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Immunizing against incorrect information

April 7 marks World Health Day, an annual occasion used to draw awareness to the importance of global health and shine a spotlight on the international aspects of healthcare.

One of the most game-changing discoveries in modern medical history is the widespread production and distribution of vaccinations, which has greatly reduced the mortality rate of a variety of dangerous infections from smallpox to mumps.

Basically, vaccines are made from weak or inactive strands of a virus or bacteria that causes a disease. In small doses, these biological compounds allow the immune system to produce the antibodies necessary to fight off future contact with the disease.

However, in recent years an anti-vaccine movement has been gaining steam in the Western world, and we’ve even seen a resurgence of diseases like meningitis as a result. Some parents have joined the movement in an effort to protect their autonomy in their child’s health. And while autonomy is something be valued, those principles don’t seem to protect children from developing and spreading cases of polio or the measles.

As the rates of infectious disease grow in our nation, a solid public health education system has become increasingly important.

Vaccinations have been instrumental in keeping the Canadian public safe from highly contagious diseases over the past century. But as more and more people lose faith in immunization, will we see resurgence of age-old ailments?

A stroke of genius

In order to truly appreciate how far the medical community has come, it’s always helpful to look to the past.

The earliest form of vaccination dates back to 10th century China, where physicians used an older form of vaccination called “variolation.” They sought to lessen the impact of smallpox by exposing healthy people to scabs caused by the disease.

Immunization didn’t make an appearance in Western Europe until the 1700s in England. British physician Edward Jenner “discovered” vaccinations in their modern form in 1796, helping to boost the scientific credibility of immunization at the same time. People violently opposed the medical procedure in the 1870s, doubting its efficacy and fearing the loss of personal freedoms, which just goes to show that opposition to vaccination isn’t a new phenomenon.

In the decades that followed, more and more vaccines for deadly infections were created, and health policies evolved around the world.

“The truth is that immunization against communicable disease is (one of the) greatest medical achievement of the past 10 decades with countless lives saved. Period,” said Dr. Sanni Yaya, a University of Ottawa professor of economics and global health.

Since vaccines are among the most highly regulated medical products in Canada, Kristiana Bruneau, a child health officer for RESULTS Canada, says that it has been built into our healthcare system.

“In theory, all Canadians have access (or subsidized access) to this core package of vaccines, which makes getting vaccinated easier and a normal practice in health maintenance/disease prevention.”

While a certain amount of skepticism is healthy, what’s important to remember about infectious diseases is that protecting the herd is of the utmost importance. Since infectious diseases are transmitted person-to-person, there is a collective effort needed to stop the spread.

“Treating all Canadians, no matter their background, with the same healthcare, means that all Canadians benefit,” said Bruneau.

Herd immunity refers to communities that are protected from contagious diseases when most of the community has been immunized and a disease can’t spread. Herd immunity is achieved when 95 per cent of the community is vaccinated against an infection.

With that being said, complete immunization doesn’t necessarily mean eradication of the disease as some diseases can live in environmental reservoirs. So far, smallpox is the only disease that has been completely eradicated, and polio is the next target on the list. But as long as the disease still exists in some form there is a risk of an outbreak, which is why the immunization of communities is so important.

“Healthcare isn’t just about the individual, it is about the community—especially in the case of vaccines,” said Bruneau.

Today there are vaccinations against measles, mumps, human papillomavirus infection (HPV), swine flu, seasonal flu, hepatitis A and B, polio, and lots of other scary contagions. There are so many available vaccines in Canada and so few visible viral diseases that it sometimes becomes easy to forget that infectious diseases are still a very real threat.

What goes around comes around

Despite the decades of immunization success, there is a growing rate of Canadians who are not getting themselves or their children vaccinated.

Immunization rates in Canada range from 73 per cent for vaccines against meningitis to 91 per cent for vaccines against polio. These rates might seem high, but they still don’t meet the 95 per cent threshold needed to prevent an outbreak.

