18th Mar 2016 MC IT

Vaccinations: Controversy or Common Sense?

Salk's-polio-vaccine_1955 Our children’s health is such a worry for us as parents. It’s surrounded by emotion, conflicting advice and confusion. Nowhere is this confusion more apparent than the topic of vaccination. I vaccinated all my five children and I’m a strong believer in vaccination to protect our children’s health. But I’ve been on the sharp end of the vaccine debate myself, and faced criticism for my choices.

So I wanted to delve a little deeper into the history and research behind vaccination and look at the reasons for the different vaccination advice in difference countries. What are the benefits of vaccination? What, if any, are the risks? And what are the risks of not having your child vaccinated?

How do vaccines work?

Most of us probably remember studying Edward Jenner in school and know the basics of how a vaccine works. It’s a substance that contains a very small amount of a disease; these days a weakened, harmless form of it, or a synthetic reproduction. The body is able to react to this weak form of the disease to develop immunity without actually catching the disease.

Since they became widely available in the 1920s, vaccines have saved more lives than any other medical product, dramatically reducing or even wiping out serious diseases like small pox, tetanus, whooping cough, measles, polio and diphtheria. Vaccination also develops ‘herd immunity’, meaning that levels of a disease are so low or non-existent in a community that even the small number people who haven’t been vaccinated don’t catch the disease.

  N031_1242_006 So what’s the controversy?

A procedure that protects us from serious disease might seem like a no-brainer. But since their widespread introduction, there has always been some level of fear surrounding vaccination, sometimes fuelled by medical scares that cause people to doubt the safety and benefits of vaccines. This can lead to rates of certain diseases rising at times as fewer people vaccinate their children.

Perhaps it’s the thought of deliberately infecting our children with a disease that worries us, or the fact that some vaccines do have potential side effects which we are exposing our children to voluntarily. When I was a child, my mother didn’t want me to get the tuberculosis (TB) vaccine because she feared it would cause adverse side effects and scarring.

But the consequences of catching TB can be serious, even fatal if untreated, and despite vaccination and antibiotics, it’s on the rise again in the UK, so I had no issues with protecting my children from it when they were vaccinated.

 Vaccine fear and the discredited MMR scare

A recent surge in vaccine fear was fuelled by fraudulent research published in 1998 by the now completely discredited medical researcher Andrew Wakefield. Wakefield made a connection between the MMR (measles, mumps and rubella) vaccine and autism. These findings have since been completely disproved and Wakefield struck off the UK medical register for falsification.

But unfortunately the dangerous legacy of Wakefield’s fraud persists, with many parents still nervous of the MMR jab, and of vaccines in general.

  rotary-voa-salk Are there any risks if I vaccinate my child?

Vaccines do sometimes have side effects, but they’re usually very mild; a slightly raised temperature or some swelling are quite common in children. In some very rare cases, a child may have an allergic reaction to a vaccine, usually just a rash that a doctor or nurse can treat. More serious reactions are even more rare, with fewer than one in a million people experiencing them.

 So what are the risks of not vaccinating?

Even though the risks of a reaction to a vaccine are small, some parents are tempted to avoid those risks altogether by not vaccinating, relying on our herd immunity to protect their children from the disease. But herd immunity isn’t foolproof, and not vaccinating means children are exposed to diseases that can cause serious illness, disability or even death.

The rise in the number of children who aren’t vaccinated also compromises herd immunity, putting those who can’t be vaccinated for medical reasons at risk too.

The confusing case of chickenpox

Chickenpox is usually a mild infection that causes an itchy rash and sometimes a temperature and aching muscles. Children usually recover quickly and develop immunity to the disease. It used to be common and was even been seen as a bit of a childhood rite of passage.

But in some rare cases, chickenpox can lead to serious complications. It’s particularly dangerous for people with weakened immune systems and for pregnant women, where chickenpox can cause serious birth defects in the unborn baby.

There is a chickenpox vaccine, which is routinely available in the USA but not the UK. I came up against this confusing conflict with my own children.

5019042002_abe1a21a3e_o-624x436 My first four children were vaccinated in the USA, where the chickenpox vaccine is standard. But when it came to vaccinating my fifth child we happened to be in the UK, and I simply wasn’t aware that he wouldn’t receive the chickenpox vaccine as part of his routine health care. Unfortunately, he caught the disease, and I was heavily criticized in the US for not having vaccinated him.

Luckily my son made a full recovery, but I regret not getting him this vaccine. The experience made me question why this important protection is not offered in the UK.

Before the chickenpox vaccination was made available in the USA in 1995, 4 million people were infected every year with around 10,600 hospitalized and 100 to 150 dying from the disease. These figures dropped drastically with the arrival of the vaccine, with an 82% decline in infection rate from 2000 to 2010 and deaths from chickenpox declining 98.5% in children.

 The benefits seem obvious; even in mild cases the symptoms of chickenpox are extremely unpleasant for suffering children and often mean parents have to take time off work for prolonged periods, as infectious children are not allowed at childcare. The World Health Organization even lists the chickenpox vaccine as an Essential Medicine.

So why in the UK is this vaccine not routinely offered? Around 20 people die every year from chickenpox in the UK.

The argument against routine chickenpox vaccination in the UK comes down to the effects of the disease on adults. Chickenpox can be much more serious in adults who didn’t develop an immunity as children, and even adults who were infected in childhood can go on to develop shingles, a very unpleasant disease.

The UK’s argument goes that if most of the population is vaccinated, some children will be missed because they can’t receive the vaccine for health reasons, or because their parents choose not to vaccinate. They are less likely to catch chickenpox as children, due to herd immunity, leaving them vulnerable to catching it much more seriously as adults. And adults who have chickenpox immunity due to catching it as children can get a ‘boost’ to that immunity through contact with children suffering from it, increasing their resistance to shingles, a boost that won’t happen if the disease is all but eradicated.

But the evidence from the last 20 years in the USA suggests that the rate of chickenpox and shingles in the adult population isn’t rising, so the evidence may rapidly make the UK’s stance outdated.

If you’re in the UK, you can get the chickenpox vaccination on the NHS if you or your child come into regular contact with someone at high risk from the disease. If you don’t qualify, you can pay privately for the vaccination, which costs around £120. I wish I’d done this for my son so that he could have avoided the disease altogether.

I know from my own experience that the subject vaccination is complex and can be worrying, but I believe getting informed about it can remove much of that worry. Here are some great resources I’ve found useful when reading about this subject.

Dr Ben Goldacre, a British academic and doctor, on the MMR / Autism scare

The Routine Immunisation Schedule in the UK, with information on what vaccines happen when, and what brands of vaccine are given.

Information on the chickenpox vaccine from the Oxford Vaccine Group in the UK.

Information and links on vaccines from the World Health Organization.