Why immunization matters

By Dana Dougherty Reinke on March 07, 2012
It's every parent's nightmare. Overnight, your nine-year-old becomes gravely ill and is admitted to the hospital. Doctors administer anti-viral drugs and things are tough and go. You're terrified you're going to lose him forever.

Only it wasn’t a nightmare last spring for Parker Murchison and his parents Brenda and Bruce of Nova Scotia. It was real life. The root of this dramatic life and death scenario was not some exotic virus picked up from foreign fruit, not even the leukemia that Parker had already survived; it was chicken pox, a vaccine-preventable illness. 

The first successful vaccine was developed in 1796 for smallpox, and that devastating disease has all but been eradicated. Over the centuries, the positive results of mass immunization should be crystal clear, and not only for smallpox. According to the Public Health Agency of Canada, there were 9,000 cases of diphtheria reported in 1924; at the time, the disease was one of the most common causes of death in children from one to five years of age. Canada now has between zero and five isolated reports each year. 

Need a more recent example? The haemophilus influenza B vaccine, introduced in 1985, reduced the number of children infected with it by 97 percent between 1988 and 2004. 

But even though medical advancements in the 20th century have given Canadian parents access to vaccines for many of the most dangerous childhood diseases, immunization rates remain a worry for pediatricians. Whether you blame the vaccines, Andrew Wakefield, the British doctor whose disgraced study linked the Measles Mumps Rubella (MMR) vaccine to autism, the internet or Canada’s patchwork public health system, it’s clear that something’s gotta give.

What's all the fuss about?

A vaccine is a medicine that typically contains a small amount of a weakened or dead disease germ. These germs invade the body and cause its natural defense system to make antibodies to fight it off, trapping and killing the germs that could lead to disease. Your body can make these antibodies two ways: by getting the disease or by getting the weakened version contained in the vaccine.

The vaccine is definitely the safer of the two options. 

The Public Health Agency of Canada recommends vaccinating children against 13 diseases, but many people have serious reservations about jabbing their little ones with a disease, weakened or otherwise, or the chemicals sometimes used to stabilized the vaccine. Despite repeated reassurance from the scientific community about the safety of vaccines, there are always those to whom the idea just seems wrong. 

Dr. Robert Bortolussi is a hospital-based pediatrician who specializes in infectious diseases at the IWK Health Centre in Halifax. Part of his job is to urge reluctant parents to immunize. He says many of the parents he sees are quite educated but they’ve heard horror stories about the side effects of vaccines. “They’ve come to kind of a belief system, almost like a religious faith if you like, that there’s something inherently wrong with immunization and that there are major problems in the formulation of vaccines.” 

Dr. Bortolussi says these parents have often gotten much of their information from the internet or from serious discussions with their peers. In his role as adviser he directs parents to legitimate, accurate resources including websites, literature, books and the hospital library to discuss the facts and persuade them to reconsider immunizing their child. But, he says, swaying them is a near impossible feat. 

Autism, the elephant in the room

No discussion of vaccines would be complete without addressing a possible link to autism. In February 1998, 13 doctors led by Andrew Wakefield published research in The Lancet, a British medical journal, that linked the MMR vaccine to autism. Dr. Wakefield’s study was discredited more than 10 years later – as was he – but not before he seriously damaged the image of vaccines around the world. 

Eventually an investigative journalist proved that not only had Dr. Wakefield taken money from a lawyer who was suing the makers of the MMR vaccine, but also that he was trying to create his own competing vaccine. His study was of just 12 children and his data couldn’t be replicated. When his co-authors found out, most of them removed their names from the paper and, eventually, the editor of The Lancet retracted the article altogether. As a result, Dr. Wakefield is no longer able to practise medicine in his native England. 

