To vaccinate or not to vaccinate? It’s a question that has sparked a heated debate that just won’t die down. It seems the whole world is polarized into one of two groups – pro vax or anti vaxxers (as they’re popularly referred to). Irrespective of background or socio-economic status, the subject of vaccination is a controversial one. The pro group deems it necessary – even vital for our health – while the anti group argues that vaccines are avoidable and, in some cases, dangerous. But is one group right and the other wrong? Or is there a middle ground that the two groups have failed to notice? We asked two pediatricians to address the common arguments and concerns in the vaccination debate. Here are their answers to the tough questions.
Read on to hear from Dr. Rita Kovesdi, Consulting Pediatrician with a Specialist Degree in Infectious Disease, at HealthBay Polyclinic in Dubai, and Dr. Jay Gordon, MD, Fellow of the American Academy of Pediatrics, author, and member of the teaching attending faculty at UCLA Medical Center and Cedars-Sinai Medical Center.
How safe are vaccines?
Dr. Kovesdi: Any vaccination may have side effects. However, they are usually minor ones such as fever, soreness from the injection and, in some cases, rashes. Allergic reactions, on the other hand, are extremely rare, although they may occur if someone is allergic to one or more components of the vaccine. More importantly, vaccines can save people’s lives. This is what we have to focus on. Approximately two to three million lives are saved annually due to vaccination.
This is how they work: Usually, when a pathogen (a harmful bacteria or virus) attacks the body, it takes the body some time to gather enough antibodies to defeat the infection. Because vaccines contain the same antigens found in the virus or bacteria itself (but in a weakened or dead form), they are able to help the body recognize the pathogen faster and provoke it to produce the antibodies needed to protect itself and do it in a safer manner.
Dr. Gordon: Vaccines are a relatively safe medical intervention, but after all, every single medication, surgery, or vaccine carries some risks. The problem is the way we administer vaccines now, which does not, in my opinion, minimize those risks. We give six vaccines at the same time to six-week-old babies! I also think that combining three live virus vaccines into one shot (MMR) is not the optimal way to protect against these three illnesses.
Are the ingredients in vaccines harmful?
Dr. Kovesdi: No. Sometimes, some vaccines may contain some preservatives, however dangerous ingredients – such as Thiomersal, which was previously blamed for its many side effects – have been removed from the ingredients of vaccines. In fact, nowadays, all the newer vaccines are free from any dangerous components.
Dr. Gordon: We don’t manufacture vaccines as well as we could. Yes, we’ve eliminated mercury from virtually every vaccine, but we still have too much aluminum in them. This ingredient may not be a high-risk chemical, but it has been shown to increase the incidence of certain autoimmune phenomena. So, the real problem is that vaccines aren’t manufactured as well as they could be. And the manufacturers have no product liability and therefore little incentive to improve their products.
If Hepatitis B is a sexually transmitted disease, why do we administer its vaccine to newborns?
Dr. Kovesdi: Because it can also be spread through other forms. Some people are carriers of the virus without having any symptoms, and when a pregnant woman carries it unknowingly, at birth the virus can be transmitted to the newborn, potentially causing the baby critical illness or even death. Other forms of spreading Hepatitis B include blood-to-blood contact, which can occur in the case of newborns as well as toddlers – the latter of which can occur through injuries at nursery. In order to maximize the effectiveness of preventing the Hepatitis B infection in newborns, the vaccination should be administered within the first 24 hours of birth as recommended by the American Academy of Pediatrics (AAP).
Dr. Gordon: In the 1980s, there was a campaign to get all high-risk adults to come in for Hepatitis B vaccination. This failed. The decision was made that it would be in the best interest of national health to vaccinate the patients we have: newborn babies. This has worked to reduce the incidence of Hepatitis B. If you are asking me if this is the very best timing for each individual baby, my answer is no. I prefer to give that vaccine later in childhood when we can discuss with the pre-teen or teen exactly what the vaccine does and what it does not do.
Do vaccines weaken our immunity?
Dr. Kovesdi: Vaccinations undoubtedly make our immunity stronger. When individuals are vaccinated/immunized, their immune system responds faster to that specific virus or bacteria because the vaccine already contains part of the virus or bacteria in it. The presence of this antigen in the vaccine allows for an immediate and active way for our bodies to fight the viruses and bacteria by provoking the body to produce specific anti-bodies that are used to fight the infection.
Dr. Gordon: I think that naturally acquired immunity may be better than vaccine-induced immunity. Obviously, this is not practical for dangerous illnesses. For some childhood diseases, like chicken pox, many countries have decided that vaccinating could take a relatively benign childhood illness and move it into adulthood where it could cause far more consequences. But generally speaking, vaccines disrupt normal immune-system function and, in rare occurrences, can actually lead to more vulnerability to infectious diseases, although this last issue is uncommon.
Let’s lay this one to rest: Can the Measles Mumps and Rubella (MMR) vaccine cause autism?
Dr. Kovesdi: To date, there is no evidence to support the theory that certain vaccines cause autism. In fact, the findings of a recent study (the largest of its kind) in Denmark that compared more than half a million MMR-vaccinated and MMR-unvaccinated children over a period of ten years found that there was no evidence of autism in vaccinated children.
