In modern times with the rapid pace of vaccine development in recent decades, the historic origins of immunization are often forgotten, leading people to underestimate the severity of the harm that vaccinations prevent. The resistance to vaccinations is a well-known occurrence, due to the positive effects vaccinations have had we forget the tragic consequences of the past’s fearsome infectious disease such as smallpox. “Those who do not remember the past are condemned to repeat it,” George Santayana. Studying history is necessary to avoid repeating past mistakes. Despite overwhelming evidence supporting the safety and benefits of vaccination, this fear has proven resistant to information. Parents are increasingly questioning the safety of and need for vaccines as a result, vaccination rates have fallen to dangerously low levels in certain communities.
Recent outbreaks of vaccine-preventable diseases in the United States have drawn attention to this epidemic. While vaccine acceptance remains high in general, fear of vaccines has grown dramatically in many developed countries. In some communities, this fear has led to significantly increased rates of vaccine refusal which are associated with increases in illness and death from vaccine-preventable diseases. Given the risk to the public health these perceptions produce, and consistent with well-established legal principles supporting government action to protect the common good, society has the right and responsibility to establish laws, regulations, and choice frameworks that discourage vaccine refusal.
“If history repeats itself and the unexpected always happens, how incapable must Man be of learning from experience,” George Bernard Shaw.
For example measles and pertussis, 2 vaccine-preventable diseases with recent US outbreaks. Since measles was declared eliminated in the United States after January 1, 2000, there have been 18 published measles studies (9 annual summaries and 9 outbreak reports), which described 1416 measles cases (individual age range, 2 weeks-84 years; 178 cases younger than 12 months) and more than half (56.8%) had no history of measles vaccination. Of the 970 measles cases with detailed vaccination data, 574 cases were unvaccinated despite being vaccine eligible and 405 (70.6%) of these had nonmedical exemptions (eg, exemptions for religious or philosophical reasons, as opposed to medical contraindications; 41.8% of total). Among 32 reports of pertussis outbreaks, which included 10,609 individuals for whom vaccination status was reported (age range, 10 days-87 years), the 5 largest statewide epidemics had substantial proportions (range, 24%-45%) of unvaccinated or under vaccinated individuals. However, several pertussis outbreaks also occurred in highly vaccinated populations, indicating waning immunity. A substantial proportion of the US measles cases were intentionally unvaccinated. Although pertussis resurgence has been attributed to waning immunity and other factors, vaccine refusal was still associated with an increased risk for pertussis in some populations.
Dr. Ron Chapman, director of the California Department of Public Health (CDPH) and state health officer, warned that the number of pertussis (whooping cough) cases would continue to increase in California in 2014. CDPH has received reports of 2,649 cases of pertussis occurring from January through May 27, 2014, more than the number of cases reported in all of 2013. More than 800 cases were reported in April alone, the highest monthly count since the 2010 epidemic. “The number of pertussis cases is likely to continue to increase,” says Dr. Ron Chapman. Sixty-six of the hospitalized cases in 2014 were children four months of age or younger. Eighty-three percent of the cases were children younger than 18 years of age. Of the pediatric cases, 8 percent who were younger than 6 months-old and 70 percent were 7 through 16 years of age. It’s important that both children and adults are up-to-date on their immunizations. Booster shots for pertussis are critical because, unlike some other vaccine-preventable diseases, neither the pertussis disease nor vaccine offers lifelong immunity. California 7th grade students receive the pertussis vaccine booster as required by state law.
Since the attack on the World Trade Center on September 11, 2001, the threat of biological warfare and bioterrorism has reemerged. Smallpox has been identified as a possible agent of bioterrorism. It seems prudent to review the history of a disease known to few people in the 21st century. “History never repeats itself, but man always does,” Voltaire. In the 1950s a number of control measures were implemented, and smallpox was eradicated in many areas in Europe and North America. The process of worldwide eradication of smallpox was set in motion when the World Health Assembly received a report in 1958 of the catastrophic consequences of smallpox in 63 countries. In 1967, a global campaign was begun under the guardianship of the World Health Organization and finally succeeded in the eradication of smallpox in 1977. On May 8, 1980, the World Health Assembly announced that the world was free of smallpox and recommended that all countries cease vaccination. The world and all its people have won freedom from smallpox, which was the most devastating disease sweeping in epidemic form through many countries since earliest times, leaving death, blindness and disfigurement in its wake.
Improved understanding of the association between vaccine refusal and the epidemiology of diseases is needed. “Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity,” Martin Luther King Jr. The effects of vaccine hesitancy are widespread,not surprisingly, vaccine hesitancy has also had direct influence on vaccination rates, which in turn are linked to increased emergency department use, morbidity, and mortality. Gaps in vaccination coverage leave populations vulnerable to illnesses, disease and can lead to death in some cases. Since the 1990s, there has been a growing movement to improve vaccination access by giving pharmacists the authority to administer vaccines according to state laws (although this has not yet taken place). To help increase and maximize vaccine coverage in our communities and fight the widespread of disease.