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Vaccines

Today's skepticism of vaccines could be as big of a health threat as HIV

Vaccine hesitancy represents a nihilistic return to the primitive. If it continues, it will be a willful, self-inflicted threat to human life.

Amesh A. Adalja
Opinion contributor

It might come as a surprise that vaccine hesitancy appears on the World Health Organization’s 2019 list of the top health threats, which include HIV, pandemic influenza and antimicrobial resistance, among others. Surely, vaccine hesitancy — a voluntarily chosen human behavior — cannot be in the same category as HIV, a virus that has killed 35 million people. However, if one thinks about the full context of vaccine hesitancy and what it represents, the WHO’s inclusion of this outrageous phenomenon is completely justified.

Vaccines are incontrovertibly one of the greatest achievements of mankind; they have quite literally added decades to lifespans and prevented millions of people from acquiring infections and suffering early infection-related deaths. If the WHO’s top 10 list was made in 1776, the list would be littered with infectious diseases such as smallpox (which is now gone from the planet thanks to the first vaccine ever developed), diphtheria, measles, rubella and pertussis. Even if the list were made in 1976, infections such as Haemophilus influenzae type B (HiB), meningococcal meningitis and hepatitis B might appear on the list.

Indeed, the infectious diseases on the latest list include infections for which no vaccine is available (HIV, antimicrobial resistant bacteria, pandemic influenza) or for which a vaccine is experimental or not fully protective (dengue, Ebola).

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Vaccine hesitancy refers to the decision by individuals to forgo or delay vaccination against various infectious disease agents despite the overwhelming evidence of vaccines’ overall benefit. These individuals decline vaccination not because of an objective threat the vaccine poses to their health (e.g., as certain vaccines do to the immunocompromised); they oppose vaccination generally, whether it is a school entry requirement or a social norm. Various claims are often cited by the vaccine hesitant, including their erroneous beliefs that the threat of the disease targeted is exaggerated and the side effects of the vaccine minimized — all in defiance of mountains of scientific literature.

While it is true that vaccine hesitancy has existed since the dawn of vaccination in the late 18th century, in recent years it has mutated to a more virulent form: The state of New York faces its biggest measles outbreak in decades, Italians are grappling with a public debate about vaccines that was settled long ago, and polio vaccinators face violent opposition in Pakistan and Afghanistan. In the past days, Washington state has declared an emergency prompted by three dozen cases of measles driven by an undervaccinated population. And the outbreak might have spread to three other states.

People have the luxury to die of other diseases

The WHO's top-10 list also includes noncommunicable diseases, which include coronary heart disease, diabetes, stroke and cancer. A chief reason that noncommunicable disease is a problem at all is because people are no longer dying from infectious diseases and are, hence, living long enough to develop these noncommunicable diseases. The control of infectious diseases, largely due to vaccination along with sanitation and antimicrobial therapy, gives humans the “luxury” of dying from diseases of adulthood.

In an ideal world, each new vaccine would be celebrated like the polio vaccine in the 1940s or each new iPhone upgrade. When Jonas Salk developed the polio vaccine and the results of the successful clinical trial were announced, he returned to Pittsburgh with a hero’s welcome that included police escort. Shop windows were adorned with thank-you messages to this benefactor of mankind.

Today when a new vaccine is developed — such as the HPV vaccine — it is greeted with derision and is the subject of conspiracy theories that even presidential candidates spread. Vaccine innovators such as Dr. Paul Offit and Dr. Peter Hotez are the subject not of Salk-like adoration but personal attacks, insults and threats reminiscent of the myth of Prometheus.

Vaccine hesitancy represents a nihilistic return to the primitive. If it continues to spread unchallenged, it will be a willful, self-inflicted threat to human life.

Amesh A. Adalja is a senior scholar at the Johns Hopkins Center for Health Security. Follow him on Twitter at @AmeshAA

 

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