My Case for Vaccines

Intro

In response to the anti-vaccine movement and because I am passionate about the health of our society and how informed people are when it comes to vaccines, I have decided to write this paper. Disclaimer: it’s lengthy. I hope that despite the length, you take the time to read it, learn from it, ask new questions, and perhaps challenge what you currently know or think. Back in May 2016 I graduated with a Bachelor’s degree in Biology, and I am currently working as a Researcher in Microbiology and Immunology at a University. This means I am knowledgeable and, importantly, I have learned how to approach new information and critically think about it. During my undergraduate studies I learned a lot about the human body and vaccines, and I’ve recently spent a lot of time learning even more. I hope to relay this information in an easy-to-understand manner, and I hope to mollify the fear surrounding vaccines. It is through learning that we can understand, and it is through understanding we can recognize we should not fear vaccines.

First a little about the immune system¹…

To understand how vaccines work, we must first understand the body’s natural defense against disease — the immune system. To begin, we can divide immunity into natural and artificial immunity, and then further divide each of these categories into active and passive immunity.

Natural active immunity encompasses our natural immune response. Simply put, we become infected with a pathogen which provokes an adaptive immune response and results in memory. Now let’s dive into a little more detail. Innate immunity, our first line of defense, is our skin, mucous membranes, and broad immune cells such as macrophages and neutrophils. But obviously, pathogens often survive these defenses and continue wreaking havoc inside our bodies. This is when our second line of defense, our adaptive immunity, comes into play. Our adaptive immunity includes many specific and diverse cells, including T cells and B cells. All cells have specific markers on their surface, allowing for identification. The cells in our body will display molecules that tell the immune system it is a self-cell, ‘do not harm.’ Pathogens also display identifying molecules, or antigens, on their surface, which is how our immune system recognizes them as something harmful. Antigens are molecules that the immune system responds to. Our immune system has T cells which are specific to certain antigens. Once a T cell recognizes a pathogenic antigen it is able to kill that pathogen. Our immune system also has antibodies circulating in our bloodstream. Antibodies are also able to recognize specific antigens and will bind to them, signaling to other immune cells that this harmful pathogen should be killed. T cells and antibodies are an important part of pathogen clearance. B cells are another important type of immune cell, as these cells will create memory. B cells will recognize antigens on pathogens, and will ingest the pathogen, and then display the pathogen’s antigen on its surface. The B cell will then come into contact with a T cell for that specific antigen, and the B cell will become activated. An activated B cell will produce thousands of antibodies per second, allowing for pathogen clearance. Some of the activated B and T cells that are now specific for that antigen will create clones of themselves and these clones will circulate the immune system as memory cells. Thanks to these memory cells the body will be able to have a quicker response if it encounters that pathogen again.

Natural passive immunity means only antibodies are given and received. During pregnancy antibodies will pass from the mother to the baby through the placenta, and during breastfeeding antibodies will be delivered to the baby through breast milk. These antibodies circulate in the bloodstream for only a few weeks, protecting the baby for that time, but the baby’s immune system does not develop any memory cells.

Artificial passive immunity is also only antibodies. An infected person may receive an antibody concoction from human donors; these antibodies will circulate in their blood stream for a limited amount of time, protecting that person for that duration of time. Antibodies have a few mechanisms of destruction, but I will not be explaining that in this paper.

Finally, we have artificial active immunity, which is achieved through vaccination. A person is injected with a non-virulent strain or a portion of a pathogen, which induces an active immune response and results in memory. Vaccines are considered to be preventative and prophylactic as they create an immune response and memory cells before a person even becomes sick. So if the vaccinated person comes into contact with the disease, the memory cells created from vaccination will be able to respond quickly, limiting the chance of illness.

But what, exactly, are vaccines?²

As defined by wikipedia, a vaccine is “a biological preparation that provides active acquired immunity to a particular disease.” So a vaccine is something biologists created that provides protection from a specific disease by provoking an immune response which results in memory cells. There are a few different types of vaccines, which I’ll explain next.

First, there are whole organism vaccines. That means we take the entire organism or virus and then weaken it, or attenuate it, so that it is not able to cause disease symptoms. There are a variety of mechanisms of attenuation which are studied, developed, and tested by scientists in labs. A common mechanism employs the use of small amounts of formaldehyde. When the whole, attenuated organism or virus enters the body a strong immune response is provoked, as if the person encountered the full organism or virus by chance. A strong immune response will result in memory to the specific organism or virus, meaning if we encounter that organism or virus in the future, our body will be able to respond quickly, limiting disease symptoms.

