evidence based medicine and thus I will not be prescribing it.

 

Let’s start with some blunt facts. Thanks to immunisation, diseases like diptheria and polio have virtually disappeared in Australia. Rates of meningococcal C have declined since the 1 year old vaccination was introduced on the schedule. Hospitilisations from diseases like rotavirus (which children are vaccinated again on the Australian schedule) and chicken pox are lower; much lower. It’s my job as a GP to counsel patients with the facts and let them make an informed decision.  I have patients questioning vaccination, or flat out refusing, and I try to keep an open mind, hear their concerns and address them. Everyone is entitled to their opinion – I appreciate that.

 

Let’s talk about herd immunity. Lots of people believe that despite being unvaccinated they are protected thanks to “the herd” – they essentially rely on the rest of us who do vaccinate ourselves and our children. The herd was great 20 years ago when it was strong, but with immunisation rates falling the herd immunity is dropping – it’s starting to look like a bunch of limpy meerkats as opposed to the lions you might have been envisioning. Herd immunity works on the notion that if the majority of people are vaccinated than those who are not are still protected because it’s unlikely anyone will get the stated illness and so it’s harder to contract it. If the majority of the herd is vaccinated and someone brings measles or rubella from overseas then the disease can’t spread as easily because the majority are protected. The herd is meant to protect the children who are too young to be vaccinated (children for instance don’t get the measles, mumps, rubella vaccine until 12 months) and those who cannot be vaccinated due to significant allergic reactions or underlying chronic diseases that weaken their immune system. It wasn’t designed to protect large number of people who simply choose not to vaccinate.

 

Quite frankly I don’t like being leaned on– I don’t think it is my child’s job to protect unimmunised children against vaccine preventable diseases (there are some kids who truly can’t be vaccinated due to allergies and I’m not talking about them). The burden is getting heavier and heavier to carry with the immunisation rates falling. More and more people are bringing in vaccine preventable diseases from overseas and its spreads much easier given we have a weak herd with more and more unvaccinated people in it. And that leaves us, the vaccinated ones, at risk too. No vaccine, likely any medical treatment, is 100% effective. If everyone around you has measles, despite being vaccinated you still have a chance of contracting it.

 

There are loads of myths about vaccination. The main one I have to address in my clinic is the myth that the measles, mumps, rubella vaccine (MMR) causes autism. There was a paper published in the Lancet in 1998 that made this claim – however, that paper was later retracted by the journal and an investigation into the research data was found to be fraudulent. Numerous respected bodies like the American Academy of Paediatrics have looked into these claims and there has never been a link between autism and the MMR vaccine found. The other debate is that vaccination is not natural – OK, honestly, I don’t even know what “natural” is anymore. If you drink soft drink or eat a cookie or apply moisturiser or live in a house or drive a car or use a bus or a train then none of that is natural either – they are all man-made things that would not naturally exist. So, what’s the difference? Antibiotics are not natural and yet we know they can cure diseases like tuberculosis, meningitis and whooping cough – so the same people who decline vaccination because it isn’t natural – do they decline treatment for potentially lethal but treatable diseases? Where does the line stand?

 

At Miss S’ childcare they require proof of vaccination under the Victorian Government’s “no jab no pay” policy. Whilst I hear the argument that the Government shouldn’t be able to control everything, I am honestly grateful for this initiative. I don’t want my child exposed to vaccine preventable diseases. I have seen a child hospitilised with whooping cough struggling to take a single breath – I don’t want to that to be Miss S. Will and I see our job as parents to give our daughter every opportunity in life so that she can grow up to be a kind, contributing member of society. We see our job as protecting her from harm as best as we can – yes she might graze her knee when she trips over or get a knock on her head now and then but we certainly won’t put her at risk of meningococcal or other potentially fatal diseases.

 

I know this might generate some hot debate, some eye rolling, some fury. But my medical practice (and modern medicine in general) is based on evidence, on the published medical papers that define how we as a profession practice. We can, and should, all have opinions but we must all be as informed as possible.

 

In short, please don’t question my “wholesomeness” because I am pro vaccination. And I won’t question yours because you use electricity.

 

 

If you would like to know more about some of the myths and facts related to vaccines you can refer to this resource (http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/AD34C3D063510C0CCA257D49001E73D4/$File/full-publication-myths-and-realities-5th-ed-2013.pdf) or speak to your GP.