Among those who decide not to get themselves or their children vaccinated are a subgroup known as “anti-vaxxers,” who vehemently blame vaccines for causing allergies, learning disabilities, and a wide range of other conditions that are difficult to identify root causes for.

Anti-vaxxers have been around for as long as vaccines have, but their rhetoric is on the rise thanks to controversial online forums, the confirmation biases’ of quick Google searches, and high-profile celebrity and media endorsements.

For a medical professional like Yaya, the situation is a lot more black and white.

“I strongly believe immunization is necessary to keep diseases like measles and even polio from making a comeback,” he said. “When it comes to healthcare, misinformation can be deadly.”

As with all innovations, the benefits of vaccines do come with side effects and risks. However, most of these risks are mild and short-term.

Take the available vaccine against HPV for example.

There’s a 90 per cent chance that people vaccinated against HPV will experience soreness, a 33 per cent chance of swelling or redness, a 10 per cent chance of fever, and a 33 per cent chance of headache. So why get vaccinated against HPV in the first place? Well, because most sexually active people will contract HPV at some point in their lives and most strains carry invisible symptoms that are extremely hard to detect, making treatment difficult.

The HPV vaccine, targeted primarily at girls between the ages of 11 and 26, is highly effective in preventing the contraction of strains that commonly result in cervical cancers and genital warts.

So while fear of a sore arm may dissuade you from getting the shot, the potential benefits objectively outweigh the potential risks.

The ghost of infections past

With falling rates of immunization, public health officials have to now consider the possible resurgence of a deadly disease of Canada’s past—polio.

Polio is a prehistoric viral disease that invades the nervous system and can cause irreversible paralysis in a matter of hours. Polio was one of the most feared diseases of the 20th century, causing paralysis and death in all parts of the world. But polio, unlike most diseases, can’t survive outside of the human body, which means that if everybody was vaccinated the virus could be eradicated.

Aggressive mass immunization campaigns in the 2000s helped eliminate the disease from the Western world. As a result, less than 40 children were infected with the disease in 2016, compared to the 40 children who were infected by polio every hour in 1998.  

“Polio basically is proof that vaccines work,” said Bruneau. “(However) as people don’t have to deal with polio in Canada anymore, they tend to forget the importance of vaccines and disease prevention. As a result, people are forgoing getting vaccinated or vaccinating their children because they don’t feel it is necessary.”

While this widespread apathy towards diseases like polio represents incredible progress and is a tribute to the effectiveness of immunization, it doesn’t mean that we should stop talking about it. The disease remains endemic in countries like Pakistan and Afghanistan, and there is no cure. This means vaccines are our best bet so far in making polio extinct.

As long as one person is infected with polio, outbreaks can easily cross borders and impact communities that have eliminated the disease. Given the very contagious nature of the disease, the World Health Organization (WHO) estimates that an outbreak of as many as 200,000 new cases of polio a year for the next ten years could happen if efforts are not made to completely eradicate the disease.

“Canadians should care about polio because an outbreak like polio could happen again—and it very well could if vaccines are not available to all, or people are choosing not to get vaccinated,” said Bruneau.

If you’re still skeptical about polio making a comeback in Canada, look at the resurgence of the measles.

Measles, once thought to be eliminated in North America in the 1990s, has made its way back to American and Canadian communities with low vaccination rates. In 2011, Quebec had 678 confirmed cases of measles. In 2015, there were over 400 cases of measles in British Columbia, and 17 confirmed cases in Ontario.

Yaya proposes three reasons for the recent measles outbreak in Canada.

“First, a general lack of interest for immunization (means) less and less children are vaccinated. Second, the rise of alternative medicine and rampant critics against the effects chemicals (produce) in the body (for example autism is attributed by some to immunization). Third, the large population of migrants coming from areas where those diseases are still prevalent.”

According to Bruneau, “Growing public disinterest in vaccines is allowing governments to rationalize cutting back on spending in health and disease prevention which, in turn, makes it harder for citizens to get immunized.”

If vaccination rates continue to drop, the world will continue to see outbreaks and resurgences of diseases that once seemed obscure.

We’re all in this together