THE MEASLES IMMUNIZATION DEBACLE IN THE US AND THE AFRICAN PERSPECTIVE II

The Commentaries

Some commentators have said that the US have gotten too used to medical success and forgotten what measles really is. Many of the modern day parents were vaccinated against the disease as infants and have never seen a case of measles or experienced its severe complications. Even the prominent advocates of freedom of choice in America were vaccinated for measles as kids. Since they don’t know what the disease is, they can afford to prevent their kids from getting their shots. After all, a man cannot run when he neither feels nor thinks something is chasing him. I do agree with the notion that Americans are getting complacent with basic public health issues like vaccination.

In Africa, we can barely afford such complacency. The horrors of poorly treated and untreated measles are evident among us. We still see deaths from measles. Vaccination rates in Nigeria for instance are between 50-79%, 80-89% for Ghana and less than 50% for South Sudan. So we cannot be accused of complacency. Our problem may well be illiteracy and ignorance among parents who refuse vaccination for their children. I long for the day when Africa can afford to sit back and see measles conquered and driven out of the continent like the former colonial masters were.

Another reason for American parents refusing vaccination may be their lack of trust for medical science in general and the big pharmaceutical companies in particular. Some Americans now feel that medical science cannot be trusted; that doctors always hide information from their patients; that medicine causes more harm than good; that the measles vaccine causes more deaths than measles itself. Informed commentators like Dawn Babcock Pabble have pointed out that the disease caused only 450 deaths per year in the USA before the introduction of the vaccine. Such people may be missing the point by looking at the death statistics alone. It goes beyond death. Anti-vaccination campaigners seem to forget about the cases of deafness, blindness and mental retardation caused by measles. They also seem to forget the amount of money used to treat measles patients, the uncertainties and emotional trauma their parents experience and the inevitable fear of death hanging over these children. In addition, they forget the people who are already immuno-compromised or who have leukemia. Such patients cannot take any vaccine and depend on the immunity of others to survive. They are therefore at risk of dying if others do not get vaccinated.

 The anti-vaccination guys also point out that these vaccines are manufactured by large pharmaceutical giants who rake in huge profits annually. Could this be the reason why they continually push more vaccines to the public so that their owners can get wealthier? Some may posit that probably, there are no inherent benefits in these vaccines. Though such suspicions are understandable, it amounts to paranoia when there are no hard facts to support them. While it may be true that the vaccine makers make more money than they should, should we stop using their products that have been scientifically proven to save lives? The Americans and indeed the whole world may be suffering from “informational gluttony” or information overload.

This leads to the issue of unhindered public access to junk science as well as access to compromised studies like the Wakefield study. In the past, medical science was limited to doctors and people in the medical community. Now, anyone can simply go to the internet and “whip” up 20 causes of anemia in less than a minute. While this trend may be considered beneficial to all concerned, caution must be applied. The internet has not only made correct information accessible but has also put a lot of incorrect facts out there. People will generally believe what they choose to believe and when a lie is repeatedly told, it begins to sound like the truth. This may be a major reason why American parents are beginning to believe that vaccines are dangerous and should be avoided. They are ignorant of the scientific fact that the incidence of measles in America is still relatively low because of the herd immunity they currently enjoy. This herd immunity is derived from the large number of people that are already immunized. However, when more and more kids refuse immunization, this herd immunity will be gradually eroded. Then the Americans may find themselves back in the pre-1963 era. That is the danger that they are subjecting themselves and the rest of the world to.

(If this were an African country, the major news stations in the West will be shouting themselves hoarse about how primitive Africans are by now. I still remember how Nigeria kept on appearing on the map of “Ebola countries” in one international news station even after the country had been declared Ebola free by the World Health Organization (WHO). I hope no one will accuse me of reverse discrimination. I simply cannot afford the cost of litigation.)

