Sound mind versus anti-vaccine campaign

Why anti-vaccine campaigners are losing the information war and in what case coronavirus might seem a walk in the park

The planet celebrates the World Polio Day on 24 October. Even though this menacing disease hasn’t been diagnosed in Russia for quite a long time, doctors don’t stop vaccination against it. Realnoe Vremya talked with experts about both poliomyelitis itself and general problems of vaccination. Read in our report how the coronavirus vaccine is doing, why poliomyelitis can’t be considered defeated, what awaits the world if cowpox or monkeypox mutate, how anti-vaccine campaigners threaten humanity’s general health and how they should be beaten in their court.

Why vaccines against poliomyelitis are still given around the world

Russia hasn’t faced poliomyelitis for many years now. If there were outbreaks in Dagestan and the Chechnya-Ingush Republic in the 90s, the WHO declared in 2002 Europe (including Russia) a territory totally free of poliomyelitis. The world consecutively fights this disease, and only 95 cases were detected in 2019 on the planet.

Boris Mendelevich, doctor, Russian State Duma deputy from Tatarstan, says: “The example of poliomyelitis shows us how important vaccination against any serious infectious diseases is. Universal vaccination from poliomyelitis and the total expulsion are the result of the vaccine that was created once and the injection of this vaccine given to the majority of people in the world.”

But one of wild strains of poliomyelitis keep circulating in some areas of the globe: it is several African republics, Afghanistan and Pakistan.

Dmitry Lopushov, chief visiting epidemiologist of Tatarstan’s Ministry of Health Care: “Of course, the WHO set a task of eradicating poliomyelitis like smallpox. But the situation in the enumerated regions isn’t simple that doesn’t allow covering all citizens with the vaccine equally. Plus, there is very active migration of the population there, this is why it hasn’t yet become possible to eradicate the wild strain completely. It means that we don’t cancel vaccination against poliomyelitis. As with open borders, active migration of people who come from Middle Asian countries neighbouring with Pakistan and Afghanistan, there is a risk of bringing the virus of poliomyelitis to the territory of our country.”

Lopushov calms down Realnoe Vremya’s readers: the modern immunisation protocol is absolutely safe for the patient. The OPV (oral polio vaccine), which contains an attenuated live virus, has already been replaced for the IPV (inactivated vaccine) around the world, which contains a completely killed virus. So now the vaccine can’t cause vaccine-associated poliomyelitis, which rarely was found when using the OPV.

When coronavirus will seem a walk in the park

The world was still familiar with the terrifying disease with a high death rate — smallpox- just several decades ago. In the previous centuries, pox epidemics wiped out European countries not taking pity on either kings or peasants. Today the WHO claims that this virus has been eradicated on the globe only thanks to immunisation. Pox is still the only infectious disease that has been defeated on Earth. There aren’t any other examples of this kind yet.

Boris Mendelevich draws readers’ attention:

“Our Soviet virologists had exceptional merit in the eradication of pox. Our virology was leading around the world. Fortunately, it has remained such. It is clear that a lot of scientists abandoned the country, that this scientific school was destroyed in the 90s, but we managed to save leading institutes and specialists. And the foundation laid as early as in the USSR allows us creating vaccines in the world even now. Precisely our virologists travelled across the world in the 20th century and vaccinated, vaccinated, vaccinated people against pox... Then Americans joined them, and humanity managed to defeat this severe infectious disease.”

But Dmitry Lopushov doesn’t advise relaxing. Yes, he confirms that smallpox was beaten on the globe but reminds us that there are monkeypox and cowpox, a person can’t contract them. And like in the case of coronavirus there might be mutation as a result of which the virus of cowpox or monkeypox will change features. If the virus learns how to pass from animals to a person, from person to person, a new outbreak will arise conditioned by the altered strain. All infectious diseases are born this way, the epidemiologist says:

“We have strategic stocks of the vaccine against pox. And this happens, vaccination will immediately resume. And two laboratories have strains of that smallpox around the world — in Russia and in the USA. They are stored there for scientific purposes. But nobody excludes, for instance, there might be a biological terrorist attack. And then coronavirus will seem to us a walk in the park.”

