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Infectious diseases pose a significant burden and negative impact on many nations, including Haiti. In Latin America, the three major causes of death that have been singled out are respiratory diseases, diarrhea, and vaccine-preventable diseases (VPDs) (Ulloa-Gutierrez et al. 1671). It is an unfortunate situation, given that some of these conditions have been almost brought under control by use of vaccines in some parts of the world. Vaccination, by definition, is an attempt to use part or all of a microbial pathogen to protect against that microbe (Plotkin and Plotkin 890). Similarly, a vaccine is a part or whole of a microbial pathogen used in the immunization process (Plotkin and Plotkin 890).
This paper discusses the history of vaccines as one of the approaches to prevent diseases. The objective is to reflect and contemplate personal experiences with vaccines and their influence on my perceptions and future interaction with them. In addition, ideas, concepts, social concerns, and issues associated with vaccines use, i.e., human values that influence the guardians’ decisions to vaccinate their children are discussed. In particular, the paper also singles out the dynamics of vaccine coverage, acceptance, and refusal, courtesy of changes in human attitudes and values. From the above objectives, the extent to which these parameters impact the success of a vaccination program and the overall health of the population will be quantified.
The History of Vaccines
Vaccination is thought to have originated from the homeopathic viewpoints about small doses of disease, enabling the body to withstand severe disease (Plotkin and Plotkin 891). By the eleventh century, there were clues in the Chinese manuscripts of the “use of variola scabs inhaled into the nose to immunize against smallpox” (Plotkin and Plotkin 891). Literary evidence shows that the practice then spread to India, the Middle East, Africa, and Europe (Plotkin and Plotkin 892). Nevertheless, the origin of vaccines as an endeavor date later in the 1700s from the works of the farmer Benjamin Jesty and Doctor Edward Jenner on the appearances of milkmaids that demonstrated the capacity of cowpox to protect people from the devastations of smallpox (Plotkin and Plotkin 892). Jesty injected his family with the materials from the poxvirus wounds, but Jenner carried out clinical trials and published his findings to the scientific community (Plotkin and Plotkin 892). The use of the poxvirus to fight smallpox was adopted globally, and it led to the eradication of the disease (Plotkin and Plotkin 892).
Additional progress was made eight decades later in the laboratories of Louis Pasteur when he discovered the procedure of attenuation using Pasteurella multocida, the causative agent for chicken cholera (Plotkin and Plotkin 892). He realized that he could weaken the virulence of a bacterium by exposure to harsh conditions and proceeded to work on anthrax and rabies vaccines. At the dawn of the nineteenth century, vaccine development started to have a justification. The main milestones were procedures to “inactivate whole bacteria, which could then be used as vaccines, the discovery of bacterial toxins, the production of antitoxins and the realization that immune serum contained antibodies that counteracted toxins or bacterial replication” (Plotkin and Plotkin 893). For instance, inactivated whole-cell vaccines against typhoid, cholera, and plague were produced and tested. It was also demonstrated that diphtheria bacilli produced an exotoxin and that an antitoxin was elicited in the sera of animals that had received sublethal doses of that toxin (Plotkin and Plotkin 893). The finding heralded the beginning of the use of toxoids as vaccines.
Currently, purification of pathogenic elements, genetic manipulations and improved knowledge of immune protection allow “direct creation of attenuated mutants, cloning of vaccine proteins in live vectors, purification and even synthesis of microbial antigens, and induction of various immunological responses through manipulation of various biomolecules” (Plotkin and Plotkin 893). These approaches to vaccine development have enabled the pharmaceutical industry to produce a wide variety of vaccines.
Examples of Vaccines
Presently, many diseases can be prevented by immunization. Both communicable and non-communicable ailments are presently within the spectrum of vaccinology, and the vaccines so far developed have accomplished significant reductions in infections and disease worldwide. Some of conventional vaccines include the BCG and hepatitis B vaccines that are administered at birth and “diphtheria, tetanus, pertussis, measles, mumps, rubella, and polio vaccines” that are given severally in a child’s early life (Kroner 7). In 2013, World Health Organization (WHO), the Centers for Disease Control (CDC), and the GAVI Alliance supported the introduction of the ‘five-in-one’ vaccine.
This pentavalent immunogen helped shield Haitian children against diphtheria, hepatitis B, whooping cough, pneumonia, and meningitis (Kroner 7). The intervention also entailed training doctors, providing vaccines at affordable prices, and ensuring appropriate distribution. Such vaccination programs are a social investment since their introduction and proper implementation and monitoring results in an increase in life expectancy. For example, the single-dose regimen of hepatitis A universal immunization program that was initiated in 2005 in Argentina for children 12 months old reduced the incidences of hospitalizations, acute liver failure, deaths, and liver transplants (Ulloa-Gutierrez et al. 1672).
