This week, with my public health doctor hat firmly on my head, I’m placing my Friday Focus on immunisation, because it’s a cornerstone of prevention as part of public health medicine, and also because this week happens to be European Immunisation Week. The goal of this initiative is ‘to improve vaccination coverage by increasing awareness of the vital importance of immunisation among parents, caregivers, healthcare professionals, policy and decision-makers and the media‘, emphasising through it’s slogan ‘Prevent. Protect. Immunise.’ that immunisation is vital to prevent diseases and protect life (Health Protection Surveillance Centre (HPSC), 2019). This year’s theme builds on last year’s of ‘Vaccines Work‘ and is all about increasing the awareness of the importance of vaccines and celebrating everyday ‘Vaccine Heroes‘ who contribute through promotion to vaccination to saving lives.
After food and nutrition, I think the topic of immunisation and vaccination in particular is one which has unfortunately been most commonly the source of confusion among the general population, largely due to pervasive myths in general and social media regarding the efficacy, safety and side effects. So, in this article, I’m going to share with you what immunisation is, why it’s important (without being overly scientific) and where to look for evidence-based, trusted information in Ireland. I’m aware this can be quite an inflammatory subject for many people, but all I’m sharing in this article is very basic facts that we should know, and I don’t feel I’d be doing my duty as a public health doctor if I didn’t. Because for the most part, media myths and hype aside, people do trust their healthcare providers and I think, similarly to how I would promote a healthy lifestyle in terms of diet and physical activity with patients, immunisation as a cornerstone of preventive medicine should be promoted too.
The first question to answer of course is – what is immunisation? The simplest definition I’ve come across was from one of our seminars on immunisation during my Masters last year – ‘The process of artificially inducing immunity or protection from disease.’ This can be an active or passive process. Active immunisation means we induce immunity through giving a dose of a disease-specific substance in a vaccine in order to stimulate an immune response in that person (such as the production of antibodies, which are proteins produced by our immune system to help us fight infection). The substance in the vaccine is specific to the disease you want to protect the person against. We might refer to vaccines as being ‘live vaccines’ which contain weakened bacteria or viruses, so that when the person is given the vaccine, their body produces antibodies against this weakened form of the bacteria or virus, resulting in a lasting immune response usually with 1-2 doses. Examples of live vaccines includes the MMR (measles-mumps-rubella) and rotavirus vaccines. We also have inactivated, or killed, vaccines, which contain essentially ‘killed’ forms of a given bacteria or virus. By administering this in a vaccine, it can’t cause disease in a person, but can stimulate an immune response against that disease, which usually lasts a shorter amount of time than in the case of a live vaccine. Examples of inactivated vaccines includes the annual flu vaccine, and that used for Hepatitis B. Some vaccines may contain a particular part of the bacteria or virus, or a toxin made by them, to induce immunity in our bodies, but I’ll hold on the nitty gritty there to keep your attention! There is a nice more detailed explanation here. Passive immunisation involves giving a person preformed antibodies to provide temporary immunity to a particular disease.
In Ireland, we have a few different key aspects of life where we mostly focus our efforts on vaccination in terms of programmes in place and promotion of vaccine uptake. We have a childhood immunisation schedule, a schools immunisation schedule, specific vaccines we target to older adults and certain at-risk groups, and also those which we make sure pregnant women are aware of. The Irish Health Service Executive has a really nice website detailing the specifics on all of these programmes and schedules, and the commonly asked questions around them, which I’ve linked here in case you want to read more in depth on them, as to do each one in turn is beyond the scope of this article (and probably your attention span!) Suffice it to say that the reason those groups I’ve mentioned above are so important to target the promotion of immunisation to is because we have the scientific evidence nationally and internationally to say that they are who we need to protect the health of the most.
Let’s look at the WHY for immunisation to continue that train of thought. Last year, the theme of European Immunisation Week was ‘Vaccines Work’, which focused on delivering key facts about immunisation and vaccination to adults and children alike, and emphasised the importance of trusting scientific fact over media myth fiction. This theme described immunisation as ‘an individual right and a shared responsibility’ which I 100% agree with. The why for immunsation is actually quite simple, but often not said enough – to reduce the incidence (new cases in a given time period) of or to eliminate a particular disease. It’s a essential component of the health protection realm of public health medicine, because it’s purpose, it’s why, is to protect the health of the population from particular vaccine-preventable diseases by reducing the numbers getting or or eliminating these diseases. When we talk about immunisation as a shared responsibility, it’s because immunisation doesn’t just benefit the individual on the receiving end, who we refer to as directly benefitting from this protection. There are also indirect benefits to everyone else in society, because with optimal immunisation uptake rates, we have the best chance of reducing the incidence of these preventable diseases, which remember are contagious and therefore can spread quite rapidly across national and international borders. This indirect benefit to society is encompassed in a concept called herd immunity, and it’s likely that you’ve heard it mentioned with regard to vaccination previously.