Dangerous viruses and bacteria live with us. What’s stopping them?

Dmitry Lopushov explains that vaccination is necessary not only against poliomyelitis but also against other dreadful diseases — measles, whooping cough, tetanus, hepatitis, rubella... The epidemiologist warns: pathogen viruses and bacteria constantly circulate in nature, and we face them more often than we might think. But they can’t attack the organism if a person was vaccinated. Tetanus is the simplest example. Its death rate reaches 25% even in the modern world, while death from tetanus previously was almost a hundred per cent outcome of the meeting with the pathogen. Meanwhile, this pathogen is found almost everywhere — in the soil. So we can meet this disease after being injured and the injury touching the soil, stepping onto a rusty nail, damaging the skin in another way. But cases of death of tetanus in Russia are isolated because we are all vaccinated against it — the disease can’t develop.

“We get protection from diphtheria, tetanus and whooping cough when we are 3, 4,5 and 6 months old. But if we take any laboratory samples of the soil, we will find tetanus there. The same applies to diphtheria: toxigenic strains of diphtheria still exist. And they are sometimes found in a swab from the nasopharynx we take in adults and children. But there is no outbreak because if everybody around was vaccinated, the disease doesn’t proliferate further even if pathogens circulate in the environment,” Dmitry Lopushov tells Realnoe Vremya.

While the situation with measles isn’t so glittering: it also still circulates in our environment, but considering that the population’s immunity has begun to go down, this virus is spreading in some countries. Because unlike tetanus, it is transmitted from one person to another in the air, moreover, incredibly fast. Tetanus outbreaks have been recently registered across Europe from Romania and to seemingly favourable Germany. The epidemic has been Ukraine in the last years. Kazan also faces this disease from time to time: three imported cases of measles were found just last autumn. So one shouldn’t refuse vaccines hoping that almost nobody has died from diphtheria or tetanus in Russia — the case is that the immunological shield still works. But it is under a big threat.

“There is a war of anti-vaccine campaigners with pro-vaccine campaigners”

The notorious anti-vaccine movement lands a serious blow on the nation’s health, most specialists claim.

Boris Mendelevich reminds the readers that last year the WHO included the refusal from vaccines to the list of the five most serious threats to humanity. He sadly acknowledges:

“It is a real problem. The movement of anti-vaccine campaigners is really very serious, including because it has a lot of public opinion leaders whom people listen to. And, unfortunately, there is almost no well-founded scientific reply on social media. There aren’t almost no doctors, opinion leaders in the medical community, and it is the trouble! I have repeatedly urged our doctors to actively take evidence-based medicine to social networks. But it is doctors’ psychology: they consider they are a bit above of all this. And this should be reconsidered. I have turned to health care workers on social media too: ‘Lads, let’s show the real picture, let’s beat false stories and anti-scientific theories!’”

Dmitry Lopushov also considers more active and positive delivery of information to people about the necessity and undoubted benefit of vaccination one of the tasks of the medical community. He also reminds us that opinion leaders don’t spread their ideas among “deniers of vaccines” selflessly:

“Anti-vaccine campaigners are almost always people who have certain benefit. Almost all of them offer some homoeopathy, their theories, books or services instead of the vaccine. In any case, there is money behind them, one should clearly understand it. Virologist Galina Chervonskaya is a famous anti-vaccine campaigner, she earns a living with these lectures. Her session costs about 1,500 rubles, and it is her job.”

How to fight against anti-vaccine campaigners in their court

The aggressive anti-vaccine campaign on the Internet became the talk of the town. Harmful ideas weren’t able to spread so fast in the era without the internet, while the Net century opened a wide road to compatriots’ minds for all kinds of “preachers”.

