Vaccination Controversy, in man and animal

The recent bout of fitting toddlers in Perth, and death of a Brisbane infant within 12 hours of a routine, seasonal flu jab, is a tragic yet timely prompt for a conversation surrounding vaccination of our hairier dependents.  Since the 1960’s, vets worldwide have recommended religious annual vaccination for both dog and cat.  More recently, the scrutineering of vaccination in man has extended to those used on our pets, and found the vet profession on the back foot, as it comes to terms with the realities of evidenced-based medicine.

diluents

.

The History

Working in a world of untreatable viral plagues, it’s no wonder the medical scientists of last century were unwavering fans of vaccination.  Antibiotics had transformed the treatment of bacterial diseases, but most viruses, to this day, remain untreatable once caught.

Few deny, preventative immunisation has saved more from pain and suffering than any other medical intervention, in both man and animal. Vaccination revolutionised our management of infectious disease, completely eradicated some scourges, and slashed mortality rates.  As a single example: small pox once killed 1 in 10 children in parts of Europe, and killed an estimated 300 million in total.

Scientists at the time openly acknowledged the risks of immediate adverse reactions, but weighed against pockmarked disfigurement, viral paraplegia and infertility, childhood mortality, and outright misery, an occasional reaction, even if fatal, seemed a reasonable price to pay for the public good.

Without the large-scale analysis of computerised medical records, delayed adverse effects were difficult to causally link with inoculations given months or years earlier. Undeterred, patients in the early 20th century, often personally touched by diseases we vaccinate against, were happy to comply.

Over time, however, public trust in mass vaccination fell victim to it’s own success.  It’s understandable for each subsequent generation of patients, with ever diminishing personal experience of serious viral disease, to start questioning their need.  Unaffecteded by measles and polio, but disturbed by inexplicable rises in autism, Alzheimer’s, anaphylaxis, cancers, SIDS, MS, diabetes and autoimmune disease, it’s no surprise inoculations are seen by some as the hidden demon.

Inject the conversation with tragic personal narratives, media-driven sensationalism, and unmoderated clamour of the internet, and vaccination can be transformed from medical miracle into monstrous conspiracy, with greedy Big Pharma and negligent, conflicted professions, crippling and killing our children and pets!

.

syringe

.

So Where’s The Truth?

Now, with the computer power for aggregating and crunching massive patient databases, we can begin to quantify long-term, downstream effects of mass vaccination, and critically appraise it’s therapeutic merit.

In the last year, sufficient statistical scrutiny has finally allayed concerns of a link between autism and combined MMR vaccination. The debate will roll-on, however. Those looking to demonise vaccines have a smorgasbord of others to choose from, many in the neurologic realm. Schizophrenia has many emerging infectious, toxic and dietary contributors, and sufficient prevalence to whip-up and sustain a publicity storm.

There still remain, however, legitimate concerns about possible relationships between over-vaccination and the rise in immune-mediated diseases, and the effects of some aluminium and mercury-based adjuvants.  Vaccines are specifically designed to provoke the immune system, and can do so in unintended ways, potentially leading to hypersensitivities or more serious autoimmune disease.

While the clinical orthodoxy remains sceptical of such links, their colleagues in research use cocktails of adjuvants and biologic products, resembling vaccines, to intentionally create autoimmune disease in lab animals, to model such diseases in man.  If we can create diseases very similar to MS and Rheumatoid arthritis, by vaccinating mice against their own body tissue, could we unwittingly do the same, to a small proportion of the population, when vaccinating against a pathogen?

The Swine Flu vaccine released in 1976, for an epidemic that did not materialise, resulted in a 7-fold increase in the chance of paitients developing the immune-mediated neurological disease, Guillain-Barré syndrome, in the 6 weeks after inoculation. It took over 25 years of research and rumination before the medical fraternity conceeded a causal relationship existed.

Even nowadays, with great advancements in immunology, delivering far more sophisticated and complex vaccinations, some of their behaviour remains unpredictable. There is no better depiction of the limits to our understanding of vaccination science than the outcome of the recent STEP trial:

Working valiantly towards a preventative vaccination for HIV, in 2006 Merck had reached stage II clinical trials: testing in human subjects. Their investment would have been considerable, probably a decade of labour and 10’s, if not 100’s, of millions spent, and recruited some of the greatest minds in immunology and HIV research.  Despite promising results in cell culture, the trial was cut-short: a vaccine designed to prevent infection was actually increasing the susceptibility of trial participants to contracting HIV.

.

mothtrailed

.

