Archana Chatterjee Editor Vaccinophobia and Vaccine Controversies of the 21st Century Vaccinophobia and Vaccine Controversies of the 21st Century Archana Chatterjee Editor Vaccinophobia and Vaccine Controversies of the 21st Century Editor Archana Chatterjee, M.D., Ph.D. School of Medicine Creighton University Omaha , NE , USA ISBN 978-1-4614-7437-1 ISBN 978-1-4614-7438-8 (eBook) DOI 10.1007/978-1-4614-7438-8 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2013940608 © Springer Science+Business Media New York 2013 This work is subject to copyright. 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Chartrand, M.D. Foreword “If you can bear to hear the truth you’ve spoken Twisted by knaves to make a trap for fools, Or watch the things you gave your life to, broken, And stoop and build ‘em up with worn-out tools…” Rudyard Kipling “If,” 1895 As long as there has been scientifi c advancement, there has existed the possibility that reports of its origins, safety, effi cacy, and implementation would be twisted and misunderstood—either intentionally or unintentionally—to further agendas that reach far beyond the pure science of discovery itself. The science of vaccination is one research area that has come to the forefront in recent years. Vaccines are one of the most benefi cial public health measures avail- able. Smallpox, once a scourge of humanity that killed millions over the 12,000 years of its recorded existence, has been eradicated through the use of vaccination. There are now a total of 17 vaccines that prevent infectious diseases across the childhood/adolescent and adult immunization schedules. Two of these—the hepati- tis B vaccine and human papillomavirus (HPV) vaccine—go even beyond the microbes from which they are derived to prevent cancer caused by the diseases. Despite these successes, real and perceived concerns about vaccines and the immunization process have resulted in a subpopulation of “vaccine-hesitant” people— those who delay or deny immunization for either themselves or their minor chil- dren. Since concerns over vaccine hesitancy are multifactorial, approaches to these concerns are equally complex. And the complexity is only heightened with the advent of more vaccines and nuances in vaccine recommendations. Lack of acceptance of vaccines may, in actuality, have less to do with minor and uncommon adverse effects attributed to the shots and more to do with a lack of knowledge and appreciation of the rigorous pre- and post-licensure testing of vac- cines, the serious nature of the diseases they prevent, and a lack of scientifi c basis upon which decisions should be made. vii viii Foreword Vaccinophobia and Vaccine Controversies of the Twenty-First Century addresses in an accessible manner the complicated facets of the vaccine hesitancy phenomenon— one that is by no means new despite the uptick in recent mass media coverage. Important considerations that fall under its aegis include issues with hesitancy and fear of vaccines that date back to Jesty and Jenner. The successes of progressively more refi ned inoculation in disease reduction have reduced drastically the potential for parents in developed countries to experience the morbidity and mortality associ- ated with vaccine-preventable illnesses that still persist in many other parts of the world. Vaccine development, approval, recommendation, and regulation processes are detailed, including the safety testing mandates put in place both prior to and after a vaccine is licensed by the United States Food and Drug Administration. While con- tinued refi nements of these processes have made new vaccines much safer than older ones, safety does come at a price. Newer vaccines are costly, and some are less immunogenic than their predecessors (i.e., acellular pertussis and conjugated meningococcal vaccines), resulting in the need for additional doses in order to maintain protection. This book emphasizes the need for everyone from parents to pediatricians to gov- ernment offi cials to make decisions based on science rather than emotion or unsup- ported information that has proliferated throughout print and broadcast media as well as on the Internet. Separate chapters examine misconceptions with which par- ents will be confronted regarding the recommended vaccine schedules; thimerosal and other additives; and even the notion that vaccines lie at the root of serious medi- cal and behavioral complications. Even propagation and penetration of these notions across various forms of media and socioeconomic groups are discussed in depth. Each of the 11,000 infant births every day in the USA begins the cycle of immu- nization over again. In each place in which that cycle is broken, there lies the pos- sibility of intrusion by pathogens many practicing physicians and nurses have not even seen manifest—due to the success of vaccines. Rather than try to warn, debunk, or condemn, the overarching focus of Vaccinophobia and Vaccine Controversies of the Twenty-First Century is on com- munication—between physicians, health care organizations, government agencies, the media, and parents. At the top echelons, among the policymakers, the burden of communication lies in providing and disseminating consistent, correct, and acces- sible information free of hype and hyperbole. This book also emphasizes the con- comitant responsibility of those on the ground—the physicians, nurses, pharmacists, parents, and more—to educate themselves using these verifi ed sources. These pages do not so much contain a solution to the problems of vaccinophobia and vaccine hesitancy but provide a foundation for its development. Larry K. Pickering, M.D., F.A.A.P. L. Reed Walton, M.A. National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Atlanta, GA, USA Preface A baby born today in most developed countries can look forward to an average life span of nearly 80 years, almost 25 years longer than a baby born in 1900. While improvements in nutrition, water quality, and sanitation as well as the introduction and widespread use of antibiotics have all contributed to this increase in life expec- tancy, vaccines have played a major role also in reducing the morbidity and mortal- ity associated with a number of infectious diseases, especially among children. In fact, vaccines have been counted among the greatest achievements in modern medi- cine, leading to the eradication of smallpox and signifi cant decline in many vaccine- preventable diseases such as polio and measles. As these diseases have become less common, particularly in developed countries, the morbidity and mortality associ- ated with them has faded from the public’s memory and anxiety over vaccine-related adverse events has been increasing. Even among healthcare workers, especially those who have grown up in the vaccine era, knowledge of these deadly diseases is limited and concern over vaccine-related adverse events is rising. It is important to note that opposition to vaccination is not new. It has existed from the time of Edward Jenner who was both lauded and also widely ridiculed for his work on the smallpox vaccine in the late 1700s. Many of his critics, especially the clergy, claimed that it was repulsive and ungodly to inoculate someone with material from a diseased animal. A famous satirical cartoon of 1802 showed people who had been vaccinated sprouting cow’s heads, illustrating popular eighteenth- century fears about vaccination. The Anti-Vaccination Society of America was founded in 1879, based on the belief that no one should ever be “complied to submit to any surgical operation” including vaccination, and that vaccines caused “corrup- tion of the blood,” and spread diseases rather than preventing them. It has been said that vaccines have become a victim of their own success. With some parents and other caregivers refusing or delaying vaccines for their children/ wards, some vaccine-preventable diseases that were well-controlled have staged a comeback. Outbreaks of these diseases have been reported from countries where they were virtually unknown for many years. This situation is continuing to worsen, despite efforts by public health agencies and others to curb the spread of ix