Why some parents won’t immunise

Administering a small dose of a modified virus or bacterium causes your body to produce antibodies against the bugs, meaning that if you are exposed to the virus or bacteria in “real life”, you can fight them off with your antibodies. Remember this from high school biology? But despite this scientifically proven fact, there is a growing tendency for some parents not to vaccinate their children. Why?

In their paper "Addressing public questioning and concerns about vaccination in South Africa: A guide for healthcare workers" (Vaccine 2012, 30S, C72-8), Dr Rosemary Burnett, a senior lecturer in epidemiology at Medunsa, and her colleagues find that South African vaccine refusers fall into broadly two categories:

1. “Affluent, relatively educated, mainly white individuals [...] and
2. Poor, relatively uneducated, mainly black, religious/cultural/traditional groups”.

Widespread vaccine refusal lowers the immunity of the whole "herd". So those who have the option to vaccinate their children but don’t, endanger those who are not vaccinated for reasons beyond their control: access, illness, or age.

These are some arguments advanced by the elite vaccination-refusers:

Argument 1: "There are too many vaccines in our schedule"

The South African government’s Expanded Programme on Immunisation (EPI) allows for all children to be vaccinated, for free, against the following 10 diseases, "all of which are very dangerous and can result in death," according to Dr Burnett: polio, tuberculosis (TB), diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenzae type b related meningitis and pneumonia, hepatitis B, rotavirus infection, pneumococcal infection and measles.

In the private sector, children additionally receive vaccines against chicken pox and hepatitis A, as well as measles, mumps and rubella in the MMR vaccine, explains Lee Baker, MD of the Amayeza Information Centre, which also runs the Vaccine Helpline. (You can call this service on 0860 160 160 between 9am and 1pm with any of your vaccination queries.)

The long-term aim of any vaccine is in fact to work itself out of a job, rather than add to the vaccine load. It is because enough children were immunised against smallpox that the WHO was able to declare the world smallpox-free in 1980 – and we no longer need the vaccine.

Polio, another crippling childhood disease, was within a whisker of being eradicated – but “because a group of people in Nigeria decided to stop vaccinating their babies because of misinformation about the polio vaccine, polio is still endemic in Nigeria, as well as Pakistan and Afghanistan,” says Dr Burnett, and it is also seen in a few neighbouring countries. As soon as the world is declared polio-free, we can all stop administering the oral live vaccine to our children. But to do so before would be dangerous.

More, not less

“Everyone would be over the moon if we invented a highly effective HIV or malaria vaccine – surely the public would want to use these vaccines if we had them?” argues Dr Burnett.

“All the vaccines offered free through the EPI are essential. The government does not have money to waste, and South African scientists have to give them irrefutable evidence that a disease causes major morbidity and mortality before they will include a vaccine on the schedule,” she says.

If you are going to selectively vaccinate, “always make sure that you include the vaccines against the 10 most dangerous diseases first, and select the other vaccines you will skip carefully,” says Dr Burnett. “Rubella, for example, is very dangerous to the foetus of pregnant women, causing deafness, blindness, and heart disease. So although you may not be worried if your child gets rubella because it is a relatively mild disease, you do need to worry if your child gets rubella when you are pregnant with your next baby.”

Some parents argue that it is healthier for their children’s immune systems if they contract the actual disease rather than obtain immunity to it via a vaccine. But Dr Burnett says science simply does not support the view that a child’s immune system is harmed by vaccine-induced immunity. And of course contracting the actual disease can cause disability or death.

To parents who deny their children essential vaccines, Dr Burnett says: “The argument that many vaccine-preventable diseases are not dangerous in well-nourished healthy children does not hold water, firstly because if all well-nourished healthy babies were not vaccinated, we would have huge outbreaks of all these diseases, and secondly because we do have cases of well-nourished healthy babies dying or being disabled from vaccine preventable diseases.”

