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Vaccination

The Netherlands National Institute for Public Health and the Environment is introducing a new national vaccination campaign to combat meningococcus. This will probably only fuel the ongoing societal discussions about vaccination. What should we make of it?
By Jurgen Tiekstra

Maarten van Wijhe

Researched the effect of vaccines

‘We looked at it from an alternate point of view: what would have happened if we hadn’t had access to these vaccines? To answer that question, we studied the period before these common vaccines were introduced, so before the 1950s. Based on the trends from that time, we created an alternative scenario. Our biggest conclusion was that we prevented between six and twelve thousand deaths among people born between 1953 and 1992.

We used a similar method to estimate the number of cases of disease. Taking into account the number of cases that were actually reported – after all, not everyone goes to the doctor when they’re ill – we estimate a prevention rate of 50 to 90 percent, depending on the kind of disease.
Most importantly, we prevented the deaths and diseases of many children. Some of these diseases are still prevalent today. Take pertussis, or whooping cough, for example. And a few years ago there was an outbreak of measles in the bible belt. That outbreak killed one person. Whooping cough has some nasty symptoms: a harsh cough and shortness of breath. Some children even have to be admitted to the hospital when these symptoms worsen.

Diphtheria is relatively rare, fortunately. This causes swelling around the throat. In the worst cases it can lead to asphyxiation, and it can damage the cardiac muscle. We know that measles can lead to neurological complications, such as encephalitis. Tetanus is also very rare these days. A classic example is people catching tetanus from stepping on a rusty nail. Tetanus can lead to all sorts of muscle spasms. When that spreads, it can lead to spasms in the muscles we need to breathe, or it can affect the cardiac muscle. If an expectant mother is infected with rubella, this can lead to birth defects. So they’re certainly serious diseases.’

 

Jaap Koot

Dean of Global Health at the department of Medical Science

‘I’m a doctor of tropical medicine and I lived and worked in Africa in the eighties and nineties. I’ve seen so many children die of preventable diseases like the measles, polio, tetanus, and even rabies. Seeing children die in my arms has given me a strong opinion on vaccination. The Dutch news showed parents of a boy who died of meningococcus last summer.

They blamed the Dutch government for not initiating a large-scale vaccination programme sooner. Other parents are also demanding their children be vaccinated against meningococcus, and fast. That sense of urgency is very important. In Africa, mothers would walk for two hours, carrying their children on their back, because they had seen others die of a preventable disease. That’s how much they cared about their children.

A large percentage of the anti-vaxxer movement gets its reasoning from an article in The Lancet that claimed there was a link between the MMR vaccine and autism. That article was retracted because it was unsubstantiated. But the anti-vaxxer movement will tell you that that was a political decision. This is not a discussion you can win with scientific arguments.

So what we have to do is show how deadly these diseases are, and how much suffering they cause. I also think we should make parents who do vaccinate their children aware of the danger parents who don’t vaccinate pose to the former children’s health. Young babies can get infected with polio or measles, if they’re too young to be vaccinated. Not vaccinating your children poses not only a danger to them, but also to other children in their environment. So parents’ councils and school boards have to take a stand. They have to say that they won’t allow those people to endanger other children.

That way it becomes a societal discussion, rather than a discussion between scientists and anti-vaxxers. The latter will just claim that scientists are in bed with the pharmaceutical industry and are only interested in making money. That’s not a discussion we’ll ever win.’

AnneMieke Boots

Professor of Immunology and Rheumatology (UMCG)

‘I get the impression that this discussion is generational: young people have simply forgotten how terrible these diseases are. One PhD student did a vaccination study with us and made a call for older people to come forward.

It was amazing how many people signed up. I think my generation remembers how bad it was. I’m 61, and I had an aunt who had polio, and she was crippled for life. Parents considering vaccination nowadays get a lot of their information online, but I think it’s difficult for them to properly understand what they read.

That’s not to say that we as scientists haven’t made mistakes in the past: the whole pandemic scare with the swine flu was a total fiasco, while we fully underestimated the impact of Q fever. That was a blow to our authority on the matter.

Infectious diseases will continue to play a larger role in the future. There are always new pathogens, new bacteria and viruses. Healthcare will have a hard time fighting them all, because the population is growing increasingly older, and more mobile: people can travel from country to country very easily, and infections spread fast. The elderly are more vulnerable as well, because their immune system declines.

I am currently part of a European research consortium where we are trying to figure out which infectious diseases affect the elderly the most. We think it might be influenza, pneumonia, and shingles. One of our goals is to get the research results to back this up.

I do think we’ll introduce new vaccines for the elderly in the future, but they’ll probably be developed on a personalised basis. We can take someone’s ‘blood fingerprint’ and determine which vaccines they need. Other people might not need vaccinations at all. That’s the definition of personalised medicine. But we’re not there yet.’

Nederlands