Vaccination And Its Opponents

"My little Boy, Sir, died when he was only Two Months old, just after he had been Vaccinated." "How very sad! Had he been Baptised?" "Yes, Sir; but it was the Vaccination as carried him off, Sir!"
From Punch, September 19, 1891

For some reason, vaccination has always been the target of the ire of rabble rousers. This was true in the 19th century when smallpox vaccination was targeted by many ill informed activists and is true today when a band of people with motives which are not really obscure anymore try to perpetuate fears regarding vaccination and in the process subject children and their families to unnecessary risks with often fatal outcomes.
Edward Jenner introduced cowpox vaccination a safe alternative to the then prevalent smallpox vaccination in the last decades of the eightieth century. Its benefits were quickly recognized and this resulted in the Compulsory Vaccination Act in 1853 in the UK. This legislation required parents to vaccinate their children by the age of 3 months, with the provision of fining the parents if they did not do so. This measure was thought necessary because previous attempts, in the 1840s to start a voluntary vaccination movement failed because of the widespread antipathy to vaccination.
There were cogent reasons for this antipathy however. The vaccine that was available was of poor quality. The serum that acted as its vehicle was of animal origin and sometimes collected in less than the most hygienic ways. Vaccination often resulted in two weeks of morbidity which was difficult for the poor to accept as they could not work during this period.
The methods used by anti vaccination activists were the familiar tools used even today. Anecdotal cases of complications were held up as proof positive of the danger of vaccination while conveniently forgetting the alternative, which were the small pox epidemics of 1857-59, 1863-65 and 1870-72. There were activists who even did not disdain from claiming that doctors were spreading the disease by vaccination in order to make money. A similar approach is seen even today.
However by the close of the 19th century these fears were largely addressed, but even so the legendary Sir William Osler had to publicly challenge the anti vaccination brigade to send 10 vaccinated and 10 non vaccinated people with him to the next smallpox epidemic location. He also offered to pay for the funerals of those who would die in the epidemic as he confidently expected those not vaccinated to do. There were, needless to say, no takers. Just like our politicians who want everybody to be educated in their mother tongues except their own children, the anti vaccinators were too wary of taking up the challenge when their own safety was at stake.
The early part of the second half of the twentieth century was the heyday of vaccines. The development of vaccines for many diseases which were sure killers, like polio, tetanus, and many others led to the development of universal vaccination programmes which eliminated many diseases from societies which implemented them. The greatest triumph of vaccination was of course the elimination of smallpox which was one of the greatest medical achievements of the twentieth century.
But of late there has been a vigorous campaign to discredit several vaccination programmes. Based on anecdotes, strong campaigns have been launched, particularly against the MMR vaccine and several others causing a drop in vaccination rates as parents, now not exposed to the horrors of the disease are taken in and stop vaccinating their children, allowing diseases which had been eliminated in several countries to make a comeback. The first such campaign took place in 1982 when a television programme led to a debate on the usefulness of DPT vaccine and led to many countries dropping the vaccination. The comeback was not long in coming. The rates of pertussis ( whooping cough) rose up to a 100 times that of the rates in other countries and the vaccine was again back in favour as parents watched their children coughing out their lives for the lack of vaccination.
But the latest scare was generated by the now celebrated article in 1998 in the Lancet by Andrew Wakefield and his colleagues. (This article has since been retracted.) The paper used dubious science to claim that the measles, mumps and rubella vaccine (MMR) caused autism in some recipients. The science on which it was based was shoddy and the data fudged, but the damage was done. There was a widespread reaction against this vaccine and there was marked fall in the use of this vaccine in many developed countries, leading to measles outbreaks, like the one in Ireland which caused over 200 unnecessary cases and three deaths. This pattern was followed in several countries where the scare had led to a reduction in vaccination.
Later investigations were even more horrifying. It transpired that Wakefield was employed (at a healthy 150 GBP per hour) by a solicitor Richard Barr to support a speculative attack on vaccine manufacturers. This contract was kept a secret while Wakefield pretended that all he had in mind was the welfare of the patients. It was also not disclosed that just days after the press conference that heralded his now infamous article in the Lancet, Wakefield got together with some business partners and the authorities of the Royal Free Hospital where he was then employed, in order to develop products based on his (fraudulent) claims, including a replacement for the widely used MMR vaccines.
The Royal Free Hospital however insisted that his pilot study be proved in a large scale clinical trial. Andrew Wakefield was found to be strangely reluctant to conduct any such trial. He preferred to highlight anecdotes rather than run a large scale epidemiological trial which would settle the issue once and for all. By now the scales were falling from the eyes of even those in the medical academia who had believed his claims, and he was kicked out of the Royal Free in 2001. In March 2004, 10 of the 13 co authors of the 1998 pare retracted their claims. The courts also rejected such claims and the hope of making money from the suffering of parents of autistic children evaporated. Wakefield lost his medical registration in 2010 and the Lancet retracted the paper thus ending the entire sordid episode.
The damage that this episode has done is considerable. The parents of autistic children have been convinced that their children were affected by vaccination and this has led any of them to fight futile court battles at vast expense. One can understand the motivations of the parents of such unfortunate children, and one can sympathise with their plight. But the campaigners who, often as a profession, led these campaigns should be exposed as the charlatans that they are and brought to book. Andrew Wakefield may have got his just deserts, but what about the others who in the pages of the social media particularly try to still perpetuate such myths. It would be laughable, if the results of such activities did not threaten to derail public health programmes in many countries, particularly poor ones which can ill afford these disruptions.


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