But in answer to the question if a law on total immunisation for everybody who doesn’t have a medical exemption should be introduced, State Duma deputy Boris Mendelevich replies negatively:

“I think being such categorical will be excessive. There is sense in mandatory vaccination for people with a certain job (for instance, doctors for infectious diseases who constantly contact patients) or in certain conditions (for example, the currently operating compulsory immunisation of people who travel to some countries of the world). But as for whole society, I am not a supporter of the strictest approach. I am for explaining, persuading so that a person will make a decision on his or her own.”

But this assumption, these explanations should be seriously reconsidered, the deputy thinks. In his opinion, it is already vitally important to create a programme, information policy at state level, together with Russia’s Ministry of Health to persuade people, deliver true scientific information about vaccination to them. Moreover, it is high time to dramatically change the approaches to this information adapting to the new reality.

“The critical mass is the case. The critical mass of anti-vaccine campaigners nowadays is much bigger than the critical mass of people who are for vaccines. And they win us, we have to admit it. I think there is a war of anti-vaccine campaigners with pro-vaccine campaigners. And in this war, we — on the side of evidence-based medicine — are seriously losing at the moment. This programme needs both good PR and good funding. And the presence of the state on social media is little. It is making extremely unconfident steps there now,” says Boris Mendelevich.

The first opponents to vaccines frightened others with horns and hooves

Dmitry Lopushov also agrees with the necessity of total explanatory work. Moreover, he considers a direct argument with the opponents to vaccines is a senseless task — their position is too firm.

“But one should provide counterarguments, and then a sensible person will choose a sensible point of view. But mainly negative information is accumulated on the Internet. While only one position is now spread on the Internet: horror stories about vaccines, recommendations not to receive them because they allegedly develop autism and serious complications arise at every corner. Very little is said here that this is impossible. The mass media, of course, focus on scoops — sex, scandals and rumours. And there is an abyss regarding educational moments. Sadly, such information is considered uninteresting for the reader.”

Anyway, the Tatarstan health ministry’s chief epidemiologist pins big hopes on people’s sound mind. He put a funny example: when vaccination against smallpox began several centuries ago, its opponents frightened people saying that one could turn into a cow after the shot. The person would allegedly have horns and hooves. There is even an engraving, which is probably the world’s first anti-vaccine promotional material, that illustrates a doctor and those people who have been vaccinated and now turn into cows. The first anti-vaccine campaigners made this hypothesis after learning that the vaccine was made of the content of vaccinial vesicle on milkmaids’ hands. And they intensively spread such an opinion. And this worked at that moment!

Lopushov offers:

“Now frighten somebody saying that the vaccine against poliomyelitis will make the person turn into a monkey. Nobody will believe it! A sensible person will calmly consider all the pros and cons. He understands that he won’t become either a cow or a monkey. So the proof of the rest of the arguments can be provided.”

Dmitry Lopushov starts with himself and provides Realnoe Vremya readers with the proof why one shouldn’t refuse vaccines because of preservatives in some vaccines.

“Don’t the products we every day buy in supermarkets contain preservatives?” he asks. “Read the list of ingredients on the jar of sauerkraut that is sold in stores. It contains sodium benzoate, which is a typical carcinogen. The same is about yoghurts and a lot of other products. This is why it is strange to say that vaccines are evil because of preservatives. Just compare the amount of food consumed throughout your life and the number of vaccines received, compare the doses of preservatives you consume. What about Chupa Chups, sweets with acid colours? What about soda? It contains phosphoric acid, but we still drink it! This is why all talks about the harm of vaccines are relative.”

“A person’s freedom ends where another person’s freedom begins

Apart from the obvious issue of a person’s own safety, Boris Mendelevich also reminds us of another consequence of a refusal of vaccination.

“It is also important to develop social responsibility in people in this aspect. People say: ‘I am a free person, you violate my rights’. In reply to this, I say that a person’s freedom ends where another person’s freedom begins. No problem, don’t get vaccinated if you don’t want to. But if you become a source of infection and other people fall ill because of you, I think it is an unauthorised action.”

