Tag Archives: vaccines

Just 10 vaccines have saved 36 million children in the past two decades

Vaccinations for 10 major diseases have prevented the deaths of 37 million people in nearly a hundred low- and middle-income countries since the turn of the century, according to a new modeling study. The news comes amid widespread hesitancy around COVID-19 vaccines, which are starting to roll out in several countries, reminding the world of just how important vaccines are for us.

Image credit: Flickr / Ericsson.

Side effects: Might save your life

Vaccines have been responsible for substantial reductions in mortality and are among the most cost-effective health interventions in the world, the authors of a new study point out . In addition to direct protection provided to vaccinated individuals, high levels of vaccination coverage offer indirect protection (herd immunity) to the remaining unvaccinated individuals.

The timescale of vaccine impact varies considerably. For some childhood diseases (such as measles, rotavirus, and pneumococcal disease), the impact is seen rapidly, whereas, for human papillomavirus (HPV) and hepatitis B, vaccine impact is commonly seen over a much longer timescale in the reduction of adult morbidity and mortality. Caroline Trotter, a co-author of the study, said in a statement:

“There has been a much-needed investment in childhood vaccination programs in low-income and middle-income countries and this has led to an increase in the number of children vaccinated. To inform future investment and ensure it continues we need to evaluate the impact of these programs on public health.”

The Vaccine Impact Modelling Consortium, a collaboration of 16 research groups, created estimates from at least two independent models, for each of ten diseases. The estimates focused on deaths averted by vaccination against 10 diseases in 98 countries, two-thirds of the world’s population, in the period 2000-2030.

The 10 diseases the researchers focused on were: Hepatitis B, Haemophilus influenzae type b (Hib), human papillomavirus (HPV), Japanese encephalitis, measles, meningitis A (Neisseria meningitidis serogroup A), pneumococcal disease (Streptococcus pneumoniae), rotavirus, rubella, and yellow fever. Vaccinations against such diseases prevented 37 million deaths between 2000 and 2019, of which 36 million were deaths averted in children under the age of 5 years, according to the Consortium’s findings. A further 32 million deaths will be prevented by 2030 due to vaccine programs, of which 28 million are deaths averted in under-5s.

Measles vaccination had by far the largest estimated overall impact, the study showed, with 33 million estimated deaths prevented in the period 2000-2019. This represents over 1.6 million deaths averted per year. The researchers also anticipate this will increase to over 2.1 million deaths averted per year in the period from 2020 to 2030.

“Our study signifies the huge public health benefits that can be achieved from vaccination programs in low-income and middle-income countries,” the study’s corresponding author Neil Fergurson said in a statement. “By projecting up until 2030 in these 98 countries we have provided insight on where investments in vaccine coverage should be directed to achieve further gains.”

Above those already achieved, the largest potential additional gains will be seen by increasing HPV vaccination coverage in girls, the study showed. This is predicted to avoid more deaths per person vaccinated than any other immunization activity. Increasing pneumococcal conjugate vaccine coverage will give the largest reductions in under-5 mortality.

The researchers also highlighted what could be achieved by further investment in vaccination programmed by countries and donors. Priorities should include increasing coverage of vaccines against HPV and pneumococcal disease. Continued funding, investment, political commitment, and strengthened health systems are needed to sustain the gains already seen.

Still, the study has some limitations, especially since many of the countries selected don’t have complete or consistent data on disease burden and death. In the countries where certain vaccines were yet to be introduced the study assumed they will reach the same coverage as a reference vaccine, which may lead to an overestimation of impact.

But regardless of these uncertainties, one thing’s for sure: millions of children and adults have been saved by vaccines, and it’s a remarkable scientific triumph.

The study was published in the journal The Lancet.

India authorizes two COVID-19 vaccines and readies massive vaccination campaign

India, the world’s second-most populous country with nearly 1.4 billion people, has authorized two COVID-19 vaccines and will start a gargantuan inoculation program this week. The country has the second-largest virus outbreak after the U.S with more than 10.3 million confirmed coronavirus cases and over 149,000 deaths — which makes mass vaccination very necessary, but also very difficult.

Image credit: Flickr / Gwydion Williams

The country granted emergency approval to two vaccines: the one developed by AstraZeneca and Oxford University and the one developed by the state-run institute Bharat Biotech. Both will be administered in two dosages and were “carefully examined,” India’s Drugs Controller General Venugopal G. Somani told AP.

The news was welcomed by Indian Prime Minister Narendra Modi, who called the vaccine approval a “decisive turning point to strengthen a spirited fight” and said every Indian should be proud of the development. Still, a massive vaccination like the one planned by the government can never be easy.

Starting this month, health care and front-line workers such as police officers will be vaccinated in the first phase of the campaign, as well as those above 50 years of age and those with pre-existing conditions. India aims to vaccinate up to 300 million people by summer. Getting the shot will be voluntary, officials say.

The massive campaign will build on the country’s election platform. Demographic information from the electoral rolls will be used to identify elderly people who need the vaccine. The vaccination sites will be set up like polling booths, with officers responsible for verifying identification documents and managing crowds.

India already carried out mock vaccinations last Saturday at more than 250 sites across the country. The test included all the steps involved in a vaccination campaign, from transporting the vaccine to checking how the doses will be administered. The government is also working on a website to monitor vaccine delivery.

