Vaccination: A personal choice?

APRIL 6 — “I want what is best for my kids, and protect them from diseases.”

Isn’t it ironic, how we can strongly agree on the above statement, and also somehow it is the very statement that drives us apart when it comes to vaccination?

Most modern parents have never seen the devastating effects that diseases like polio, measles, or whooping cough (pertussis) can have on a family or community.

It’s easy to think of them as diseases that only existed in the past when the bitter truth is, they still exist.

The growing number of people who are anti-vaccination in Malaysia, coupled by the large number of migrant workers from India, Pakistan, the Philippines and Indonesia exposes those who cannot be vaccinated among us to unnecessary risk.

As a medical doctor with a public health background, I have an obvious bias towards vaccination.

“My baby is healthy, why should I vaccinate?”

Many don’t realise that vaccination is not about treatment. It’s about prevention.

Malaysian babies are without polio, measles and whooping cough today thanks to a high vaccination rate among Malaysians. These immune Malaysians confer “protection” to those who are not vaccinated by breaking the chain of infection, and preventing the nasty viruses from reaching them.

They form sort of a shield, if you will.

And this can only happen when the vaccination rates are above a certain level of the population.

But taking into consideration the migration of workers from neighbouring countries especially Indonesia, the Philippines, India, and Pakistan where immunisation rates are low, coupled by the anti-vaccination movement in Malaysia, it is safe to believe the decline in that threshold.

This puts those who are not vaccinated in danger of contracting these diseases, which I will illustrate next.

“This is my decision, not yours.”

Let us take the MMR vaccine as an example.

If the American CDC number of 99 per cent efficacy for MMR is accurate, and assuming we vaccinate 100 per cent of the population, then we would see:

* 1 per cent of those vaccinated still susceptible to measles, and,

* Another 1-2 per cent (rough figure) or so susceptible from contraindications to vaccinations i.e. those with allergies, or severe immunodeficiency i.e. from haematological disorders, on chemotherapies, or long-term immunosuppressive therapies, patients with AIDS, and,

* Another 7-8 per cent or so of the entire population susceptible because they are too young to have received their full dose of vaccination.

This means about 10 per cent of the population is at risk when an outbreak occurs, assuming of course that those who can be vaccinated are vaccinated.

The number is higher if those who can be vaccinated, refused.

Do MMR vaccines cause autism?

No.

But proponents of anti-vaccination often cite Andrew Wakefield to justify a causal link between vaccines and autism.

While his original paper did not prove causality, his statement linking the vaccines and autism caused panic, and inspired a number of other studies to confirm or disprove his conclusion. The scientific community found significant ethical problems with Wakefield’s study, but also realised that his research data was not reproducible.

According to the writer, the growing number of people who are anti-vaccination in Malaysia, coupled by the large number of migrant workers from India, Pakistan, the Philippines and Indonesia exposes those who cannot be vaccinated among us to unnecessary risk. — Reuters pic
According to the writer, the growing number of people who are anti-vaccination in Malaysia, coupled by the large number of migrant workers from India, Pakistan, the Philippines and Indonesia exposes those who cannot be vaccinated among us to unnecessary risk. — Reuters pic

Reproducibility is an important criteria in any study where similar results should be able to be replicated by anyone using the same research methods and procedures.

Needless to say that his study, and therefore findings were dismissed.

Some argued that just because we do not have evidence linking autism and vaccinations, nor government-reported correlation between the two, it doesn’t mean that vaccines do not cause autism.

Alright, but by the same thinking neither can anyone prove that it does.

The conspiracy theorist will say this is done to protect the pharmaceutical industries, but again, for the sake of this article, let us keep the discussion to facts. Unless you have evidence to suggest conspiracy, let us move on.

Is vaccination absolutely safe?

Nothing is absolutely safe. Flying, driving, crossing the streets.

There’s risk involved in everything we do hence the term relative safety. So the question we need to ask is, are vaccines relatively safe?

Absolutely yes.

Again, referring to the statistics from the American CDC, and again using MMR vaccines as an example, we are looking at 1 in a million getting a life threatening allergic reaction, and another 1 in a million to develop a serious neurological disorder, and another one in a million will get deafness from the MMR vaccine.

To put it in perspective, it is safer than driving a car in this country.

Malaysian Institute of Road Safety Research (MIROS) said there were 462,423 road accidents and 6,917 road deaths on our roads in 2012. If our population was 29.3 million then, the road accident rate in Malaysia was 15,782 for every million population and road death was 236 for every million population.

Which means that the vaccines are 15,782 times safer than driving in Malaysia.

The “toxins” in the vaccines

And there are those who question the “toxins” contained in the vaccines.

To them, they should learn the time honoured pharmacological principal of, “It is the dose that makes the poison.”

Even natural things can kill you at the right dose. Water, for instance, can kill you when consumed in huge quantities at one time.

Traces of formaldehyde in vaccines, for instance, do not pose a safety concern since it is present in such small amounts compared to the concentration that occurs naturally in the body.

Yes, unknown to many, formaldehyde is produced in small amounts in the human body as a part of normal physiological functions.

Same goes to other chemicals used to manufacture other vaccines.

A national obligation

A four-week-old baby died in Australia of whooping cough. He was too young to be vaccinated.

One family’s choice to not vaccinate has effectively ended another’s life.

Given that the vaccines are safe, there is no reason to refuse vaccination except for personal preference. So the real question we should ask those who refuse vaccination, and more importantly to the policy makers, is whether personal preference should be allowed to take precedence over the public’s when it comes to health?

If we can make education compulsory for our young, and mandate parents to send them to school regardless of what they think of the education system, why can’t we do it for vaccination?

If we can compel parents to send their children for National Service, and bride and grooms to undergo mandatory “kursus”, why can’t we do it for vaccination?

Where is our priority as a nation?

While the poverty stricken African continent are calling for help to vaccinate their citizens, we, in a relatively wealthy nation, are rejecting them outright even when given for free.

Imagine that.

It is true that we have the right to choose. But I am also cognizant of the fact that the rights of one, ends where the right of another begins.

Politically, socially, even medically.

Vaccination should not be a personal choice but a public and national obligation.

 * This is the personal opinion of the columnist.

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