The chief epidemiologist of Tatarstan’s Ministry of Health Care directly says:

“So we know that pathogenic viruses and bacteria haven’t disappeared anywhere but continue circulating in nature and in the population. And a stage for their attack is prepared thank to anti-vaccine campaigners.”

Dmitry Lopushov puts an example of whooping cough. Everybody got used to that it is children’s infection, and little kids indeed feel bad. The risk of dying from it at an early age is low. Nevertheless, an adult can also get infected and become a source of infection for children in his surrounding area.

“This is why in the republic we bought the vaccine we do children before school. Now they are vaccinated against diphtheria and tetanus before school, while we bought the medication that contains whooping cough too. So we extend their protection from whooping cough for another 5-7 years because the immunity they received from the vaccine as a baby already ends. It means they can infect their younger siblings.”

Lopushov pays attention to the fact that children’s revaccination before school is at the moment absent in the federal schedule of vaccines, and Tatarstan has become one of the few regions of the country to start to do it this year.

“Vaccination of a pregnant woman’s close circle is another important moment. During the first months after birth, the baby is unprotected from whooping cough unless he is vaccinated. And, for instance, if the baby has a mom who is an anti-vaccine campaigner, a dad who lost his immunity, grannies, elder siblings are nearby, he can early contract the disease that is almost safe for an adult but a very serious for it. By the way, we have registered a rise in the number of whooping cough cases in the republic in the last year. There is a problem, and we are working on its solution.”

What about coronavirus and flu?

Boris Mendelevich says that the coronavirus epidemic encouraged the topic of vaccination against the flu.

“We see a bigger number of people who want to get the vaccine than in the previous years. I will say more: we receive information from many regions that they don’t have enough vaccines, they are running out. But it is a temporary occurrence, I am sure that our capacities will cope with it and everything will be fine.”

Dmitry Lopushov says that 40% of the population has been vaccinated against the flu in the republic at the moment (we should remind you that the Health Care Ministry’s target number this year is 65%). The republic has just recently received the second lot of the vaccine, it will be delivered to districts from Monday. There will be the third lot too.

The chief epidemiologist of the Ministry of Health Care explained how the testing of Sputnik-V vaccine was going in the republic, it is a vaccine against coronavirus Tatarstan has already received 42 doses.

“We already have 25 people vaccinated. Only one of them complained about a high temperature on the first day after vaccination. The rest is feeling great, they don’t have complaints. Now we are waiting for the moment when they will have to receive the second vaccine (Editor’s Note: the vaccine of the Gamaleya Institute consists of two vaccines that are administered every 21 days). Before this, we will do them antibodies tests.”

Everybody who is participating in the testing of the vaccine in Tatarstan is a health care worker. Each of them did a blood test for coronavirus and its antibodies — all samples needed to be negative for experimental integrity. The second vaccine will be given to the first person in a week already.

The republic expects the second lot of the vaccine until 31 December — it will be given to teachers, health workers and other people who often contact others. This medication is so far not permitted for use for children, disabled people and the elderly. At the first stage, the vaccine is tested on workable people — from 18 to 60 years. The vaccine for children will be available only at the final stage. The appearance of vaccines can be expected approximately by the middle of the next year, says Dmitry Lopushov.

Boris Mendelevich pays attention to the fact that one shouldn’t be afraid of the “preliminary” registration of Sputnik-V vaccine — such a mechanism was considered in Russian legislation a long time ago.

“We took advantage of quite a legal right to register a vaccine with further post-registration research. Such an opportunity has always been considered in legislation, but it has rarely been used. Now there is an urgency like at war, and we took advantage of this opportunity. The absence of serious post-vaccination complications means that we are in the right direction and it was correct to register the vaccine at this stage.”

The deputy admits that he had another opinion at first: “I cautiously and anxiously followed this registration and can say now that everything was done absolutely correct, from scientific, tactical and even political perspective. He recognised to Realnoe Vremya that he planned to get the vaccine from coronavirus as soon as he will get access to the vaccine.

By Lyudmila Gubayeva