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“If all else fails to convince your anti-vaxxer client, there is always the ultimate test”

30 May 2019, at 9:30am

I am feeling reasonably optimistic that the anti-vaccine movement may finally be being brought to task in the public eye. I know I am preaching to the converted, but I thought a quick review of recent stories in the public domain would be useful to have handy for your next discussion with a client about the pros and cons of vaccination.

There have been a few headlines recently that have brought to light two important points: vaccination works and saves lives, and not vaccinating a population makes them vulnerable to disease. Yes, all medical interventions have some risks, but these are small, and Andrew Wakefield has been struck off.

If I have a client unduly fretting over possible adverse reactions of any medicine, I like to do a “guess the medicine” quiz with this list of nasty side effects: “Stop taking this medicine and go to hospital straight away if you notice... allergic reaction... rash, blistering or peeling of the skin, swelling of face, lips, tongue or throat... sudden wheezing or collapse... bruising, bleeding, breathing problems... abdominal discomfort, dark urine... changes to your liver.” What is this evil potion? Is it the MMR vaccine? Is it some sort of chemotherapy agent? An immunosuppressant? No. That is from off-the-shelf supermarket 500mg paracetamol. Who’d take something with that list of side effects?

Point 1: Vaccines work

A good news story buried in all the Brexit chaos explained that the human HPV vaccine is working to reduce cervical cancer in women. From the ITV news service this week: “The team, led by Tim Palmer at the University of Edinburgh, analysed vaccination and screening records for 138,692 women born between 1988 and 1996 who had a screening test result recorded at age 20... They found that compared with unvaccinated women born in 1988, vaccinated women born in 1995 and 1996 showed an 89 percent reduction in CIN grade 3 or worse, an 88 percent reduction in CIN grade 2 or worse, and a 79 percent reduction in CIN grade 1... Unvaccinated women also showed a reduction in disease, suggesting that interruption of HPV transmission in Scotland has created substantial ‘herd protection’, researchers said.” The Cancer Research website shows a 24 percent reduction since the 1990s. And as a bonus, the HPV vaccine in our area is provided by Virgin Healthcare. There’s an aptronym for you!

Point 2: Not vaccinating exposes people and animals to disease

This came in the unusual case of Rockland County, New York. They have banned all unvaccinated people under the age of 18 from public places for a month due to a measles outbreak. This includes schools, playgrounds and shopping centres. Those breaking the rule could face a $500 fine or six months in prison. We have had measles outbreaks in the UK following reduced vaccine uptake, including some deaths.

The WHO cites vaccine hesitancy as one of the top 10 threats to global health. A recent study in Vaccine showed that anti-vaxxers fall into different subgroups, with some not trusting the medical profession, some believing in alternatives and some not believing the diseases exist. Most vets will have seen some of the diseases we vaccinate for, be it clostridial disease in sheep, parvovirus in dogs or cat flu in cats. I think vaccination is so successful that once you get a generation that has not experienced the diseases, all they hear about are the rare side effects, and the hoaxes.

Side effects from one vaccine are often lumped together by anti-vaxxers into generic vaccine adverse side effects for all vaccines. It is also not just an issue in the UK and USA. The following is a report on a new vaccine (2017) for dengue fever in the Phillipines, which did have some genuine adverse effects: “The result was broken public trust around the dengue vaccine as well [as] heightened anxiety around vaccines in general. The Vaccine Confidence Project measured the impact of this crisis, comparing confidence levels in 2015, before the incident, with levels in 2018. The findings reflect a dramatic drop in vaccine confidence from 93 percent ‘strongly agreeing’ that vaccines are important in 2015 to 32 percent in 2018. There was a drop in confidence in those strongly agreeing that vaccines are safe from 82 percent in 2015 to only 21 percent in 2018.”

Things are starting to shift though, with the major social media platforms coming under pressure to stop anti-vaxxer misinformation being spread. The fundraising platform GoFundMe has banned anti-vaxxers from using its site.

If all else fails to convince your anti-vaxxer client, there is always the ultimate test. Probably best left as a thought experiment, but if anyone ever does it for real, let me know! Take one fully vaccinated vet with post-exposure vaccine protocol ready. Take one anti-vaxxer client. Take one rabid dog. Shut all three in a room for three hours. See which one (and there will be only one) is still alive in six months.