Vaccination: Personal Choice Or Community Responsibility?

Aug 14, 2019

My recent investigation into the history of smallpox and measles provided strong evidence that the vaccines for these diseases are safe and effective; 93 to 97% effective in the case of the measles vaccine. However, some diseases are harder to prevent with vaccines.

The flu vaccine, for example, has to be modified every year to accommodate for changes in influenza strains. Some Utahns feel that vaccines should be a personal choice, others believe that getting vaccinated is a responsibility to protect all of the members of our community. 

Rich Lakin, the immunization program manager at the Utah Department of Health, explains the difficulty with influenza.

“So the flu is its own bug," he said. "This is why you have to get the flu shot every year because it does change.” 

According to the Center for Disease Control, the flu vaccine for the 2017-2018 season was approximately 40% effective (https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm), but this is still well below the 97% efficacy rate of the measles vaccine. Lakin sees the flu vaccines as bigger than the individual. 

  

“Here’s the thing," Lakin said, "those that cannot get the flu shot - so kids under 6 months of age, maybe some kids who are going through cancer therapy, immuno-compromised conditions, the elderly, those in long-term care - if those people around them get the flu vaccine, they’re protecting them. And don’t we have some type of community responsibility to protect those who can’t? I do.”

“First of all, you can’t spread something you don’t have.” This is Kristen Chevrier. She is among a small group of people who do not believe the scientific evidence that vaccines are safe or effective. She identifies as a vaccine-choice advocate, often called anti-vaxxers.

 

“If you’re not sick, you can’t spread something. So requiring everybody to get the flu shot and then assuming that the people who didn’t get it are going to spread it, is kind of silly,” she says.

But Lakin disagrees.

 

“If you do get the flu, there’s two days before you show symptoms that you shed the virus, and then there’s two days you shed after your symptoms,” he said.

In addition to concerns about how effective some vaccines are, some people also distrust the information provided by healthcare professionals. Chevrier cited a claim that Merck, the developer of the Measles Mumps, and Rubella vaccine, or the MMR, lied about the efficacy of the mumps portion of the vaccine.

 

“The efficacy levels were falsified during the testing that they did pre-release of the MMR vaccine on the mumps vaccine [by adding] rabbit blood. That skewed the test results prior to the release of that vaccine and that is the current subject of a lawsuit,” she said.

That lawsuit was filed in 2012 and is currently underway. According to the lawsuit, Merck claimed a threshold of 95% efficacy when the vaccine was originally produced, but the efficacy of the product decreased over years of production due to the way it is made. Merck has so far denied the charges.

 

The CDC indicates that the mumps vaccine provides a 78% reduction in risk of getting mumps with one dose, and an 88% reduction of risk with two doses. The lawsuit does not claim that the vaccine is unsafe, but lawsuits like the one Merck is currently facing reinforce the fears of some groups of people when it comes to vaccines. Every vaccine is associated with some risks, mostly rare and relatively mild. However, the effects of vaccine-preventable diseases can be devastating.

Mark, who prefers that I do not use his last name, learned first-hand how dangerous vaccine-preventable diseases can be.

“In the late nineties there was a publication that came out linking the MMR vaccine to autism that gained a lot of attention,” he said.  

That publication has since been retracted and the physician that submitted it has lost his license to practice medicine.

“My parents actually found an out-of-state doctor that was willing to pretend to vaccinate me. So, what I have logged but did not actually receive were all three rounds of the Hep. B vaccine and a booster of MMR.”

Fast-forward to adulthood, and Mark is a scientist. He works in the Democratic Republic of Congo, where rates of vaccination are low in rural areas, and rates of many vaccine-preventable diseases are high. Mark works with needles so he suspects that at some point he nicked himself without noticing and became infected with Hepatitis B.

“I went on a 20-mile bike ride and a few miles into it I had to lay on the floor. I got off my bike and I remember just really feeling like my liver had this really sharp stabbing pain. And then that night I started getting really sick. Fevers, vomiting, I’m just feeling extremely weak. And I stayed in bed for four or five days before I went to the emergency room. When I went in they pointed out how yellow I was, and I think the following day, they confirmed it was Hep. B.”

Still, Mark feels lucky. His infection could have been worse.

“What the worst case scenario is you end up with a chronic infection. Those tend to be more mild, as far as symptoms, but it doesn’t leave your body so it’s slowly attacking your liver. Someone who I worked with closely recently died from a chronic Hep. B infection that they didn’t even know they had.”

Mark is not angry at his parents but he does not agree with their decision to avoid vaccinating him.

“Before or after I had this experience, I think that they are essential. And whatever minimal side effects can occur and the few cases where you have more significant impacts from vaccines, are far fewer than the positive impacts that we have from these vaccines.”