''Vaccination is not a story about personal, but about social''
A general physician about the attitude towards vaccination, anti-vaccination movement and measles
The increase in the number of measles cases in the world is causing concern of the World Health Organization (WHO). Several measles cases have also been recorded in Tatarstan. Doctors say that the reason is the anti-vaccination movement. Meanwhile, Russia launched additional measles vaccination from 1 April to stop an outbreak. Aleksey Vodovozov, a science journalist, general physician, told Realnoe Vremya about who make money on anti-vaccination movement and why it causes concern of the WHO.
In St. Petersburg people called the police to protect themselves from vaccination against measles
Mr. Vodovozov, several measles cases have been registered in Tatarstan for the first time since the '90s. Epidemiologists believe that this is because people refuse vaccination. What is the cause of the incidence in your opinion? And how much does it have to do with refusal to vaccinate?
It is really connected with refusal to vaccinate. When the World Health Organization published ten challenges that doctors will have to struggle with in 2019, it included in the list the anti-vaccination movement along with climate warming, global influenza pandemic, antibiotic resistance and Ebola.
Russia has launched additional vaccination against measles from 1 April. Do you think it will help to avoid an increase in the number of cases?
Since measles is the most contagious infectious disease in the world, 95% of the population must be vaccinated to be protected against it. The percentage is not accidental, it is calculated based on Fred mathematical model. It shows the rate at which the pathogen infects the population once it spreads.
If the percentage of people vaccinated against measles is below 95%, we first get local outbreaks, then — larger, and then an epidemic begins. Measles is one of the diseases against which we have not developed a good therapy. This is a virus, and the situation with antiviral drugs in the world and our science is bad. Yes, we can handle with some viruses, such as hepatitis C viruses, but we can't handle with measles. Therefore, the only thing that is effective today is vaccination.
''Since measles is the most contagious infectious disease in the world, 95% of the population must be vaccinated to be protected against it. The percentage is not accidental, it is calculated basing on Fred mathematical model. It shows the rate at which the pathogen infects the population once it spreads.'' Photo: itv.com
In this case, should everyone be vaccinated against measles?
When there is a measles outbreak at school, house, district, then an emergency vaccination is announced, and everyone must be inoculated. If there is a close contact with the disease, people may not remember if they got measles or not, or over time their immunity to infection could reduce. In this case, it is better to be vaccinated in the foci of emergency immunization.
Sometimes they say: ''If there is immunity, but they add antibodies above, they will destroy each other.'' No, such vaccination will not cause harm. To determine the state of immunity against measles, adults can be tested for immunoglobulin G in any laboratory. Depending on the level of antibodies, it will be possible to tell what immunity is now and whether it is necessary to vaccinate against measles to those who were vaccinated in childhood.
If a student gets measles in one of the classes, it is possible that both teachers and children can be vaccinated. But most often outbreaks occur not at school but at home because students are vaccinated. For example, there was an interesting story in St. Petersburg. Residents of several houses even called the police when there came doctors with emergency vaccination against measles. And as a result, the outbreak spread.
''The WHO states a sharp rise in the incidence of measles. In Russia, the statistics are depressing. According to Rospotrebnadzor, 86 cases of measles among the unvaccinated were detected in 2016, in 2017 — 367 cases, and in 2018 — 3300 cases, 6 of which ended in death.'' Photo: spektrum.de
Measles has long been the world leader by child mortality
What are measles statistics on post-vaccination immunity?
In developed countries, measles deaths occur in one case for every thousand cases. In developing countries, the death rate from this infection is 10 times higher, sometimes 100 times higher. For a long time measles was the world leader in child mortality in the section — mortality of children from 0 to 5 years. A large number of deaths were stopped only after mass vaccination, which was carried out all over the world. Then in six-fold decrease in child mortality due to measles.
How often should I be vaccinated against measles? In this regard, the opinion of physicians is at odds, someone claims that 2 doses of the vaccine form a stable life-long immunity in the majority of the population, but on the other hand — some doctors recommend check every 10 years. Who is right in this matter?
