There was a time in secondary school when I, as a 16 year old female, was due to receive the first dose of the Human Papilloma Virus (HPV) vaccine that protects against the most common forms of HPV causing cervical cancer. We were presumably kitted out with information and sent home to our parents with consent forms, though I can’t remember that detail.
What I can recall as a striking memory surrounding that time is a YouTube video that was in circulation among the girls in my school. It was a short chronicle of a girl in America, an ex-cheerleader, who as a consequence of receiving the HPV vaccine could no longer walk forwards, but who could walk, run and skip in a coordinated fashion backwards. When this young girl attempted to walk forwards, her knees bent towards the ground and her arms flew out, her body jarred frenziedly. To encouragement from a disembodied voice in the video, the girl staggered forwards, out of control, exhibiting a wild and unimaginable disability in a girl who was described as once athletic, popular, and everything else you want to be as a 16 year old girl.
This was my first experience of the unbelievably fantastic and outlandish examples of scaremongering that surrounds vaccine and immunisation programs. Immunisation is one of the most effective and economic public health measures to improve the health of both children and adults. It is an enterprise that aims to bolster immunity in children, who are particularly susceptible to disabling and life-threatening infections as their rudimentary immune system matures.
The most notable success of immunisation to date has been the worldwide eradication of smallpox, achieved in 1979. Many other diseases are on the path towards eradication with carefully implemented immunisation programs. To the detriment of public health, a recent media storm surrounding incidences of polio in the Ukraine and Mali looks set to halt this progress for some time to come. Poliovirus infection is a childhood disease that is covered by the 6-in-1 vaccine that children in Ireland receive at 2, 4, and 6 months. The “6” of the 6-in-1 refers to the infectious entities that the vaccine covers: diphtheria, tetanus, pertussis, polio, HiB, and hepatitis B. Polio is a highly infectious viral infection of the nervous system incorporating the nerves that exert control over muscles.
The disease process of the poliovirus leads to irreversible paralysis in around 1% of those who are infected. Death follows due to paralysis of the respiratory muscles, those muscles that control the movement of your chest to allow air into the lungs. There is no cure for polio.
Primary prevention of polio came about in 1960 with the invention of vaccine to protect against polio virus. As a once fearful entity with only devastation awaiting those infected, leaving hundreds of thousands of people paralysed around the world each year, the vaccine offered a welcome relief. In fact, polio is very close to worldwide eradication as a direct consequence of vaccine programs that protect against its infection and manifestation as a devastating disease. In 2014, India was declared free from polio; more recently, Nigeria boasts a huge success story for the polio vaccine, with the country nearing eradication of poliovirus infection in a nation that was once a known hotspot for the disease.
Out of sight is not to think out of mind or mindfulness for poliovirus. The vaccine, only in existence for just over 50 years, has only offered protection since then, and can still awaken fear in those who recall its more prevalent days. Even this year, on July 24th, new outbreaks of polio in the Ukraine left two children aged ten months and four years paralysed. Even more worrying for the image of immunisation regimes in the media is the mechanism by which the virus was contracted; vaccine-derived poliovirus (VDPV).
VDPV is a rare condition arising when a virus used in the live vaccine regains its virulence from its weakened form. This is a risk of the weakened virus contained in the vaccine reactivating in areas when vaccination rates are low, allowing it to circulate among the population and accumulate genetic mutations making it stronger and able to cause disease. The World Health Organisation (WHO) has explicitly stated that these incidences of polio in the Ukraine occurred because immunisation rates in the country were extremely low: currently, the rate of vaccination against polio among children less than one year old is only 14.1%. Only half of children in the country are fully immunised. Conflict between the Ukraine and Russia has been cited by the WHO as one possible reason for poor vaccine uptake causing a strain on the health systems and their ability to provide vaccines to children. A second influence on the low immunisation rates is said to result from public distrust towards vaccines.
On 2nd September, the reputable Washington Post, perhaps irresponsibly, published an article titled: “Outbreak of rare, mutated poliovirus that originated from vaccine in Ukraine leaves two children paralyzed.” In essence this is true to fact, in that the vaccine administered in a very specific environment was able to reactivate and cause disease. In misquoting this article by saying that administration of the vaccine was the causes of the disease, opposition to immunisation regimes appear to have struck quite an expansive well of ready material with which to feed into people’s doubts and concerns and to augment public distrust.
As we can see from above, public distrust towards vaccines is not a desirable outcome from this particular heap. People need to be informed and informed well in order to be able to make decisions that will ensure the safety, health, and wellbeing of children. Regrettably, it is in misinformation that sceptics about vaccinations abound. Precisely what the image of immunisations doesn’t need is a self-propagating spiral into which it will fall, taking a tumble alongside the numbers of vaccine uptake. Public distrust, perhaps fuelled by fear caused by knowledge of the disease process, is an issue to address. It is entirely reasonable to be fearful of the diseases covered by vaccines. They are more than real entities that can cause catastrophic disease and disability. They are real and happening processes, and all can be fatal. But what we must note is that all are almost entirely preventable with immunisation. It is safety and protection that represent the only end-goals of vaccinations.