Ask Amma

Evidence-based vaccine policy

In Call to Action on 31 March 2014 at 8:00 pm

Is it true that the human life expectancy increased over the years because of vaccines? Would this be the basis for you to vaccinate your child? We may have all heard stories from our grand parents or even our parents how they lost their siblings to some disease, which is considered completely curable these days or has a vaccine.

Mama in Bangalore

I do not doubt that vaccinations have played a role in reducing incidence of their respective diseases.   Other factors have also played a role in reduced incidence and mortality due to the same diseases –  nutrition, sanitation, workers’ rights, women’s rights, which resulted in improved nutrition as well as maternity leave and protection for breastfeeding, which strengthens immunity.

Apart from the vaccine-preventable diseases, there are also a number of factors that are reducing longevity in the present, such as pollution, increasing rates of hunger/homelessness (for the poor) and obesity (for the rich).  And if you believe Malcom Gladwell and his sources, there is also the role of close-knit community in promoting longevity – that is certainly declining globally.  And in some populations, decreased breast-feeding is also weakening the immune system, but due to increased use of medicine, those populations may not experience decreased longevity.

A vaccine stimulates the immune system so that it is better prepared to attack a pathogen and thus make you far less likely to get a disease.  If that disease is fatal then you can say that the vaccine lowered your risk of from dying of that particular disease and thus increased your life expectancy.  Germs in the environment can also stimulate the immune system – sometimes but not always resulting in disease.  Which form of stimulation is “better” for you — that depends on many factors including nutrition and environment.  It is also different for different diseases and also different vaccines and different people.  I would look at each vaccine and judge its risks and benefits and also look at each disease and judge its risks and benefits.  The key book that helped me was Aviva Jill Romm’s Vaccination: A Thoughtful Parent’s Guide.  See also Vaccines: How to Decide.

Should we trust the researchers to develop safe and effective vaccines and ethically prioritize which diseases are better dealt with through vaccination and which are better dealt with through other approaches such as nutrition, public health, and environmental justice?  And which diseases we should just allow ourselves to get and recover from?  Can we trust our policy makers to decide according to the best interests of the public, and the environment?  Unfortunately I don’t think there is enough reasonable public debate on these questions.  Maybe people in the government and health industry don’t trust the public to make sound decisions; to some extent, the feeling is mutual.  In most of the information available to the public, there are two “sides” that are highly polarized – as if to question a vaccine is to be “anti-vaccine” or to take a vaccine is to be “pro-vaccine.”  Or worse, that those who refuse vaccines put their personal health before that of the public.

At the same time, people have little confidence in the pharmaceutical industry to act in the public interest, or in policy makers to apply rigorous standards to guard against corporate influence in health policy.  To ensure that vaccines are developed and administered in the public interest and not for private gain, the government, medical institutes and health workers should respect the public, provide accurate information on vaccines, and listen patiently to questions and concerns as they arise.  A group of health workers published a policy document called “Evidence-based National Vaccine Policy” in the Indian Journal of Medical Research (May 2010, pp 617-628).   The recommendations concern vaccines but not in isolation from nutrition, environment and decentralized democracy.  These are the kinds of policies we need to improve public health holistically.  More importantly these are the kinds of honest, rational documents that we need to inform the public debate and restore trust in civil society.

Personal Note

I think that the CDC does a decent job with its “fact sheets” of alerting parents to the risks and benefits of various vaccines.  I was able to use their fact sheet to explain to my doctor why I did not opt for a specific vaccine.  Of course I last checked these when my daughter was very little.  I understand there is a more concerted push on vaccines today, in response to the growing public skepticism regarding vaccines.  So I don’t know if that has influenced the way they present the facts in the fact sheets. What I detected while reading the fact sheets and general information on some of the newer vaccines is that there is a presumption that one should avoid “sick-days.”  I myself am not comfortable with the idea of vaccinating to avoid “sick-days[1].”  I think we need well days and sick days in our lives.  Even though each and every time one of us gets sick I want us to get well as soon as possible, if I think back some of the very important moments and memories in our lives were from times of illness.

While reading the vaccine recommendations I got the feeling that there is also a presumption that very young children are in daycare and not breastfeeding.   Those in home-care and who are breastfeeding may not have the same risk profile, but still get the same recommendations – because how could they write different recommendations?  So they set the recommendation to try to fit all kids regardless of these very important criteria.  This is one reason I took a selective and delayed approach to vaccination.

When I was just starting to look into vaccines, a friend cautioned me about a certain vaccine.   I asked him, “which vaccines did you give?”  He replied, “the point is not to follow what I did, but to learn about the issue and make your own decision based on your understanding and your circumstances.”

Notes
1.   See for example this reason for the varicella vaccine to reduce absenteeism from school and work: “To many parents, chicken pox is a mild illness that is a rite of passage. However, the social and financial implications of children missing a week of school and parents staying home from work is huge from a global perspective; the cost to society of varicella was estimated to be $399 million per year in the United States.”  from American Academy of Pediatrics Committee on Infectious Diseases, “Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule.”  Pediatrics. 2007 Jul; 120(1):221-31.

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: