An intensely polarising debate about the efficacy of several vaccines is raging in the US. The cost-benefit analysis is the gist of the discussion, albeit each side of the aisle has a way of enumerating data favouring their viewpoint.
In the appraisal, the overriding issues are the advantages and disadvantages of taking a jab or swallowing a dose, their side effects together, and a “do nothing option”.
Since Tanzania and like-minded countries are too distracted to manufacture their vaccines, this US vaccine debate carries significant implications for the access to affordable vaccines we need to keep our people healthy from deadly diseases.
This discussion will constrain itself on the vaccines dealing with six scourges: measles, diphtheria, tetanus, rubella, polio and mumps.
This discourse aims to remind us that the old adage “prevention is always better than treatment” still makes sense.
One of the common complaints is that babies are receiving too many inoculations, which devastate their natural immunity systems and develop side effects from those vaccines, such as autism, stunted growth, reproductive ailments and many others.
Vaccine experts push back those side effect fears by claiming that modern vaccines contain fewer stimulants to the immune systems than older generations of vaccines.
As a result, vaccines are much cleaner and very effective in detecting diseases.
Of more encouraging, the immune reactions generated by the vaccines are less in quantities and potency.
What is least understood is that children inherently harbour innumerable numbers of bacteria and, apart from that, get infected with the pathogens from the surroundings they interact with and from living creatures.
Those bacteria act as powerful stimulants to jump-start the natural immunity system to act and defend the body.
The anti-vaccine community argue that for precisely the same reasons, children should not be immunised because they have a natural defence system that annihilates the hosts and the intruding invaders. Any effort to interfere jeopardises that delicate ecosystem.
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They conclude vaccines endanger the lives of children by messing up with their natural defence system, which is too fragile to withstand the turbulence caused by the vaccines.
Therefore, vaccines ought to be banned from sparing children from man-made catastrophes.
One of the doctors said it is normal for children to have fevers and develop immunity against all organisms in the environment around them. That natural immunity system is designed and built to overcome diseases.
Some children may succumb to preventable illness and may end up with permanent disabilities or deaths, but the anti-vaccine proponents argue that it is the “survival of the fittest”.
They aver that the few who perish or get maimed is a “collateral damage” the human race has to bear to preserve the survival of humanity as a species.
The weaker is sacrificed in a natural sieve to ensure the stronger is not diluted by the weaker humanity.
A vaccine source of power hails from the antigens it contains.
Antigens are a mixture of pathogens and proteins that trigger immune reactions in the body. In other words, vaccines introduce germs into the body in a manner that will catalyze the natural immunity system to abandon its hibernation mode and begin to produce counterattack measures.
The amount of pathogens is too small to cause serious illness but sufficient to activate the immune system to rescue us.
It is akin to springing up an umbrella in anticipation of rain after hearing loud sounds of thunderstorms accompanied by lightning and heavy clouds.
It is preparing yourself for an emergency landing or unlocking a parachute in the event of ditching a tipping plane.
Once out of hibernation mode, the natural immunity system is taught how to recognize and neutralize pathogens, and by extension, it is like taking a tizzy before confronting a real match.
The argument goes on to allege children’s immunity system is too strange for the fight that lies ahead because, inside the mother’s womb, it was shielded from the hostile environment.
But once exposed, has to be taught by vaccines how to recognize the threats and destroy them before they kill or disable the child.
Hence, the child’s immune response is prepared and can respond faster and more robustly,
Modern vaccines contain around 10 antigens. However, outdated vaccines used to bear up to 3000 antigens, which is ten times the current number.
More than a century ago, children were vaccinated only against smallpox, which had previously killed about one in three infected people.
Smallpox is among the largest viruses known to infect people, and the vaccine dose contained as many as 200 proteins that could cause the body to react.
In the 1940s, a vaccine for pertussis, or whooping cough, was widely used. Pertussis is caused by bacteria — roughly 10 times the size of an average virus — and that shot held at least 2,000 proteins.
As scientists learned more about the pathogens that harm or kill children, they homed in on the most important proteins.
They also made big strides in refining techniques to purify and standardize vaccine components.
By the 1990s, smallpox had been eradicated, and the archaic pertussis vaccine was supplanted with a better version containing two to five proteins per dose, depending on the formulation.
Many other vaccines, including those against measles, rely on just one or two antigens per dose.
Anti-vaccine movements have claimed that thimerosal, a mercury-based preservative in some childhood vaccines, causes autism.
They have pointed to the combined vaccine against mumps, measles and rubella. But that vaccine has never contained thimerosal.
Even when the preservative appeared in other vaccines, trace amounts were present at about the levels found in a can of tuna fish. Further, the form of mercury in thimerosal is not toxic to people in small doses.
In any case, it has not been an ingredient in most childhood vaccines since 2001. A small proportion of influenza vaccines are in multidose formulations that contain thimerosal, but thimerosal-free options are available.
As a matter of standard of practice, vaccines are thoroughly tested for safety and effectiveness in animals and then in progressively larger studies of people, sometimes over decades. (The Covid vaccines were a notable exception).
As the anti-vaccine movement grows, parents, too, have been caught up in a mind-boggling dilemma of whether to support it or to side with the authorities’ position.
With a focus hellbent on potential side effects, the benefits of preventing diseases are drowning.
Partly, because vaccines have successfully prevented disease, that feat is now being penalised. We are beginning to take achievement for granted. Since we do not experience the disease,e there is a temptation to question their lingering disadvantages.
Questions today about the risk-benefit ratio of vaccines might just be a product of the vaccines’ success.
Let us take a quick review of the six major diseases that were discussed and how they have fared in Tanzania:
Measles
Measles, a viral infection often spread by coughing or sneezing, is extraordinarily contagious.
Nine out of 10 people around an infected person will catch measles if not vaccinated.
Measles can be contracted in a room up to two hours after someone with the disease has left it.
Measles is not a mild illness, particularly for children under 5. It can cause a high fever, coughing, conjunctivitis and rashes, and if it leads to pneumonia or encephalitis — brain swelling — it can quickly become lethal.
Before the vaccine was licensed in the United States in 1963, almost every child had contracted measles by age 15.
Tens of thousands of measles patients were hospitalized each year, and between 400 and 500 of them died.
Two doses of the MMR vaccine together are about 97% effective at preventing measles.
But epidemiologists say a 95 percent vaccine coverage rate is necessary to prevent virus transmission in a community.
Over the past four school years, the
kindergarten vaccination rate has fallen below that threshold — in some communities, far below.
Nearly 8 million children in Tanzania have received vaccinations to stay protected against measles-rubella following the sporadic and hot spots of measles outbreaks in different areas of the country since July 2022.
In response, the Ministry of Health, the World Health Organization, and partners conducted several periodic surveillance exercises, and now the intensive vaccination campaign targets children between 12 months and 52 months of age across the country.
Diphtheria
The Greek word diphtheria means leather — a fitting reference for a bacterial infection that creates a thick, grey membrane over the throat and tonsils, suffocating its victims.
There was a time in the United States when up to eight children in a single-family suffered that fate — a burden so grave that a science historian called it “childhood’s deadly scourge.”
A bacterium strain in respiratory droplets produces the toxin driving the disease. It kills healthy tissues, leading to difficulty breathing and swallowing, especially among young children with smaller airways.
It can also gravely damage the cardiac and nervous systems, resulting in heart failure or paralysis.
In 2019, 86% of Tanzanian children were vaccinated with the third dose of basic diphtheria, pertussis and tetanus-containing vaccine (DTP3), a conventional yardstick for immunisation coverage in general.
By 2021, that had dropped to 81%, rising to 84% in 2022.
Tetanus
A fully developed tetanus infection can be alarming: fists clenched, back arched, legs rigid from extreme, excruciating muscle spasms that last several minutes.
Extreme fluctuations in blood pressure. A racing heart. Neck and stomach muscles are tight enough to impair breathing.
Treatment for tetanus must be immediate, and up to 20% of people who become infected will die.
It all starts with a bacterium that lies dormant in soil and animal faces until it enters the body through broken skin like a cut. The microbe begins to grow, divide and release a toxin that impairs nerves.
Rubella.
The first sign of rubella is often a rash on the face, and while the infection often remains mild in children, it can prove devastating for pregnant women whom the children infect.
When passed on to a fetus, rubella can cause a miscarriage or lead to severe birth defects, such as heart problems, liver or spleen damage, blindness, and intellectual disability.
At least 32,000 babies worldwide are born annually with congenital rubella syndrome. About a third of them die before their first birthday.
Rubella is transmitted through coughing and sneezing, and up to half of people who spread the infection do not know they have it.
Most women who contract rubella in adulthood say they experience arthritis. In rare cases, rubella can also cause brain infections and bleeding problems. There is no specific treatment.
In 2014, Tanzania introduced the combined measles-rubella vaccine in the routine immunization schedule.
Two doses of measles-rubella vaccine (MR1 and MR2) were recommended at 9 and 18 months, respectively.
In 2015, MR2 coverage among eligible 18-month-old children in Tanzania was only 57%, lower than the WHO-recommended coverage (95%).
During the same period, Mtwara District Council (MDC) reported coverage of 52%, which is lower than the national average.
Factors associated with non-uptake of measles-rubella vaccine second dose among children under five years in Mtwara district council, Tanzania, 2017.
Over half the children under five years in MDC were not vaccinated with MR2.