Producing vaccines

India’s Serum Institute, the world’s largest vaccine manufacturer, was contracted by AstraZeneca to produce one billion doses for its vaccine for developing nations, including India. But exports from India won’t be allowed for several months says Adar Poonawalla, Serum Institute’s CEO, told AP, which might delay vaccination in other countries.

Although the manufacturer doesn’t have a written agreement with the Indian government, India will undoubtedly be its main priority, having already given the country most of its stockpile of around 50 million doses. The decision was taken to ensure protection to vulnerable populations in India and to prevent hoarding, Poonawalla said.

India is the second country to approve the AstraZeneca-Oxford vaccine after the UK approved it last week. It’s a cheap vaccine, costing between $3 to $4 per dose to produce. AstraZeneca has vowed not to make a profit during the pandemic. It’s also easier to transport and store than others like Pfizer’s.

But this isn’t India’s only choice amid the pandemic. The country is also betting on COVAXIN, the second vaccine so far approved by the government. It was developed by Bharat Biotech in collaboration with government agencies but it’s still in stage 3 clinical trials, with the results yet to be released by the manufacturer.

The trials started in mid-November with over 25,000 volunteers. The Drugs Controller General of India said in a statement that the vaccine has been found “to be safe as per the data available” but India Drug Action Network, a public health watchdog, asked for more transparency and said there’s not sufficient data. It’s a somewhat similar situation to Russia, where the vaccine has also been approved before completing Phase III trials.

As well as India, other countries are also working to secure vaccines and start vaccination as soon as possible. At least 7.7 billion vaccine doses have already been purchased, with another 3.9 billion reserved should countries or blocs elect to expand their orders, according to Duke University’s tracker.

The U.S. has reserved nearly one-quarter of the global supply with 2.6 billion doses, combining both categories. On the other hand, not a single country in sub-Saharan Africa has announced a deal to purchase vaccine doses. Nevertheless, Johnson & Johnson is aiming to produce 300 million doses in South Africa next year, and other vaccines are also right around the corner.

Numb and Nope obstruct vaccine efforts

In a world turned upside down by the pandemic, we’re following a lot of different threads: vaccine news, data graphics, infection hot spots, distribution issues, you name it. But… how are we doing, really? It’s hard to get an accurate sense of how the pandemic is going.

At the close of 2020, says Harvard T.H. Chan School of Public Health Dean Michelle Williams, we are at an inflection point. At a presentation called “COVID-19: Chasing Science to Save Lives,” she discussed the current opportunities and challenges brought by the vaccination campaigns that are just around the corner.

Williams says that on the plus side, news of vaccines really is promising. The mRNA technology has brought forth a whole new class of vaccines that are safe and quick to develop. But on the flip side, the pandemic is hitting a new spike and daily news is as bad as ever.

With all this news, one also can see how people can easily become numb.

Numbness is actually a major enemy in this pandemic. All across the country, we see footage of people in malls and at birthday parties, congregating without masks, without physical distancing, and with growing disinterest towards the pandemic.

“Is numbness the way we are coping?” she asked. It may very well be.

Resistance to science endangers all of us

What’s more, Williams (like all of us) has grappled with the fact that some of our leaders were so unwilling to follow the science. She said resistance to science was a clear and present danger to all of us.

The other danger is vaccine hesitancy. She referred to a Pew survey, where about 20 % of Americans said they were pretty certain that they would never take the vaccine no matter what new information they learned about it.

There are two main actors in this pandemic drama: scientists trying to find answers and the public who are free to accept or rebuff the answers. Scientists and the public need to work together. “We can’t work in silos,” she said. Establishing a good communication structure is even more important as this isn’t the first nor the last pandemic to pose a threat to mankind. “What we do means a lot to all the future global threats ahead of us.”

Williams also mentions what Napoleon famously said to his valet ahead of one battle. He said to dress him slowly because he was in a hurry. Sometimes, slowing down and assimilating things is the fastest way to protect ourselves and our loved ones. “We cannot afford to go numb.”

Some degree of normality

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was part of the presentation and he spoke of ways to get out of the pandemic. He said not getting vaccinated should not turn out to be the missing link in achieving success.

“What percentage of people in our society are going to be willing to be vaccinated? If we have a 95% effective vaccine and only 40 to 50% of people in society get vaccinated, it’s going to take quite a while to get to that blanket of herd immunity that’s going to protect us enough that you and I would feel comfortable in going out into society and saying the level of virus is so low that its not a threat to anyone.”

Fauci believes if vaccinations are done efficiently enough over the second quarter of 2021, “by the time we get to the end of the summer, i.e., the third quarter, we may actually have enough herd immunity protecting our society that, as we get to the end of 2021, we can approach very much some degree of normality that is close to where we were before.”

A recent webinar featuring scientists in epidemiology had similarly commented that a hurdle to success would be vaccine hesitancy. The view was that if the vulnerable among the elderly and other communities refused to take vaccines when available, the battle to eradicate Covid-19 would not go far.

Barry Bloom, research professor of public health and former dean of the faculty, Harvard T.H. Chan School of Public Health, moderated. “Let me just say there’s a mantra,” said Bloom, among immunologists and vaccine people that “vaccines do not save lives. Vaccination does.”

