DEPARTMENT OF BIOMEDICAL SCIENCES
FACULTY OF MEDICINE AND HEALTH SCIENCES
SBP3408 – BASIC IMMUNOLOGY
SEMESTER 2 SESSION 2019/2020
Concern and Opposition to the Efficiency and Safety of Vaccination Programmes
Lecturer’s Name: Prof. Dr. Daud Ahmad Israf Ali
Prepared by: Sharifah Nabilah Huda bt Syed Kassim
Matric Number: 199176
Abstract
Vaccine hesitation has become a global trend for parents who refuse to vaccinate their children and are thus involved in increasing cases of vaccine-preventable diseases. The reasons why parents refuse to vaccinate their children differ widely but can be in four categories which are religious region, personal beliefs, safety concern and trust in the health system and provider. This issue can be avoided or minimized if we seriously consider why vaccination is necessary. Education is a crucial factor in equipping parents with the requisite knowledge to make informed decisions about their children’s immunizations.
Keywords: vaccine refusal, religion, safety, effectiveness, personal beliefs, herd immunity
Table of Contents
Concern and Opposition to the Efficiency and Safety of Vaccination Programmes. 4
Reasons for Vaccine Hesitancy. 5
Personal Beliefs or Philosophical Reason……………………………………………….. 6
Trust in Health System and Provider………………………………………………………………………… 9
Immunization can Save Our Child’s Life. 12
Childhood Vaccine Contribute to Herd Immunity. 14
List of Figures
Figure 1. Use of Religious Exemption to Avoid Vaccination. 5
Figure 2. Non-medical State Exemptions from School Immuniation Programmes. 7
Figure 3. How Vaccination Protects the Community. 10
Figure 4. Most States in the US Allow Religious Exemptions for Childhood Vaccine. 16
List of Tables
Table 1 Comparison of 20th Annual Morbidity of Vaccine-Preventable Diseases. 11
Table 2 Herd Immunity Threshold of Vaccine-Preventable Diseases 14
Concern and Opposition to the Efficiency and Safety of Vaccination Programmes
According to Smith (2017), anti-vaccine movement is defined as a group of people who doubt the efficiency and effectiveness of vaccine thus refused to be vaccinated. Emerging trend among parents in Western countries in this 21st century that hesitant to vaccinate their children due to numerous reasons even when the vaccine is readily available. Vaccine is one of most significant discovery in the 20th century which plays a vital role in preventing diseases among children. Nevertheless, there has been a growing increase in anti-vaccination sentiments regarding claims that vaccinations do more harm to the health of the children who receive them than the benefits they may get.
It is crucial for the pharmacist and health professionals to understand why some parents refused or delayed the vaccination given to their children. Although there is no federal legislation on the administration of vaccines, each state has laws that dictate which vaccinations are required for children before they enter school. Low-vaccination areas have resulted in localized disease outbreaks, including measles and pertussis. A drop in vaccination level threatens the herd immunity that the medical world has worked hard to achieve. Nonetheless, other motives for the anti-vaccination movement may be due to their personal beliefs, such as religious or secular views.
More parents now than a decade ago are refusing to vaccinate their children, but the reasons for refusals have shifted, a new study suggests. The researchers found that parents who refuse to vaccinate their children are now more likely to indicate their reason is because they do not see a need for vaccination. Pediatrists interpreted that the reasons for parents to postpone vaccines varied from the ones that parents avoided vaccinations altogether. For instance, in the new survey, parents seemed to postpone vaccination more commonly because they were worried about the discomfort of their children, and because of the misguided belief that vaccinations could strain the immune systems of children. By contrast, the researchers found that parents who refused to vaccinate their children did so more commonly because they considered vaccines unnecessary.
A variety of studies have investigated the reasons why parents avoid, postpone or hesitate to vaccinate their children. Parents’ rationale differs widely but can be grouped into 4 overarching groups. Such types include religious reasons, personal values or philosophical reasons, safety issues, and low trust from health system and provider.
Reasons for Vaccine Hesitancy
Religious Reason
Religious objection has become one of the reasons that influence some parents to not taking part in vaccinating their children. Furthermore, some studies show that the number of parents that often use this excuse is surprisingly increasing which lead to the growing number of cases in vaccine preventable diseases such as mumps outbreak in a protestant orthodox group in The Netherlands.
