The Anti-Vaccination Movement is One Outcome of Profit-Driven Medicine
In the past few years, media has spent a lot of time focusing on a small but rapidly growing number of parents refusing to follow the ‘expert’-approved vaccination schedules for their children. Even many self-proclaimed normal people (stupid morons) like to demonstrate their “normality” by condemning parents who do so without trying to understand what is the major driving force behind this newish phenomena.
But why is the modern anti-vaccer movement a newish phenomena? Haven’t there been anti-vaccers since the original smallpox vaccine was introduced in the 1800s?
And this brings me to my first point. While there have been ‘anti-vaccers’ as long as there have been vaccines, the traditional ones opposed vaccinations for reasons that are quite different from most of those who do so today. The traditional anti-vaccers saw vaccines as un-religious, un-traditional, immoral or somehow opposed to their mental model of the universe. While people like that are still around, the majority of anti-vaccers today are driven by a very different set of concerns about vaccinations.
These concerns are based on a very realistic assessment of the intentions of those who promote an ever-expanding vaccination schedule than pleasing an imaginary skydude.
The real conflict is not about the science behind vaccination. Sure, you will always come across a few especially loud and fervent believers in invisible sky-dudes. But the majority of anti-vaccers today are not scientifically illiterate or any more delusional than the ‘experts’ who oppose them.
The conflict is about which vaccines are suitable for general use based on a realistic evaluation of the risk-benefit ratio of that particular vaccine.
Let me explain that point with a few examples. How many of you have been vaccinated against botulism (all subtypes), anthrax, epidemic typhus or yellow fever? Effective human vaccines against these diseases have been around since at least the mid-1940s. So why don’t we vaccinate everybody against these diseases along with diptheria, tetanus, whooping-cough, chickenpox etc? Or what about rabies? We have multiple extremely effective human vaccines against that disease, yet they are used almost exclusively as post-exposure prophylaxis. People who work with lots of wild or domesticated animals such as veterinarians or people who hang around bats are among the few who take it pre-exposure. Or what about smallpox? Why did we stop mass vaccination against smallpox once the disease was eradicated?
It is about the benefit-risk ratio of a given vaccine versus the probability of encountering that pathogen in the real world.
For example, the bacteria that cause tetanus or diptheria are found in soil and can survive without human hosts. We simply cannot eradicate them. In the absence of vaccination they can cause life-threatening and often fatal disease at a level serious enough to prominently show up on the mortality statistics. The same is true about whooping-cough, though it is more about the morbidity than the mortality. Even less problematic diseases without an inanimate reservoir (chicken pox, measles, mumps, rubella) can be problematic because of their hyper-infectiousness and ability to travel across the world inside their human hosts.
But what about pathogens (Neisseria meningitidis, Haemophilus influenzae type B) that are uncommon? what about pathogens that are not endemic (Hepatitis A, Hepatitis B) to entire countries? Should we vaccinate everybody against these diseases or just restrict ourselves to epidemiologically defined high-risk groups? It certainly makes a lot of sense to vaccinate teenagers attending university or joining the army with the meningococcal vaccine. Similarly vaccination against HepA and Hep B make a lot of sense if you are going to visit a country with low levels of sanitation. But why everybody?
Then there is the issue of partially effective vaccines such as those against especially pathogenic stains of Streptococcus pneumoniae, HPV and rotavirus. While few doubt that vaccines against the worst rotaviral strains reduce the risk of severe diarrheal illness in children, they are often pushed by the medical profession to be far more effective than they really are. The same is true of vaccines against HPV. While the vaccine will certainly reduce the incidence of cervical cancer it won’t have much effect on the less problematic stains of HPV that also cause genital warts. However it is frequently pushed as an anti-genital warts vaccine rather than as one to reduce the risk of cervical cancer.
Let us also talk about vaccines that work as designed, but not as well as intended. Vaccines against Influenza A are the best example of this peculiar and problematic class. While they do indeed elicit a good immunologic response against the strains utilized in their creation, the antigenic drifts characteristic of influenza epidemics make many of them partially or totally ineffective by the time the epidemic reaches the vaccinated individuals. Sure, you can get some cross-protection if the strain infecting you is similar to the one you were vaccinated against- but that is about it. Yet each year, we spend tons of money and resources on vaccinating people against influenza. It certainly does not help that a lot of people vaccinated against influenza go on to later fall ill from strains they were not vaccinated against.
The problem with the public image of vaccination has little to do with the science behind it. Instead the problem lie in human follies such as trying to make the maximum amount of money by pushing vaccines for uncommon diseases and promising stuff that is based in marketing rather than hardcore science.
It certainly does not help that the healthcare education system is some countries, such as the USA, selects for people who make decisions based in monetary and legal considerations to the exclusion of patient welfare. It is a game of who can extract the most money while still looking good and legal, irrespective of whether they are helping the patient or not. While not all physicians are like that, the ones who end up on committees and expert panels are frequently the worst suited to be on them. The defensiveness and misplaced elitism of physicians also does not help the cause of promoting evidenced based medicine, including vaccination.
In conclusion, the modern anti-vaccination movement is a reaction to the almost exclusively profit driven and legalism ridden medical systems seen in countries such as the USA.
What do you think? Comments?