Another type of whole organism vaccine is achieved by using an organism that is not the exact organism you’re trying to achieve immunity from, but a related organism. The related organism will carry similar antigens, which will result in a strong immune response and memory cells. An example of this is the smallpox vaccine. While many people were becoming ill and dying of smallpox, milkmaids were not. After further observation it was realized that milkmaids were exposed to cowpox, had an immune response to cowpox, and because cowpox and smallpox are related, were not susceptible to smallpox. This is how the smallpox vaccine was developed.

There are also killed organism vaccines. Organisms or viruses can be killed using heat or formaldehyde. Once injected, they create an immune response and result in memory. Because the organism is killed the immune response is not as strong, so these vaccines often require boosters.

Next, we have purified macromolecule vaccines. For these vaccines, scientists focus on a specific part of the pathogen. One example is designing vaccines based on surface components of the pathogen. The vaccine will be a mixture of proteins found on the surface of the pathogen. When injected into the body this will provoke an immune response and the immune system will produce antibodies to clear the pathogen. These vaccines require boosters as the immune response isn’t very strong. Another example is toxoid vaccines — it sounds scary, but it isn’t. Some pathogens create toxins, so toxoid vaccines will create an immune response to the toxin. Toxin proteins can be inactivated with heat or formaldehyde, and when injected as a vaccine will provoke an immune response resulting in B cells and memory. There are also conjugate vaccines, sometimes known as adjuvant, which will be a surface molecule of a pathogen combined with something immunogenic such as an inactivated toxin. The idea is to create a strong immune response without having to use the whole organism.

Vector vaccines are a vaccine currently being developed and tested. These vaccines will take a specific gene from a pathogen and insert it into something that is not a pathogen, and then inject that combination into a person. The person will then have a strong immune response to the pathogen and the non-pathogen vector.

From this we see that there are a variety of vaccines. It takes ample research and development to figure out which vaccine is best for which pathogen.

Vaccine testing and approval³⁴

While people are quick to assume vaccine development occurs quickly, it is actually a long and complex process — one that may take up to 15 years. I will proceed to explain the process in chronological order, although I doubt it ever clearly occurs in this successive manner. Like I said, it’s a complex process. The stages of vaccine development are described in Chapter 6 of The Children’s Vaccine Initiative: Achieving the Vision and by the Center for Disease Control and Prevention on their website. Here is my summary:

  1. An idea is born. More often than not this idea is in response to a public health issue. Perhaps that issue is a majority of the population becoming sick with smallpox. Perhaps the issue is a majority of the nation’s children becoming disabled by polio. But it’s always an issue affecting a large portion of the population and an issue that demands priority.
  2. This idea moves to the lab. If the issue is a priority and there is funding, basic research laboratory work begins. Due to ethics laws the work typically begins with animal models. Basic research has to be conducted to understand the pathogen/disease in question and how it interacts with the immune system. Then that basic research can be applied towards developing vaccine options. After failures and then reproducible successes with the vaccine candidates, a foundation is set for subsequent study. Once a viable vaccine candidate is found, researchers must submit an Investigational New Drug application to the FDA to be considered for clinical trials. Keep in mind, research may continue even if a specific vaccine candidate moves forward to clinical trials.
  3. Clinical Research Lab. Clinical development, itself, has three phases. During Phase I, the vaccine is given to a small amount of humans. Phase I is designed to learn how safe the vaccine candidate is, how strong of an immune response is provoked, the optimal dose of the vaccine, and the best administration route (liquid shot, aerosol nasal spray, etc.). Each person is monitored and documented. If this group receives the vaccine and there are minimal to no adverse effects, the vaccine will proceed to Phase II upon approval. During Phase II, the sample size expands to include people with characteristics of the vaccine target group. For example, the polio vaccine was needed for children, so Phase II studies would have included children. The goals of Phase II are similar to Phase I, but the sample size is much larger and a placebo control group is typically used as well. Again each individual is monitored and documented. If this group receives the vaccine and there are minimal to no adverse effects, then the vaccine, upon approval, will proceed to Phase III. During Phase III the vaccine is administered to thousands of people, the largest sample size yet. Again each person is monitored and documented to determine the efficacy and safety of the vaccine. Many vaccines may undergo a fourth phase of ongoing studies even after approval, typically for postmarketing surveillance. Once a vaccine candidate has made it through clinical trials, the scientists may apply for licensure through the FDA.
  4. Production and Manufacturing. Scientists work to figure out the safest, easiest, and best way to mass produce the approved vaccine. Additionally, the safest, easiest, and best ways to transport and store the vaccine must also be determined. Pilot lots of vaccines are created and tested before vaccines for human use are permitted to be made. Typically, commercial vaccine manufacturers will assume responsibility from here. Once a vaccine makes it through pilot production, vaccine production will be up-scaled to commercial levels.
  5. Distribution and Use. The vaccine can now be distributed to clinics nationwide and administered by healthcare Personnel. Recommendations for use are established during the licensure process (above) which occurs through the FDA. Recommendations for general vaccine use are made by the CDC — as you might know, the CDC maintains the immunization schedule. Communication between government sectors, healthcare personnel, and patients or parents of patients are crucial for immunization coverage.
  6. Surveillance. After vaccines are being regularly administered nationwide, surveillance is important to ensure the vaccine is doing as it is designed. During surveillance four specific things are monitored: rate of immunization in the target group, how effectively the vaccine is preventing disease, frequency and type of adverse-affects to the vaccine, and recognition of new diseases that might require attention. Health care personnel, public health workers, and government organizations work together to achieve proper surveillance.