Two worlds exist for the Haitian children regarding vaccine equity: those who can access new vaccines and those who have poor access due to economic limitations. I happen to come from a family, which was not endowed economically, and there were no funds for the doctors. Therefore, I could not access all the necessary vaccines. When new vaccines are brought to the market, they come at an exorbitant price. Such vaccines are usually available in the private sector and afforded by a few. Later, when such vaccines are availed at a reduced cost, it takes a lot of communication and social mobilization to stir the interest of the parents in the vaccines.
Flexible state laws regarding vaccination of children make parents careless and fail to immunize their children; my parents could not allow me to be vaccinated because it was not mandated. Their hesitance to immunize me probably was influenced by issues of confidence, the inability to see the need and value for a vaccine and access to the vaccine provision. The complacency might also have stemmed from the surrounding community’s low priority accorded to the vaccines, under-appreciation of the need for vaccination or lack of knowledge. Traditionally, Haitians have been falsely blamed for acting as carriers of infectious diseases like HIV/AIDS and tuberculosis. Thus, testing, research, and health care provisions, mainly from the USA were met with mistrust, apprehension, and caution.
Another reason might have been the tendency to rely on home remedies. In a society which lacks accurate knowledge about vaccines, beliefs that other therapies (traditional medicine or naturopathy, religious authorities, breastfeeding) are equally or even more important than vaccination in controlling VPDs and maintaining health make people hesitant to embrace vaccines (Sadique et al. 1671). Superstitions on vaccines such as vaccines infecting one with the very diseases they are meant to cure, that VPDs are required to build immunity, and those vaccines destroy crucial natural resistance or that supernatural forces cause some of the VPDs contribute to vaccine hesitancy (Sadique et al. 1671).
Despite the benefits of vaccine introduction in national immunization programs, below-average vaccine coverage rates are frequently recorded in ethnic minorities. The subtleties of vaccine acceptance and use are complicated and depend on both social factors and cultural perceptions (Burghouts et al. 2). These include opinions on vaccinations and diseases, perceptions of vulnerability and protection, and the function of medicines in producing and maintaining health. Burghouts et al documented the fear of side effects, perceived limited vaccine tolerance by toddlers and sick children, and experiential concept that side effects of vaccines are diseases as some of the reasons for refusing vaccination (3).
The triumph of a vaccination program is incumbent upon high numbers of approval and coverage. Unfortunately, there is evidence of escalated cases of vaccine rejection and of regional crowding of refusals which result in outbreaks (Omer et al. 1987). A decline in the occurrence of a VPD mostly makes people think that the gravity of the infection and the vulnerability thereof has reduced. The complacency reduces the urgency to seek immunization services. Likewise, the awareness of real and alleged adverse effects associated with vaccines has increased, resulting in many people refusing vaccines. Statistical evidence supports the observation that there is the tendency for geographical clustering of incidences of vaccine acceptance or refusal (Omer et al. 1988).
The reasons for this trend are unknown, but it is speculated that the characteristics of the local population -socioeconomic status, income, cultural issues, and awareness – and beliefs of local health practitioners, opinion leaders, and local media coverage are factors that play a role (Omer et al. 1988). Community leaders, politicians, the clergy, and celebrities can have a profound impact on vaccine acceptance and refusal. On the same note, the media and social media create constructive or destructive sentiments among people and provide the podium for lobby groups and opinion leaders to influence the society (Omer et al. 1988).
Recent parental concerns about purported vaccine safety issues have led to an increasing number of parents refusing or delaying to vaccinate their children. Children who do not comply with school immunization demands are at risk of suffering pertussis and measles and “can communicate a disease to others yet to be vaccinated due to age, medical reasons, or insufficient body immunity” (Omer et al. 1988). In a state where the school immunization policy is adequate, the number of children that are exempt from this requirement for health unrelated reasons serves as the primary parameter to quantify vaccine rejection in a population.
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Concerns are on the rise about the probable link between vaccines and disorders such as autism, attention deficit syndrome, learning disabilities, juvenile diabetes, autoimmune diseases, asthma, and sudden infant death syndrome (Kroner 7). Vaccines contain a mixed blend of chemicals, microbes and other foreign matter. These ingredients are of three categories: the ‘bug’ material (live or killed viruses or bacteria, nucleic acids or toxoids), preservatives, and adjuvants (kroner 8). Some of the preservatives and adjuvants used may include Ethylene glycol, Aluminium, Gelatin, Benzethonium chloride, Formaldehyde, Glutamate, Neomycin, Phenol, Streptomycin, and Thimerosal (Kroner 8).
