Vaccines effective, and controversial, since their invention

When Edward Jenner first observed that effects of cowpox had prevented the development of smallpox in the milkmaid Sarah Nelmes, I doubt he had any thought of how polarizing and divisive this lifesaving and critical aspect of health care would become. There has been controversy surrounding vaccines since the discovery of inoculation and the invention of vaccination. As we enter National Immunization Awareness Month in August, I want to share my experience with vaccine policy and reinforce the importance of vaccination as our greatest way to prevent disease.

Whenever a new science or technology is introduced, there will always be skeptics and naysayers who seek to discredit and undermine these advancements. Many people cannot or will not be open to innovative ideas or allow their beliefs to be challenged, and fear has long been a deterrent to progress. When smallpox was ravaging the world, inoculation with cowpox was attacked by misinformation and advertisements that people would turn into cows, deliver half-cow babies, and a whole host of other ridiculous and laughable statements that many believed to be true. It is no different today, but there is more technology to further the mis- and disinformation that endanger society.

I have had the privilege for the last several years to serve as ACP's liaison to the CDC's Advisory Committee on Immunization Practices (ACIP). This public body is made up of physicians, scientists, public members, and others who analyze the safety, efficacy, and utility of vaccines. The staff at the CDC is dedicated to transparency, research, and fully understanding all aspects of vaccine science to make the best possible recommendations for how we vaccinate our patients.

At the time of this writing, ACIP is under attack and the hardworking, properly vetted and appointed members have been removed and replaced by individuals who have not been serving on the workgroups or involved in the process. The lack of transparency and speed with which the committee has been overturned are quite concerning and potentially erode the public trust in vaccines and the process. Your ACP has been at the forefront of this issue and an active voice to make sure open and honest dialogue, transparency, and respect for science and evidence-based decisions are maintained.

This responsibility is not taken lightly, and every person I have worked with at the CDC has always kept patient safety at the forefront of every decision, challenging manufacturers to prove vaccines are safe and effective and making tough decisions to ensure the best possible guidance is available. While the FDA evaluates how a vaccine could be used based on safety and efficacy, ACIP evaluates how a vaccine should be used for the best possible outcome. I have been privileged to be part of these discussions and offer perspective on behalf of ACP and of patients.

With that experience in mind, I can appreciate that many are skeptical and hesitant about vaccines and do not see their necessity. Physicians can focus on the evidence and decades of study to help patients understand the importance of continued vaccination. We must make a distinction between an infectious agent and the disease it can cause. Pneumonia, as an example, is a disease that affects the lungs and can lead to severe hospitalization and death, but the infectious agent can be one of a multitude of bacteria, viruses, or even fungi.

Each disease is different, and each vaccine only affects a certain infectious agent. Despite wishing it were otherwise, there is no single universal panacea that will prevent every disease. The purpose of a vaccine is not always to prevent infection, as that may be impossible, but to prevent severe hospitalization and death, a disease's worst expression. After vaccination, the immune system is able to create a defense against future assaults by those pathogens without having to suffer the negative consequences. A person may get the flu but not die of it, which is why the vaccines work.

I often tell patients a vaccine is like a seat belt: It will not stop the car accident, but it will stop you from being thrown through the windshield. And those who say we no longer need vaccines because we do not have certain diseases anymore have not studied history. It is similar to the parable about crime and the police force. If a city invests in enough police to combat crime, eventually it will have a large police force and no crime, begging the question of why so much is spent on a police force. The minute the police force is cut, crime increases. We do not have as many vaccine-preventable diseases anymore because vaccines have very effectively done what they are supposed to do. If we stop vaccinating, we will see a surge in the very diseases we are trying to prevent.

Vaccines are not only effective but exceedingly safe, as vigorous study goes into their development. There are reporting systems in place to analyze any concerning signals. Fever, chills, and body aches after vaccination are not unexpected and are a typical immune response; this does not mean the individual is sick or becoming infected. The CDC investigates any safety signals and if enough concerns are raised, guidelines and warnings will be revised. Merely reporting an adverse event does not mean it has a direct causal relationship to the vaccine. Yelling louder about an issue does not make it true.

The amount of vaccine misinformation and disinformation in recent years has truly been astounding, and I have heard every possible myth and superstition: Vaccines affect DNA. They contain microchips to track us. They contain alien DNA and fetal tissue. Vaccines will make you mutate or actually cause infection. These and many other myths have been debunked time and time again.

The most egregious and pervasive myth is that vaccines, particularly the measles, mumps, rubella vaccine, are somehow linked to autism. This claim comes primarily from a study that the lead researcher later had to retract after admitting to falsifying the data. While childhood vaccination rates have increased, autism rates have not done so in the same proportion, something we would expect to see if the two were truly linked. Similarly, although autism presents around the same time children get vaccines, that does not mean there is a causal relationship.

Because we have contained measles for so many years through vaccination, many have not seen its severe effects, like brain damage and death, and mistakenly believe it is not a serious or concerning disease. As I write this article, the U.S. is facing an unprecedented outbreak of measles that never should have happened. The vaccine for measles is almost 99% effective and unequivocally does not cause autism.

What childhood vaccination does cause is adults. We must continue to support and strengthen child and adult vaccination programs. It is my hope that more people will take the time to seek appropriate medical consultation and information on the importance and efficacy of vaccines and that we can remove the politicization of this life-saving technology. As we head into National Immunization Awareness Month, I will simply paraphrase the English and say, “Keep calm and vaccinate.”