“Are you feeling all right?” I asked her.
“I feel all sleepy” she said.
In an hour, she was unconscious. In twelve hours she was dead.
- Roald Dahl, “Measles: a dangerous illness”
Roald Dahl’s poignant essay about the death of his daughter, Olivia, from measles in 1962 is both a touching individual story and an illustration of the benefits of vaccination. The famous children’s author laments that there was no vaccine available back then but notes that a vaccine is now available to prevent children suffering his daughter’s fate and urges parents to vaccinate their children. It’s worth a read.
It’s a reminder of the progress we have achieved in preventing so many diseases and subsequent deaths today, many of them children.
The World Health Organization lists 26 diseases today that can be prevented with vaccines, everything from cholera through to yellow fever, and this list has grown over the last few decades. While some vaccines for diseases like polio and tetanus have been around for a long time, newer generation vaccines that help prevent diseases like cervical cancer, malaria and rotavirus have become a reality in recent times.
The additional good news is that there are new vaccines in development today for diseases like Chagas Disease, HIV, hookworm and Nipah Virus, as well as better vaccines for diseases like dengue fever, malaria and tuberculosis. Just as diseases like measles, rabies and tetanus once upon a time had no vaccine and people just died from them, in the future there will be vaccines for diseases that today kill and incapacitate people.
To be honest, looking through the proof of the benefits of vaccination is a little overwhelming because there is just so much data, evidence and historical experience which proves that vaccination is worthwhile. It is one of our greatest achievements as a species that we have stopped the deaths of literally millions of people each year through vaccination.
It’s difficult to do justice to the whole story, but here’s a few examples:
· Every year, immunisation prevents the deaths of between two to three million people from diphtheria, tetanus, measles and whooping cough, however an additional 1.5 million deaths could be avoided if global vaccination improves.
· Since 2000, the measles vaccine has saved more than 17 million lives – equivalent to the entire population of the Netherlands or Zambia today. Global deaths from measles have fallen from 550,000 per year in 2000 to 89,780 per year in 2016 due to vaccination.
· Polio has virtually been eradicated from the world, with the number of cases falling by 99% since 1988. The number of countries with endemic polio has fallen from 125 in 1988 to just three (Afghanistan, Nigeria and Pakistan).
· Smallpox, once a major killer, has been completely eradicated with the only remaining samples of the disease now stored in laboratories.
· If we achieve our global vaccination targets for the top 10 vaccines between 24 and 26 million deaths will be averted. That’s roughly equivalent to the population of Australia or Madagascar being saved from death.
· As well as saving millions of lives each year, various studies have shown that vaccination has a huge economic payoff for society.
· One dollar spent on childhood vaccination saves society $44 in low- and middle-income countries.
But, in a trend reminiscent of the debate about action on climate change, we know from experience that just having the scientific facts isn’t going to win this argument.
Opposition to vaccination has a long history ever since Edward Jenner first developed the smallpox vaccine in 1796. Incidentally, Jenner is often labelled the person who saved the most lives in human history.
The Lancet published an article on the psychology of anti-vaccination in 1927 which noted that
“In this common tendency to produce reasons for beliefs already formed upon an emotional basis we find the explanation for the failure to settle some controversies by appeal to facts.”
Almost 100 years later we are still dealing with the consequences.
Ostensibly technical concerns about vaccines are regularly raised by anti-vaxxers, or vaccine deniers, whether it is the now completely discredited link between MMR and autism, or concerns about thimerosal in vaccines, the spacing of vaccine treatments, or aluminium in vaccines. As each criticism is explained, critiqued and debunked, the next one is raised. This has had dangerous repercussions, with various outbreaks of preventable diseases such as mumps, measles and whooping cough resulting from the campaigns of vaccine deniers.
The reality is that it’s usually not technical issues that drive vaccine deniers. Opposition to vaccines is less about facts and more a cultural movement stemming from a belief in alternative medicine. It’s based not on science, but motivated instead by political, ideological and social beliefs that persist, regardless of the evidence. Social media has helped fuel its persistence.
It can stem from a libertarian refusal from being told what to do, to a distrust of governments and corporations. In many cases it is a desire for natural alternatives to seemingly 'artificial' technological developments by humans. It can be a moral belief that vaccinating people against disease interferes with the natural process of evolution. It can be inspired by religious beliefs that humans shouldn’t interfere in the Creator’s plan or shouldn’t presume they know better than God or the gods.
For these reasons, you see some bizarre situations where the Alt-Right, radical environmentalists, Christian fundamentalists and the Taliban all agree with each other on something that is not supported by the evidence.
Part of the problem is also that vaccination has been so successful in eradicating many deadly diseases that today’s generation has forgotten what it was like to die from these illnesses. For example, people in high-income countries don’t die from cholera or tuberculosis any more, so they’ve forgotten what life was like in the days when people in those countries did regularly die from such diseases.
The vaccination argument can be won if we combine the mountains of supporting scientific evidence with ongoing passionate advocacy that is informed by where the anti-vaccination movement is coming from.
Yes, at times humanity has not thought enough about the consequences of how we manipulate the natural environment in the name of development – climate change, the extinction of numerous species and the toxic islands of plastic in our oceans are examples of this.
But, ultimately, when we can save the lives of millions of people based on all the best science in the world, it’s hard to find a moral argument to oppose vaccination.
People who oppose vaccination often argue they are saving their children.
But it’s just not true. The evidence simply doesn’t support their argument.
In fact, all the scientific evidence humanity has at its disposal shows that the best approach to protect humanity is to promote vaccination.
Whether you’re talking about saving the lives of billions or just one, we have a responsibility to each other and to our children to protect them through vaccination.
If you doubt this, just read Roald Dahl.