Figure 1
The use of a religious exemption to avoid vaccinating children.
Note. This figure was produced in 2019 in North Carolina that shows the increasing percentage of parents that using the religious exemption to avoid their children from being vaccinated. Although all kind of school in the area requires the student to be vaccinated, religious reason had been on the rise than medical exemption. Copyright 2019 by N.C. Department of Health and Human Services.
In the Catholic perspective, the most questionable issue regarding vaccination in Catholicism is the use of cell lines derived from voluntary aborted fetus. According to Pelcic et al (2016), The Moral Reflection on Vaccines published by the Pontifical Academy for Life states that vaccination should be avoided and using another alternative is encouraged. The Catholic Church has approved the “temporary” use of vaccinations, such as some rubella vaccinations, which could be produced from aborted fetal tissue cells. Nevertheless, the church also urges members to search into alternative vaccinations that do not use these cells. Thus, three vaccines derived from aborted fetuses are vaccine for Rubella, Hepatitis A and chicken pox. However, in the new document from 2017 Pontifical Academy for Life had issued an updated document regarding the use of vaccination. The Catholic Church has not opposed vaccinations in principle but does consider as morally illicit the development of vaccines from aborted fetal tissues.
Wombwell et al evaluated different religions, and the reasons why vaccines can violate their religious principles. The most common reason for why certain vaccinations contradict religious beliefs includes components of the vaccines. Most major religions including Islam, Judaism and large denominations of Christians have no stated opposition to vaccines. Some vaccine elements also raised many ethical questions. Many vaccinations including some vaccinations for measles, mumps and rubella (MMR) and varicella, or vaccines for chickenpox may contain gelatin derived from pigs. Most Muslims and Jews do not eat pork items. However, Judaism and Islamic religious authorities have said that the vaccinations are permissible.
Personal Beliefs or Philosophical Reason
Another common reason that some parents give to refuse or delay vaccination to their children is personal or philosophical excuses. In Figure 2, a recent study shows that the number of non-medical exemptions (NMEs) from childhood vaccines issued has risen in various states and major metropolitan centres. Researchers therefore believe that these areas are becoming more vulnerable to outbreaks of vaccine-preventable diseases. According to the National Conference of State Legislatures, 47 states have laws authorizing parents to exclude their children from having a vaccine if it violates their religious convictions and 18 states allow philosophical exemptions based on spiritual, family or other convictions.
Although this seems to be contradictory to human nature, there are number of people who see some benefit in making their children contract such preventable diseases. Many parents claim that their children’s natural immunity is stronger than that gained by vaccinations. Some express the conviction that if their child develops a preventable disease, it will be of long-term benefit to the infant, as it will help to improve the child’s immune system as it grows into adulthood. Some parents think the diseases we are vaccinating for are not very common and their children are at low risk of contracting such diseases. For this reason, they also believe that the potential negative side effects of administering vaccines outweigh the vaccine benefits. Many parents may not see the preventable diseases as extreme or life-threatening and would prefer not to bring additional chemicals into the bodies of their children. Some parents believe they are at a decreased risk of developing preventable childhood diseases if their children have safe diets and lifestyles. They are often believed that if they contracted one of the diseases it would be easy to treat.
Figure 2
Non-medical State Exemptions from School Immunization Requirements.
Note. There are 45 states and Washington D.C. that grant religious exemptions for people who have religious objections to immunizations. Currently, 15 states allow philosophical exemptions for those who object to immunizations because of personal, moral or other beliefs. Copyright 2019 by LexisNexis State Net Database and the Immunization Action Coalition.
Those with real moral objections to vaccination, however, do not constitute the entire danger to society. Many individuals have progressively taken these exemptions not on account of personal convictions, but simply because they are too lazy to vaccinate their children. Because these parents “do not explicitly bear [the] negative externality costs or damages” of losing herd immunity, they “do not take them into account when making their decision not to be immunized”[20]. In addition, thousands of parents have entered mail-order or fake religions, such as the “Congregation of Universal Knowledge,” so that they can apply for religious exemptions and do not go to the trouble of vaccinating their children (Anthony, 2008).