Both sides of doctors are right: in the vast majority of cases, two doses of the vaccine are enough to acquire a stable immunity from measles, but it is necessary to take into account the individual characteristics of the body. If we talk about immunity, which gives the vaccine, then after the first vaccination aged 9 months 85% of people become immune to the disease, and after the second vaccination, which is done aged 12 months, the number of immune people reaches 95%. That is, the vaccination does not give 100% protection. This is influenced by the individual characteristics of the immune system, or a person does not produce immune bodies, or produced in insufficient quantities, and they can get sick.
How to chech if the vaccine worked? How long before you can do an antibody test?
For the full development of antibodies, it takes three weeks, and if you are interested, it is better to track the antibodies in six months, when a stable and tense immunity is already developed, memory cells are formed.
What are the statistics in Russia on the incidence of measles among vaccinated and unvaccinated children?
WHO says a sharp rise in the incidence of measles. In Russia, the statistics are depressing. According to Rospotrebnadzor, 86 cases of measles among the unvaccinated were detected in 2016, in 2017 — 367 cases, and in 2018 — 3,300 cases, six of which ended in death. And if we evaluate the structure, more than 90% of the diseases accounted for people who either did not have vaccinations or did not have information about vaccination.
We can't say for sure if they have a vaccination or not if there are no supporting documents. I would like to add that in the 90s and now people actively buy medical certificates about vaccinations to get a job, enrol a child in a kindergarten or school. It is possible that among the people who are considered vaccinated there can be with ''acquired'' purchased immunity. If you look at the age structure, among them children are leading, and 90% of patients did not have vaccination.
''Vaccination calendars in all countries have a serious background. They are not just invented, spaced by date. A lot of work was done to compile them. And they often combine several antigens to reduce the number of injections.'' Photo: babysfera.ru
''Today people know how reach the necessary instance and to achieve what they want''
How should we approach the issue of vaccinations? Does everyone need to be vaccinated strictly according to the National calendar or based on the characteristics of the child?
A sticky situation, vaccination calendars in all countries have a serious background. They are designed for a reason, spaced by date. A lot of work was done to compile them. And they often combine several antigens to reduce the number of injections. Because for parents and children the most terrible thing is the injection itself. Today they are trying to reduce this traumatic moment. If earlier it was necessary to make five injections, today one is enough.
Vaccines close the most dangerous periods of life for a child. For example, whooping cough is most dangerous for children under 24 months. The maximum mortality from it falls on the first two years. Therefore, if this vaccination is postponed, and the TDaP is not loved in our society, the child becomes infected with pertussis in the most vulnerable period and may die.
In addition, abandoning the TDaP, they also refuse the tetanus vaccine. Which leads to unpleasant situations. For example, in Samara in 2015 a girl died of tetanus. In modern times, this is nonsense. When we studied at the Military Medical Academy in the '80s, they couldn't in the entire city to find even diphtheria and tetanus to show that the students what they look like.
And now, thanks to anti-vaccination followers, we can see on their children how those infections, about which several generations of physicians forgot, look like. Although whooping cough and diphtheria is very easy to catch. Strains of diphtheria in each person are in the throat. Another thing, they can be toxigenic and non-toxigenic. And a diphtheria shot is a protection against the toxin. With the vaccinated person, even if it is a toxigenic strain, nothing terrible happens, but it can become a source of infection for unvaccinated people. If there are no contraindications, it is better to vaccinate on the calendar. This is what all doctors say.
How to properly assess the condition of the child before vaccination and what contraindications can be? Parents complain that in practice the child with an allergy should beat out the medical exemption though allergic reactions as a possible side effect are written in the instruction to any vaccine.
Of course, for each vaccine there are indications and contraindications. For example, if we are talking about a measles vaccine, then a temporary medical exemption will be an acute respiratory disease, or an exacerbation of the existing chronic. There is no cancellation of vaccination, but its postponement until the time of recovery or remission. Permanent contraindications from measles can be with primary immunodeficiency, and secondary, HIV infection, is not a contraindication, but primary — yes, because the immune system cannot develop.
