1st 'Thoughts Out Loud' discussions focuses on vaccination

  • Published
  • By Don Branum
  • Air Force Academy Public Affairs
U.S. AIR FORCE ACADEMY, Colo. --  Vaccines may not come up for discussion all that much among Airmen: They're mandatory, so what's to discuss? But with the United States facing its worst measles outbreak in 25 years, more people are talking about getting vaccinated and why vaccines matter.

Dr. Katherine Bates, an assistant professor with the Biology Department here, held a discussion with that theme March 19 in Fairchild Hall as the first in a series of "Thoughts Out Loud" discussions hosted by the Academy's Audeamus Club.

A vaccine consists of a microbe in either a dead or weakened state. Once injected into a healthy patient, the vaccine triggers an immune response, Bates explained. Special white blood cells called Memory B-cells "memorize" the microbe's protein sheath so that the body can kill future infections more quickly.

"The goal is to provoke a response without you actually becoming ill," said Bates, who holds a PhD in human genetics from the University of Utah.

Edward Jenner is credited with discovering a vaccine for smallpox in 1796, though China, Turkey and cultures in Africa may have practiced vaccination centuries earlier, according to the College of Physicians of Philadelphia website "A History of Vaccines." And nearly 20 years before Jenner formally documented his research, Gen. George Washington had ordered smallpox inoculations for the Continental Army.

That's not to say Americans or Europeans approved of the practice right away. Some opposed the vaccine because it came from animals; others because they felt it violated their personal liberty. But by the turn of the 20th century, several states had made vaccines mandatory to promote public health, and the Supreme Court of the United States ruled in 1905 that such laws were constitutional.

Less than 50 years later, the U.S. recorded its last case of smallpox, and by 1977, smallpox had been completely eradicated in the wild. Only two vials of the virus remain: one in the Centers for Disease Control and Prevention in Atlanta and one in a Russian facility.

Other vaccines have proven similarly effective. Since polio vaccination began in the '60s, worldwide cases have plummeted from hundreds of thousands to just over 200 in 2012, according to the World Health Organization.

Measles also infected hundreds of thousands of people each year in the U.S. until the vaccine became widespread, but the number of cases has averaged less than 100 per year in most years since measles vaccination began in 1963. Cases of the disease spiked in 1989-1991, resulting in more than 55,000 cases and 123 deaths. The CDC states that lack of vaccination coverage was the most important cause of that outbreak.

Lack of vaccination is also to blame for the spike in cases that began last year. An outbreak among the Amish population led their community to start vaccinating children, according to an NPR report in June 2014.

An outbreak at Disneyland, near Los Angeles, in December has accounted for nearly 180 cases so far this year. A research letter published in the Journal of the American Medical Association March 16 cites low vaccination rates as the primary cause.

"Our study estimates that MMR (measles, mumps and rubella) vaccination rates  among the exposed population ... might be as low as 50 percent and likely no higher than 86 percent," wrote Dr. Maimuna Majumder, the research letter's primary author and research fellow at Boston Children's Hospital.

"Measles is incredibly infectious," Bates said. "It's spread by aerosol, and it can remain in the air for hours. If I had measles, everyone in this lectinar now or later this evening would be exposed."

Those who oppose vaccination fall largely into two camps, Bates said. The first consists of people who object to receiving any vaccines at all, while the second is made up of people who believe in "delaying" vaccinations because they're worried that too many vaccinations in short sequence will overtax the body's immune system. But delaying, Bates said, ends up exposing infants to the very diseases they might otherwise be immunized against.

Col. John Putnam, the Biology Department head and permanent professor, said that many of those who reject vaccination are largely well-educated but may fall victim to cultural cognition, or groupthink.

"You make decisions not based on the information you get but based on a desire to stay in your group," he said. "It's a question of who you trust. Some of these people trust their peer groups more."

Scientific evidence about vaccination poses a challenge to people who have adopted views based on testimonials or personal experiences, Putnam said.

"There was a study about six months ago where researchers gave vaccine opponents all sorts of information related to vaccines," he said. "Many of those people, afterward, rejected vaccines even more strongly. There wasn't a case where someone said, 'I didn't know that.'"

Instead, Putnam said, people responded that they didn't trust "big government" or didn't trust the science.

Misinformation is another obstacle in getting people vaccinated, Bates said. A now-infamous study written by Dr. Andrew Wakefield and published in the Lancet medical journal in 1998 linked the MMR vaccine to autism. The Lancet retracted the study in 2010, and the British Medical Journal declared in 2011 that the study was a fraud.

"Hundreds of people tried to replicate his results," Wakefield said. "It's been completely debunked, but that study planted a seed of doubt in people's minds."

Vaccines are not completely risk-free, Bates said, but the risks associated with preventable diseases far outweigh the risks associated with their vaccines. For example, one in 1 million people will experience a serious allergic reaction to an MMR vaccine, but the fatality rate in the 1989-1991 measles outbreak was 2.2 in 1,000, and the chance of measles to cause partial or total permanent deafness is one in 10.

"If you compare those risks, what seems safer?" Bates said. "It's an order of magnitude different."

But as important as vaccination is for individuals, it's even more important for the general public, Bates said. A sufficiently high rate of vaccination protects people who, due to age or poor health, can't receive a vaccine.

"Vaccination is about protecting the community," she said. "You are protecting those who cannot protect themselves. That's what vaccination does."

Cadet 3rd Class Shane Culver organized the discussions. He said discussions on other topics are tentatively scheduled on a biweekly basis.

The Audeamus club is a Center for Character and Leadership Development initiative and part of the Colorado Leadership Alliance, a group of clubs at nine Colorado universities that supports character and leadership education and experiences at the undergraduate level, according to the Air Force Academy's course catalog. Audeamus is Latin for "let us dare."