To vaccinate or not to vaccinate? That is the question

By Neale McDevitt

Immunization has become a fiercely debated topic around the world and here at home. According to an Angus Reid poll, nine out of ten Canadians believe that vaccines protect people from contracting diseases. But two Canadians in five question the scientific development of these remedies as well as the potential side effects.

The anti-vaccination movement seems to be gaining traction, certainly in the media, with celebrities like Jenny McCarthy, Jim Carrey and Donald Trump warning anyone who will listen about the link between vaccines and autism.

But vaccines work. Smallpox, once a major endemic disease that killed some 400,000 Europeans each year in the mid-18th century, was completely eradicated by 1979 thanks to an aggressive global vaccination campaign. Here in Canada, the vaccine for mumps reduced reported cases of the disease in Canada from 43,671 (1950-54) to 1,110 (2007-11).

But, because some people refuse immunization today, a number of Canadian researchers fear that those numbers will rise.

Dr. Brian Ward is a professor of Medicine & Microbiology and a prominent researcher in the field of immunization. An expert on many aspects of infectious diseases, from influenza viruses to blood-borne parasitic infections, Dr. Ward serves on a wide range of government and industry advisory committees related to vaccines, vaccine safety, international health and parasitology. He was a key media spokesperson during the SARS outbreak and recent H1N1 pandemic. 

Recently, Dr. Ward spoke to the McGill Reporter about the efficacy of vaccines, the bad science at the core of the anti-vaccination movement and Sidney Crosby’s recent bout of mumps.

In simple terms, how do vaccines work?

They stimulate an immune response that provides full or partial protection from one or more of the infectious diseases for which they have been developed.

But Sidney Crosby got the Measles Mumps Rubella (MMR) vaccination twice and he still got the mumps this past December. How come vaccinations don’t work 100 per cent of the time?

You’ve honed in on one of the most interesting and important questions. In the old days, people got measles or mumps during childhood. So we not only got infected, we were also given a boost to our immune system periodically when we were exposed to the wild-type viruses that circulated in the community when our brothers, sisters and friends would catch them.

Initially we thought that vaccines provided really solid, lifelong immunity and that one dose of MMR would do it. You had sort of a mixed immunity for a while in the community because people who were being vaccinated also were being exposed to wild-type viruses once or twice to further boost their immunity.

The challenge to our immune system from these wild-type viruses is pretty significant and may not be fully matched by the wimpier vaccine strains. But as those wild-type exposures declined (because more and more of us were immunized), we began to rely exclusively on vaccine-induced immunity.

However, now so many of us are immunized that we’ve essentially eliminated these wild-type circulations of these viruses. Now we’re figuring out that there are small portions of our population that, despite having one or even two doses of these vaccines, will not have lifelong immunity.

Are we heading toward a third round of vaccinations?

We probably are. More to the point, I think we’re heading toward the identification of, or the development of simple diagnostic tests will tell you specifically what you need in terms of vaccines. ‘You’re 52 years old and you are fine for mumps, rubella and varicella. But you really don’t have any evidence of measles immunity.” Then we can say, let’s give you a booster of a cocktail of vaccines that you need. That would be personalized medicine at its best.

How close are we to that scenario?

We aren’t there yet, but maybe in another five years.

It isn’t uncommon for a toddler to receive 3-4 vaccinations during one trip to the pediatrician. Can that overload a child’s immune system?

Has your child ever fallen down and scraped himself on the sidewalk? Well, the number of antigens in your average skinned knee is probably somewhere between four and five times the orders of magnitude higher than that group of 3-4 vaccines.

The idea that a kid’s immune system is somehow overwhelmed by these relatively pure vaccine products compared to the thousands of different bacteria that are in that wound, quite frankly, an uninformed opinion based on a misunderstanding on what is in an injection versus exposures in every day life. Your child’s immune system is completely capable of saying ‘this is dangerous, this is not.’

A lot of anti-vaxxers still point to the now debunked 1998 research paper by former surgeon Andrew Wakefield that linked the MMR vaccine to the development in autism. What is your connection to Wakefield?

Full disclosure: I was an expert witness for the U.S. Department of Justice and was one of their chief expert witnesses in the Omnibus Autism Proceeding [that ended in 2009] that completely threw out Wakefield’s fraudulent claims.

Also, full disclosure: Andrew Wakefield approached me in the early 2000s to work with him and I have had a number of confrontations with him because he had taken and reinterpreted my data. Andrew Wakefield is just a bad scientist.

In what way? 

You can start with his blatantly fraudulent behaviour in which he did not acknowledge that most of the study subjects in his Lancet paper were sent to him by lawyers [looking to launch a class action lawsuit against drug companies which manufactured the MMR vaccine].

He also never disclosed that he had a financial interest in the development of a monovalent measles vaccine.

