The Critical Ingredient to the Success of Vaccination Programs

By Bill Miller, MD | Published 2/22/2017 1

infant vaccination

(Photo credit: File Photo by Sanofi Pasteur via Flickr Creative Commons)

Only a few weeks into a new administration, unwelcome medical news made headlines. Robert F. Kennedy, Jr, a highly visible critic of vaccination, announced he had been invited by President Trump to chair a commission on vaccination safety, a claim the administration was quick to deny.

If this commission does come to pass, it would rekindle the age-old debate about the safety and appropriateness of vaccination. And, one result can be accurately predicted. It will become a confused platform of ideological rhetoric that will diminish trust in those scientific bodies charged with making sound judgments for the public welfare. This inevitable outcome is particularly unfortunate since

there has never been any advance in medical history that has had a more positive impact on our lives than vaccination.


A bit of history

Humanity has been in eternal conflict with infectious diseases throughout history. Perhaps no disease better illustrates the vast range of impacts of epidemic disease than smallpox. In 18th century Europe, at least 400,000 people died annually from smallpox. One-third of the survivors went blind. Mortality rates were as high as 60% in some communities. Infant mortality was even more frightening, approaching 80%.

The ultimate success of smallpox vaccination is credited to Sir Edward Jenner in England. In 1796, he successfully introduced the technique of cowpox vaccination, demonstrating its subsequent protective effect against smallpox. Today, due to the effectiveness of worldwide smallpox vaccination programs, that disease has been effectively eradicated from the planet.

However, this is not the case for other consequential infectious diseases. Two years ago, a whooping cough epidemic swept through California where vaccination rates are steadily lagging. Contrary to any ordinary expectation, it is often the most affluent parents who are shunning immunization. Some of these anti-vaccine proponents are highly educated people being misled by social media.

The trend appears to have originated with a fraudulent report in a British medical journal linking vaccination with autism. This report was subsequently revealed to have been based on fraudulent research and was retracted by that scientific journal. Similar rumors that vaccine stabilizers, such as thimerosal, contribute to autism have also been refuted.  Nonetheless, a lot of damage has been done by ill-informed repetition.

There is no doubt that those parents that refuse to vaccinate their children are well meaning. However, their actions are ill-advised on two levels. The first is that refusing to appropriately vaccinate themselves or their child exposes both of them to the risks of deadly infections that can be entirely avoided. Yet, although vaccination is safe and highly effective, it does have its limits. This links to the other critical factor that makes universal vaccination so crucial.


The importance of herd immunity

No vaccination ever devised provides 100% protection, and some individuals in any population cannot be vaccinated. This includes very young infants whose immune systems are not yet mature enough for vaccination and members of our community that are immunosuppressed due to diseases that weaken their immune system from a variety of illnesses including cancer. Their protection is through our actions.

When there are high levels of vaccination within any community, the infectious agent is unable to find enough hosts to reproduce and sustain itself within that population. This level of community-wide protection is termed herd immunity. It is our joint responsibility, all of us together, to be part of the process of achieving this level of immunity both in our own interests and for the protection of the other members of our community.


We need science, not politics

The next outbreak of a preventable infectious disease with its incumbent tragedies is always lurking. A political committee to examine the evidence based on ideological biases is not needed. Instead, our policies should rely on the expertise of already existing scientific organizations such as the Global Advisory Committee on Vaccine Safety (GACVS), an independent expert clinical and scientific advisory body, as well as our own Centers for Disease Control and the National Institutes of Health.

The critical ingredient to the success of vaccination programs is education. Therefore, there needs to be a concerted program to recover our eroded memories of the consequences of now distant epidemic diseases that have been conquered or reduced through vaccination. The success of vaccination programs depends on being familiar with the bitter lessons of our continuous struggle with epidemic diseases. Such an educational process must be ever ongoing.

Bill Miller, MD


Dr. Bill Miller had been a physician in academic and private practice for over thirty years. He is the author of The Microcosm Within: Evolution and Extinction in the Hologenome. Dr. Miller is an internationally recognized evolutionary biologist and an expert on the emerging science of the microbiome. He is the author/co-author of numerous academic papers on the microbiome and evolution, serves as guest editor of a major academic biology journal and is co-editor of a forthcoming textbook on developmental and evolutionary biology.


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