Trypanohobia: an inexplicable fear of medical procedures involving needles. While most of us cannot be categorized as trypanophobic, receiving injections are not typically cited as pleasant experiences. Yet the countless vaccinations, the seemingly endless booster shots, and the growing numbers of recommended inoculations must all have been worth the cringing faces and sore biceps.
Undoubtedly, vaccines epitomize Public Health’s concern with preventative medicine. And undoubtedly, vaccines are a contributor to the grand conquest of several infectious diseases. However, a recent article in the Washington Post details the resurgence of whooping cough, a once-quelled infectious disease that is no longer a “whimsical memory.”
Whooping cough (pertussis) is caused by Bordetella Pertussis, a bacterium that propagates in the respiratory tract to release toxins and conduce sharp intakes of breath followed by oxygen-robbing coughs. As an unfortunate right of passage for young children, pertussis claimed up to 10,000 lives per year in the United States. But the 1940’s whole-cell vaccines (using deactivated pertussis bacteria) and the acellular vaccine (containing purified pertussis proteins) effectively reduced the number of whooping cough cases in the U.S. by 99%. This undeniable efficacy, though, is undermined by the whooping cough’s cyclical nature. Recent cases in California reveal the concerning rise in number of pertussis cases, especially when most children have been vaccinated.
The persisting presence of the whooping cough can be attributed to several factors, as cited by the article. Acelluar vaccines for whooping cough only guarantee 80-90% efficacy. Additionally, Bordetella Pertussis can be manifested in lighter forms even when patients have been vaccinated. Newer theories have determined that the certain strains of pertussis bacterium have evolved resistance to the vaccine-induced immune responses. But the most resolvable reason for the resurgence of the whooping cough arises from parents’ exercised option to refuse vaccination for their children.
The decreasing number of immunizations for whooping cough, and even other infectious diseases, can be attributed to the concept of herd immunity. Herd immunity occurs in a population when a significant portion of vaccinated individuals protect the unvaccinated inadvertently; when a large population is vaccinated, the infectivity of the pathogen amongst the population will decline. As the number of vaccinated individuals in a population increase, the transmission of the pathogen from infected individuals to others will reduce.
After a certain number of individuals in a population are inoculated – herd immunity threshold – the disease will cease to persist within the population. In the case of the whooping cough, 92% of the population must be immunized for the threshold to be reached (CDC). When those vaccinated sinks below this threshold, the population’s collective immunity is compromised, and pertussis can make a comeback.
But why would the number of vaccinated individuals decrease over time when vaccines are generally effective protective measures?
The prevalence of whooping cough in young children has been rising throughout the nation, and this new trend can be traced to multiple contributing factors on a personal, socio-economic, and even political level.
Controversies about the efficacy of vaccines have lingered, as many parents fear for the potentially negative health effects they may have on their children. Scares about autism or other ramifications of immunizations have altered parents’ perception of the necessity of vaccination. Parents’ general refusal of vaccination for cultural reasons or personal beliefs also compromises the child’s health. Herd immunity, in this context, is not enough to protect a child from contracting an infectious disease if the population immunized drops below the threshold.
Blame cannot solely be placed on the parents, considering that Public Health measures rely on the network of the community. Health care providers and physicians are equally responsible for declines in immunizations. When physicians do not adequately educate their patients about the importance of being vaccinated or explicitly share the associated risks of vaccinations, parents will be less inclined to have their children vaccinated. Unclear distribution plans and incomplete studies about different vaccinations also hinder the system, as more bacteria are forming resistance to treatments.
The overarching healthcare system, though, is a major contributor to the failure to keep vaccinated population levels about the threshold. Patients who have limited access to affordable healthcare cannot readily vaccinate their children. Without these provisions, levels of vaccinated children drop. Political regulations that allow parents to opt out of vaccinating their children further increase their child’s susceptibility to infectious diseases.
Yet, from a Public Health standpoint, what can be done to prevent outbreaks of infectious diseases? The answer is multifaceted.
It involving a combination of educating the public about the importance of vaccination in prevent diseases, creating mandates in policy that require individuals to be immunized, and offering services for the impoverished to get inoculated.
Trypanohobia. Yes, we may have a fear of needles for our various reasons. But vaccines are Public Health’s way of allowing us to exist on this planet in good health - worth every cringing face and sore bicep.
Wow! Nice job on the post Aleesha. Gripping and compelling insights abound. You really hit the nail on the head and, in essence, wrote a literary opinion editorial. You should submit it for publication. You summarized the WP article well. I would only add that another intervention we should embrace, as a nation and beyond, is more research into developing vaccines that are even more effective and safer. Let me reiterate one important point: most, if not all, vaccines are effective when administered appropriately (with appropriate boosters) and afford excellent protection from the burden of many diseases and certainly save many lives while causing relatively rare and usually mild side effects. Complacency and the false feeling of safety (invincibility) from disease when a disease is rare (usually rare because of the vaccine) tends to slowly erode the sense of importance of vaccination. This sense of safety and complacency quickly erodes when enough people are unvaccinated for the disease and it then stages sometimes a nasty a comback. This is a classic behavioral cycle repeated in healthcare, politics, economics, and most other social constructs - think of stock market bubbles, wars over the same issues over and over agian, etc. One may ask: have we not learned from mistakes of the past? As a well known cliche says: "Those who do not know history are bound to repeat it". I would add: ... whether it is good or bad, constructive or destructive, etc. OK, enough rambling - you get the point and made it yourself in the blog in so many words. Really good work this week!
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