By Glenn Ellis
It’s that time of the year when, between back-to-school and flu season, the conversations for and against vaccines really heat up.
Let me be clear at the outset, the purpose of this column is not to advocate one or the other (even though I do have my own personal opinion). This column is simply to bring a broader context of facts into the discourse.
To begin with, let’s look at vaccines, their history, and their purpose.
According to data from the Centers for Disease Control and Prevention “at the beginning of the 20th century, infectious diseases were widely prevalent in the United States and exacted an enormous toll on the population. For example, in 1900, 21,064 smallpox cases were reported, and 894 patients died. In 1920, 469,924 measles cases were reported, and 7,575 patients died; 147,991 diphtheria cases were reported, and 13,170 patients died. In 1922, 107,473 pertussis cases were reported, and 5099 patients died.”
Keep in mind that in 1900, the leading cause of death was infections, in large part due to the lack of public sanitation and hygiene. As infectious diseases continued to spread during this period, few effective treatments and preventive measures existed. Thus, the death rates from infectious diseases continued to skyrocket.
Since 1900, vaccines have been developed or licensed against 21 other diseases. It is important to mention that 10 of these vaccines are recommended for use only in selected populations at high risk because of the area where they live, their age, their medical condition, or certain high-risk behaviors.
Today, one of the most controversial topics in medicine and healthcare is vaccines! Doctors; nurses; parents; politicians; activists; the young and the old – everybody is on one side or the other of the argument.
But I believe it time to remember what our society was like before vaccines.
Neglected Tropical Diseases
As of this writing, Vaccine Nation, the organizer of the World Vaccine Congress, released a list of 10 most important infections with no licensed vaccine. Most of these infections belong to a category known as neglected tropical diseases, or “NTDs,” which disproportionately affect the poorest people living in resource poor countries. For the most part, living in the United States, we are relatively unlikely to ever encounter any of these.
Granted, there are some infectious diseases that there is no vaccine in existence to treat them with, but there are quite a few which exist that have made the world a healthier and better place.
It’s hard to convince a parent to give their child a polio or a measles vaccination if they have no idea what these diseases can do to the human body. So, let me offer a brief review of just a few of those that are treatable with vaccines:
The no. 1 culprit was polio, a crippling and potentially deadly infectious disease that is caused by poliovirus. The virus spreads from person to person and can invade an infected person’s brain and spinal cord, causing paralysis. Polio reached epidemic proportions in the early 1900s. Because of widespread vaccination, polio was eliminated from the Western Hemisphere in 1994. I, personally, am old enough to remember public campaigns showing wards filled with children in mechanical tubes, called” iron lungs”, just to be able to breath, and others with braces on their crippled legs in order to walk. There was little effort required to have students at schools to stand in line and be administered a sugar cube with the polio vaccine on it.
Tetanus (or lockjaw) is a disease of the nervous system caused by bacteria called clostridium tetani. Generally, between 10 percent and 20 percent of tetanus cases result in death, though fatalities are more likely among patients older than 60 years of age, and among unimmunized individuals. After approximately eight days (ranging from three to 21 days), it begins to short-circuit nerve signals and block the relaxation of muscles. This results in sustained muscle contractions, notably the lockjaw for which tetanus is nicknamed.
Spasms of the jaw or facial muscles may follow, spreading to the hands, arms, legs, and back and blocking the ability to breathe. Spasms are often precipitated by noise or touch. Once tetanus has spread, the mortality rate is approximately 30 percent, even with modern medical facilities.
Rounding out the top three is the flu (influenza). This is a respiratory illness caused by the influenza virus that infects the nose, throat, and lungs. The 1918 influenza pandemic was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. It is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States. The CDC estimates that since 2010, flu-related hospitalizations among children younger than five years have ranged from 7,000 to 26,000 in the United States.
Each year, health researchers update the seasonal vaccine to include the most current influenza virus strains that are infecting people worldwide. The fact that influenza viral genes continually change is one of the reasons people must get a flu vaccine every year.
Bottom line: The world before vaccines is a world we can’t afford to forget. Without vaccines, just as we are seeing with measles, epidemics of vaccine-preventable diseases would return.
Glenn Ellis, is Research Bioethics Fellow at Harvard Medical School and author of Which Doctor?, and Information is the Best Medicine. Listen to Glenn, on radio in Birmingham or V94.9, Sundays at 7:50pm, or visit: www.glennellis.com.