The Great Vaccination Debate
Editor’s note: Faculty member in Walden University’s School of Health Sciences, epidemiologist, and mother Dr. Aimee Ferraro weighs the risks and benefits of childhood vaccination. You can hear more from Dr. Ferraro in the World Health Day webinar on Monday, April 7, in which she and other faculty members will share examples of research in public health and community work that address the issue of vector-borne diseases in communities around the world.
Vaccines may be the most hotly debated issue in public health today. You have probably heard many perspectives.
Expert: Vaccination is one of the greatest achievements in the history of public health.
Concerned Parent: I trust my physician, but I keep hearing all these horror stories about side effects from vaccines.
Anti-Vaccination Parent: The dangers from vaccines are just too great. I will take the risk of my child getting the actual disease.
So who is right? The answer is not necessarily simple. Each party makes a valid point, but to varied extent. The key to making a critical decision about the importance of vaccination is to understand all the facts, make sure they come from reliable sources, and assign appropriate risks and benefits. Physicians and public health professionals are trained to do that, and parents should educate themselves on the issue as well.
The facts. At the beginning of the 20th century, infectious diseases were prevalent and killed thousands annually. According to the Centers for Disease Control and Prevention (CDC), influenza and pneumonia were the leading causes of death in the U.S. in 1900, and about 500,000 Americans died during the 1918 influenza pandemic. World War II accelerated vaccine development, and by the 1950s, the U.S. had implemented nationwide vaccination programs against polio and smallpox. Currently, the CDC, the American Academy of Pediatrics (AAP), and the Advisory Committee on Immunization Practices (ACIP) approve and recommend a regular vaccine schedule for children ages 0–6 that protects against 14 different infectious diseases.
The risks. Vaccines, like any medication, can have side effects. Most are mild, such as redness and swelling at the injection site, but in very rare cases a vaccine can cause an allergic reaction, seizures, paralysis, or death. Parents should pay extra attention to their child for several days after vaccination and call their doctor if something warrants concern.
There has been a persistent, although unfounded, argument that vaccines are linked to autism. The idea was put forth by Dr. Andrew Wakefield in 1998 based on his study of 12 children that showed an association between the combination measles, mumps, rubella (MMR) vaccine and the onset of autism spectrum disorders. However, this study has since been retracted and at least seven large epidemiologic studies have been unable to replicate the results. Nonetheless, based on concerns that vaccines with the mercury-containing preservative thimerosal may expose children to unsafe neurotoxin levels, the AAP and Food and Drug Administration (FDA) pushed to remove thimerosal from all vaccines.
There is some contention that other additives contained in vaccines (e.g., formaldehyde and aluminum) are harmful. The FDA maintains that these chemicals only exist in trace amounts and further research is under way. Another concern that has been raised by some parents is that the use of combined vaccines could overload a child’s immune system. One study in Pediatrics, the official journal of the AAP, indicated that if infants were given 11 vaccines at one time, about 0.1% of their immune system would be “used up.” So far, there is no scientific evidence to support the claim that vaccines overload the immune system.
The benefits. Strategic vaccination campaigns have resulted in the eradication of smallpox worldwide; elimination of polio in the Americas; and control of diphtheria, tetanus, measles, mumps, rubella, and Haemophilus influenzae type b meningitis in most of the world. A 2001 report by researchers at the CDC estimated that childhood vaccinations prevent 14 million cases of infectious disease and 33,000 deaths per year in the U.S.
There is also an altruistic aspect to vaccination. People who are unable to get vaccinated—children who are very young, people with compromised immunity (e.g., those in cancer treatment or with autoimmune disorders), or the elderly—depend on others to stay healthy and avoid transmission of vaccine-preventable diseases. When a child is vaccinated, it may save someone else’s life in the future.
When all factors are weighed, I believe that the evidence tips in favor of children being fully vaccinated. Parents may miscalculate the risk from potentially deadly diseases because they have not seen the effects firsthand, and they may be swayed by media reports since they don’t know how to interpret the scientific findings. Even though vaccine-preventable diseases such as measles and mumps are virtually gone in our communities, they may only be a plane flight away. It will take continued vaccination efforts to eradicate infectious diseases internationally and keep them from re-emerging in the U.S.