Safety Concerns
Concern about the safety of vaccine is not an old issue thus influence the acceptance upon vaccination for some people. Anti-vaccine activists have been shown to spread fears about vaccination, particularly regarding vaccine safety. There is still pervasive concern in our culture about the MMR vaccine casing autism and this secondary ‘experience’ may have an effect to the parents. While there is little evidence on the association between anti-vaccine websites and parents’ decision-making about vaccination, it is disturbing to know that studies have shown that parents who have postponed or rejected vaccinations are more likely to be those who have pursued internet awareness about vaccinations. Similarly, news about adverse outcomes with vaccinations, including those mentioned by the media, would impact parents’ levels of trust regarding vaccination. Media that identify issues with vaccine components (such as thimerosal) and suggest that vaccines can cause autism, brain harm or behavioral problems make parents more vigilant and have more questions about vaccine safety. Nevertheless, thimerosal has been withdrawn from all vaccines intended for children under the age of 6 for more than a decade now.
Safety concern regarding introduction to new vaccine also become the strongest predictor among vaccine-hesitancy parents. When a new vaccine is released, majority of parents did not want their child to be the among the first to vaccinate as they think the vaccine is still in the ‘trial’ set. Back in 2006, Human Papilloma Virus (HPV) vaccine was introduced in Malaysia respectively for female aged 9 to 40 years old. When it newly released, there was poor uptake of the immunization since it was done on voluntary basis. While it has been shown to be effective against cervical cancer and other cancers, this vaccine has a lower acceptability rating than other vaccines. The rise in the study’s vaccine refusal rates can be partially explained by the fact that the HPV vaccine was approved at the time of the second survey in 2013 and that more parents may have declined to use this vaccine for their children. The same phenomenon is recorded during the H1N1 vaccine was introduced in 2009. One of the reasons for vaccine-hesitancy parents may be the concept of awaiting the ideal vaccine concoction with high effectiveness and a reasonable safety profile. Until a new vaccine is proved safe in the long run, this aspect remains the most important in deciding the parents’ trust in vaccines.
Trust in Health System and Provider
In medical literature the word ‘trust’ has variety of meanings. To put it clearly in the sense of health and vaccines, when someone has insufficient or inaccurate knowledge, it is about taking a risk or benefit decision. Several studies have shown that vaccine hesitancy is closely related to the concept of trust in health practitioners and health care services, including the health care system and health care institutions. Trust in the health care system and health care providers, who prescribe the use of vaccines and determine the vaccination schedules, has a strong impact on the development of vaccine hesitancy among parents.
Certain potential causes include the use of imported products such as additives made from thimerosal, albumin or aluminum which can cause negative effects to the body. Uncertainty about the reliability and potential harmful effects of these constituents will play a role in parents’ vaccine hesitancy. However, porcine constituents are one of the main concerns for us, as they are against the ‘Halal’ concept in the religion of Islam, followed by most of our participants. There is a misunderstanding that the vaccines contain porcine DNA, which makes them impure and illegal for Muslims to use.
A crucial function for pharmacists and other healthcare professionals will be to provide reliable, accurate information on vaccines and to discuss such materials with parents. When parents do not obtain the information they want from their providers, they will seek information from other sources that may possibly confuse and misinform them, leading to poor choices that may affected their children.
Reasons to Get Vaccinated
From my point of view, I am strongly disagreed with this vaccine hesitancy issue because refusal to take vaccine brings more harm than good for our life. In this modern era, we can easily get knowledge and information at the tip of our finger mostly from the Internet but it is depending on us whether we can trust the sources or not. Research tells us parents have immunization concerns but it can be difficult to find credible sources with knowledge based on actual medical science. The amount of misleading or straightforwardly false information available on the Internet about the vaccines is nothing short of disturbing. Unfortunately, discerning what is true and what is not, can be difficult.
There are so many reasons why we and our generation should get vaccinated. Vaccine is existed to prevent the diseases and it is always better to prevent that to treat the disease after it had occured. Over the years, it is proven that vaccine has saved millions of lives by preventing countless cases of disease such as polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, rotavirus and Haemophilus influenzae type b (Hib). In addition to providing individual protection for those people who are vaccinated, vaccines can also provide community protection by reducing disease spread within a population as in Figure 3.