Hopefully my brief summary of the process has demonstrated what a long and regulated process vaccine development is. For added emphasis, I’d like to repeat that safety is the primary concern throughout the process. If you’re interested in learning more about this process, I’d encourage you to read the book or website I have referenced.

CDC Vaccine Schedule⁵

I’m sure you recall receiving shots as a child, or perhaps you have siblings or children of your own who have received them more recently. Why are there so many shots? And why does it matter when we get them? Complete immunization schedules can be accessed on the CDC website. The schedules lay out which vaccines should be administered and at which age in life they should be administered. It also lays out what disease the vaccine protects against, how that disease is spread, and complications that may arise due to that disease. If you’re interested in reviewing the immunization schedules, they can be accessed through the following website: https://www.cdc.gov/vaccines/schedules/

The Anti-Vax Movement⁶

In 1998, Andrew Wakefield and his 12 colleagues published a paper in the British journal Lancet that suggested the Measles, Mumps, and Rubella (MMR) vaccine could cause autism. The paper received a lot of publicity, spurring concern and fear everywhere. A decrease in MMR vaccination was observed, as parents now questioned the safety of the vaccine. In response to the widespread fear, epidemiological studies were conducted and published — these studies refuted Wakefield’s publication. Shortly thereafter, ten of Wakefield’s colleagues began retracting their data interpretations, claiming “insufficient data” and “no causal link.” Next, the Lancet completely retracted the publication, citing several flaws, including ethical violations and scientific misinterpretation. Additionally, Wakefield was found guilty of deliberate fraud as he selected which data to use rather than making interpretations based on all of his data (as is appropriate scientific technique). Wakefield was also found to be funded by a law firm that was involved in a lawsuit against vaccine-producing companies. Despite Wakefield being found fraudulent, his paper and findings being retracted, and the end of his scientific career, the damage of his claims have not been undone. He has sparked a movement. Fear surrounding the MMR vaccine persist today, despite the many studies that have since been conducted (and have found no connection between MMR vaccination and autism)⁷⁸. The fear has expanded to include other vaccines and specific vaccine ingredients. These fears have resulted in parents choosing not to vaccinate their children and we have seen outbreaks of preventable diseases as a result⁹. As a sidenote, Wakefield has also caused the public to have distrust in science — scientists who publish their research have an ethical responsibility to uphold, one Wakefield abused. Fabricating findings or irresponsibly choosing data to create a conclusion is wrong and can result in a lot of harm and damage to individuals, our society, and the scientific community.

Common Concerns of the Anti-Vax Movement

“Vaccines are poison.”

As we know, poison is harmful to us — poison will make us sick or will kill us. Poison is a scary word. But it’s important to recognize that poison is dose-dependent. Many things are poisonous in large amounts, or in increased dosages. During vaccine development, the toxicity of the ingredients and of the vaccine itself are determined — a vaccine cannot be considered safe without this determination. The FDA provides guidelines with which scientists and industry workers must be compliant¹⁰.So when certain vaccine ingredients are present in minute amounts, they have been determined not to be toxic; they have been determined safe to inject into the human body. Sometimes people fear the entire vaccine, a concoction of chemicals, is poisonous — the vaccine, as a whole, has also made it through the entire development process and has been found to be safe for use. It is not poisonous.