He and his collaborators also put a five-year gag order on a senior U.S. scientist who had demonstrated conclusively that the results their company had been generating were inaccurate.

Andrew Wakefield has a complete lack of moral compass. It is not just bad science it’s unethical and, many would say, criminal.

There have been children who have died or had complications from natural measles whose parents decided not to have been vaccinated based on Andrew Wakefield’s findings. My feeling is that he is personally culpable.

If you want to know more, you should check out the website of [London Times investigative Reporter] Brian Deers. He has a great website that basically gives the chronology. It’s an expose of what a bad person Andrew Wakefield really is in every respect.

If Wakefield’s findings have been so thoroughly debunked, how do they still have so much traction?

Because many people don’t understand the difference between coincidence and causality.

The fact is we gave the MMR vaccine right around the time of peak diagnoses for autism. It’s exactly when we start to see it in children. The median time of diagnosis is in the 20-22 months area. We give our measles vaccine at 12 month and a year later at 24 months. Some people give it of 18 months. It all happens around the same time and some people are quick to make a connection that doesn’t exist.

In some ways it is understandable. Most kids cry when they get a vaccination and some kids actually become a little sick or fussy. It’s a big event and parents remember big events. I certainly remember my kids getting their vaccines.

You’re handing your kid over to somebody who’s going to stick a needle in their arm. Subsequently, if something else happens that is frightening, some people will link the two events.

So are vaccines without adverse effects?

There are very clearly some vaccine-associated adverse events. For example, the live attenuated polio vaccine resulted in paralysis either for the child or for the caretakers of the child in about 2 to 3,000,000 doses.

We know exactly what happened. It was revertant virus, typically a type III virus. That’s one of the reasons why Canada switched from the oral to the inactivated polio vaccine to avoid that very low but predictable risk.

There is a very low risk of Guillain-Barré syndrome (GBS) following some influenza vaccines in some seasons. We don’t know exactly why yet but it’s there.

If a risk exists in most cases we’re talking about less than one in one million or one in 10 million. These are tiny risks compared to the very real risks of not being vaccinated.

Can we argue that, at the very least, people should have their children vaccinated in order to reduce the chance of having a measles outbreak like we saw originating in Disneyland earlier this year?

Arguments for altruistic vaccination are, at some level, lame. If I have to accept the risk for my child and my child derives no benefit from a vaccination, I’m going to be like any other parent and say ‘no thanks.’ On the other hand, if my child derives a benefit and, in addition, my child’s immunity helps protect others then we’re talking win-win.

As an example, let’s say we live in a dictatorship and the dictator had had a family member die of smallpox and the dictator says ‘I don’t care that smallpox has been eliminated. I’m still sufficiently frightened of it that everyone in this country must be vaccinated with this smallpox vaccine.’ I would do everything in my power to hide my children because the smallpox vaccine, in the context of no smallpox circulation, is actually quite a dangerous vaccine.

The relative risk for vaccines is contextual. In the event that there was smallpox circulating, I wouldn’t hesitate for a microsecond to have my wife, my children and myself immunized.

Can we use the eradication of smallpox as a global blueprint to get rid of other diseases?

If the only reservoir for a disease is human beings then you can eradicate it. Tetanus is in the environment so we will never be able to stop immunizing it. Many people believe that human beings are the only reservoir for measles mumps and polio and probably varicella, so there is at least some possibility of eventually being able to stop vaccinating against a couple of those.

Since chickenpox also causes shingles and that can occur 70 or 80 years after you got chickenpox, it’s pretty hard to imagine ever being able to stop vaccinating against chickenpox.

This type of initiative takes takes political will and organization. Yes, where you have civil wars you have decreasing vaccination rates. But there were civil wars when we eradicated smallpox so it is certainly feasible.

Is polio the next major scourge to be eliminated?

Polio is on its way to being eradicated worldwide. But there are some roadblocks. The idea of using a polio vaccine worker to try and find Osama Bin Laden in 2011, while smart in terms of getting Bin Laden, was not so smart in terms of polio vaccination programs in certain fundamentalist Muslim environments.

Some 67 polio vaccination workers have been killed in a small number of countries since that time. It has slowed vaccination efforts in some parts of the world. Would you volunteer to go into some of these regions where 67 vaccinations workers have been slaughtered? It is costing us billions and billions of dollars in terms of continuing to have to vaccinate against polio.

How do you respond to people who say a massive conspiracy involving industry, Big Pharma and various levels of government is selling vaccines for huge profits?

My colleagues and I have spent years working very closely with the government, the vaccine industry and academia. If there were a conspiracy we would know about it.

I love my kids just as much as these anti-vaccination people and all three of them are fully immunized. So either I’m really dumb and can’t see this conspiracy or, worse yet, I’m ready to sacrifice my own kids and put them at risk just for my next grant. I don’t think so.