THE IMPORTANCE OF VACCINE ADVOCACY

Infectious diseases, with rare exceptions, never go away entirely. Someone, somewhere may harbour a deadly disease that can potentially spread to others and cause an epidemic. Bubonic plague, smallpox and poliomyelitis (polio) are diseases that once killed millions and terrified everyone. Of these, only smallpox has been officially declared eradicated, with animals still carrying plague bacteria and pockets of polio outbreaks in places with low vaccination rates. While measles was declared eradicated in North America and Europe, imported cases still occurred. Ironically I did not appreciate those facts when I declined an offer of a fellowship in infectious diseases with an expert in the field, thinking that they were all controlled by antibiotics. I instead went off into oncology.

In my childhood, measles, mumps, rubella and chicken pox were common and simply considered ‘childhood diseases’, but there were always those who had major complications and some who died from them. Measles in particular could cause pneumonia and encephalitis, an inflammation of the brain. Polio was so prevalent and dangerous that we were told to avoid public spaces such as swimming pools during hot summers. It was vaccines that eliminated these diseases so that most parents and younger physicians today have no experience with those fearful times. That in itself poses a threat. Santayana’s famous aphorism, often misquoted, is ‘Those who cannot remember the past are condemned to repeat it.’ It would be a catastrophic mistake if the vaccines that have removed so many threats to life without causing major toxicity were abandoned because we thought those threats were gone forever.

Six of us, classmates from the Harvard College class of 1957, recently gave a webinar to our other classmates on vaccines and have remained together as an advocacy group. All of us are retired Professors of Medicine, Pediatrics or Neuroscience. We are a public health group, not a political one, and we have never asked one another their political views. Nevertheless we find ourselves having to counter misinformation often promoted by those in power in the US. For example, vaccines are rarely dangerous in themselves, with severe or catastrophic side effects occurring in far fewer than 1 in 100,000 doses. That is infinitesimal compared with the risks of misery and death that they prevent. There is even evidence that vaccines can be helpful, sometimes in unexpected ways. The vaccine against shingles may help to prevent Alzheimer’s disease in a way yet to be illuminated. More directly, hepatitis B vaccine given at birth prevents cancer of the liver and HPV vaccine prevents cancer of the cervix.

The threat of the MMR (measles, mumps, rubella) vaccine causing autism is based on a lie from a British physician whose paper on the subject was discredited by an investigative reporter and retracted by The Lancet. Yet there are those who continue to assert the linkage between the two, which has caused many parents to withhold vaccinating their children. The myth of an epidemic of autism ignores the fact that the diagnosis of the disease has changed to include those on the autism spectrum. There is still no credible evidence linking any vaccine or combination of vaccines with autism. Nevertheless the false assertion persists, causing ‘vaccine hesitancy’ – ie refusal to vaccinate – which has already led to outbreaks of measles with fatalities and tetanus in two US states.

Our advocacy group has had personal experience with the diseases now controlled by vaccines. One of us is an eminent neuroscientist who had paralytic polio before the Salk and Sabin vaccines were available in the 1950s. He overcame his disability and had a brilliant career. Tragically, 75 years later he is experiencing post-polio syndrome, where nerve cells affected initially are continuing to weaken. Another of us had a stepmother who contracted polio on her honeymoon with his father and was unable to stand afterwards. He has written movingly about how helping her off the floor after a fall when he was a teenager led him into a career in medicine. Another of us had to push on the abdomen of a woman with polio giving birth in an ‘iron lung’. I myself treated an unvaccinated young man with tetanus who fortunately survived but had suffered before admission to the hospital with the typical clenched jaw and rigid posture of the disease.

Our personal encounters with infectious diseases are what compel us to fight against misinformation and complacency. Otherwise, the diseases we think we have already defeated will re-emerge and wreak havoc on our children and ourselves.

It is particularly fitting that this commentary appear in an Oxford publication. As a Fulbright Scholar in 1959–60, in the midst of my medical school training, I had the great privilege of learning immunology under Dr (later, Sir) James L Gowans at the Dunn School of Pathology as his first graduate student. Professor Sir Howard (later, Lord) Florey wrote to me before I came that Gowans was ‘one of the best people’, long before I or most people had ever heard of him, and he was right. I learned sound scientific method and the necessity to wait until the whole story was developed before publishing. We kept in touch intermittently and I visited him at his home, with my wife and youngest son, 50 years later. When the Oxford Vaccine Group announced the Phase I trial of the new ChAdOx vaccine against the Bundibugyo ebolavirus, I saw that as part of the legacy of immunology that began with Gowans and Sir Peter Medawar at the Dunn School.

We in America owe Oxford and the UK government not only our gratitude but perhaps our lives for trying to contain the disease. Infectious diseases do not respect borders.