Sri Lanka has eliminated measles

While measles continues to be a problem in Europe, America and several parts of Asia, and Africa, the World Health Organization (WHO) recently announced that Sri Lanka had successfully eliminated measles from the island country. The country reported its last case of measles caused by an indigenous virus in May 2016. According to the WHO, an independent verification committee had comprehensively studied the country’s efforts towards eliminating the disease before declaring it as a ‘measles-free’ country.

The WHO South-East Asia Regional Director Dr. Poonam Khetrapal Singh said Sri Lanka’s success demonstrated its commitment, the determination of its health workforce and parents to protect children against measles.

“The risk of importations of measles virus from countries near and far will remain, especially from those that have significant population movement with Sri Lanka. Further strengthening the immunity of the vulnerable population, capacities to detect and readiness to respond to measles virus both at the national and sub-national levels, would be the key to the country’s continued measles-free status in the coming years,” said the WHO official.

Measles is a highly contagious viral disease transmitted via droplets from the nose, mouth or throat of infected persons. It is characterized by a prodrome of fever and malaise, cough, coryza, and conjunctivitis — the three “C”s – a pathognomonic enanthema (Koplik spots) followed by a maculopapular rash. Common complications from measles include otitis media (ear infection), bronchopneumonia (pneumonia that causes inflammation in the alveoli), croup (or laryngotracheobronchitis, swelling inside the trachea), and diarrhea. Even in previously healthy children, measles can cause serious illness requiring hospitalization.

While global measles deaths have decreased by 84 percent worldwide in recent years — from 550,100 deaths in 2000 to 89,780 in 2016 — measles remains an important cause of death among young children globally, particularly in parts of Africa and Asia. Measles. The return of measles in other countries who have previously been declared “measles-free” reflects historical amnesia, declining faith in institutions, the spread of health misinformation, and a troubling lack of concern for the public good.

Sri Lanka is the fourth country in the WHO South-East Asia Region, after Bhutan, Maldives, and Timor-Leste, to eliminate measles and control rubella. Last year, Sri Lanka achieved rubella control, along with five other countries – Bangladesh, Bhutan, Maldives, Nepal, and Timor-Leste. Under the Global Vaccine Action Plan, measles and rubella are targeted for elimination in five WHO Regions by 2020.

Most people believe that vaccines are safe and effective

But the amount of people that don’t believe vaccines are safe and effective is alarming and until everyone is convinced, we are all at risk.

The biggest and first of its kind global survey into public attitudes to health and science revealed high overall global trust in doctors, nurses and scientists, and high confidence in vaccines. Over 140,000 people ages 15 and older from more than 140 countries gave their views on the safety and efficacy of vaccinations as part of an almost two-year project funded by London-based biomedical research charity Wellcome Trust.

 

The results of the Wellcome Global Monitor, published on 19 June, suggest that 79% of people worldwide agree, to some extent, that vaccinations are safe, three quarters of the world’s population trust doctors and nurses more than anyone else on healthcare issues, and 72% trust scientists. The survey also shows a first glimpse into what people think about the issues for many countries, including Colombia, Nigeria, South Africa, and Vietnam.

Vaccine skepticism higher in high-income countries

Source: Wellcome Global Monitor [From Nature]

Only 72% in North America and 73% in Northern Europe said vaccines are safe, but the number even lower in Europe. Just half of those in Eastern Europe and 59% in Western Europe strongly or somewhat agreeing with the statement “vaccines are safe”. By contrast, two lower-income countries—Bangladesh and Rwanda—had the strongest confidence in vaccines (97% and 94%, respectively). The report said that was attributed to the two nations’ strong commitment to vaccines. The numbers remain high throughout South Asia and East Africa.

For most parts of the world, higher confidence in health systems, governments, and scientists translated to high trust in vaccines, except for Europe, where the picture was more complicated, with respondents from France reporting the lowest levels of trust in vaccines: 33% of French respondents disagreed that vaccines are safe, and 10% disagree they are important for children to have. Countries with the highest percentage of parents saying they don’t vaccinate their children are China (9%), Austria (8%), and Japan (7%).

According to Seth Berkley, CEO of GAVI the Vaccine Alliance, “The results of the Wellcome Global Monitor illustrates how vaccines have been a victim of their own success. Confidence is lowest in countries where the terrible impact of many vaccine-preventable diseases is no longer felt.”

About 1 in 5 (19%) felt they were “excluded” from the benefits of science and 57% of global respondent said they do not know much, if anything, about science.

Alongside learning science at school or college, confidence in national institutions such as the government, the military, and the judicial system are among the strongest factors that relate to trust in science.

The researchers also found a gender difference in people’s reports on their understanding of science, with men significantly more likely to report a good understanding level compared with women. The gender gap was greatest in Northern Europe and lowest in the Middle East and Southeast Asia.

Jeremy Farrar, Director of the Wellcome Trust, said “No matter how great your idea, how exciting your new treatment, or how robust your science, it must be accepted by the people who stand to benefit from it. Vaccines, for example, are one of our most powerful public health tools, and we need people to have confidence in them if they are to be most effective.”

Understanding the causes of low confidence is essential. We must now find ways to address people’s country / regional / vaccine-specific concerns and build trust. Vaccines work. Vaccines save lives but we are all at risk of vaccine-preventable diseases until everyone is convinced.

Do not enter sign.