In addition, cultures of human fetal tissue, chicken embryos, guinea pig embryo cells, and bovine serum are used (Kroner 8). Despite the fact that these materials have been permitted by the US Food and Drug Administration (FDA), many people have found them to be controversial and have reservations due to fear that they can be harmful to the body (Kroner 8). What is more, these substances trigger common and even adverse reactions associated with vaccines. The common side effects include fever, swelling, pain, crying, vomiting, diarrhea, anorexia, sleepiness, aches, and rash while serious side effects include Guillain-Barre Syndrome, encephalitis, seizure disorders, and sub-acute sclerosing panencephalitis, among others (Kroner 9).
Concerns that vaccines might cause autism rose from three hypotheses (Plotkin and Plotkin 892). First, there was fear that a blend of measles-mumps-rubella (MMR) vaccine causes autism by irritating the gastrointestinal membrane, causing the permeation of encephalopathic proteins into the body. Second, it was believed that the thimerosal, an alkyl mercury-containing preservative in some vaccines, causes an insult to the central nervous system (Plotkin and Plotkin 892). Thirdly, researchers held that concurrent administration of several vaccines overpowers or weakens the immune system (Plotkin and Plotkin 892).
Furthermore, controversy arises from procedural aspects of childhood vaccinations like the number of shots a child should receive by a certain age. Worldwide, there is a debate that the escalated diagnosed cases of developmental disabilities and learning disorders are directly proportional to the excessive shot regimen recommended by world health bodies (Kroner 9). In the USA, for instance, the number of vaccines received by children rose from 10 in the 1970s to 18 vaccines in the 1990s to the current 24 vaccines (Kroner 9). The vaccine schedule is more complex nowadays, and children are subjected to far more shots than before (Kroner 9).
Occasionally, parents refuse these vaccines or postpone immunization of their babies by following novel timetables proposed by GPs (in place of those formulated by multidisciplinary expert committees) for convenience and safety concerns (Kroner 9). Refusal to vaccinate children puts such children at a higher risk of acquiring and transmitting VPDs. In cases of spatial aggregation of individuals not immunized, VPD clusters are also expected to be documented. The risk of VPDs and the consequences of such diseases change as the child grows. Since infants are at a higher risk of illness, disability and death related to communicable diseases, vaccine delays have resulted in severe repercussions.
In contemporary Haiti, fortified policy interventions, e.g., the need to immunize children before they are admitted in schools have caused an improvement in vaccine coverage thus playing an essential part in decreasing or eliminating widespread transmission of several diseases. Meningococcal disease caused by Meningococcus bacteria is a contagious disease, which most frequently affects teens and young adults (Omer et al. 1986). It is best protected by vaccination using the MenACWY and MenB vaccines. It is now a state requirement that people in these age brackets are immunized against the disease.
The history of vaccines and their contents have been particularized. The arguments surrounding childhood vaccination and its role in influencing parental decisions have been assessed. As it has been shown above, there are many reasons for and against vaccination. Therefore, concerned parents need to be enlightened, so that they make informed choices regarding their children’s health. Maintenance of the huge benefits that vaccines have brought to the society call for concerted efforts to enhance public awareness and confidence in the vaccine monitoring and quality assurance system.
Burghouts, Jochem, et al. “Childhood Vaccine Acceptance and Refusal among Warao Amerindian Caregivers in Venezuela; A Qualitative Approach.” PLoS ONE, vol. 12, no. 1, 2017, pp. 1-14.
Kroner, Shannon. Childhood Vaccinations: The Development of an Educational Manual. Dissertation, The Chicago School of Professional Psychology, 2013. UMI, 2013.
Omer, Saad, et al. “Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases.” The New England Journal of Medicine, vol. 360, no. 19, 2009, pp. 1981-1988.
Plotkin, Stanley, and Suzan L. Plotkin. “The Development of Vaccines: How the Past Led to the Future.” Nature Reviews/Microbiology, vol. 9, no. 1, 2011, pp. 889-893.
Sadique, Zia, et al. “The Effect of Perceived Risks on the Demand for Vaccination: Results from a Discrete Choice Experiment.” PLoS ONE, vol. 8, no. 2, 2013, pp. 1-9.
Ulloa-Gutierrez, Rolando, et al. “Vaccine-Preventable Diseases and their Impact on Latin American Children.” Expert Review of Vaccines, vol. 10, no. 12, 2011, pp. 1671-1673.