By skipping vaccines, you are not only exposing your own child to the possibility of contracting unnecessary diseases, but you are also threatening other children, especially children who are too young to be vaccinated, malnourished children, or sick children with compromised immune systems, who come into contact with your child. Your child may be robust enough to survive measles with relative ease, but other children die of measles every day. Be aware of the implications of your choices.

Argument 2: “I object to the additives or ingredients in vaccines”

Unless you follow a very restricted diet indeed, most of your food contains animal products, preservatives and other additives. So do your vaccines.

 Animal products vegans and vegetarians may object to the animal byproducts used in vaccines, such as chicken embryos or bovine gelatine. Phone the Vaccine Helpline (0860 160 160) for a vaccine-by-vaccine analysis of the ingredients used, plus details of alternative vaccines, if available, if this is a concern for you.

Thiomersal Live (as opposed to inactivated) vaccines don’t contain preservatives (they would kill the active ingredient). In South Africa, multidose acellular vials of vaccines contain a very small amount of the preservative thiomersal, or thimerosal as it’s known in the US. Multidose vials are used to vaccinate more than one baby at a time, so the preservative is necessary to prevent contamination when the vial is opened. If you are vaccinating in the private sector with single dose vaccines, it is likely that your child’s vaccine contains no preservatives (check the Vaccine Helpline though).

Why the fuss about thiomersal? Well, methylmercury is a form of mercury we know to be toxic in high concentrations, especially to the developing brain, and it is found in foods such as fish. Thiomersal is an ethylmercury-based preservative. Ethylmercury is completely different from methylmercury. Also, “vaccines that contain thiomersal do not contain mercury as such, just as table salt does not contain the highly toxic elements sodium or chlorine as such,” according to Burnett et al 2012. Humans are able to excrete ethylmercury, whereas methylmercury accumulates in the body, and numerous studies have failed to find any safety concerns regarding the use of thiomersal in vaccines.  However, based on environmental methylmercury levels that babies are naturally exposed to through ingesting water or breastmilk, the WHO set a safe limit for daily methylmercury ingestion. All thiomersal-containing vaccines contain far less ethylmercury than that limit.

Some parents have claimed that thiomersal causes autism, but since the removal of thiomersal from all vaccines in the USA in 1999, the incidence of autism in the USA has not decreased, and many studies have found that there is no link between thiomersal and autism.

    Other ingredients “Aluminium-based adjuvants are used in some vaccines. An adjuvant is something that helps the vaccine to illicit an immune response; without the adjuvant the immune response to these specific vaccines is often not strong enough,” says Dr Burnett. Additionally, vaccines may also contain traces of formaldehyde, antibiotics and egg proteins and yeast proteins, and human serum albumin (the most common protein in blood plasma) which may be involved in the manufacturing process. The vaccines are then purified leaving no, or minimal residue of these ingredients. The amounts of controversial additives are monitored and controlled, and are far less than the safe doses stipulated by world health bodies. For example, people with egg allergies can still receive vaccines that are grown in eggs, because the egg proteins are removed during the purification process.

For a comprehensive yet simple explanation of the components of vaccines, go to ncirs.edu.au/immunisation/fact-sheets/vaccine-components-fact-sheet.

The medieval physician Paracelsus already knew in the 15th century what we are currently forgetting again, that “the dose makes the poison”. Water, alcohol, vitamins, sugar, salt, the colourant in your child’s jelly babies, the potassium in bananas: all are toxic in high doses. Almost everything we know is thus a toxin, but many potentially toxic substances are safe (and some are essential) if consumed at the correct dosages.

Argument 3: “My child’s reaction to vaccinations make them not worth my while”

Vaccines contain antigens. An antigen is the substance to which the body reacts in order to mount an immune response and manufacture antibodies. Reacting to these antigens is exactly what you want to do, in order to manufacture those life-saving antibodies. So, yes, vaccines do cause common adverse reactions such as redness, swelling, tenderness and fever. According to Burnett et al 2012, “Very rarely does a vaccine cause a severe adverse reaction (one per several thousands or millions, or so rare that one cannot calculate the risk).”