New York county declares state of emergency over measles and bans unvaccinated kids from public areas

New York’s Rockland County has declared a state of emergency this Tuesday. Officials also issued a directive barring unvaccinated children from all public spaces.

Do not enter sign.

Unvaccinated children will be banned from entering public spaces for the next 30 days.
Image credits Nicholas Jackson.

The outbreak began last October and has afflicted 153 people so far, mostly children. In a bid to prevent further infections, the county barred unvaccinated children from public spaces for 30 days, or until they receive their vaccines. Anti-vaccine parents tried to take the decision down in federal court but their case was dismissed.

State of emergency

“We must not allow this outbreak to continue indefinitely,” said County Executive Ed Day in a statement announcing the emergency declaration. “Every action we have taken since the beginning of this outbreak has been designed to maximize vaccinations and minimize exposures.”

“We are taking the next step in that endeavor today. We must do everything in our power to end this outbreak and protect the health of those who cannot be vaccinated for medical reasons and that of children too young to be vaccinated.”

Last September, a traveler arrived in Rockland from Israel, which is also struggling with outbreaks of the highly infectious virus. It has since spread through the local communities, particularly among the county’s insular Orthodox Jews, authorities note, and other groups with low average vaccination rates. Currently, Rockwell is one of six locations in America going through a measles outbreak.

Starting from midnight on Wednesday, March 27, anyone aged 18 or younger who has not been vaccinated against measles will not be allowed to access public spaces in Rockland for 30 days — or until they get the shot. In their directive, authorities define public spaces as areas where “more than 10 persons are intended to congregate for purposes such as civic, governmental, social, or religious functions, or for recreation or shopping, or for food or drink consumption, or awaiting transportation, or for daycare or educational purposes, or for medical treatment. A place of public assembly shall also include public transportation vehicles, including but not limited to, publicly or privately owned buses or trains.”

“We’re not punishing the people who are doing the right thing already and following the rules. We just want to encourage everyone to do the right thing so we can stop this outbreak,” said John Lyon, Rockland County Executive Ed Day’s director of strategic communications.
The step is “extremely unusual. [We] don’t believe it’s been done anywhere in the country before.”

So it’s pretty comprehensive. The prohibition was decided upon after county health officials announced six new exposure sites in Spring Valley and Monsey, including several supermarkets, public transport areas, and other social hotspots says USA Today. It also follows an order the county issued last December which barred unvaccinated children from schools in the 10952 and 10977 ZIP codes that were not at a minimum 95% vaccination rate. Taken together, the two are intended to stymie the spread of the measles virus by limiting potential exposure to those most at risk: the unvaccinated.

These measures didn’t go unchallenged. Earlier this month, ArsTechnica reports, anti-vaccination parents took the ban to court. It violated their religious freedom, they argued, as they had used religious exemptions to opt their children out of the standard vaccination programme. However, their case was denied, and the judge did not agree to issue a temporary injunction that would let the children return to school.

Personally, I think that was the right move on the part of the judge. Some of the parents, however, seem not to agree:

“As this outbreak has continued, our inspectors have begun to meet resistance from those they are trying to protect. They have been hung up on or told not to call again. They’ve been told ‘we’re not discussing this, do not come back,’ when visiting the homes of infected individuals as part of their investigations,” Day noted in his announcement.

“This type of response is unacceptable and irresponsible. It endangers the health and wellbeing of others and displays a shocking lack of responsibility and concern for others in our community.”

So far this year, the Centers for Disease Control and Prevention has confirmed 314 cases of measles across 15 states. This figure stood at 372 cases total in 2018 and 120 in 2017.

Day said the timing of this ban was meant to coincide with family gatherings during the upcoming holidays of Passover and Easter. Noncompliance will incur penalties of six months in jail or a $500 fine, although law enforcement will not be deployed at any location seeking proof of vaccination, Day adds.

 

Yet another study shows that vaccines don’t cause autism

Researchers found that the mumps, measles, and rubella (MMR) vaccine does not increase the risk of autism, does not trigger autism, and is not associated with autism in any relevant way.

More than 20 years ago, Andrew Wakefield published what is perhaps the most horrid paper in modern history: he reported a hypothesis that linked the measles, mumps, and rubella (MMR) vaccine to autism. The paper has long been retracted and discredited, and Wakefield’s methodology was so flawed and fraudulent, that even his medical license got revoked. Study after study showed that there’s just nothing to the Wakefield study, but nevertheless, his ideas were picked up and became the seed that bloomed into the antivaxxing community. Today, vaccination rates are decreasing significantly in many parts of the world, with more and more children becoming sick and dying as a result.

Hoping to help change that perception, a team of Danish researchers studied the potential effect of the MMR vaccine on children who are at risk of autism.

“We see vaccine skepticism growing,” says the study’s lead author Anders Hviid, an investigator at the Statens Serum Institut, the national public health organization in Denmark. “So we thought it was a good idea to revisit the hypothesis and try to get scientific answers to the different criticisms from skeptics of the original study.”

Hviid and colleagues studied a total of 657,461 children, evaluating whether the MMR vaccine increased the risk of autism in children over more than 10 years, from 1999 to 2010. Vaccination rates were around 95%, and 6,517 children were diagnosed with autism over the study period.

