Say “Yes” to Vaccines, for Your Children’s Sake

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Science and statistics have time and again shown that vaccination does prevent certain diseases. But why are so many parents still not listening?

The recent outbreak of diphtheria, a vaccinepreventable disease, in June and July this year has worried the whole nation. As of July 27, the total number of diphtheria cases nationwide stood at 25 including five deaths1, with Kedah topping the list with eight cases and one death.

The tragic news about 11-month-old baby, Muhammad Rushaidi Rizqi from Sungai Petani, passing away from diphtheria2 ignited much public debate about the National Immunisation Programme for children, which was introduced more than 50 years ago (Table 1 and Figure 1). It was found that Rushaidi had not completed his scheduled vaccinations.

Incidentally, Kedah had the highest number of vaccine rejections in the country with 318 cases in 2015 – 79 more than the preceding year3. The cases of parents refusing to vaccinate their children also increased from 470 in 2013 to 1,054 by May 20154. According to the president of the Family Medicine Specialists Association of Malaysia, Dr Norsiah Ali, the number of cases for vaccinepreventable diseases such as measles, pertussis, tetanus and diphtheria, has also increased in line with the trend of vaccine rejection.

The anti-vaccine movement is obviously gaining ground, despite numerous sources of credible health information either in the press or online indicating the health benefits of receiving vaccination. Still, antivaxxers continue to dissuade people from vaccinating their children on the ground of side-effect(s), religion (halal doubt) and conspiracy theories.

The most common and damning allegation is the association of the MMR vaccine with autism, despite the claim being conclusively and repeatedly denounced by prestigious professional bodies and health authorities based on scientific consensus and reviews. The publication paper was also fully retracted by The Lancet in 2010, and the author Andrew Wakefield was reported to have multiple undeclared conflicts of interest, manipulated evidence and behaved unethically. In 2011 the alleged autism-vaccine connection was called “the most damaging medical hoax of the last 100 years”5.

During the onset of the diphtheria outbreak in June, the former contestant of the local Imam Muda reality TV series, Ammar Wan Harun, took to his Facebook page and openly mocked and belittled the health benefits of vaccinations6. There was also a front-page paper headline, “Kami Takut Vaksin” (We Fear Vaccines)7, reporting a sensational story about a child who did not behave normally after receiving the third dosage of vaccination. Unfortunately, these acts did nothing but stoke fear among the public, seeding doubts to mislead and “encourage” more parents to reject vaccines. Some even suggested that immunity can be built naturally, therefore questioning the need to introduce “foreign” particles or pathogens into the bodies of their children; instead, they promote a healthy lifestyle to defend the body against real pathogens.

No doubt, innate immunity is the inbuilt first line of defence for human beings. Although it is very important, innate immune cells (macrophages, dendritic cells, neutrophils, mast-cells, etc.) are not specialists. An adaptive (or acquired) immune system is absolutely required to contain some specific deadly pathogen attacks. It can be acquired only through “learning” – by encountering and recognising some features of particular pathogens, such as its surface antigen; then only can the “specialist” effector or memory T and B cells be tailored to act against wildtype and virulent pathogens swiftly and effectively in the next encounter. Antibodies can also be released to target and contain the pathogen.

Usually, a vaccine is made up of small quantities of attenuated or inactivated pathogens, added with adjuvants to elicit an immune response from the host body. It is always better to vaccinate children rather than to let them be directly exposed to the wild-type and potent disease-causing pathogens. Just practising a healthy lifestyle will not help build the adaptive immune system against corresponding diseases.

Recommended vaccines listed in the WHO’s Expanded Programme on Immunization (EPI) are effective. The success stories of vaccines that greatly reduce child mortality in the modern era are well documented. Before the introduction of the measles vaccine in 1983, Malaysia saw 9,268 cases of measles (1982,) but in 2014 the number was down to only 221. That is a whopping 97.6% reduction in measles cases, and this is more impressive given that the population size today in absolute terms is bigger than in the 1980s. There is overwhelming evidence that immunisation is one of the most successful and cost-effective health interventions known. In fact, smallpox was successfully eradicated through concerted vaccination efforts – one of the greatest accomplishments in medical history.

