Rationale
Advances in medical technology has had countless positive impacts on the health and wellbeing of humans. In fact, life expectancies have more than doubled, with a predicted age of 30 in the 1900s rising to approximately 70 years in the 21st century (Rosser, 2015). The eradication and prevention of cases and outbreaks of infectious diseases such as small pox, influenza, measles, etc. heavily contributed to that increase.
However, a lack of knowledge and general fear cause many controversies to surround our current medical practices. Vaccination is a major concern in society as the fear of disease has shifted to a fear of disease prevention. And although these vaccination practices have ultimately caused a 96% decrease in death from infectious diseases in the last 100 years (AIHW, 2006), parents and some of the medical community continue to encourage this knowledge deficit in the form of a rapidly disseminating sentiment known formerly as the ‘Anti- Vax’ movement.
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Dubé (et al, 2014) states that although immunization is widely accepted globally, the most recent infectious disease outbreaks and epidemics have been prevented with the use of vaccinations. Her article roughly discusses the proportion of immunity toward common diseases in relation to the use of vaccination. Therefore, the research question, “What are the impacts of the Anti-Vax movement on the immunity of diseases?” was formed to coincide with the claim and preliminary research. However, with further investigation it was determined that that question was too broad and thus was refined and specified to consider the immunity of the ‘Morbillivirus measles virus’ (measles) as explicated below.
Measles is an extremely contagious disease and although immunity of this disease can be achieved through 1-2 doses of the Measles, Mumps, Rubella (MMR) vaccine, long term immunity on a global scale must be achieved through ‘herd immunity’ (Funk, 2017). To properly protect from this communicable disease, a 95% minimum of vaccinated population (with MMR vaccine) must be reached (Australian Government Department of Health, 2019). A smaller percentage of vaccinated peoples enable the disease to spread more rapidly and, therefore, a greater number of people would be infected- causing outbreaks. This also puts people who can’t receive the vaccine in great risk as they will be exposed and due to its highly contagious nature, would almost certainly contract the disease.
Background
Like most common viruses, such as Influenza and Chickenpox, measles is an airborne virus, meaning it is spread though coughing, sneezing, etc. This ultimately means that it is highly contagious, with 90% of non-immunized people who come into contact contracting the disease (CDC, 2018). When measles is contracted, generally only acute symptoms such as small white spots (Kopliks spots), fevers and runny nose occur. The addition of these acute symptoms and the fact that once you develop and get over Measle- you are immune, causes parents to be hesitant and choose not to allow their child to get the MMR vaccine. However, complications can happen. Inflammation of the respiratory system (bronchitis, laryngitis) and in extreme cases inflammation of the brain (Encephalitis). Pneumonia is a common complication of measles, with 1 in 20 contacting pneumonia and is the most common cause of death by measles. In addition to this, the disease suppresses the immune system for up to years while they are recovering from measles- making them more susceptible to other infectious diseases (Oxford, 2019).
The MMR vaccine works by injecting weakened forms of living Measles, Mumps and Rubella into the body. This causes the immune system to produce antibodies to remember the virus and quickly fight it if ever encounters it again, also causing it to not become contagious or cause symptoms (CDC, 2019). he first dose of MMR causes a 93% immunity against measles; however, a second dose is recommended to increase this immunity to 97% (CDC, 2019).
So, the question lies- why do people not vaccinate their children? Exclusive of poverty, allergies, fears of chemicals and the refuted article by Andrew Wakefield (Rao et al, 2011) linking MMR vaccine to Autism, a major contributor to the anti- vax movement is the belief that infectious diseases such as measles don’t or barely exist today. A lack of frequency of measles news cause global complacence, despite the disease causing over 100,000 deaths yearly (Meyerowitz-Katz, 2019).
As stated previously, herd immunity is a crucial factor linking vaccination to long- term immunity. It is the concept that as the percentage of vaccinated (and therefore immune) people increase, the reach of disease spread is limited and therefore reduces outbreaks and protects any who cannot receive vaccination due to age restriction, allergies, etc. (Watson, 2018). Hence, herd immunity is in direct proportion to long term immunity.