There was absolutely no connection between vaccination and autism, neither in the general study population nor in the at-risk children. In other words, children vaccinated with MMR did not develop autism at a significantly different rate than those who were not vaccinated. Furthermore, the timing of autism diagnoses did not cluster after the MMR vaccination

Around the world, measles cases increased by 48.4% between 2017 and 2018, according to data from the World Health Organization (WHO). The WHO has declared vaccine hesitancy as one of the top 10 threats to global health. At this point, there have been 17 studies done across 3 continents involving millions of children, all finding the same thing: vaccines don’t cause autism.

The myth that vaccines cause autism needs to go away. It’s been disproven time and time again and it’s putting the health of children (and to a lesser extent, also adults) at risk.

“This idea that vaccines cause autism is still around and is still getting a lot of exposure in social media,” noted Anders Hviid, lead study author and senior investigator at Statens Serum Institut in Denmark.

 

Study reference: Hviid A, Hansen JV, Frisch M, Melbye M. Measles, mumps, rubella vaccination and autism: a nationwide cohort study. Ann Intern Med.

 

 

 

 

 

Australia says ‘bye bye’ to rubella. Cervical cancer is next

Good riddance, Rubella! Thank you, rubella vaccine.

The World Health Organization (WHO) has officially declared Australia free of rubella. Rubella, also known as German measles, is a contagious viral disease. The symptoms in children include fever, rash and sore throat – but infection can be devastating for expectant mothers who may contract rubella during the first 10 weeks of pregnancy. Many will suffer miscarriage or have children born with heart defects, liver disease, vision issues, deafness, or intellectual disabilities.

“The elimination of rubella is a highly significant public health accomplishment for Australia and sends a powerful message that vaccinations work,” Federal Minister for Health Greg Hunt stated. “The science is in and the medical experts’ advice is absolute — vaccinations save lives and protect lives and they are an essential part of a healthy society. I commend the efforts of Australia’s health professionals over the decades and the millions of parents who ensure their children are always vaccinated.”

In the 1940s, Australian ophthalmologist Sir Norman McAlister Gregg was the first to describe the connection between rubella infection in mothers, and cataracts and other birth defects in babies. This discovery led to the development of the rubella vaccine in the 1960s. Before the rubella vaccine was developed, large outbreaks were recorded. In 1963-64 there were more than 3,000 documented cases of rubella. Australia’s first vaccination program, introduced in 1971, only targeted schoolgirls, with the aim of preventing infection during pregnancy and the subsequent risk of congenital rubella syndrome. Today, the National Immunization Program provides free vaccinations against rubella for all 12-month-old children. A second booster is given at 18 months.

Australia now joins a cohort of over 30 nations who have all been declared rubella free. Despite the WHO’s current Global Vaccine Action Plan, which intends to see rubella eliminated in five WHO regions by 2020, the disease remains prevalent in many countries.

Cervical cancer, you are next to go! Thank you, HPV vaccine (and screening)!

Research published in The Lancet Public Health predicts cervical cancer will soon be a rarity in Australia, with fewer than six new cases per 100,000 women by 2022, and fewer than four new cases per 100,000 women by 2035. With this, Australia is set to become the first country in the world to effectively eliminate cervical cancer as a public health issue within 20 years, thanks to national vaccination and screening programs.

In 2007, Australia launched a national publicly-funded school immunization program for the vaccine to tackle the human papillomavirus (HPV). Since the introduction of the National Cervical Screening Program (NCSP) in 1991, there’s been a 50% reduction in cervical cancer cases in Australia.

“If high-coverage vaccination and screening is maintained, cervical cancer could be eliminated as a public health problem in Australia within the next 20 years,” according to researchers from the Australian Cancer Council.

The basic technology behind the HPV vaccine against cervical cancer was developed by Australian immunologist Professor Ian Frazer at the University of Queensland. While most developed countries have now implemented some form of the vaccination program, some challenges remain including widespread misinformation regarding the risks of vaccines.

Vaccines work, definitely!

These public health accomplishments were possible because of the nation’s health care system and vaccination program. The number of children in Australia with full immunization coverage has spiked, hitting a record high, according to the latest data. The rate of vaccination among Indigenous children has also reached its highest-ever level, according to official data from the National Centre for Immunization Research and Surveillance (NCIRS). The proportion of fully immunized five-year-olds reached 94.5 percent, and 93.8 percent of one-year-olds had also received all the vaccinations on the National Immunization Program (NIP). According to NCIRS director Professor Kristine Macartney, the high vaccination rates were crucial to maintaining Australia’s status as being measles-free since 2014, particularly with other Western countries struggling to contain the disease.

Vaccine hesitancy among the top 10 global health threats

Illustration by Eoin Kelleher

The World Health Organization (WHO) has ranked vaccine hesitancy as one of the top 10 health threats in the world for 2019. Other threats flagged by the WHO were diabetes, cancer and heart disease, people living in vulnerable settings, antimicrobial resistance, Ebola, weak primary health care, dengue, and HIV.

Vaccine hesitancy is sad and worrying because vaccination also plays a role in reducing antimicrobial resistance as well as reducing complications in patients with non-communicable diseases – two other global factors in WHO’s top 10 list of health threats. There are well-documented reports showing that some vaccines decrease antibiotic use, thus lowering the likelihood of antibiotic resistance. Studies also show that people with type 2 diabetes can significantly lower their risk of major cardiovascular events such as stroke and heart failure during the influenza season by getting the flu vaccine.

Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Dr. Bruce Y. Lee, perfectly explains what vaccine hesitancy is – “it is people questioning whether to get vaccinated or more often whether children should be vaccinated, despite the abundance of scientific evidence showing the effectiveness of vaccines in preventing disease, despite the lack of proven alternatives, and despite experts around the world urging people to get vaccinated.”

Vaccination is one of the most cost-effective ways of preventing disease – it currently prevents up to 3 million deaths a year from tuberculosis, diphtheria, tetanus, pertussis (whooping cough), polio, measles, hepatitis B, and Hib (Haemophilus influenzae b) infections. A further 1.5 million deaths could be avoided if global vaccine coverage rate improved. Vaccines have an indisputable track record – through vaccines, we have eradicated smallpox and contained polio to just three endemic countries and greatly reducing many other diseases

From Pfizer. Adapted from CDC. JAMA, November 14, 2007; 298(18):2155–63. † CDC. MMWR, January 8, 2010; 58(51,52):1458–68. ‡ 2008 estimates, S. pneumoniae estimates from Active Bacterial Core Surveillance.

One of the biggest drivers of health behaviors is risk perceptions. Anti-vaccine information shapes this and science advocates need more effective responses. We need to highlight stories about the success of vaccines, educate people on how to appraise information (distinguish facts from fake news), have pro-active communication between parents and healthcare professionals, provide education materials on social media platforms).

There are several anonymous anti-vaccination messages on social media that have no clear sources other than blogs and dubious publications. A lot of these websites are still referencing Andrew Wakefield’s retracted and fraudulent paper published in The Lancet. Compare this with the real doctors and healthcare professionals and experienced scientists who are willing to clearly put their names and list their experience and qualifications on messages that support vaccination.

8 New Tools and Emerging Technologies For Tuberculosis

Scanning electron micrograph of Mycobacterium tuberculosis bacteria, which cause TB. Credit: NIAID, Flickr.

Scanning electron micrograph of Mycobacterium tuberculosis bacteria, which cause TB. Credit: NIAID, Flickr.

 

World TB Day is celebrated every year on March 24 to raise public awareness about the devastating health, social and economic consequences of tuberculosis (TB). World TB Day 2018 is exceptionally noteworthy because never in the history of TB has there been more attention and commitment to ending the infectious disease that kills 1.7 million people each year.

The animation below shows how TB spreads in the body and how the immune system fights it. It also illustrates the different ways the TB bacterium can develop into the disease; either through overwhelming the immune system (common in children) or by latent TB waking up and becoming active (typical for those with weak immune systems such as older people, those who are HIV positive, or have had organ transplants or chemotherapy).

Global progress depends on advances in TB diagnosis, prevention, and care in countries with high TB burden. In celebration of World TB day, here are eight new developments about tuberculosis drugs, vaccines, and diagnostics.

  1. TB is diagnosed using a skin test, or by culturing bacteria from a person’s sputum. Both methods can only be performed by trained microbiologists and may take several days to give results. Good news! Professor Alessandra Luchini, of George Mason University in Virginia, and her team developed a urine test that detects a specific sugar that coats the surface of TB bacteria and gives results in half a day.
  2. A team of chemists working in collaboration with doctors and public health researchers in South Africa has developed a new test that makes it easier to diagnose TB. The test developed by Professor Carolyn Bertozzi and the team at Stanford ChEM-H is called DMN-Tre and takes just a few steps and produces results in under an hour. They attached the sugar trehalose to a fluorescent dye that, once ingested, glows about 700 times brighter than before. When you see a very bright cell, it means live tuberculosis is present.
  3. The only licensed TB vaccine, BCG (Bacillus Calmette Guerin), was developed by Albert Calmette, a French physician and bacteriologist, and Camille Guérin, a veterinarian more than a century ago. However, a new study suggests that when given to adolescents who had been vaccinated as infants, a single dose of BCG could prevent a sustained TB infection by 45 percent.
  4. A newer live attenuated TB-vaccine ‘MTBVAC’ developed by Biofabri, Professor Carlos Martin and his team at the University of Zaragoza has finished Phase 1b trials carried out in healthy HIV unexposed newborn infants in South Africa, a country highly endemic for tuberculosis. MTBVAC was found to be well tolerated and induced a dose-dependent immune response that was distinct from the response induced by BCG. A subsequent Phase 2 trial in newborns to confirm its safety and to determine the final dose will go ahead in the next months.
  5. To create a better TB vaccine, a better understanding of the pathogenesis of TB is essential. A granuloma is an aggregate of cells and is the pathological hallmark of TB. To study how granulomas form, Professor Joanne Flynn and colleagues from the University of Pittsburgh use animal models, mainly using different macaques to watch how infection spreads in real-time. Flynn and her team developed an imaging modality called PET/CT, which uses fluorodeoxyglucose (FDG) as a probe, just like in cancer studies where they measure the level of inflammation or metabolic activity for each granuloma.
  6. The World Health Organization (WHO) has requested drug makers to submit an Expression of Interest (EoI) for Bedaquiline and Delaminid, two new-generation drugs, recommended for drug resistant-TB. Drugs passing the standards (or pre-qualified) will then be included in a list for procurement by the UN and other organisations.  This will ensure more manufacturers to supply quality medicines, which will make the market more competitive and prices more affordable.
  7. XDR-TB refers to strains of TB that are resistant to rifampicin and isoniazid and a fluoroquinolone and at least one of the three injectable TB drugs, capreomycin, kanamycin, and amikacin. The Nix-TB trial is the first TB clinical trial to test a new drug combination which has the possibility of being a shorter, all oral, and affordable treatment for XDR-TB. This combination does not require injections and has far fewer pills.
  8. Research conducted by Rockefeller scientists offers hope for a new and potent weapon against tuberculosis. Their work focuses on an antibiotic that kills MTB in the laboratory but is not suitable for clinical use. Fidaxomicin is uncommonly adept at killing tuberculosis cultivated in the lab. However, when taken orally, an antibiotic must be absorbed by the gut and eventually reach the lungs – but fidaxomicin is unable to do so. By understanding how fidaxomicin operates, the research by Rockefeller scientists could allow others to design new antibiotics that could be used to treat tuberculosis patients and might even work on other bugs.
Haha3.