When multiple vaccines are given at the same time, such as at 6, 10, and 14 weeks of age when babies are vaccinated against tetanus, diphtheria, pertussis, polio, Heamophilus influenza tybe b and hepatitis B, parents may be concerned that their children are receiving too many antigens at once.

However, Lee Baker notes that vaccines are becoming less reactive. “The newest version of the pertussis vaccine, for example, has far fewer side effects than the older whole cell pertussis vaccine which we used up to 2009.” Acellular vaccines are made from only those fragments of bacterial cells that stimulate a strong immune response.

According to Burnett et al, in 1926 the pertussis vaccine contained 3000 antigens, but the version introduced in 1991 contains just two to five antigens. The overall effect on the body is far, far smaller with modern vaccines, as they have become smarter and more efficient, even though the actual number of vaccines our children are given has increased.

Besides, says Burnett, children are exposed to many more antigens than are contained in vaccines in their everyday lives, as are we all, just by interacting with our environment.

Living memory is short, and it is perhaps easy to forget the widespread suffering and bereavement diseases such as polio caused only a generation or two ago. A short-lived, mild reaction to a vaccine is surely preferable to living with or worse, dying from, polio.

A very small number of children can be allergic to gelatine, or the antibiotics, such as neomycin, used in some vaccines. Phone the Vaccine Helpline if you are concerned about using these vaccines.

However, do discuss delaying or skipping vaccines with your doctor if your child has an immune disease such as HIV, or a congenital condition such as cerebral palsy.

Argument 4: “Third world vaccines are inferior or unsafe”

“All vaccines have to comply with incredibly stringent safety regulations, and South Africa has an excellent track record in this regard. This said, there have been isolated cases where vaccines have failed to work because of improper storage conditions,” says Burnett.

All vaccines should be kept at a constant temperature of between 2 and 8 degrees Celsius, says Lee Baker. So as long as the cold chain has been reliable, your vaccine should be effective. Multidose vials of live vaccines need to be used up within six hours of being opened to prevent spoilage, so check at the clinic that your baby’s vial is fresh.

Argument 5: “I vaccinated my child and he still got that disease. Vaccines don’t work”

It’s true: your baby can get ill from a disease he was vaccinated against. Vaccines have about an 85 to 95 percent success rate.

This example from the WHO, also quoted by Burnett et al, is useful: imagine a school has 1000 pupils, 995 of whom are vaccinated against measles. All 1000 children are now exposed to measles. All five unvaccinated children and seven of the vaccinated children then contract measles. So in percentages, 100 percent of the unvaccinated children but only 0.7 percent of the vaccinated children got sick.

But stated differently, the same statistic sounds dreadful: of the sick children, 58.3 percent (7 out of 12) got sick despite being vaccinated! Put this way, it sounds as if more vaccinated children actually get sick from that disease than unvaccinated ones (which is an argument often seen on anti-vaccinators’ websites). When you next read a statistic, examine the way the information has been presented to you carefully according to the agenda of the person presenting it to you.

Argument 6: “Pharmaceutical companies want to make money off us”

Some parents believe that vaccinations are a way for pharmaceutical companies to sell unnecessary products and make large profits. Whether or not “Big Pharma” is dirty, overcharging, or invested in selling unnecessary products (and like many industries, it probably is), it realistically cannot use all vaccines as tools for its nefarious purposes, all by itself. It cannot undo the hundreds of years of scientific research that has brought us to a point of understanding disease and immunity. It cannot influence all independent scientists who advise governments on vaccines to add to their schedules after rigorous independent research. There really isn’t a cabal out there whose life’s work is to keep our children sick.

Conspiracy theories work both ways. If a professional or website is advising you to refuse vaccinations, examine if the person or organisation wants you to spend money on something else in their stead.

“Not vaccinating your child in fear of the risk of side effects would be the same as not buckling your child in the car because there have been instances of seat belt decapitation.” – skepticfamily.com