Let’s be frank. Nobody wants to be unwell, or see their loved ones unwell. This is true whether we’re talking about infectious (known as ‘communicable’) diseases, or non-infectious (known as ‘non-communicable’) diseases. Whatever physical or mental illness a person may have, the overall desire is always to get better, or better yet, avoid actually developing the condition in the first place.
So given that we have the potential through immunisation to prevent a whole range of infectious diseases and their (potentially life-threatening) sequelae, why wouldn’t we jump at the chance to use them to their maximum preventive potential? And this is where the ability of media myths and scare-mongering campaigns to completely and utterly confuse and frighten the general public baffles and terrifies me. I’m very aware that as I step into my public health specialist training this year, this is something which I will battle (proudly) everyday, but to be honest that just makes me more determined than ever to do so, and continuously improve my knowledge on these topics and my ability to communicate them to you guys, the general population.
At this stage, I think it’s fitting to share the immunisation facts published by our Irish National Immunisation Office last year as part of the 2018 European Immunisation Week. Remember, contrary to what social media might say, national and international public health bodies have nothing to gain except to achieve their goal of securing your optimal health and that of the population by promoting the scientific evidence base for immunisation. Here’s some fast facts on immunisation (HSE National Immunisation Office, 2018):
- It is important to get vaccines on time, every time
- The best way to protect yourself and others is to complete the vaccination
- Serious diseases will come back if we do not vaccinate (!!!)
- Vaccines protect the wider community (i.e. the concept of herd immunity)
- Vaccines are safe
- Vaccines are effective
- Combined vaccines provide the best protection
- The HPV vaccine is safe and effective
- Vaccines are important for pregnant women
- People trust what healthcare workers say about vaccines
Do vaccines have side effects? They do have the potential for side effects – as do all medications we take! But the point to make about side effects from vaccines is that we know from the studies done on them that they may occur, but that the benefit from the vaccine outweigh the risk of these side effects, and if that wasn’t the case, the vaccine would not be recommended by national or international health authorities. I’ve linked a great Health Service Executive website page here with common reactions that may occur after some of the immunisations in the childhood schedule, and advice on what to do if they occur. For parents reading this, the HSE has a full guide for parents on childhood immunisation here.
There are two particular vaccines which have over the last 3 decades received the most attention in terms of myths causing confusion and as a result, reduced vaccine uptake rates, and those are the MMR vaccine and the HPV vaccine. I was only 7 years old when the doctor Andrew Wakefield’s controversial (and widely disproved, with the result that Dr. Wakefield was struck off the medical register for serious professional misconduct) MMR and autism report was published, so I don’t remember it of course, but I do remember learning all about it in medical school, and subsequently, and more importantly, learning about the consequences of it. Wakefield’s claims about the MMR vaccine and the way in which these were portrayed in the media led to a LOT of public confusion, especially among parents. This has led to reduced MMR vaccine uptake rates in the childhood schedule and as a result, we have witnessed ongoing measles and mumps outbreaks in Ireland, the U.K. and mainland Europe over the last year. The World Health Organisation (WHO) advises that in order to prevent and eliminate vaccine-preventable disease such as measles, mumps and rubella, we must get vaccine uptake rates to 95% and above nationally and internationally. In Ireland, we are still falling short of this target at approximately 92% for MMR uptake over the last couple of years (HPSC, 2019). As a result, in Ireland we’ve seen many measles outbreaks particularly among children over the last year, and in 2019 we are seeing an excess number of mumps cases compared to what would be expected based on previous years, particularly among adolescents. We have got to trust science and fact over fear propagated through social media to stop myths communicated through these channels from continuing to cause real world harm.
