05 Aug Vaccines : science or rumors, it is necessary to choose
Specialists of vaccination are concerned about the growing mistrust of the population towards this essential tool of public health and wish to respond ” in the name of the collective interest, and in particular the most vulnerable “..
What is it ?
This is called hesitation or even distrust, toward the vaccination, is an understandable perception, especially among young parents, when their children will be vaccinated. The principle of universal vaccination was self-evident when infectious diseases are very frequent weighed heavily on the company. This principle may seem today less essential, or optional, parents who are no longer faced with the tragedies infectious yesterday.
Out yet of our bubble, let the old, let’s see what are the infectious diseases of childhood in the poorer countries where children are still very inadequately vaccinated, or in countries at war such as Syria, where the vaccine protection – sometimes long-established date – was shattered with the disintegration of the public health. Observe what happens in our own countries when the rate of immunization coverage decreases against diseases, however, regarded as having almost disappeared.
Because so many diseases have been controlled or even eliminated, by vaccination, the microbes responsible for these infections continue to exist, ready to rise up again. Only the smallpox virus has been eradicated, which has helped to stop this vaccination. While we can hope one day to eradicate other diseases, such as measles or polio – we’re not there yet – others, such as tetanus and tuberculosis, will probably never be completely. The microbes are circulating more often, silently.
Stop the vaccination against pertussis, as was the case in some industrialized countries and the disease re-emerged in the months that follow, affecting very young infants, sometimes in a lethal way. Because the rate of immunization coverage against measles is not enough, France was just emerging from an epidemic that has hit at least 25 000 people between 2008 and 2015, while the disease was almost eliminated. A thousand of hospitalizations to an intensive care unit, 10 deaths ! In France, in 2015… Who has heard of these numbers, which is moved by it ? Ten lives lost as a result of the vaccination was impossible because of a too young age, or immunosuppressive therapy, and the low level of immunization has not offered the benefit of group immunity. Measles is not a benign disease. It can be complicated dramatically, and epidemics of european and recent us confirm that it re-emerges as soon as we lower the guard of vaccine.
Too many cases of bacterial meningitis, sometimes fatal or cause serious sequelae (amputations, hearing loss) are still observed in our country so that vaccination could prevent most. Other examples can be mentioned as the failure to protect young adults against hepatitis B, or even the very low vaccination coverage in France – but not for our neighbors ! – against papillomavirus infections responsible for many cancers, including those of the cervix, an approach that is essential, in combination with the smear, to eliminate this cancer. The prevention of gastro-enteritis, bronchiolitis, disease pervasive, could also benefit from the widespread use of existing vaccines or to come. The tb has declined among us, but not on the planet, the BCG vaccine is no longer routinely recommended in France except in areas or among at-risk children, which, moreover, shows that the health authorities are not arc-boutées on vaccination as a dogma intangible.
The moral of these stories ? Because you have to speak of ethical or moral collective : the vaccine protects certainly individually, but also collectively, in particular the most vulnerable, those who cannot be immunized, provided that the vaccination coverage is sufficient.
Public health is a building in fragile, requiring a permanent adaptation. In the field of infectious diseases, it is based on three pillars : hygiene, anti-infective agents and vaccines. One of them is failing, it is the whole of the edifice which is tottering. Hygiene has greatly contributed to control the infectious diseases, at least those transmitted by water or by insect vectors are controllable (cholera, plague), but not the other. Hygiene single, collective and individual, is a barrier on the fragile, easily overwhelmed by pathogenic microbes, whose strategies are formidable, and virtually adaptable to all situations.
The “health or natural immunity” is a fantasy potentially dangerous. This concept could lead to the worst-case scenario of a recurrence of epidemics. The excessive use of antibiotics in the medical world and veterinary as well as for the livestock on a large part of the planet has generated a situation of resistance so widespread that, in the absence of new antibiotics – and they will have to wait – we might, after a century, to lose this miracle of medicine.
Imagine a world without antibiotics… That vaccines reduce the use of antibiotics in reducing the incidence of certain infections, therefore treatments anti-infective, and thus the selective pressure for resistance. If in this same impetus regressive we were brought back to a world without vaccines, we rétablirions the terms and conditions of a health insecurity is particularly dangerous and would put in serious danger the balance of the already fragile of our health systems.