Conspiracy theories and anti-vaccine sentiments go hand-in-hand

People with a propensity to believe conspiracy theories also generally think that vaccines are unsafe, new research reports.

Haha3.

The picture is appropriately entitled “haha3” on wikimedia.
Image via Wikimedia user ggggggg.

People who believe John F. Kennedy was assassinated following an elaborate plot, that chemtrails really are the gov’nment’s fingers wiping your brain clean and that sort of fluff, are more likely to also think vaccines are unsafe — despite any and all scientific evidence to the contrary, research from the American Psychological Association shows.

“Vaccinations are one of society’s greatest achievements and one of the main reasons that people live about 30 years longer than a century ago,” said lead researcher Matthew Hornsey, a PhD at the University of Queensland.

“Therefore, it is fascinating to learn about why some people are so fearful of them.”

The study is the first of its kind to analyze the link between beliefs in conspiracy theories and anti-vaccination attitudes across a global sample, Hornesy says. Between April and mid-May 2016, he and his co-authors surveyed 5,323 people from 24 countries on five continents using online questionnaires. These were designed to measure anti-vaccination attitudes and belief in four conspiracy theories: that Princess Diana was murdered, that the American government knew about the 9/11 attacks in advance and let them happen, that a shadowy group of elites exists — plotting a new world order– or that John F. Kennedy was murdered as part of an elaborate plot.

The psychological roots of anti-vaxxing

Regardless of country, those with strong beliefs in conspiracy theories were more likely to also hold antivaccination attitudes. The correlation held for all the theories the team inquired over. This suggests that it’s not a particular belief but rather the general predisposition toward conspiracy theories that is linked with the conviction that vaccines are bad.

The relationship between the two is also direct and proportional: the more a person believed in any one of these theories, the more they viewed vaccines in a negative light. Education levels had a very small impact on anti-vaccine attitudes — the authors describe this find as ‘surprising’, however, as someone who constantly has to purge his social media feed of the (otherwise quite educated) anti-vaxxers which keep popping up there, I can attest it’s anything but.

“People often develop attitudes through emotional and gut responses,” Hornsey said. “Simply repeating evidence makes little difference to those who have antivaccination attitudes.”

He explains that large pharmaceutical companies, which derive profit from selling vaccines, are often targets for conspiracy theorists.

Many equate these companies making profits to veiled, vested interests which aim to force vaccines onto the public in order to make more money.

And honestly, I wholeheartedly agree that big pharma has a veiled interest in making money and that’s an ethics conflict — but the only way to make people buy those products, vaccines included, is to actually make sure they work.

“Trying to reduce people’s conspiracy beliefs is notoriously difficult,” Hornsey added. “An alternative possibility is to acknowledge the possibility of conspiracies, but to highlight how there are vested interests on the other side too. Vested interests that are motivated to obscure the benefits of vaccination and to exaggerate their dangers.”

[READ FURTHER] Here’s what’s inside a flu shot.

Other findings of the paper are that anti-vaccine attitudes were also linked to intolerance towards a perceived limiting of freedom by others, a disgust towards blood and needles, as well as an individualistic worldview.

If you’re thinking of skipping vaccines for your child, please don’t. Not only does it put your children at risk, but it does so too for everybody else’s, and everybody else too.

The paper “The Psychological Roots of Anti-Vaccination Attitudes: A 24-Nation Investigation” has been published in the journal Health Psychology.

asthma

New Immunology Theories Shine Light on a Potential Link Between Vaccines and the Rise in Allergies and Autoimmune Disease

asthma

Credit: Pixabay

It has been speculated over the last few years whether vaccines play a part in the dramatic rise of allergies and autoimmune disease in the last four decades. The U.S. currently requires the highest number of vaccines than any developed nation and also has the highest incidence rates of autoimmune disease as well as allergies. Could there be a connection?

The National Institute of Health estimates that a shocking 23.5 million Americans suffer from an autoimmune disease. According to the American Autoimmune Diseases Related Association, however, that number should be closer to 50 million. The reason? NIH research only takes into account 24 of the 100 researched autoimmune disorders as only those 24 have good epidemiology studies to back them up.  