Talking about cost, the ballooning cost of healthcare in the USA has also not helped the pro-vaccination cause. With healthcare getting more expensive, and health insurance companies struggling to stay afloat, it will not come as a surprise that Americans are thinking of cutting down their medical bills. A major contributor to this health costs may be the several tests conducted and treatments given to patients that are simply not needed. More access to medical knowledge has made doctors prescribe more and more drugs to avoid future litigations. This has pushed the health cost higher and higher. Though vaccination is covered by standard health insurance, many Americans feel that the current immunization schedule is not set up in an optimal cost effective way. One American parent complained of his child getting 23 vaccination shots in just one year compared to the 8 shots he had in the 80s when growing up! Are ALL of these vaccines necessary or are Americans just simply been extravagant because they have “excess” medical knowledge? It is unlikely that an African parent will subject his/her child to such torture in the name of preventing diseases. So, if a parent disagrees with this schedule, he/she may be excused.

The real solution though may be to reduce the current vaccination regimen to acceptable levels. Isn’t it possible to remove some of the inoculations? The notion that one size fits all may actually be a dangerous one and may be the cause of the adverse reactions that is often talked about. The future of safer measles vaccination may lie in the ability of medical science to make vaccinations individualized through the use of genetics and molecular biology.

The Politicians

Funny as it may sound, some opposition politicians have latched onto the vaccination saga to score cheap political points. It is shocking that even first world politicians will stoop so low as to use just about anything to discredit the Obama administration. While I cannot give judgment on his health policies, I erroneously thought that only African politicians play such mischievous “politricks”. New Jersey Governor Chris Christie and Kentucky Senator Rand Paul both stand out in this hall of shame. Governor Chris Christie initially stated publicly that parents should have "some measure of choice" in vaccinating their children and Senator Rand Paul called the decision not to vaccinate "an issue of freedom.

" Freedom!!!??? When a person’s freedom endangers the life of other people’s children it ceases to be freedom. It becomes an assault! If people have the freedom not to vaccinate their children, then drunk drivers should be allowed on the roads and smokers allowed to smoke on commercial flights. The remarks of these two gentlemen have stoked the controversy further and given impetus to the anti-vaccination movement.

 Here in Africa, it has also been reported that highly influential figures deny their children vaccination as well. This accounts for the presence of polio in Nigeria till date. Americans should be wary of such politicians as Christie and Rand who seem to want to take them back to the dark ages by their statements. They should probably watch out for them in 2016 when they launch their respective presidential campaigns.

Risks, Benefits and the Middle Ground

It must be realized at this point that there are risks as well as benefits to the measles vaccination. A proper risk-benefit analysis should be conducted to determine the full extent of this.  In highlighting the risks of vaccination, it is important to recall that the association between measles vaccine and autism has been scientifically disproved several times. That leaves the incidence of adverse reactions like febrile convulsions and thrombocytopenia purpura. Since these are relatively rare, isn’t it wiser to still give the vaccine and prevent blindness, deafness, mental retardation and death?

The anti-vaccination camp will wisely remind us all that the “rare” cases of febrile seizures and thrombocytopenia purpura are not just cases. Rather, they are children born to loving parents, with siblings and other caring relatives. Should they become sacrificial lambs for the good of society? In the same vein, the pro-vaccination camp will probably retort “is it better to endanger the entire population and spend millions of dollars to treat and rehabilitate measles patients because an infinitesimal few will get thrombocytopenia purpura?”

 The middle ground here will be to ask “how committed is the medical community to making vaccines safer for the populace?” If vaccines are made safer, then there will be less adverse effects or no adverse effects. Then the anti-vaccination guys will probably be convinced to allow their children get vaccinated. Then this whole debate will end and Americans will begin to behave like the responsible people they are known to be. Then I can stop writing this article and go to sleep.

If wishes were horses, beggars they say will ride. The debate will probably go on forever because vaccines may never be 100% safe. No drug can ever be 100% free of side effects. (Though, I still recall one of my lecturers in medical school saying “never use the word ‘never’ in medicine”). But as Africans, we must draw some lessons from the measles debacle in America.

Firstly, we should strive to eradicate measles by encouraging vaccination. Maybe then, we can begin to consider opting out of vaccination. Next, politics should never be allowed to come between proven medical science and the lives of our citizens. We should also educate our populace by regularly giving out correct and factual health information. Next, we should remember that good Patient care does not necessarily mean doing more tests and prescribing more medication but rather optimizing available resources to achieve good health. Finally, we should never take success for granted and become complacent like the Americans seem to be doing.

I rest my case. Thanks for reading this rather long post. See you again......