I spoke about the HPV vaccine in my recent article on Social Media Myths, and I’ve included the HPV paragraph from that article here because it’s very relevant to the Irish context. This vaccine has also been the subject of a LOT of media discussion over the last few years, the extent of which I’ve only really become fully aware of through my public health Masters this year, in terms of the damage myths spread about the vaccine has done to uptake rates. The HPV vaccine is recommended by our health service and our National Immunisation Advisory Committee, the World Health Organisation, the International Federation of Obstetrics and Gynaecology, and many more global health organisations. I’m going to give you this excellent website by our Irish Health Service here which has a lot of frequently asked questions about the vaccine, details on the schools vaccination programme in Ireland, and the vaccine safety and efficacy information too. In Ireland, we administer a vaccine called ‘Gardasil’ which protects against 4 sub-types of HPV – 2 that cause 70% of cervical cancer (16 and 18) and 2 that cause 90% of genital warts (6 and 11). We run a schools vaccination programme that administers the HPV vaccine to girls in first year of secondary school (2 doses in total if under 15 years old, and 3 if over 15). Giving this vaccine is what is called ‘primary prevention’ in public health lingo. We give it in first year of secondary school because, as I’ve said, its most effective if given at this age of a young woman’s life, ideally before she is sexually active. Each year in Ireland approximately 300 women get cervical cancer, and 90 die from this disease – so given that we have such a powerful prevention strategy to reduce this numbers, why wouldn’t we use it?! We also plan in Ireland to bring in the HPV for boys through our schools programme – it seems likely this will begin later this year.
The safety of the vaccine has been monitored consistently since it was introduced over 12 years ago – in particular, by the European Medicines Agency, the WHO Global Advisory Committee on Vaccine Safety and the US Centers for Disease Control and Prevention. If you have specific questions about the vaccine side effects, I would highly recommend having a read of this Irish health service webpage on those here, which is informative, easy to read and very clear and details the side effects that are expected based on many many vaccine studies. Unfortunately in Ireland, as we’ve seen with MMR vaccine uptake, anti-vaccination campaigners and claims about unusual vaccine side effects (which are entirely without evidence to back them up, as you’ll see from the consistent safety evaluations by the EMA, WHO and CDC) led to a major drop-off in HPV vaccine uptake. This was as drastic as from 86.9% in 2014-2015 to a record low of 50% in 2016-2017, largely due to anti-vaccination lobby groups who had a large social media platform and unfortunately spread a lot of worry and concern with misinformation. Thankfully, a major response by public health officials in Ireland to this vaccination uptake crisis to dispel myths and address parental concerns has led to improvements in vaccination uptake – for example, in 2017-2018 uptake went up to 61.7%. I would definitely recommend checking out this Lancet publication by the Irish Health Service Executive’s National Immunisation Office detailing this crisis and their response here (which is where the above HPV vaccine uptake figures were sourced from), Clearly, there has been a LOT done to counter this issue, but also a lot more to do with the ongoing (unregulated) media presence of anti-vaccination groups.
Okay folks, let’s bring this Friday Focus to a close. Immunisation is a cornerstone of preventive medicine. It works, it saves lives every single day (now and in the future), at the individual and population level. It is absolutely an individual right and a shared responsibility for us all. If you have personal concerns about vaccines either for yourself, or your child, PLEASE speak to your general practitioner/family care physician/provider to address your concerns, and allow them to answer these questions IN PERSON and from an EVIDENCE-based viewpoint. ‘Google said…’ or ‘that group on Twitter said…’ is NOT a valid argument or reason to not vaccinate,and especially not a source of information to quote and tell your friends your views too.
I’ve linked some fantastic national and international immunsation scientific, evidence-based and easy to understand resources below for you guys to check out for more detailed information, and I really hope you found this post both helpful and informative, and that maybe, just maybe it will contribute towards dispelling the media myths and fears around immunisation in Ireland. As always, get in touch and let me know what you think of this article, I love hearing from you guys! I’m @theirishbalance on Instagram/Twitter/Facebook!
Ciara 🙂 x
Health Protection Surveillance Centre (2019) ‘European Immunisation Week 24-30 April 2019 – Celebrating vaccine heroes.’ Available at: https://www.hpsc.ie/news/title-18983-en.html
HSE National Immunisation Office (2019) ‘Vaccines work.’ Available at: https://www.hse.ie/eng/health/immunisation/vaccineswork/eiwfacts.pdf
Health Protection Surveillance Centre (2019) ‘Immunisation uptake – graphs.’ Available at: http://www.hpsc.ie/a-z/vaccinepreventable/vaccination/immunisationuptakestatistics/immunisationuptakestatisticsat12and24monthsofage/Immunisation%20Uptake%20Graphs%20by%20Quarter%20Draft%20v1.1.pdf
- Vaccines Work: https://www.hse.ie/eng/health/immunisation/vaccineswork/eiwfacts.pdf
- European Immunisation Week: https://ecdc.europa.eu/en/EIW2019
- Vaccine Frequently Asked Questions Ireland: https://www.hse.ie/eng/health/immunisation/pubinfo/
- ‘After Immunisation’ – Potential side effects of vaccines in the childhood immunisation schedule and what to do if they occur – https://www.hse.ie/eng/health/immunisation/pubinfo/pcischedule/commonqs/afterimmunisation/