Figure 3
How vaccination protects the community.
Note. (A) A highly susceptible population in which a transmitting case is likely to meet a susceptible person leading to a chain of person-to-person transmission. (B) A highly immune population in which a transmitting case is unlikely to encounter a susceptible person, thereby breaking the chain of transmission and achieving indirect protection of remaining susceptibles because they are not exposed. From “Simply Put: Vaccination Saves Lives,” by W. Orenstein and R. Ahmed, 2017, Proceedings of The National Academy of Sciences, 114(16), p. 4031-4033. Copyright 2019 by PubMed Central.
Immunization can save your child’s life
Newborn babies are immune to many illnesses, since they inherit their mothers’ antibodies. Nevertheless, within the first year of life, the immunity goes away. If an unvaccinated infant is exposed to the germ of an infection, the body of the infant may not be healthy enough to prevent the disease. Before vaccines, many children died of diseases that are now prevented by vaccines such as whooping cough, measles, and polio. Nowadays, these same germs occur, but since babies are covered by vaccination, we do not see such diseases as much as we do. Most childhood vaccines are effective in preventing disease from 90 to 99 per cent. Even if a vaccinated infant is diagnosed with the disease, the effects are generally less severe than in an infant who was not vaccinated.
Table 1
Comparison of 20th century annual morbidity and currents estimates vaccine-preventable diseases
Note. Table 1 shows the effects of nine vaccine-preventable diseases in the United States, including smallpox and a complication of one of these diseases, congenital rubella syndrome, showing representative average numbers of cases in the 20th century relative to 2016. Reprinted from “Simply Put: Vaccination Saves Lives,” by W. Orenstein and R. Ahmed, 2017, Proceedings of The National Academy of Sciences, 114(16), p. 4031-4033. Copyright 2019 by PubMed Central.
Vaccines are truly one of the 21st century’s biggest advances in public health. Vaccines have significantly decreased the prevalence of certain diseases and removed other diseases that just a few years ago killed or seriously harmed people. Smallpox vaccination, for example, has eradicated this disease globally. Your kids no longer need to get smallpox shots, as the disease no longer exists anywhere in the world. By vaccinating children against rubella, we have significantly reduced the risk of transmission of this virus to newborn pregnant women. If we continue to vaccinate now, and vaccinate entirely, parents will have faith in the future that any diseases that still exist and present danger today will no longer be around in the future to harm their children.
Safe and Effective
According to a 2014 study from Centers for Disease Control and Prevention, over 732,000 children’s lives have been saved in the last 20 years due to routine vaccinations. Additionally, according to the study, 322 million cases of children becoming sick have been avoided. There is a debate risen that claimed vaccine can cause autism. Study have shown that there is no connection between autism and vaccine according to a study by Gerber and Offit (2009). A study by the CDC in 2013 added to the research showing that vaccines do not cause autism. During the first two years of life, the research investigated the amount of antigens (substances in vaccines that trigger the immune system of the body to develop disease-fighting antibodies) from vaccines. Results indicated that the total amount of antigen received from the vaccines was the same between children with autism and those without autism disorder.
One specifically studied vaccine ingredient is thimerosal, a mercury-based preservative used to prevent contamination of vaccine multidose vials. Research shows that thimerosal is not causing autism. Nonetheless, the final report of the Immunization Safety Review Committee in 2004 concluded that “the evidence supports denying a causal association between thimerosal – containing vaccines and autism.” There have been nine CDC-funded or conducted studies since 2003 that have found no link between thimerosal-containing vaccines and autism, as well as no link between the vaccine for measles, mumps, and rubella (MMR) and autism in kids. Thimerosal was removed or reduced in all childhood vaccines between 1999 and 2001 to trace amounts, except for certain flu vaccines. This was done as part of a broader national effort to reduce all kinds of exposure to mercury in children prior to studies that determined thimerosal was not harmful.