Herd immunity

Herd immunity is the idea that if a sufficient amount of a population is immunized, then the small portion that is not immunized should still be safe from preventable disease. This is possible because in a population where the majority is immunized, the spread of infection is more likely to be disrupted. The more people immune to a disease, the less likely for a non-immunized person to come into contact with the disease. Some parents think their children will be protected by herd immunity. This is true when the amount of non-immunized is a small portion of the population, but when this percentage of the population is large enough we will see outbreaks of disease, such as the semi-recent whooping cough outbreak in Southern California¹¹. Additionally, herd immunity is important for people who cannot get vaccinations for legitimate health reasons such as allergies or perhaps they are immunocompromised. The safety herd immunity provides for this select group is compromised when many others decide to not vaccinate their children.

Formaldehyde¹²

Another scary chemical. You may recall that formaldehyde is used to inactivate pathogens in whole-organism vaccines — it ensures that the harmful pathogen is not harmful in the vaccine, that it will not cause illness. In other words, it purifies the vaccine. The amount of formaldehyde present in vaccines is often excluded from packaging because the amount present is too miniscule to measure. You might also take interest in the fact that our body produces formaldehyde as a waste product, and formaldehyde is found in a variety of fruits, nuts, and other foods. So formaldehyde is often in our blood, and in amounts that are measurable. Keep in mind that formaldehyde is toxic, so our body filters it out quickly. But the minute amount present in vaccines should not be a concern. Formaldehyde is used in vaccines to kill and/or inactivate pathogens that would otherwise be harmful.

Thimerosal (Thiomersal outside of the U.S.)¹³

People fear the harmful effects of mercury poisoning when they think of thimerosal. Don’t you remember learning of the dangers of mercury thermometers? First and foremost, thimerosal is not mercury in its elemental form; the mercury in thermometers is mercury in its elemental form, and it is dangerous. Thimerosal is a mercury-containing compound, and it is a toxic compound. But remember that poison is dose dependent. Small amounts of thimerosal are not toxic. Additionally, thimerosal does not stay in the body long (most things do not), and it is unlikely to make us sick. Furthermore, thimerosal is not widely used in vaccines anymore. Thimerosal has not been used in vaccines for children since 2001, and today is typically only used in flu vaccines (however you can ask for a flu shot that does not contain thimerosal). Thimerosal acts as a preservative to prevent bacterial or fungal contamination — if bacteria and fungi were to grow in a vaccine and then be administered to a patient, the patient would likely get ill. Thimerosal is used in vaccines to prevent contamination that would otherwise be harmful.

Vaccines are causing autism.

This idea is rooted in Wakefield’s fraudulent paper, which has since been disproved by over 20 publications⁷⁸. There is no scientific evidence that proves vaccines cause autism, and there is ample scientific evidence showing that vaccines do not cause autism. I am aware that there are many, many stories from parents that claim their child developed autism after vaccination. It’s important to realize the age at which vaccines are administered overlap with the age that autism is typically detected and diagnosed. Both events occur in early childhood. I think that parents are eager to find an explanation as to why their kid has autism, and thanks to fraudulent Wakefield, parents can cling to the idea that the vaccine their child received is the reason why. It would be naive to overlook increased rates of autism in children compared to previous years, and that increase is something to be investigated. Personally, I hypothesize that improved health care and increased health care accessibility could be partially accountable for that increase as this would increase detection and diagnosis. I also believe that there are a number of environmental factors that could be responsible — vaccination is an easy and lazy culprit to blame due to disproved and discredited research.

Some other vaccine ingredients¹⁴

Aluminum salts are often used as adjuvants to increase the strength of the immune response which will result in better immunity. Sugars and gelatins are often used in vaccines as stabilizers. They ensure that the vaccine remains effective from the time the vaccine is made in manufacturing through transportation and storage, so that when it reaches the patient it will still work. Egg protein is often used as culture materials during vaccine production which ensures that enough of the pathogen grows so that enough vaccines can be created. Neomycin is a residual antibiotic that is used to prevent contamination in vaccines.

Vaccines or vaccine ingredients may seem intimidating and scary, but if you take the time to learn and understand them beyond their ambiguous name you will find that if they are being used they are not harmful to humans.

The Importance of Vaccination

Let’s take a step back in history. It’s 1663. The first European settlers have set foot and established communities on the East Coast. With them comes smallpox, which kills 70% of the Native American population and a smaller portion of the European settlers. In response to the mass disease and numerous deaths, Edward Jenner creates a smallpox vaccine. With this vaccine, people become immune to smallpox. The amount of disease and death decreases, and the idea of immunity through vaccines is born. Smallpox vaccines have not been necessary in the United States since 1972, after a widescale vaccine initiative.

