Public perception of the benefits of vaccines anti vaccination lobby

Transcription

1 Public perception of the benefits of vaccines anti vaccination lobby Vytautas Usonis Vilnius University, Vilnius,Lithuania European Society for Paediatric Infectious diseases (ESPID)

2 What have vaccines achieved? Smallpox eradicated Poliomyelitis nearly eliminated Measles (Americas, Europe)- controlled Other diseases dramatic reductions tetanus diphtheria pertussis (whooping cough) rubella (including CRS) meningitis (Hib, pneumo~, Men-C) liver cancer (due to the hepatitis B)

3 Value of vaccines for the Every year... individual 3 million deaths are prevented 1 750,000 children are saved from disability million years or 100 million Disabilityadjusted life years saved 1 Millions of children are protected from suffering... due to vaccines 1 Ehreth J. Vaccine 2003;21:

4 Value of vaccines for society One of greatest public health achievements in the industrialised world With the exception of clean drinking water, vaccines are the most effective intervention in reducing and preventing the return of infectious diseases 26 diseases are now vaccine preventable

5 Value of the vaccinated society for individual Herd immunity leads to global protection : immunised individuals provide indirect protection to susceptile (unvaccinated and partially vaccinated) members of a population

6 Vaccines works!

7 If vaccines are so good, why antivaccine lobby exists? From RT Chen, CDC

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9 DTP vaccine There are 16 contra-indications DTP often causes complications and many of them - severe In 1982 only 27.8% of kids were given a complete course of DTP Vaccine production is dirty therefore merthiolat is needed Since 1985 merthiolat is prohibited in Europe

10 Lithuanians becomes test rabbits

11 Medicines vs vaccines Problem (eg.headache) Hope for the problem solving, readiness for adverse events Results are visible soon No problem (healthy child) Fear of postvaccinal events Results in protection what is difficult to feel

12 Most common general statements of the antivaccine lobby Infectious diseases are not serious Immunisation is not responsible for the decline in communicable diseases as improved living standards and sanitation have reduced the incidence of infectious diseases Vaccines suppress the immune system Vaccines do not protect against diseases as many cases of disease occur in immunised children

13 Antivaccine actvists:... The vaccines do not protect against diseases as many cases of disease occur in immunised children... Is it really true?

14 The effect of measles immunisation on an outbreak of measles in a hypothetical school of 2,000 students Infection Poland G.A. Arch.Int.Med. 1994;154(16):

15 Scientific paper. Summary Methods: Vaccination history of 195 children with measles has been investigated. Results: Measles vaccine was given to 95 (49%) of them. Conclusion: vaccine is ineffective in about half of vaccinees. Correct calculations Vaccine not given 100 Vaccine failure 95 Protective efficacy 95%

16 Vaccines do not protect against diseases as many cases of disease occur in immunised children But how correct is the diagnosis of the disease?

17 NONE HAD MEASLES OR RUBELLA! Parvovirus B19 17% Group A Streptococcus 15% Adenovirus 4% Group C Streptococcus 3% Human Herpes 6 6% Enterovirus 5%

18 Most common specific statements of the antivaccine lobby The side effects of DTPw include brain damage DTP is related to the SIDS Hepatitis B vaccine and demyelinating neurologic disorder Influenza vaccines and neurological complications Hib vaccine and diabetes mellitus Thiomersal, MMR vaccine and autism

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20 THE LANCET Vol 351 February 28, children In eight children the onset... had been linked either by the parents or by physician with MMR...

21 THE LANCET Vol 363 March 6, Serious allegations of research...

22 Listen to the second opinion of physicians: Donald W. Miller, Jr. In summary, this is a vaccination schedule that I would recommend: December 10, 2004 No vaccinations until a child is two years old. No vaccines that contain thimerosal (mercury). No live virus vaccines (except for smallpox, should it recur). These vaccines, to be given one at a time, every six months, beginning at age 2: Pertussis (acellular, no whole cell) Diphtheria Tetanus Polio (the Salk vaccine, cultured in human cells)

23 Donald Miller, D.W., Jr.: CV Teaching Responsibilities Program Director and Speaker, The Practice of Coronary Artery Bypass Surgery, University of Washington, CME 0931; Seattle, May 20-21, Training cardiothoracic surgery fellows at the University of Washington, Training general surgery residents at Swedish Medical Center, 1980 to Training cardiothoracic surgery fellows at the University of Washington:

24 Donald Miller, D.W., Jr.: CV Books Written Miller, D.W., Jr.: The Practice of Coronary Artery Bypass Surgery (243 pages). New York: Plenum Publishing Corp., ISBN Dillard, D.H. and Miller, D.W., Jr.: Atlas of Cardiac Surgery (258 pages). New York: MacMillan Publishing Corp., ISBN Atlas of Cardiac Surgery translated into Japanese and published by Dobin Shoin, Tokyo, Miller, D.W., Jr.: Heart in Hand (251 pages) Xlibris Corp., ISBN (Hardcover), (Softcover).

25 Listen to the second opinion of physicians: Donald W. Miller, Jr. December 10, 2004 In summary, this is a vaccination schedule that I would recommend: No vaccinations until a child is two years old. No vaccines that contain thimerosal (mercury). No live virus vaccines (except for smallpox, should it recur). These vaccines, to be given one at a time, every six months, beginning at age 2: Pertussis (acellular, not whole cell) Diphtheria Tetanus Polio (the Salk vaccine, cultured in human cells) Has Dr. Donald W.Miller, Jr. ever worked in the field of vaccinology?