Dr. Gordon: Autism, along with type one diabetes, autoimmune arthritis, lupus, and similar medical conditions have a genetic predisposition and environmental triggers. Dr. Wakefield’s study [an infamous study by Dr. Andrew Wakefield and his colleagues was published in 1998 in a British medical journal, Lancet, but was retracted 12 years later] showing a connection between vaccines and autism is so badly flawed that it should have been published as a one-paragraph letter to the editor suggesting that we study thousands more children. Instead, it became a major publication in the most prestigious medical journal in the world. That was wrong and I base nothing I do on that published research. Flame retardants, pesticides, plasticizers, and more are triggers to childhood disease. But I do think that, for a small percentage of children, vaccines could trigger regression.
If certain diseases are eradicated, why do we still give the vaccines for them?
Dr. Kovesdi: The polio virus, for example, is still not eradicated in certain parts of the world. Therefore, within hours, a traveler can bring it from one part of the world to another, which would be disastrous to non-vaccinated individuals, as it can lead to polio paralysis and death. Also, if these vaccinations were stopped, polio and other diseases would re-enter communities with full speed and strength, causing millions of fatalities.
Dr. Gordon: Polio is now confirmed in Afghanistan and Pakistan. While getting the vaccine for it offers an extremely small risk for the receiver, it could be argued that the benefit to healthy children taking it in Western countries is also close to zero. I understand the need to set an example for the rest of the world and I don’t want to change national policy, but I do think that the choice to opt out of polio vaccinations is a reasonable one. Having said that, I certainly would like to continue and improve polio vaccination programs in the Third World.
If some diseases are harmless – like chicken pox, rubella, or rotavirus – why are vaccines necessary for them?
Dr. Kovesdi: Who said that these diseases are harmless? While they are usually mild, most people do not know how many others have died from these diseases before their vaccinations were available, as such information was not shared with the public. As an Infectious Diseases specialist, I have first-hand knowledge of these figures, and an absolutely healthy child can die from any of the above-mentioned diseases if they come into contact with them and are not vaccinated against them. This is why it is necessary to vaccinate individuals against chicken pox, rubella, or rotavirus, among many other diseases.
Dr. Gordon: While these illnesses might create very little risk for healthy children, there can be complications when there are tens of thousands of cases. For instance, chicken pox still creates fatalities – especially in the Third World – every year. Rubella was eradicated from the United States about ten years ago, but prior to that, many fetuses and infants were damaged by that illness if the mother contracted rubella at a certain stage in her pregnancy. Rotavirus is dangerous to less-healthy babies and can even be fatal.
Do you think that vaccines for each child should be evaluated and administered differently depending on the child’s genetics, pre-existing conditions, and biology?
Dr. Kovesdi: Definitely. Each child should be thoroughly checked before vaccinations are administered, as their requirements may differ based on their pre-existing conditions and biology and this can only be judged by a medical professional. For this reason, it is best that children are vaccinated by their own pediatrician, who knows them well, knows their medical history, and has records of their early years and growth.
Dr. Gordon: Our genetics are different and our responses to vaccines are different. In younger patients, responses to vaccinations are very different to what they would be in older patients. To me, one of the most important factors to consider is family medical history. History of adverse reactions to vaccines and also incidence of autoimmune diseases within the family must be considered and discussed with the family.
Should parents have a say on what vaccines to give their kids?
Dr. Kovesdi: Yes, I think parents should definitely have a say on what vaccines to give their kids, however only after a thorough discussion with a medical professional and not through their own internet research. If parents receive the right professional advice and are properly informed about vaccinations, I am certain – based on my own personal experience as well – that they are likely to follow the right advice and vaccinate their children.
Dr. Gordon: Vaccination, like virtually every other medical intervention, carries some risk – but most experts would agree that it is quite small. Nevertheless, parents must participate in this and every other medical decision.
Between the pro and anti-vaccine groups, is there a middle ground? If so, what is it?
Dr. Kovesdi: No, I do not think that there is any room for flexibility whatsoever, but you are asking the person who has a degree in infectious diseases and is completely pro-vaccine! Obviously, some vaccinations can be prioritized or postponed upon request, but they should still be administered at some point. I assume people that are against vaccinations have probably never been in the middle of an epidemic like measles or polio, and therefore are unaware of just how many lives are being saved on a daily basis thanks to the vaccines in place. Anti-vaxxers should stop reading opinions on the internet and take it as legitimate medical advice. I urge them to consult with their pediatricians because they are putting the lives of their children as well as our own at risk.
Dr. Gordon: I am the middle ground: I give vaccines every day and have received them routinely during my travels for medical work in Ethiopia, South Africa, and Nepal. I have recommended that families living in the midst of a measles outbreak (or a pertussis outbreak) vaccinate their children even if they might have planned to refuse or delay giving these shots. However, I never give six vaccines at a time. I prefer to start later and go slower. I also encourage families to consider their travel plans, family history, and accept the very small but real risk of delaying certain vaccines.
The problem with the vaccination debate is that the two sides are unwilling to understand each other. We need doctors and healthcare professionals to listen to their patients and understand that their concerns are valid and coming from the perspective of worried parents. Similarly, we need patients to trust their doctors more. Perhaps vaccination isn’t an all-or-nothing decision. Spreading out the shots while considering our family history when it comes to certain vaccines seems like a smart – and reasonable – compromise.