It’s 1921. Diphtheria is sweeping the nation. Thousands of children are sick, their necks swollen, their throats covered in a thick, gray film. Thousands of children are dying. Diphtheria is caused by the bacterium Corynebacterium diphtheriae, and once this is discovered scientists go to work on developing a vaccine. In response to vaccination, diphtheria rates plummeted. Still today we are vaccinated to protect ourselves against diphtheria. And thanks to another medical wonder, if diphtheria is contracted it can be treated with antibiotics.

It’s 1952, the peak of the polio epidemic. Polio is a viral disease that causes paralysis. Children everywhere are losing their ability to walk. During the early stages of the virus, the infected struggle to breathe. The iron lung, a tank respirator, is commonly used. Eventually, Dr. Jonas Salk develops a vaccine and by 1962 the rates of polio have decreased. America has been polio-free since 1979 thanks to vaccination.

There are many other health epidemics that have swept our nation, causing disease and death. If we are going to fear something it should be preventable, widespread disease afflicting our society. Vaccines are a preventative measure against disease. They allow our immune system to develop immunity against harmful diseases before the diseases can hurt us. Vaccination is safe and effective — the process to develop, test, and approve a vaccine for widespread use is long and comprehensive; it seeks to create vaccines that are safe for widespread use. Vaccinations protect individuals from harmful diseases, and protect societies from epidemics. Choosing not to vaccinate your children puts them at risk of disease. Choosing not to vaccinate puts our communities at risk. Choosing to fund vaccine-skeptic research will allow fear of vaccines to spread in our society and will result in smaller vaccination rates and increased disease rates. If large portions of our society choose not to vaccinate we may see the return of preventable diseases. We may see preventable deaths. In this paper, I have provided a foundation of knowledge and an argument that supports vaccination. I encourage you, whenever you question something, to research it. Find information from reputable sources and seek to understand the information. Vaccines are not something I fear; they are something that protects me and allows me to live a life free of preventable disease.

Sources

  1. Wyckoff, Timna. “The Immune System.” Class Lecture at the University of Minnesota Morris, Morrs, MN, January 27-February 27, 2016.
  2. Wyckoff, Timna. “Antimicrobials.” Class Lecture at the University of Minnesota Morris, Morris, MN February 29-March 28, 2016
  3. Mitchell, V. S., Philipose, N. M., Sanford, J. P., & Institute of Medicine (U.S.). (1993). The Children’s vaccine initiative : Achieving the vision. Washington, D.C.: National Academy Press. http://books.nap.edu/books/0309049407/html/index.html
  4. “Vaccine Testing and Approval Process.” Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/basics/test-approve.html
  5. CDC Vaccine Schedules. https://www.cdc.gov/vaccines/schedules/
  6. Rao TSS, Andrade C (2011) The MMR vaccine and autism: Sensation, refutation, retraction, and fraud. Indian J Psych 53: 95–96. doi: 10.4103/0019–5545.82529
  7. DeStefano, F. Chen, R.T. (1999) Negative Association between MMR and autism. The Lancet. 353: 1987–1988. doi: 10.1016/S0140–6736(99)00160–9
  8. Taylor B, Miller E, Farrington CP, et al. (1999) Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 353(9169):2026–2029.
  9. Sifferlin, Alexander. (2014) 4 Disease Making a Comeback Thanks to Anti-Vaxxers. http://time.com/27308/4-diseases-making-a-comeback-thanks-to-anti-vaxxers/
  10. “Guidance for Industry: Considerations for Developmental Toxicity Studies for Preventive and Therapeutic Vaccines for Infectious Disease Indications.” Centers for Biologics Evaluation and Research. http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Vaccines/ucm074827.htm
  11. Gorn, David. (2015) State Issues Whooping Cough Warning. California Healthline. http://californiahealthline.org/news/state-issues-whooping-cough-warning/
  12. Franks, SJ. (2005). A mathematical model for the absorption and metabolism of formaldehyde vapour by humans. Toxicology and Applied Pharmacology. 206(3): 309–320. doi: 10.1016/j.taap.2004.11.012
  13. Pfab R, Mückter H, Roider G, Zilker T. (1996) Clinical course of severe poisoning with thiomersal. J Toxicol Clin Toxicol. 34:453–460. doi: 10.2478/v10102–012–0026–1
  14. “For Parents: Vaccines for your Children.” Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/parents/vaccine-decision/index.html