Child with measles. Before the introduction of the measles vaccine in 1983, Malaysia used to have 9,268 cases of measles (1982,) but in 2014 the number was down to only 221.

The WHO estimates that 29% of deaths among children aged 1-59 months (1.5 million in 2013) were vaccine-preventable. In fact, 194 member states of the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP) 2011-2020, which aims for universal access to immunisation by 2020. GVAP aims to strengthen routine immunisation to reach vaccination coverage targets for individual member countries. The WHO is dedicated to monitoring and surveying vaccine-preventable diseases in the world, and ensuring that immunisation targets are being met.

When a large proportion of the population is immune to an infection, herd immunity gives indirect protection even to individuals who are not fully immunised against certain infectious diseases. For example, an individual who is immune-compromised or has experienced only partial efficacy from a certain vaccine would be protected because the likelihood of encountering any sick patient is low. So, when the disease burden in the largely immune population is low, chains of infection are likely to be disrupted, thus stopping or slowing disease dissemination. That is why the national immunisation programme is commonly a top priority for health policymakers, because “prevention is better (and cheaper) than cure”.

The Ministry of Health spent RM130mil just on the national immunisation programme in 2015 alone. Although vaccination is not a mandatory school entry requirement, schools will check the immunisation status of the children at enrolment, and routine immunisation is given at school. Unprotected children are in the most vulnerable risk group to communicable diseases, especially when they gather and interact with each other in a confined space. Therefore, exercising one’s “freedom” in opting out recommended scheduled vaccines should not be allowed for the sake of herd immunity.

Modern vaccine development goes beyond Edward Jenner’s method of cowpox inoculation. Now it is an established discipline of evidence-based scientific pharmaceutical research. Millions of manhours and billions of dollars have already been spent in this intensive field in search for the next breakthroughs. Not all infectious diseases can easily find a counterpart vaccine; the best elusive example is HIV.

The public should understand that in order to have a vaccine sold in the market, it has to pass through at least three stages of clinical trials according to the WHO guidelines. A responsible drug authority has to act as the gatekeeper for the public and perform stringent safety checks and monitor the possible side-effects of any drugs – including vaccines. In the US, this is the duty of the Food and Drug Administration (FDA), while in Malaysia, the equivalent department is the Drug Control Authority (DCA).

In the process of vaccine development, many well-controlled and designed studies are also carried out and peer-reviewed. Often, substantial knowledge contributing to vaccine development originates from public-funded research institutions or via public-private partnerships. It is true that some vaccines may have a varied efficacy range in different geo-locations and demographics, but strong side-effects are usually rare, and certainly vaccines cannot be harmful when administered on infants and children.

The scientifically established correlation between immunisation coverage and the number of incidence or mortality rate for certain diseases should be more heavily weighed. One should not simply dismiss any WHO-recommended vaccines just because one reads some argument against them in the Internet – death and suffering from certain diseases are unnecessary and can be prevented.

1 “Status of Diphtheria cases in Malaysia” Press statement issued by the Director General of the health department, Datuk Dr Noor Hisham Abdullah, 27 July 2016
2 Masriwanie Muhamading, “Baby dies days after diphtheria check-up”, New Straits Times, 25 July 2016
3 Ibid.
4 “Anti-vaxxers to blame for diphtheria casualties, medical experts say”, The Malay Mail Online, 24 June 2016
5 Dennis Flaherty, “The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science”, Annals of Pharmacotherapy, Oct 2011, 45(10):1302-4
6 “Shameful misuse of Islam! Health DG says of ‘Imam Muda’ star’s anti-vaccine remarks”, The Malay Mail Online, 23 June 2016
7 “Not true Kedah boy’s condition caused by vaccination, ministry says”, The Malay Mail Online, 29 June 2016



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