The CDC describes allergies as being  “among the most common medical conditions affecting children in the United States. An allergic condition is a hypersensitivity disorder in which the immune system reacts to substances in the environment that are normally considered harmless.” They also state that both food and skin allergies (some of which can be labeled autoimmune disorders) have been increasing in prevalence since 1997 in children under 18.

The theory of self/non-self recognition has dominated immunology for a very long time. This theory states that the immune system responds to pathogens (antigens) that it recognizes as foreign, or not self. Regarding vaccines, this would mean that the immune system responds to the viral matter in them and recognizes it as foreign, then forms memory to it and attacks. This is the way most people think of vaccines. However, not only is this theory overly simplistic, new research brings to light the many holes in it.

One of the biggest holes in this theory, is the lack of explanation for why our body doesn’t attack foreign protein introduced by ingestion. Much of the food we eat are proteins that are foreign and therefore not part of “self”. In addition,  we are exposed to environmental proteins on a daily basis. It doesn’t make sense that the immune system would not react to foreign proteins we eat or are exposed to, but does react when the foreign protein is injected via vaccine.

Newer immunology theories, called the danger/damage model, might help explain this disconnect and why the immune system reacts. The danger/damage model states that if there is any cellular or tissue damage occurring in the body, and that damage is associated to an unrecognized antigen (i.e. attached to a protein), the immune system will associate that protein as dangerous.

A recent article titled “Vaccine Allergies” from the National Center of Biotechnology Information (NCBI)  explores the possibility of the proteins in vaccines causing many of the hyper-sensitivies and allergies seen today. The authors state that:

“The vaccine components include active immunizing antigens, conjugating agents, preservatives, stabilizers, antimicrobial agents, adjuvants and culture media used in the preparation of the vaccine, as well as inadvertent contaminants that are introduced during vaccine handling.

Almost all the vaccine components can be considered as potential triggers of an allergic reaction.

Of particular importance are culture derived proteins from egg, gelatin and yeast. Other sources of allergic reaction are antibiotics and vaccination antigens.”

Examples of components in vaccines that may trigger allergic reactions are eggs, yeast, latex, and casein, a protein found in cow’s milk. A vaccine that uses casein, for instance, is the Tetanus-diphtheria-pertussis vaccine, commonly known as the Tdap. Several studies have found a possible link between the number of Tdap booster shots children receive and their casein allergies. Though the studies are inconclusive, the evidence is compelling.

A study published in The Journal of Allergy and Clinical Immunology notes that the children in the study “tolerated their initial vaccine but reacted to booster shots”. This suggests that the children had no milk allergies prior to receiving the first Tdap vaccination, and developed one after repeated doses. Essentially, repeated exposure to the protein via vaccine seems to result in an immune response to it.

When it comes to autoimmune diseases, studies linking them to vaccines seem to be as inconclusive as those linking allergies and vaccine proteins. However, once again, some of the findings are compelling.

The following excerpt is from a study titled DNA released from dying host cells mediates aluminum adjuvant activity. It supports beliefs regarding how all vaccine components that are protein in nature are potential candidates for the immune system to form memory to. Additionally, it entertains the notion that adjuvants in vaccines, such as aluminum, by producing cell necrosis in the host, potentially renders the host susceptible to develop an allergy to its own cells (so to speak).

The finding that host DNA released from dying cells acts as a damage-associated molecular pattern that mediates alum adjuvant activity may increase our understanding of the mechanisms of action of current vaccines and help in the design of new adjuvants.

In other words, there appears to be a connection between current adjuvants used in vaccines and autoimmune disorders. This study also reinforces the belief that the immune system does not just memorize foreign proteins introduced via vaccine, but rather, foreign proteins that are attached to an adjuvant that causes cell necrosis in the host. Put another way, it appears that in order to elicit an immune response from the host, a vaccine must meet the following criteria: 1. viral matter attached to a protein (to form memory), 2. Said viral matter and protein must produce cell necrosis in the host in order to appear threatening to the immune system.

Other studies have specifically focused on vaccines’ potential link to autoimmunity. A study from NCBI titled “Vaccination and autoimmunity (Vaccinosis): a dangerous liasion?” points to clear evidence of certain autoimmune disorders being caused by vaccines.

“Even though the data regarding the relation between vaccination and autoimmune disease is conflicting, it seems that some autoimmune phenomena are clearly related to immunization (e.g. Guillain-Barre syndrome). The issue of the risk of vaccination remains a philosophical one, since to date the advantages of this policy have not been refuted, while the risk for autoimmune disease has not been irrevocably proved.”

What all of these studies have in common, as previously mentioned, is that they are deemed by the authors as inconclusive. While they all find good evidence to support the danger/damage model, it remains unclear whether all allergies and autoimmune disorders stem from vaccination. Likely there are many other factors contributing to the dramatic rise in prevalence of such disorders, though the fact that some of them (like Guillain-Barre Syndrome) have been definitely linked to vaccines is a step in the right direction.

Furthermore, the question of whether the growing list of vaccines in the country is linked to the growing number of allergy and autoimmune disorders remains unanswered. It is perhaps worth noting, however, that the majority of these disorders present themselves in childhood and therefore during the time when most vaccines are given. Whether or not this is relevant is still a mystery. As new research continues to emerge, hopefully the enigmas surrounding the issue of allergies and autoimmune disease will begin to be resolved. For the time being, the role vaccination plays in these disorders remains an interesting speculation.