It seems highly plausible that we have become victims of our own public health success: has the astounding triumph of multiple vaccination strategies led us to complacency? We could be dangerously close to shirking our apparent social responsibility and consequently endangering the lives of those around us.
1796. Knowing that individuals who had previously suffered from cowpox were unlikely to develop the much more severe smallpox, an English physician infected a young boy with the cowpox virus. Generated CD4 and CD8 T cells remained within his system at a low concentration for tens of years; maintained by interleukins 7 and 15 even in the absence of the antigenic peptide. Memory B-cells also remained; displaying higher affinity antibodies. The combination of these remnant cells meant that when the boy was infected with the often deadly smallpox virus some time later, he remained entirely healthy. Imminently following detection of smallpox antigenic peptide, the mechanisms to overcome it were activated by circulating memory cells, no symptoms arose, cuing one of the greatest medical breakthroughs in mankind’s history.
Today these are the same principles on which modern vaccinations are created and we can see they have an astonishing effect. In the year preceding the WHO’s smallpox eradication programme there were 15 million cases worldwide, including 2 million deaths. Just 8 years later, the last natural case was reported in Somalia. Incredibly, vaccines mean that we can manipulate our own biology for the protection of not only ourselves, but our family, our friends, our entire community.
Incredibly, vaccines mean that we can manipulate our own biology for the protection of not only ourselves, but our family, our friends, our entire community
But if we pause to reflect upon this, we cannot help seeing that it is not down to the vaccine development process alone – without entire participation compliance it is rendered useless. Successfully developing a vaccine that provides safe and effective lifelong immunity without side effects is a rarity in itself; yet any refusal or unwillingness to participate in vaccination schemes prevents them being effective.
Cultural attitudes to vaccination seem hugely determinative of implementation strategy efficacy. Over the past 5 years, we have seen a gradual decline in immunisation uptake for children under 12 months of age in the UK; which although is merely fractional likely reflects the increased fear creeping into society. It appears that much of this sense of scepticism and mistrust surrounding vaccination is intertwined with parents’ love and concern for their children, particularly since fraudulent reports suggested MMR vaccines caused autism.
The fear of not undertaking vaccination that was once so prevalent has now been replaced with a fear of doing so.
This fear is even more acute in some African and Asian countries. ‘Western plot’ theories suggesting that vaccines are distributed to sterilise or infect non-Westerners significantly impact implementation success; not least in Pakistan where Taliban militants have killed 70 polio workers since 2012 as result of these conspiracies. We can see how this results if the only portrayal received is that of vaccines being an imported concept carried out by western NGOs; particularly when social media allows the wide and rapid spread of these theories.
Without entire participation compliance, vaccination is rendered useless.
This raises the question of how we balance the fear and refusal of vaccines with our evolved sense of social responsibility and understanding of the need to protect our communities. We can see this enforced in the US, where children are legally required to have certain vaccinations before they are allowed to enter school. But how can we balance this with peoples’ strong religious objections, mistrust of the modern medical system, and fear of side effects? Perhaps the day will come where a global scheme of compulsory immunisation is necessary.
As reluctance to vaccination continues to rise whilst our sense of social responsibility falls in a world of individualistic consumerism, we can only wait to see how the protection of individual freedom can be aligned with the maintenance of public health.