Evidence
The MMR vaccine has proved highly effective since its introduction in 1968. As seen in figure 1, there was a significant decrease in reported measles cases instantly after its first year, with an estimated case number of 900 000 reducing to 250 000 (Hendriks et al, 2013). Not only was the first introduction of MMR successful, but its individual effectiveness on patients shows the efficiency of the vaccine and its vast development over the years.
Although opposition to MMR vaccinations have been found since the vaccination’s introduction in the 1960s, the true Anti- Vax movement began with the surge of the internet- where filtered conversations of bias fuels false information and prejudiced opinions. It is clear in figure 1 that this time was approximately 2010, and in addition to the links made between MMR vaccine and Autism, a rise in reported measles cases occurred- causing a medical regression.
In 2014, an incident occurred in Disneyland that caused 52 reported measles cases (Palmer, 2015). This occurrence is an example of the negative impacts of not vaccinating, as these 52 cases would result in a large spike in number of reported cases for that year. As shown in figure 2, the number of cases rises from an approximate 100 to 644. Predictably stemming from the spread founded in Disneyland.
This incident also proves the importance of herd immunity worldwide as international travel currently poses as an immense risk by connecting, and therfore spreading, across all countries and communities, causing a need of worldwide vaccination. Because measles is so highly transmissible, in addition to its extended allowance of communication, herd immunity is the only way to effectively prevent outbreaks and epidemics. The 95% of population vaccinated target allows children too young, allergies and religious reasoning to be excluded. Although this number causes an increase in the casualty of not vaccinating because it justifies a belief that people can opt out of the vaccination process- despite the impacts of reduced vaccination on vulnerable people such as children, allergic and religious.
Currently, measles is experiencing another outbreak- with severe and prolonged effects. This outbreak has been occurring and rising in the last few years, with a steady rise in reported cases, as shown in Figure 1. The number of reported measles cases has almost doubled from the recorded number this time in 2018 (WHO, 2019). This recent surge has spread to 182 countries and proves to be a great risk and destroys the former belief that measles spread was locally eliminated (seen in Figure 1) (ECDC, 2019).
Evaluation
Although several issues are apparent within this data. The use of government and medical sites, such as Australian government- Department of Health and Centre for Disease Control (CDC), aimed to increase the credibility of data and provide accurate and precise results. However, since these websites encourage and support vaccination practices, they are most likely biased. This means that they may have only shown data that was relevant to their opinions and withheld information that was crucial to the anti- vax point of view. Thus, the data may be less credible because of this.
The year some articles have been published may also be cause for concern as, while most are within the last 5 years, some date back to the late 90s and therefore reliability is reduced. Although the data within these articles ae relevant, their statistics and facts may have been disproved and ultimately causing errors within the conclusions drawn. However, any information collected from these outdated sites are most likely from investigations taken at that time.
A major issue noticed within the collected data was clear variances between results. Several sites debate the year of MMR vaccine introduction and figures like Figure 1 display different numbers in decrease and increase per year. Locating a graph from a credible source and ensuring its credibility with the data collected will have increased the reliability of this data source, however that is still recognized as a minor error and creates a limitation for the evidence.
It should also be noted that the MMR vaccine is a combination vaccine (Measles, Mumps, Rubella) and therefore the data shown cannot account for the safety and effectiveness of the vaccine for the other two diseases. This creates a limitation in the evidence as the conclusions drawn include the lack of risks for the vaccine and its high efficacy to protect against disease.
Conclusion
In conclusion, the claim that controversies surround vaccination and relate to short- and long-term immunity is not fully proved by the research question as it is so broad that the it can only incorporate a fraction of it. However, the created question relating the Anti- Vax movement to an increase in measles cases is supported by copious amounts of data and shows that the Anti- Vax movement is in direct proportion to the number of measles cases due to their relationship with herd immunity and thus the prevention and protection of measles. However, within all collected data, the most relevant sites were government sites which are most likely biased toward encouraging vaccination and therefore may not have been entirely credible. Although even considering this, the same conclusions can be drawn.
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