Veterinary Controversies

Since the 1960’s, the veterinary profession has recommended a puppy or kitten series, followed by religious annual vaccination, with little consideration of patient or environmental factors, unique to the individual. This level of blanket protection was reasonable at a time when serious viral disease was commonplace; serologic responses poorly studied; and vaccination protocols were based on empiric evidence alone.

Immediate reactions to vaccination were easily recognised, but usually mild. Typically allergic in nature, they manifested as local, injection-site reactions, or more generalised, with facial swelling, hives, and itch. Very rarely a reaction may be sufficiently severe to result in gastrointestinal symptoms, collapse and full anaphylaxis. For more on these types of allergic reactions, see Insect Bites: from Itch to Anaphylaxis.

Without systematic collection of epidemiological statistics for cat and dog, no coronial oversight, and only voluntary notification of disease or vaccination reactions, delayed adverse effects of immunisation were even harder to quantify in animal than in man.

After decades of use, and possibly complacent over-use, the veterinary profession was confronted by a series of scientific reports describing some unexpected, hidden risks of vaccination:

1989: First reports of feline vaccination-associated fibrosarcoma, a cancer typically arising at injection sites, over the shoulder of cats, years after annual inoculations.
1996: First reported link between vaccination and immune-mediated haemolytic anaemia in dogs.
2003: Proposed relationship between Bovine IgG and IgE, used in the manufacturing of canine vaccines, and the development of food allergy to beef in some dogs.
2004: Proposed theoretic mechanism for vaccine-induced immune-mediated kidney disease in cats, followed by confirmation, in 2007, of experimentally-induced interstitial nephritis in small numbers of cats.

It must be emphasised, all these events are very rare and reverting to a world of rampant viral epidemics would be far more costly for pets, and their owners, emotionally and financially.  If you have any uncertainty about this, spend some time working in the animal shelters of Asia and witness, first-hand, the mass suffering of a Distemper outbreak. With scant treatment resources, euthanasia medicine transforms orphanage into Auschwitz.

That being said, the profession was forced to acknowledge that long-term costs of immunisation were real and significant.  When administered to millions of animals each year, globally, these rare events do mount up.  Articles began to appear in the professional press, admitting over-vaccination now seemed a genuine concern, and how best to integrate consideration of these risks into vaccination recommendations.  Check out Canine viral vaccines at a turning point—A personal perspective.

Deciding the best way forward was difficult, especially with so many gaps in our understanding of vaccinations, most notably: 1) serologic responses, especially longitudinal studies of large populations, after serial inoculations; 2) levels of serum antibody deemed protective; and 3) the epidemiologic consequences of falling herd immunity. Without this fundamental science, there was a chance winding-back immunisation frequency could open the Pandora’s Box of viral plagues past.

.

abalone gonads

.

The Shifting Vaccination Landscape

Over the past decade, with the rise of evidenced-based medicine and community concern surrounding immunisations, in both man and animal, and greater investigation of vaccination science, many national veterinary associations have updated their recommendations. Now separating core and non-core vaccinations, and extending intervals to 2-3 years, the response of vets in the field has been mixed.

Vet practitioners are apprehensive that investigations of new protocols are insufficient, and it’s true, in 10 years, when the statistics are in, we may look back on the move to 3-yearly vaccines with some regret.

There’s also a genuine concern that pet owners, freed from regular commitment to maintaining animal health, may further neglect their responsibilities to a pet’s wellbeing.  Without vaccination, annual visits would be less imperative and many problems, identified at check-ups (skin, dental, mobility, tumours, heart, hormonal), would progress unchecked. This seems a legitimate issue in older pets, less valid in the under 5’s.

Behind the scenes, on all sides of the debate, there are perceptions of commercial self-interest. Vets and vaccine manufacturers, fearful of lost income; and pet owners, rejecting immunisation out of miserly indifference to pet welfare, rather than any commitment to vaccination best practice.  Of greater potential cost to the profession, was that of lost credibility if it failed to respond to shifting science and public opinion.

In the past, a one-shoe-fits-all approach to vaccination made the message easy: once a year.  Now there’s a diversity of options, individualised, based upon patient, pet owner, and environmental factors. When deciding what’s best, you should do your research.  Consider the following information:

  • Herd Immunity, Whooping and Kennel Coughs. If you believe decision-making surrounding vaccination is simply balancing very small risks of adverse event, against similarly slim chances of catching a preventable disease, you’re ignoring the issue of herd immunity. If we all act in self interest, and neglect our responsibility to the collective, after 10 years the annual viral toll may rise from hundreds, to hundreds of thousands.

Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

One Response to “Vaccination Controversy, in man and animal”

  1. antonia staff says:

    Dear Matt, a very comprehensive article on the subject which clarified many of the issues for me.

Leave a Reply