''If you take a measles vaccine, the high temperature occurs in about 4%. And this is the most common reaction to the drug. Even convulsions may occur, but their frequency is lower — 0,025% of cases, an allergic reaction appears in one case out of ten thousand.'' Photo: orenburg.sm-news.ru
Also, measles vaccination cannot be done with malignant blood disease, a pronounced reaction to the previous vaccine. By reaction, we mean hyperthermia over 40 degrees with febrile seizures and infiltration over 8 cm at the site of administration of the vaccine. In this case, the same drug can not be administered.
It is often said that the measles vaccine cannot be administered if you are allergic to chicken egg. But true allergy, not food intolerance — are two different things. Allergy to chicken protein is rare. In addition, we are the only developed country in the world where this contraindication remains. Around the world, repeated epidemiological observations have proven that even the presence of allergies to protein is not a contraindication for measles vaccination. Because usually there is no powerful allergic reaction that would cause health problems.
How often do allergic reactions occur after vaccination? Doctors often deny that the allergy arose as a reaction to the vaccination.
The reaction of the body is not always due to vaccination. Of course, I understand that parents begin to look closely at children after the introduction of the vaccine and find obvious or not obvious deviations, but it is rather a coincidence. The vaccine was studied, possible complications were described, the mechanism of immunity formation was well studied. We know to cells and molecules, how it happens, and we can say what complications are associated with the vaccine and which are not.
Also, we have a system to account for adverse reactions. Naturally, it is not a doctor from the clinic, but Roszdravnadzor who are responsible for that. On the website of Roszdravnadzor there is a form ''Notice of side effects, adverse reactions or absence of the expected therapeutic effect of the drug.'' If you believe that the reaction occurred as a consequence of the vaccine, you can print out the form from the site and require it to be filled out by a doctor. If the doctor refuses to fill, go to a department chair, if the chief of department does not do it — go to the head to the chief medical officer to the chief physician. Today people know how to reach the necessary instance and to achieve what they want.
After filling out the form, a mechanism for determining the cause-and-effect relationship is launched. If you take a measles vaccine, the high temperature occurs in about 4%. And this is the most common reaction to the drug. Even convulsions can occur, but they have a lower frequency of 0,025% of the cases, the allergic response occurs in one case out of ten thousand. Anaphylactic shock occurs once per million doses of measles vaccine.
Some conditions after vaccination can develop within 24-36 hours, and the most distant reaction occurs after 72 hours. If in 72 hours nothing appears, the subsequent response of the organism is not associated with the vaccine. But sometimes there are coincidences: the child was given a vaccine, and he got sick.
''Of course, vaccines must be stored in certain conditions, and if the cold chain is broken, the vaccine can become more reactogenic to humans. But this is not directly related to the antigens and excipients that are inside the vaccines.'' Photo: upulmanologa.ru
They do not write about a million cases where the vaccine is absorbed without problems. They will inflate stories about diseases that have arisen after vaccination, and when there are denials or investigations about the results — the media and the victims are silent about them. Of course, sometimes cases with vaccinations reach the court and health workers are punished. The most frequent violation of personnel or violation of the rules of storage, or the rules of administration, or they confuse the drug or dose. Many remember the story when schoolchildren in Primorye were subjected to tuberculin diagnostics and 2,5 thousand times exceeded the dose of allergen. There were no deaths, allergic reactions were stopped, 29 children were hospitalized.
Of course, vaccines must be stored under certain conditions, and if the cold chain is disrupted, the vaccine may become more reactive to humans. But this is not directly related to the antigens and excipients that are inside the vaccines.
''It seems that anti-vaccination movement is funded by 'big pharmaceutical industry''
You compare the anto-vaccination movement with business. Who and how makes money on it? Who benefits it?
Ordinary anti-vaccination followers are mostly in favour of the idea and the audience, where professional anti-vaccinatination followers make money on. The movement itself originated in the United States on the basis of legal organizations that are engaged in filing collective claims. Collective lawsuits are profitable: the company makes 5-6 thousand claims at the same time, it is difficult for it to dismiss them, and it goes to a pre-trial agreement on payments. In this case, lawyers earn.
