American children and parents in the 21st century are naive to many infectious diseases. Thanks to vaccinations, populations have seemingly forgotten about smallpox, measles, polio, pertussis, and many others. This lack of knowledge and recognition of diseases has left us vulnerable to these reemerging illnesses. Pertussis (aka Whooping Cough) is reemerging in California, as described in the article, “Whooping Cough Makes a Comeback,” featured in the Washington Post.
Bordetella Pertussis is the bacteria responsible for Whooping Cough. There are two vaccines currently available for Pertussis: whole cell (deactivated pertussis bacteria) and acellular (purified pertussis proteins). Since the 1940s, the whole cell vaccine has decreased the pertussis infection rate by 99%. In the 1970s, the vaccine shifted to acellular, due to rare but severe side effects from the whole cell. This change, along with three other factors have lead to the reemergence of pertussis: bacteria are mutating, effectiveness of vaccines are in dispute, and parents are opting to refuse vaccination.
Fear is the main factor compromising immunity. Parents are opting out of vaccination due to popular misunderstandings concerning vaccines, as they are uninformed and fall susceptible to rumors (i.e. the MMR vaccine causes autism). Scarred parents then rely on herd immunity to protect their vulnerable children from infectious diseases. Herd immunity is the concept that not every person needs to be immunized for a population to be protected from a disease. When the majority of a population is protected, an illness’ infectivity deceases, lessening the opportunities for the bacteria or virus. Thus, even those not inoculated are inadvertently protected.
However, when too many parents rely on this theory, herd immunity fails. If too few children are vaccinated, the threshold drops bellow effective levels, allowing the bacteria or virus to spread rapidly through a population. This trend is observable in many wealthy communities, where parents are less likely to subject kids to vaccines due to a false sense of security. Consequences of this decision can be detrimental, causing an upsurge in cases and increasing risk for immunodifficient children. Despite all the popular beliefs, there is one truth: benefits of vaccination far outweigh the potential risks.
Fearful parents are not the only obstacles, as physicians, pharmaceutical companies, and the healthcare system share the blame. Health care providers need to inform their patients of the actual risks of vaccines, correcting any preconceived beliefs. Pharmaceutical companies are becoming reluctant to developing vaccines because they face legal implications over risks associated with vaccines. Furthermore, there is only a small return on investment, so vaccines are not profitable for the company to continue to produce and innovate. Finally, due to access disparities in healthcare, children of lower socioeconomic status tend to have lower rates of vaccination. Only through eliminating this access disparity and by inoculating these children can any population be effectively protected against infectious disease.
There are many approaches the public health sector can take to tackle the reemergence of Whooping Cough: mandating boosters to ensure continued immunity, screening those who are at highest risk, educating the community about the truth of vaccination, providing children with equal access, and incentivizing the pharmaceutical sector to continue production of vaccines. Appropriate public policy must be implemented to ensure these changes.
Hi Anna,
ReplyDeleteYou did a nice job summarizing the article. I find it interesting that there is such a high percentage of parents who refuse vaccinations in Marin County. This represents a large failure the the risk communication to parents by physicians and public health officials.
I was also struck by the fact that experts in California think that recent outbreaks are do to more than just lack of vaccinations, but are also due to lack of booster vaccines and to mutations in the bacteria.
Also sadly 8 out of the 9 children who died were to young to even get the vaccine. These children rely the most on "herd immunity" to protect them, which is clearly waning due to poor vaccination rates, boosters, and less effective vaccines.
You listed a number of good public health approaches to the problem. What are some specific ways you would mandate boosters--I mean how would you make sure this was happening? Similar to incentiving pharamceutical companies, I would also add providing funding for research on how the bacteria has changed and what are the most effective ways of delivering the vaccine.
Michael