Vaccines: Has the Quest for the Perfect for Every Single Person Become the Enemy of the Good for All?

Depending on who you believe, vaccinations have represented one of the greatest medical advances of the last 100+ years, or have been a kind of unethical  experimentation foisted on humans by Josef Mengele -class doctors and profit-hungry pharmaceutical  companies. The consensus of the readers of this blog is very likely to be in favor of the first proposition, so that to some degree this blog entry is preaching to the choir. But the choir might appreciate some fresh musical scores to guide them, given that some discordant notes  are surely going to be coming our way.

The latest challenge to vaccination arises from the emergence of Vaccine-Derived Polioviruses or VCDPs. As reported in the September 28^th, 2007 issue of the Center for Disease Control’s MMWR , and in the World Health Organization’s Weekly Epidemiological Record, and in Science on the same day, 69 cases of polio that had derived from a Sabin oral vaccine made from chemically weakened “attenuated” poliovirus had appeared to cause the disease instead of preventing it. While the Science story focused on Nigeria, the MMWR &  Weekly Epidemiological  Record reports detailed previous instances of similar very highly limited outbreaks in Cambodia (2 cases), Myanmar (4),  the People’s Republic of China (4), Iran(3), Syria (5)  and Israel (no patient number reported, just viruses detected in environmental samples).

While it is clear from genomic or proteomic analyses that all of the cases came from vaccine  viruses that were initially “attenuated”, but may have subsequently mutated, it is not clear that all of the cases were of persons who had taken the vaccine themselves. 

It has since been determined that several of these cases involved infants or immunologically-compromised adults. All of the patients lived in isolated areas with spotty rates of immunization of any type, oral Sabin or Salk injection,  against polio. The most likely scenario is that while some of these immunologically weakened individuals responded poorly to the attenuated  (and possibly mutated) virus in the oral Sabin vaccine and then directly developed the disease, other future victims were simply living close to someone who had received the vaccine.  That nearby vaccine recipient may have incubated the disease without him or her showing any polio symptoms, but nonetheless subsequently  passed the virus on to the victim who got the disease full-blown.

In the terminology of clinical virology,  this latter group “shed” the virus to the ultimate  polio patients who may not themselves ever have been given the vaccine. This scenario is entirely plausible, particularly in poor areas of the world with major problems in food safety and general sanitation. The most common means of “shedding” the virus to nearby people begins with fecal contamination that ends up on hands, or in the water supply, or on food,  and then ultimately it gets into the mouth and then takes hold internally of the patient.

The real tragedy was not that 69 Nigerians (out of a national population of about 125 million, btw ) may have gotten the disease, directly or indirectly, from taking the vaccine, it is that millions more in some predominantly Muslim districts are now at greater risk of getting the native “wild” varieties of polio virus that have literally been running wild in Nigeria, in the very districts where 60% of the world’s new  polio victims live,  because  they are now boycotting  the vaccine.

This undeniably adverse outcome for a tiny fraction of the population has reinforced belief  in, and compliance with, some incredibly inaccurate and paranoid  pronouncements from  some imams & tribal chiefs . According to an article in PLoS Medicine by Dr. S.A.Jegede, a professor at the University of Ibadan in Nigeria,   these much venerated authority figures, sadly including some Muslim physicians who apparently forgot  not only their medical school training, but the consensus view of Islamic scholars that  nothing in Islam requires  the abandonment of scientific and medical  progress, proclaimed that these “polio vaccines were corrupted and tainted by evildoers from America and their Western Allies….We believe that modern-day Hitlers have deliberately adulterated the oral polio vaccines….[the largely Muslim Kano State Government argued]….it is the lesser of two evils to sacrifice two, three, four, five even ten children [to polio] than allow hundreds of thousands or possibly millions of [Muslim] girl-children likely to be rendered infertile.” The fact that the Sabin oral vaccine program has been successfully administered in 55 other Muslim countries without notably lowering their population growth also seems to have escaped their notice.

But Americans and Europeans are scarcely free of disproportionate fears  of the tiny but very real risks of almost any vaccine,  and  often hold beliefs about the causation of diseases by vaccines that have been scientifically disproven.  And like their Nigerian counterparts, they can be risking the general public health through their non-compliance.

In the UK and the US, there have been growing boycotts of MMR (Measles, Mumps, & Rubella) shots given to children. While there has been a few cases per hundred thousands of shots incidence of adverse effects owing to the antibody components of the vaccine (which there is with virtually every vaccine ever made) there  clearly has been an overblown reaction to a putative link between a mercury-based vaccine preservative, thimerosal, and autism.

Under this theory, the addition of this preservative, which prevents deadly bacterial contamination of vaccines, btw, has caused  the rapid rise in diagnosis  of autism. While this has been refuted in every single comprehensive analysis of the situation, it has not stopped something arguably even worse for global public health than  mad mullahs, American trial attorneys, from appearing to make their living looking for multimillion dollar  settlements or awards in cases  that involve the undeniable misery of parents who had their children immunized and whose children coincidentally later showed symptoms of being autistic.

Among the telling statistics to the contrary is that the rise of diagnosis of autism in Denmark was the same as the rest of the developed world, even though Denmark never used vaccines containing thimerosal. Likewise, if thimerosol was the cause of the autism, and a roughly equal number of boys  and girls were immunized, why is it that a great many more boys than girls have autism?  Moreover, even as thimerosal  is gradually being eliminated worldwide for fear of lawsuits (even at the risk of far more statistically probable fatal bacterial infections) ,  the rate of children being immunized with absolutely no contact with thimerosal who are subsequently diagnosed as autistic continues to rise. 