The most famous scandal occurred with the measles vaccine MMR. British Doctor Andrew Wakefield published an article in the authoritative medical journal The Lancet that the MMR vaccine causes autism in children, diseases of the gastrointestinal tract. However, British journalist Brian Deere studied his work and found out interesting details: Wakefield's research was falsified. He did it on the order of one of the legal organizations, which was engaged in collective claims.
They were preparing a class action suit against MMR, and they needed the invoice they got from Wakefield. The doctor was paid for a false examination. When it turned out, the article was withdrawn from the magazine, he was kicked out of the register of doctors and now in the US he and Robert De Niro promote anti-vaccination sentiments.
British Doctor Andrew Wakefield (pictured) published an article in the authoritative medical journal The Lancet that the MMR vaccine causes autism in children, diseases of the gastrointestinal tract. However, British journalist Brian Deere studied his work and found out interesting details: Wakefield's research was falsified. Photo: Lee Durant / National News / TopFoto / Scanpix
Also, doctors or public figures make money on the anti-vaccination movement. Doctors are better listened to, especially to those who used to be a terrible vaccinator, it was bought by 'Big Pharma' (the general conventional name that is used by opponents of pharmacology – editor's note), and now he ''saw the light'' and decided to bring the light of knowledge in society. These whistleblowers are loved, and their books are published in millions of copies. In addition, they are applied to various tours, performances, which is also paid. These people conduct paid workshops, and tickets for the famous anti-vaccination movement are 10 times more expensive than tickets for lectures educators.
Another option earning — the sale of various ''detoxifying'' drugs. Mostly it is homeopaths, ''saving'' children from the terrible consequences of vaccination. Trusting parents, they sell drugs that can supposedly remove mercury from the child's body, antigens. It is assumed that anti-vaccination followers are disinterested people who work for the idea, but doctors do not. Although if we unearth any anti-vaccination story, there is sure to be money in the beginning. I discussed this issue in detail, talked with Brian Dir, his work was published in Russia.
When he performed at the festival Nu Tozhe Nauki, he joked that anti-vaccination movement is funded by ''big pharmaceutical industry''. Because everything they do benefits vaccine manufacturers, not harm. The famous story with mercury compounds, which were used as antiseptics in vaccines Thiomersal, is exemplary. The actions against anti-vaccination movement against mercury led to the fact that Thiomersal ceased to produce multidose vial by going to monodoze vaccine. Wholesale is always cheaper than retail, and vaccine it is manufacturers who benefited in the end. Now they can sell the vaccine piece by piece and even more expensive than before, because it has a syringe, needle.
What do you think about repressions exercised by the government in respect of anti-vaccination followers: it refuses to visit kindergartens, does not allow unvaccinated children in schools?
We have repressions against tax evaders, against those who do not wear a seat belt, and these repressions are similar. This is absolutely correct. Vaccination is not a personal story, but a social one. I understand that it is extremely unfashionable to say that there is a public duty, but as long as you live in society, you must abide by the rules. For example, when you drive a car you have to follow the rules of the road. If you are a pedestrian, you must not cross the street in the wrong place.
The main thing is that vaccines protect people with contraindications, to whom we can not inoculate in principle. They are few, but they exist, and we must protect them from infection. We can only do this by creating an immune shield. If the infection does not spread among the population, vulnerable people will not be affected.
''It is clear that people can have their own beliefs, certain rights, but it rests on the rights of others. We have the right not to be sick and the duty not to become a source of infection. The only option today is vaccination.'' Photo: Rinat Nazmetdinov
When we vaccinate, we don't allow the infection to develop at full capacity, because if it goes out in the field, it can mutate. This is evident in the flu, which is the only infection we can't get into the septic tank, and it runs around the globe, and we have to respond to its changes. The flu can adapt: in one season to change a pack of antigens and come already in different clothes and we will have to start to develop the vaccine again.