Saving lives and preventing irreparable harm
By Chandrea Serebro
Modern medicine has come up with ways to counteract many of the most fatal diseases in history, saving lives every day, and it is working day and night to find new ways towards preventing those that it hasn’t managed to quell yet. Among the many great inventions of medicine are included numerous vaccines, many in the last 100 years, that have stopped dangerous and deadly infectious diseases such as polio and measles from wreaking havoc. Countless millions upon millions of lives have been saved as a result – with as many, or even more, people saved from the terrible complications, such as brain damage, hearing loss, paralysis, etc., that can often result, G-d forbid, from these dreaded diseases. In light of the recent outbreak of mumps in South Africa, we take a look at the importance of vaccinations.
What do vaccines do?
Dr. Seymour Waner, a Pathologist who specialises in microbiology and infectious diseases at Lancet Laboratories, says that, with modern advancements in medicine and disease control, we have lost sight of the fact that infectious diseases still plague our world. Take, for example, diphtheria, a dread disease that took out so many in its day. Does anyone know what it actually is? How it presents? No, thankfully not! But Dr. Waner relates a story of a late colleague and medical doctor who used to tell him stories of the number of children who came through his doors in the 1950s with diphtheria, many of whom died from it.
Consider the case of the collapse of the Soviet Union in the early 1990s. There was no money to go around, so people stopped vaccinating and very soon people began dying of diphtheria, young and old alike. “Diseases still exist. Vaccines don’t eradicate them, as many might believe. Diseases still subsist in the environment, in the air, in spores. But, today, we don’t see many of them anymore thanks to vaccines that have been developed to counteract them.” Vaccines interact with the immune system to produce an immune response similar to that produced by the natural infection, explains Dr. Lana Marcus, GP in Waverley, but, she says, they do not cause the disease or put the immunised person at risk of its potential complications. What a vaccination does is expose the body to inactivated or weakened viruses, or proteins and toxins of the pathogen so that the immune system can learn to recognise these diseases and build immunity against them.
Consider measles, a highly transmissible virus for which there is no specific antiviral treatment, and which is a leading cause of death in small children. “It’s not just a sick child with a rash as some people would like to believe,” says Dr. Marcus. Measles vaccinations resulted in an 84% drop in mortality worldwide due to measles between 2000 and 2016, with an estimated 20,4 million deaths prevented because of the preventative measure of wide-scale vaccinations. That said, there were still 90 000 deaths caused by measles globally in 2016, which goes to show how deadly the disease is. Whether this persistence in the disease is caused by naysayers who choose not to vaccinate, or another reason, remains to be seen.
There are some practical reasons why these diseases persist. Too often, says Dr. Waner, the vaccine is not administered straight from the fridge into the arm, which reduces its efficacy, or the jab was given in the wrong place. Sometimes the vaccine “doesn’t take”, explains Dr. Waner, and these children, says Dr. Marcus, rely on a concept called ‘herd immunity’ – if enough children are immune to the disease, vulnerable individuals are less likely to be exposed to it, since chains of infection are disrupted. But, there is also the fact that many people are choosing not to vaccinate. “With the increase in anti-vaccine sentiment, herd immunity is diminishing, and this is why we are seeing outbreaks of measles and mumps, and more spreading through our communities,” says Dr. Marcus. Just like the one we are seeing currently, locally in the Jewish community, but also in the broader South African context.
Allergies to things such as eggs, neomycin, or streptomycin are an issue with certain vaccines and so, as a result, some people can’t have vaccines containing them. Immunosuppression due to malignant disease, high dose steroids, or radiation would contraindicate live vaccines, and such cases would have to be discussed with a medical practitioner, but otherwise for many people it’s all systems go. Especially with the new vaccines available, lives can be saved, says Dr. Waner. Pneumonia can now be prevented, which is particularly important for the elderly. The influenza vaccine is paramount, he explains, particularly in children under the age of six, those with heart and lung disease, pregnant women in all trimesters, and the aged.
Why vaccinate?
Pam Kantor’s bobba, Dora Feldman, never got over the death of her little sister from diphtheria when she was a baby. So, as vaccinations became more prevalent and more popular, she marvelled at the ability to protect kids from so many dread diseases – something she constantly spoke about to Pam, her own children, and all her grandchildren. Her knowledge of the tragic reality of the disease made it a “pleasure” to see all the ones she loved being vaccinated during her lifetime, and for Pam this too is a priority now.
“The proven benefits of vaccinating against deadly diseases far outweigh the risks,” says Dr. Waner. So overwhelmingly, in fact, that it is “reckless and irresponsible” not to vaccinate. “We shouldn’t be losing children or women or the elderly from influenza in this day and age. There are effective vaccines against this, and so many other things,” he states, speaking both as a father and as a medical practitioner who looks at these issues every day. “Education and knowledge are the only way to deal with sceptics.” Around the world, billions agree with him, vaccinating against a host of previously fatal diseases that raged rampant, and are now, thank G-d, a distant memory. “Vaccination is safe and has been demonstrated to reduce illness and death worldwide,” says Dr. Marcus, and as a mother of two boys, she “hasn’t hesitated vaccinating my sons according to the vaccination schedule”. “Having seen the true extent of real illness and disability in my line of work, I feel it would be negligent not to protect my children the best way I possibly could.”
The MMR/Autism debacle
In 1998, Andrew Wakefield and twelve others published a case series in the medical journal The Lancet, which suggested that the measles, mumps, and rubella (MMR) vaccine might cause Autism Spectrum Disorders. The press jumped on the story. As a result, MMR vaccination rates began to drop because parents were concerned about the risk of autism after vaccination, and measles outbreaks in the UK and USA were attributed directly to the growing non-vaccination sentiment. Almost immediately afterwards, multiple epidemiological studies were conducted and published, and any causal link was refuted. Ten of the twelve co-authors published a retraction. The study was found to be fraudulent and subsequently debunked. Investigative Journalist Brian Deer found that evidence and results had been manipulated, multiple conflicts of interest and financial gain went undeclared, and many ethical codes had been broken during the study. The Lancet retracted the paper completely in 2010, and Wakefield was eventually struck off the medical roll. Yet the damage that it caused continues until today.
Despite all of the hard proof, there is still an Anti-Vax movement that exits today, which believes in the validity of the MMR/Autism study. Anti-Vaxxers claim that, among a myriad other things, the pharmaceutical companies are in it for profit, and that lies and falsifications are spread to cover up the negative impact that vaccines might inflict. They theorise that the risks outweigh the benefits. Deciding not to vaccinate is not for the faint-hearted. It is not free of criticism or judgment and it is certainly not free of risk.