But this all came too late. The public’s perception of vaccine safety had been rocked, not only by the article, but by antiimmunization activists who used the study’s dubious results to add credibility to their own messages via the internet. “If it were true,” says Dr. Bortolussi, “public health would have picked that problem up years in advance.” Nonetheless, vaccination rates dropped, especially in Europe, and diseases that were nothing but a memory, such as measles, have begun to experience a resurgence. 

The internet effect

The ubiquity of the internet has given this generation of parents access to unprecedented amounts of medical information (good and bad). Parents are empowered to consider the ramifi cations of the medicines they give their children. This increased awareness has encouraged the removal of thimerosol (a form of mercury that was commonly used as a preservative in many vaccines) from most of the vaccines we get. While there’s no proof that thimerosol ever had any negative effects, people just didn’t want to inject their children with it. As a result, the only vaccine that contains thimerosol in Canada is the flu vaccine. 

On the other hand, an online search for causes of autism can present you with a myriad of possibilities, says Mike Bovin, a pharmacist turned medical writer whose own daughter, Danielle, has autism spectrum disorder. In his blog on commpharm.com he discusses how the internet can overwhelm good parents with bad information.

“Who do I believe? Do I believe the video of the crying mother that tells me the passionate story about how her child was fine until he received the MMR vaccine?” he writes. “Do I believe the government agency telling me that the cause of autism is not fully understood based on clinical trials? Do I believe the medical community that told me ‘they did not see any signs of autism in my daughter?’ If they can’t diagnose it or identify it, how can their information on the cause of autism be credible? The answer is my wife and I looked at everything and made an opinion, not based on the passion of the message, but on the science that backs it up. The reality is we don’t know what causes autism.” 

So what if I don’t get my child immunized? 

Immunization works best if everyone does it. Vaccines protect the children who get them, but they also protect the people who didn’t, a concept called herd immunity. “Consequently, the natural diseases that those vaccines are preventing have a resurgence,” says Dr. Bortolussi. “And we do know that children who get these diseases, sometimes they die.” 

Dr. Bortolussi treated Parker, the sick little boy at the beginning of this article. Chemotherapy had left his immune system weak and as careful as his parents were, they had no idea that a vacation with relatives would put their son’s life in such danger. Parker’s cousin had missed getting the varicella vaccine because he moved from one province to another – different provinces have different immunization schedules – and developed chicken pox soon after the visit. 

And where did his cousin get it? From a friend whose parents deliberately hadn’t immunized him. Despite everything, Brenda, Parker’s mother, says she understands why the family decided against immunization – she was on the fence about it for a while too. “I think people just don’t realize what could happen. You’re doing this for the community. It’s not about the healthy kids – you’re doing it for the sick ones.” 

The Public Health Agency of Canada has been working on a national registry – the Canadian Immunization Registry Network – since 1998. Its goal is to track immunizations and ensure children who are due for their shots are notified. 

Dr. Bortolussi says he feels the number of parents who don’t immunize out of principle is relatively small. As it is though, immunizations are given several times during a child’s development and it’s easy to miss one or slip through the cracks in provincial standards. When children start school, parents are required to submit their immunization records, but parents who don’t believe in immunization can still get their child admitted to school by signing a statement of conscience. 

The bottom line is that while declining immunizations may seem like a family issue, it affects everyone. There’s a social responsibility that we need to acknowledge that this isn’t solely about one child but about the lives of all children says Dr. Bortolussi, who remains worried about the declining immunization rates in Canada. 

As for Parker, he recovered from his bout of the chicken pox, and although he needs to continue chemotherapy for another year, Brenda says her son is eager to get on with his life. And while she admits that it’s tempting to keep him in a bubble for the next year, until his immune system is back to normal, he’s having none of it. “He’s OK now. He doesn’t act the way you’d expect a kid with leukemia to act.”


Dana Dougherty Reinke is a freelance writer and mother of three in Oakville, Ont., and a frequent contributor of health features to ParentsCanada.

Originally published in ParentsCanada magazine, February/March 2012.

By Dana Dougherty Reinke| March 07, 2012

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