As one trial attorney, quoted in the Washington Post admits without any sort of shame (this assumes they are capable of shame in arguing against facts they or their clients simply don’t like)  “There is a difference between scientific and legal proof….one is 95% certainty, and the other is 50% and a feather.” According to this logic, facts are decided by majority opinion, not by experts: the gerbil in the classroom is a female, not because it was examined by a veterinarian or  even by a competent pet salesperson, but because the kindergarten class voted that way.

This would be almost comical  except for two facts. The Third World watches what happens in the developed countries, and may boycott these critically well-preserved and safe thimerosal containing vaccines because they smell a conspiracy perhaps akin to the Nigerian tragedy that is even now unfolding, and 454,000 more unvaccinated children could die of measles, much as they did in 2006.

I find it somewhat disingenuous that some attorneys claim to be taking the tort  route because they are not fighting vaccines as an idea: they are fighting  the lack of perfection in vaccines. I would argue that as early as  1998 there was a vaccine that stopped severe dehydration and avoided the subsequent hospitalization of infants and children owing to rotavirus infections. But it caused a rare (1 in 20,000) but serious & curable complication called intussusception. So they held it  up for six more years trying to eliminate that 1 in 20,000 possibility, in the face of the demonstrated certainty that in the interim 2,000,000 children died of diarrheal disease because that vital if not totally perfect vaccine was not there for them.

Vaccination controversies will not be ending any time soon,  and even if polio is not much of threat in America, or if your clientele are MMR and other immunization compliant, because a vaccine connected with, gasp, SEX,  is being widely recommended and in some places mandated to guard girls against four sexually-transmitted varieties of   the Human Papilloma Virus that are known to cause genital warts at their best and cervical cancer at their worst.  Marketed under the name Gardasil, it has been proven safe and reasonably effective in carefully-planned and closely-monitored clinical trials.

Does if perfectly prevent every case of cervical cancer and absolutely stop all HPV viruses?

No,  it does what it can, and that’s still a lot.

Will it have adverse side-effects in some patients ?

Undeniably .

Will some of them ultimately turn out to be very serious in a one in hundreds of thousands of cases.

Very likely.

Is it unseemly  to be giving it to adolescent girls, condoning & perhaps unleashing uncontrollable urges to have sex ? 

Comically, one might answer that this is not likely to be the case , as it has not been marketed as an aphrodisiac for gullible adults on the internet or on late night cable infomercials. But seriously, it is given at this age because the vaccine takes immunological hold the best at this stage of their lives.

Will avoiding giving this vaccine cut down on women of all ages having sex, “licitly” in lawful marriage or out of wedlock in America in the future ?

Sure, every year there will be about 4,000 fewer women to have sex, because about that many women will have died needlessly.

Allen, A. (January 25, 2007). For the good of the herd. New York Times Section A, Column 1, Editorial Desk, pg.25.

Allen, A. (2007). Vaccine: the controversial story of medicine’s greatest life saver. NY: Norton, 523pp.

Clements, C.J.; McIntyre, P.B. (2006) When science is not enough: a risk/benefit profile of thiomersal-containing vaccines. Expert Opinion in Drug Safety 5 (1): 17-29.

Colgrove, J.; Bayer, R. (2005) Could it happen here? Vaccine risk controversies and the specter of derailment. Health Affairs 24 (3): 729-739.

Global Specialized Polio Reference Laboratory et al.  (September 28, 2007) Update on  vaccine-derived polioviruses---worldwide, January 2006-August 2007. MMWR 56(38): 996-1001.

Global update on vaccine-derived polioviruses, January 2006-August 2007. (September 28, 2007) Weekly Epidemiological Record 82 (39): 337-343.

Hilton, S; Hunt, K. Pettigrew, M. (2007) MMR: marginalized, misrepresented and rejected? Autism: a focus group study.  Archives of Diseases in  Childhood 92 (4): 322-327.

Jegede, S.A. (2007) What led to the Nigerian boycott of the polio vaccination campaign? PLoS Medicine  4 (3) e73.

Meldrum, M.L. (1999) The historical feud over polio vaccine: how could a killed virus contain a natural disease? Western Journal of Medicine 171 (4): 271-273.

Moss, W.J.; Griffin, D.E. (2006) Global measles elimination. Nature Reviews Microbiology 4 (12): 900-908.

Parker, S.K. et al. (2004) Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics 114 (3): 793-804.

Plotkin, S. (2007) Vaccines: life savers and controversy makers. The Lancet 369 (9571): 1421.

Roberts, L. ( September 28, 2007) Vaccine-related polio outbreak in Nigeria raises concerns. Science 317:1842.

Roden, R.; Wu, T.C. (2006) How will HPV vaccines affect cervical cancer? Nature Reviews Cancer 6 (10): 753-763.

Vedantam, S. (June 10, 2007) Fight over vaccine hits court: Families, after hearing claims rejected by experts, face lower burden of proof. The Washington Post Section A, Pg.A6.

Tony Stankus, [email protected] Life Sciences Librarian & Professor, University of Arkansas Libraries MULN 223E, 365 North McIlroy Avenue, Fayetteville, AR 72701-4002 Voice: 479-575-4031 Fax: 479-575-4592

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