Lack of caretaker knowledge about appropriate vaccination age, unavailability of vaccine, insufficient numbers of children waiting to warrant multidose vial use and long clinic waiting times were associated with MR2 non-uptake.
It was advised that the community should receive education about the MR vaccine; it was recommended that thorough screening of children’s vaccination status at each clinic visit and vaccine provision whenever possible.
Vaccine distribution should be improved in MDC.
Polio
Parents in the early 1950s lived with a terror few could later imagine: the substantial prospect that their child could touch an infected object and end up in a wheelchair, a prosthetic lung or a grave.
Polio epidemics, which had been occurring for decades, had gained new magnitude by the middle of the 20th century, killing or paralyzing more than half a million people worldwide each year.
Families avoided congestion and imposed isolation quarantines, knowing the malady struck like lightning.
In the words of the historian and author Richard Rhodes, “One day you had a headache and an hour later you were paralyzed.”
In some parts of the world, the disease is still a major threat.
It is transmitted by exposure to faecal matter, such as on contaminated foods or objects.
Most people contracting the virus have no visible symptoms, though they can still pass it on.
About a quarter develop common flu symptoms such as a sore throat, fever and nausea. In severe cases, polio can affect the nerves and brain, causing meningitis and paralysis.
When the muscles responsible for breathing are affected, the case can be lethal.
Even decades after a resolved polio infection, people can experience muscle weakness and atrophy, which is referred to as post-polio syndrome.
More than 3 million children in six border regions received vaccination in Tanzania against polio from 21st to 24th September 2023, following its recent resurgence after seven years of no recorded cases.
The regions include Rukwa, Katavi, Mbeya, Kagera, Songwe and Kigoma.
Besides supporting the vaccination campaign, the WHO has also expanded its support for polio eradication by extending environmental surveillance.
The surveillance drive in Tanzania was part of Africa’s continent-wide environmental surveillance that was initially planned to be implemented in 46 countries under the auspices of the Global Polio Eradication Programme.
Mumps
The mumps virus, spread through saliva and respiratory droplets, triggers a fever and swollen salivary glands in the ears — which is why patients often have a puffy jaw and cheeks — and can, in severe cases, cause deafness.
Mumps is an acute contagious viral disease caused by paramyxovirus characterized by complications that include orchitis, oophoritis, aseptic meningitis, and spontaneous abortion, among many others.
The disease is dangerously insidious: It can lie dormant for up to a month before symptoms appear, and most people are infectious before their salivary glands begin to swell.
Complications are more common in adults than children. Still, they can include inflammation in the ovaries and testicles — which can cause infertility or sterility — or in the brain and spinal cord, which can put patients at risk of seizures and strokes.
The High Seropositivity of Mumps Virus IgG Antibodies among School-Aged Children in Rural Areas of the Mbarali District in the Mbeya Region, Tanzania.
Tanzania is among the countries where mumps vaccination is not implemented and has limited epidemiological data.
A study documented a high seropositivity of mumps IgG antibodies among school-aged children in rural areas of the Mbarali district in the Mbeya region,
Tanzania. The study urged that it was high time the National Immunization Program in Tanzania was considered.
Concluding remarks.
The election of US President Donald Trump, an anti-vaccines advocate, has opened a door for his vaccine sceptics to fill vacancies in the health department.
Some, even before the US Senate ratifies their appointments, have begun lodging pleas to have various vaccines being paused. The real intent is to ban almost all types of vaccines that they accuse of meddling and weakening our natural immune system.
Some of the anti-vaccine faithful believe human intervention in the immunity system is questioning God’s creativity and wisdom, and humanity’s arrogance is driving us to destroy our natural defences.
The anti-vaccine advocates argue once we have damaged our natural systems, there would be no way of retrieving it. They conclude the survival of the human race is at stake.
While the debate is good and should be encouraged, trusting science more may be productive.
Experience has shown vaccination saves lives and improves the quality of life.
Without it, the global pandemic would have killed too many people to tempt our collective contrition.
Some plastic proteins included in the modification of vaccines should indeed be treated with the contempt they deserve.
Out outright rejection of vaccines is a reckless disregard for human life, amounting to manslaughter.
Plastic proteins inside our bodies present new threats since they are not biodegradable.
Such proteins are known to destabilize our natural proteins, unleashing untold medical conditions.
The clergy in Africa, especially in Kenya, have been making a specious allegation that vaccines are laced with infertility ingredients!
It was a concerted ploy to dissuade the faithful from taking a jab. Regrettably, no concrete scientific evidence was ever presented to anchor their cockeyed claims.
Vaccine bans in the US will lead to the inaccessibility of vaccines in the developing world, such as Tanzania, where the effects of environmental degradation and unhealthy lifestyles are also suspiciously held guilty as charged in bankrolling the diseases that we confront daily.