Before a vaccine is distributed to the population, it has gone through a lot of tests and evaluation which takes a long time to prove its safety and effectiveness. The safety testing includes Testing and assessment of the vaccine prior to being approved by the Food and Drug Administration (FDA) and recommended for use by the Disease Control and Prevention Centers (CDC). Apart from that, the vaccine’s safety to the infants, children and adult also has been monitored after recommended.
Childhood Vaccine Contribute to Herd Immunity
Herd immunity is an essential tool for protecting the larger population. If enough people are resistant for such disease then the spread of the disease will be decreased or eliminated. This is particularly so for diseases like rubella and pneumococcal disease. High coverage of the vaccines must be preserved to prevent the disease from re-entering the population. The direct results of vaccination usually apply to the vaccinated individual’s own protection, resulting in decreased risk of infection, and likely complications. The indirect benefits of vaccination, by comparison, apply to protective effects found in unvaccinated populations. By way of contrast, the indirect advantages of vaccination contribute to protective effects found in unvaccinated populations. The whole principle is when we take vaccination, we not only protect ourselves but also the community around us by preventing the transmission of the disease especially people who are immunocompromised such as babies, people with vaccine allergy and immune-suppressing disease like HIV or cancel because they cannot get vaccinated.
Some vaccines do better than others in generating herd immunity. The vaccine for measles, mumps, and rubella (MMR) is effective in preventing measles by 97 per cent. Moreover, when many people in a group get this vaccine, the levels of safety remain high. The flu vaccine is very different. It is successful in any given year just around 40 per cent to 60 per cent. This is because the virus strains in the vaccine often do not exactly match the spreading virus. Often, the flu vaccine is perfect for protecting small groups of people like in our home, workplace or school.
If a person is resistant to a disease they may serve as a barrier for slowing down or preventing disease transmission to other people. It is called the herd immunity threshold (HIT) when the number of people in a population that are immune to a disease is reached, so that a disease no longer exists in the population. Table 2 shows the HIT for several diseases.
Table 2
Herd Immunity Thresholds of vaccine-preventable disease
Note. Measles and pertussis are extremely infectious respiratory diseases so to avoid transmission a greater percentage of people need to be vaccinated. Regardless of this these diseases must hit the highest HIT level. For example, two doses of measles vaccine provide 99 percent protection, while the lifetime risk of infection is nearly 100 per cent in the absence of immunization.
Conclusion
Vaccination rejection among parents is emerging globally, regardless of religious or political context or geographic location. The number of religiously qualified vaccination refusals is growing. The problem is whether religious freedom poses a danger to public safety, in this case to the vaccination program. As shown in Figure 4, with only 5 states in the US not providing vaccine exemptions for religious convictions, this represents a significant challenge for those trying to raise childhood vaccination levels. Although there are other reasons that also play a role in vaccine hesitation by parents, we need to consider using religious reason is getting more attention day by day. This argument is especially difficult to dissuade from seeing as it is specifically associated with the parent’s core religious values and moral universe, as opposed to be an option based on ignorance. Hesitancy due to religious affiliation is typically related to a complete rejection of all vaccinations rather than a specific form.
When pharmacists and other healthcare professionals can consider the parents’ key concerns regarding vaccinating their babies, they will be better equipped to have detailed immunization conversations. Children will also be able to provide their children with the knowledge parents need to make the best-informed decisions. People who decline to vaccinate or who reject vaccines care for their kids and want to do what they can to protect them, just like any other parent. This information would allow patients to have direct access to reliable information which will help them make the right decisions for their families.
Most significantly, from my point of view, if parents opt not to vaccinate their child, they are not only potentially harming their own child, but probably exposing other children and families to diseases that are no longer expected to have a place in our time. This will not make vaccination a personal decision but a decision that affects the entire population.
Figure 4
Most states in the US allow religious exemptions for childhood vaccine.
Note. As of June 2019, Maine’s law barring nonmedical exemptions takes effect September 2021. From “Amid Measles Outbreak, New York Closes Religious Exemption for Vaccinations- But More States Retain It, by Aleksandra, 2019. Retrieved 23 July 2020, from https://www.pewresearch.org/fact-tank/2019/06/28/nearly-all-states-allow-religious-exemptions-for-vaccinations/. Copyright 2019 by Pew Research Center analysis of state regulations.
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