The topic of vaccinations can be a contentious one, especially when talking about childhood inoculations. The prevalence of information (and misinformation) available online has created a gray area for some people on whether parents should follow vaccination recommendations from the Centers for Disease Control and state health departments. Dr. Brian Yablon gave a presentation at last Sunday’s Anchorage Science Pub on the history and reasons behind these recommendations.
Yablon was quick to disclose at the beginning of his presentation that while he is an employee of the U.S. government, the same government that endorses the vaccine schedule he would be talking about, he did not have any financial relationships to disclose. Taking a quick read of the room, Yablon asked how many in attendance worked in public health. Around a dozen people raised their hands.
“Who think that vaccines are the greatest thing since sliced bread? [Many hands raised] Okay, a lot of you. Who doesn’t like sliced bread and doesn’t like vaccines?”
While there were a couple of hands raised to that question, a majority of the audience kept their hands down. The crowd was in attendance for a science presentation, not a debate.
Cartoon courtesy of Veterinary Science Tomorrow
Yablon gave the audience a quick vaccine “beginner’s guide.” A vaccine is a substance that stimulates the production of antibodies. Yablon explained these can be prepared from a piece of a live, weakened virus or a killed virus. Vaccines can also be developed from bacterial protein that can also trigger an immune response.
“The goal of that is that you get the immunity, but you don’t have the disease,” Yablon explained. This gives the advantage of developing an “immune memory” before you are exposed to an infection. The vaccine doesn’t provide immunity in-and-of-itself; it prompts your body to develop an immune response. Many of the recommended childhood vaccines are for diseases that can cause death or permanent disability.
The audience was then presented a round of slides showing pictures of people suffering from the diseases that these vaccines are intended to prevent. Many people in the audience were eating or had just finished eating. There were more than a few downward stares or turned heads during this part of the presentation. Pictures of babies suffering from measles was unpleasant, but images of children with skin lesions caused by diphtheria were downright uncomfortable. (You can look at the images by downloading the presentation slides here. After dinner)
The main crux of Yablon’s presentation was that the diseases we’re encouraged to vaccinate children from are very serious. More serious is the case of children who are unable to be vaccinated because of an allergic reaction or other medical condition. These children (and later, adults) depend on the “herd immunity” provided by the people around them who have already been vaccinated. But as some groups, for one reason or another, have made the decision to not vaccinate their children, the U.S. and Alaska have seen outbreaks of diseases that should have been preventable.
One of the most recent measles outbreaks in the U.S. was in Juneau, Alaska in 1996. Many of the children in the 63 confirmed cases had had a single measles vaccination, but not the recommended second dose. Since that incident, Alaska now requires children to have two measles vaccinations before being admitted to public school. Yablon said there were many common reasons for parents not following the recommended vaccination schedule, ranging from busy schedules to low parental education to a lack of available health structures. He explained that fears or skepticism over vaccinations was a factor for some, but despite media sensationalism, the more prominent barriers to timely childhood vaccinations tend to have more to do with socioeconomic status and healthcare access.
“[referring to the image to the right] This is a large school district in Alaska, and this is a graph that shows the vaccination coverage rates plotted against their age. Coverage, you know, the higher the better, right at the top. And the reason it looks like that, with the steps, that first line is how many people got their first vaccine when they were supposed to, so between the age of three months and five months, did they have one dose? Between five and seven months did they have two doses? Between seven and 15 months did they have three doses? And then later at 16 months or later did they have the fourth vaccine? And so you can see in this school district that most people get vaccinated. And so, over 90 percent were vaccinated with that first dose, when they should have been at some point. Later on, you sort of have attrition and you lose the numbers.
And then when you break that down by socioeconomic markers and you look at the children in blue who are higher socioeconomic status, not on school lunch, and then the purple, the children who have lower socioeconomic status who qualify for free or reduced school lunch, you see that there is a very large disparity between those two groups. It’s about 11 percent disparity. And so what this practically means is that within Alaska there are going ot be subgroups and subsets where the herd immunity is different. And that the socioeconomic status in Alaska and nationally are still an issue when we talk about vaccine coverage.”
It’s important to keep these socioeconomic challenges in mind when discussing vaccination rates, and letting the conversation focus on people who choose intentionally not to vaccinate allows the more urgent problems of access and education to be ignored.