26 Donald W. Miller, Jr. A user friendly vaccination schedule, Dec.10,2004 Vaccine Pa/1 Pa/2 Pa/3 D/1 D/2 D/3 T/1 T/2 T/3 IPV/1 IPV/2 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 Age years There is no monovalent Pa, D or T vaccines available! BUT!!! Not protected against: Hepatitis-B Hib Measles Mumps Rubella

27 D.W.Miller, Jr. : No vaccinations until a child is two years old During , 63 percent of infants under six months of age diagnosed with pertussis required hospitalization, and infants this age accounted for 90 percent of pertussis deaths.

28 Infant s death from pertussis, 2004 Lynne Baker suspects she contracted pertussis from a coughing customer in a bookstore about two weeks before giving birth to her son Nelyn on April 7, "She coughed all through labor," her husband reports. "Overnight, it got worse and worse. Twelve days after Nelyn's birth, on her second visit to her family physician, Lynne received antibiotics. Four days later, Nelyn began coughing and was hospitalized the following day. The next morning, April 25, he died. The results of bacterial cultures started during his hospitalization indicated Nelyn had died from pertussis.

29 FATAL CASE OF WHOOPING COUGH IN AN INFANT In June 2005, a five-week-old child was admitted with expiratory bursts,... desaturation, but without apnoea or cyanosis.... Despite antibiotics,... and oxygen therapy, the child s condition deteriorated and it was transferred to... intensive care unit. Here, the child rapidly developed circulatory failure... and died. Post-mortem, Bordetella pertussis was detected on PCR. Mother and brother 1 week previously had coryza but no cough.

30 ...Immunisation is unnatural... All active substances of the vaccines are natural microorganisms or parts of them There is no more natural medicine as vaccines are! Believers of the natural style of life oppose vaccination to the healthy life stile. There is no contradiction however between healthy life stile and vaccination. We promote both

31 Different target groups for the advocacy of vaccination Medical professionals Governmental structures decision makers Politicians Public NGO s Media Different strategy of vaccine advocacy is necessary for each of these groups!

32 Health care professionals Evidence based medicine cornerstone for the decision making and professional activity Value of vaccination is proven by evidence/facts to be the most effective health intervention Numerous regulatory documents in different countries confirm the obligation of the professionals to act in the area of prophylaxis including vaccination Repudiation of vaccination by health care providers should be considered as professional incompetence which reduces person s/patient s access to the appropriate medical care

33 Governmental structures decision makers Cost effective approach Vaccines are considered as medicines in many countries however compensation (reimbursement) mechanisms often differ

34 Politicians Vaccination as an issue of children s and person s/patients rights 1905 Supreme Court of the USA 2002 Constitutional Court of Slovenia Other cases e.g. UK a lawsuit when vaccination was not given

35 THE REPUBLIC OF SLOVENIA CONSTITUTIONAL COURT Decission Number: U-I-127/01-27 Date: 12 February 2004 In the opinion of the petitioners, compulsory vaccination involves violation of fundamental human rights, guaranteed by the Constitution <...> Decission: Sub-Para 1 of Para. 1 of Article 22, Item 4 of Para. 1 of Article 57 and Para. 2 of Article 57 of the Contagious Diseases Act (Official Gazette RS, No. 69/95) are not inconsistent with the Constitution

36 THE REPUBLIC OF SLOVENIA CONSTITUTIONAL COURT Decission Number: U-I-127/01-27 Date: 12 February 2004 Vaccination is a proven and safe measure to prevent and to control a number of contagious diseases < > Vaccination was supposed to be not only to the benefit of the individual, but to the benefit of the whole population Compulsory vaccination involves an interference with the above constitutional rights of the children who with reference to their age and maturity cannot enforce them by themselves, but their parents do it on their behalf Article 24 of the UN Convention on Children Rights stresses special care for the child's health. The member countries recognize the child's right to the highest possible level of health and to the services by institutions providing medical treatment and after-care

37 Public Responsibility of parents for the decision on behalf of the child should be clearly explained Public prefers an emotional approach General trends and statistics on the value of vaccines are not effective enough Anecdotal cases, tragedies are more efficient How to present? How to comply with ethic requirements? First hand information from the victims of the vaccine preventable diseases is very convincing

38 NGO s How to include vaccines and vaccination into vocabulary of NGOs? How to convince activists and supporters of NGOs? (e.g. activists of UNICEF raise funds for UNICEF s supported vaccination programs worldwide but sometimes they refuse to vaccinate their own children)

39 Media Prophylaxis including vaccination is not an area of the breaking news Antivaccine front-page news is much more attractive as sales promoter compared to everyday practice of vaccination Physicians and researchers are not prepared to deal with media Continuous discussions with media are needed

40 Vaccination is: The right of children which is sometimes limited by adults The most effective (biology-economy) health intervention The duty and responsibility of health care providers. Uncertainty of the professionals regarding the value of vaccines should be considered as a lack of proficiency Something to be understood properly and accepted by everybody Vaccination is part of our responsibility as professionals, parents and as members of the global community