A fraction of the population and also healthcare professionals are sceptical about some of the vaccines. They forget the benefits and risks are amplified to listening to unfounded allegations. It is necessary to hear these doubts, but respond to it by making effort of pedagogy and scientific rigor.
Childhood vaccines confer protection very high ensuring, by their universal use, have sufficient coverage to hope for the elimination of the targeted diseases. The noises according to which they would or would worsen the disease in question are spurious and immunologically absurd. A doubt about safety ? The new vaccines are in clinical trials and coverage for pharmacovigilance equivalent or even superior to those of any drug.
This being the case, yes vaccines can in rare cases be responsible for adverse effects. There are accidents allergic rare, most often predictable by the interrogation of the local effects of inflammation, or even general. They are for the most part benign, and caused by the vaccines themselves or by the need to add in some vaccines, an adjuvant that creates the conditions for a better immune response, and memory, more sustainable
These additives can be diverse in nature, but the aluminum salts used in the last ninety years in the world, initially to stimulate the response to diphtheria and tetanus, remain the most used because they have the best performance. These aluminum salts generate a concern, certainly understandable, but largely irrational. In fact, if they had created all the evil that some of their lend, the past four generations of use in billions of people, the adverse effects should be visible at the scale of the planet, which is not the case. In any case, the rarity of these events may not call into question the analysis of profit/risk is very favourable to those with adjuvanted vaccines, as indicated by the world health Organization.
That said, science progresses, including new adjuvants, with the objectives to improve always more tolerance and duration of efficacy of the protection. The vaccinology is not a science set in stone.
The other allegations on the risk of multiple sclerosis (hepatitis B), and autism (measles) are absolutely not based, as shown by many studies in France and abroad. They were, unfortunately, significantly undermined the confidence in these vaccines and continue to do so. It removes nothing to the need to maintain vigilance on the occurrence always possible adverse effects on rare or exceptional, and to inform without ambiguity users and health professionals.
To add to the confusion surrounding the legal status of mixed vaccines “mandatory” vaccines and “recommended” is an archaism that confuses both parents and doctors. It is historic and does not meet any rational, medico-scientific. The vaccines “recommended” are just as important as the vaccines are ” mandatory “.
At the bottom, vaccination is a victim of its success. Not knowing most of the diseases that it prevents, the French do not see more than a few side-effects, including the undeniable fact, but rare existence is being exploited shamelessly by activists antivaccins to which the Internet has offered a great sounding board.
It is urgent that physicians and all caregivers who are in the front line and the guarantors of this preventive medicine, that the French, particularly parents, worried and hesitant, receive training and a high-level information tailored to the knowledge and the sociology of Twenty-first century on vaccinology, and more largely on the real issues of our public health in the area of communicable diseases. In these times of emergence supported new infectious diseases (300 since 1940 !) and resistance to antibiotics, it is necessary to regain his senses and act. It is also interesting to see that in every emergence of a new disease (HIV, Ebola, Chikungunya, Zika), the company, the media will return to the researchers or even to the industry to quickly make available a vaccine.
We, the signatories of this text are physicians and researchers from the academic world, we owe it to our fellow citizens with scientific rigor, pedagogy and transparency, manufacturers must be aware of this same duty. These elements are vital to restoring confidence. Do not, however, the baby with the bath water, we need manufacturers to produce our vaccines. They are the only ones to have the means to ensure development and security.
A mobilization of the carers and of the population in favour of vaccination, under the aegis of the health authorities is indispensable today. This is what is recommended for the steering committee of the citizen Consultation [chaired by professor Alain Fisher, co-signatory of this forum], which is based on a collective reflection and depth of citizens, health professionals and experts.
Don’t let the relativism and populism ambient (all “opinions” are equal), calling into question one of the biggest advances to date of the medicine in which our country has played a historic role. We hope that our new political authorities will have in heart to take on the topic of preventive medicine in France, starting with the vaccination, as do the Italian government faced with a situation identical to ours. The citizen Consultation has shown the way. Leadership is a choice…