give me the awe of understanding over the awe of ignorance every time - Douglas Adams


Vaccinations: Quell....or Spark Pandemic? A reply

This essay is a reply to a leaflet issued by persons unnamed that was passed onto me. Here is a facsimile of the leaflet.

The first paragraph claims that a smallpox pandemic of 150 years ago that killed hundreds of thousands was caused by a vaccine.
There was no smallpox pandemic 150 years ago, there was an epidemic in Pennsylvania in 1860-61 which re-emerged in the Pacific Northwest the following year and then again on the east coast in various cities from 1865-72. Is this a long standing American confusion between the World and USA? As far as I can ascertain there is no credible evidence that these epidemics were caused by vaccination.
The fact that smallpox no longer exists as a crippling, blinding, scarring, killing disease is due entirely to the effectiveness of a sustained worldwide vaccination programme. The reason people today don't have to fear smallpox or have to be vaccinated against it is due to the previous generations who saw the logic and effectiveness of the smallpox vaccine.

I could go on to deal with all the claims in the above leaflet one at a time but this would be tedious and pointless. The fact is that if any disease could be eradicated by vaccination then is was going to be smallpox. Other diseases may possibly be eradicated by vaccination but there are not only the technical problems of vaccine effectiveness and safety but also of the universal human cooperation required to achieve complete eradication.

The plain fact is no vaccination is 100% safe. As with every substance introduced into the human body there is always a risk of an allergic reaction that may vary between a mild ache to sudden death. In addition to allergic reactions there may be other unwanted side effects that may only become apparent from the collection of statistical data once the vaccine is being used by large numbers of people.

The fear that this leaflet and all the associated websites it links to are playing on is the fear that a vaccine may cause illness, injury or even death in an otherwise healthy person. This not entirely unreasoned fear that needs to be put into perspective. Lets consider influenza, as it is presently much in the news.

There is a risk you might catch the flu. If you do catch the flu there is a risk that you might die (or be permanently damaged).You may be offered a vaccine against this particular strain of flu. No vaccination is 100% safe. To vaccinate or not to vaccinate? This is the question! If you would like to base your decision on reason rather that fear then we need to consider risk and put some values to these risks.

In the Spanish flu pandemic following World War I the death toll has been estimated between 20 and 100 million. A wide ranging estimate but let's take the lowest figure of 20 million. The world population in 1918 was less than 2 billion, so if you were alive in 1918 there was about a 1 in a 100 chance you would be dead from flu by 1920. A risk worth taking? There was no flu vaccine then so everyone took the risk! Although there are many factors which affect the survivability of flu, lets for the sake of brevity assume that we face a similar possible risk rate with swine flu or some future flu pandemic. The figure we really need to know is what is the risk taking the flu vaccine? This is where hard figures are quite hard to come by. As with the death toll estimates of the Spanish flu pandemic there is a wide variation between the upper and lower estimates of potential adverse reactions. The following figures are pure speculation but based on typical drug adverse drug reaction data. Lets assume that 1 person in a 100 gets a mild ache, 1 in 1000 feels quite ill but makes a full recovery, 1 person in 10000 gets really ill, recovers but with some permanent damage, and one person in 100000 dies as a result of the vaccine. Now we have all the risk factors laid out before us in this hypothetical situation what decision should be take?
Option 1 do nothing – 1/100 chance of death
Option 2 take vaccine – 1/100 chance of a mild ache
1/1000 chance of illness
1/10000 chance of serious illness with consequences
1/100000 chance of death

There are no risk free options in life. Every action or inaction involves risk!
The above above figures are of course entirely made up but I speculate that they represent a fair representation of the problem. In order to make an informed decision we need to look at the risks involved in a reasoned and dispassionate manner. If you were unfortunate enough to wake up one morning with a huge and unsightly wart on you face, I would guess you would go to some medical practitioner and ask if it could be removed. If your doctor said “yes, it can be removed but you will need a general anesthetic” then you may say “what's the risk of a general anesthetic?” Fact is the risk of not waking up from a general anesthetic is about 1 in 100000. This is a risk most of us would be quite willing to make for a purely vain reason.

The leaflet that sparked my effort at a reply is I think dangerous propaganda that may possibly in the extreme cause more medical harm than the perpetrators wish to save. I am not saying that all vaccines are wonderful, effective and safe. Far from it! What I am saying is that vaccination is a risk, a risk that one must balance against the risks of not being vaccinated. Its true many nurses opt out of vaccination programmes, does this mean they know stuff we don't? Question nurses why they are opting out and you may find they are acting more rationally than you may think. They are often exposed to epidemic/pandemic diseases before the general public and may therefore already be immune and have also through their career been injected with more vaccinations than a lab rat. So feel that the added risk of yet another injection is not outweighed by the possible benefits. They may also be as ill-informed as the rest of us!

So this is the decision making process we all need to go through. Assess the risk the disease poses to you, assess the risk the vaccine poses to you and through this risk/benefit analysis decide upon the appropriate action (or inaction). Of course what you need to make this decision is reliable data, that's the tricky bit! It is my opinion from from studying the available advice from academics that study the data that is available that especially if you are from a particularly vulnerable group, such as those with a compromised immune system, the possible benefits of the flu vaccine far outweigh possible risks.

Mick Burns 08/12/2009