Immunisation

Many parents in my clinic have asked me for my thoughts on immunisations and it is especially for them that I have attempted to summarise my point of view as concisely as I can. The main problem with all of this, and one that must be understood from the outset if we are going to talk about it at all is that not getting your children immunised definitely puts them at some risk but that getting your children immunised also definitely puts them at some risk...

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This is the harsh reality of parenthood; whatever you do, you cannot prevent your children from being exposed to at least some risk. Immunisation, however, is an especially fearful subject for a parent.

The fear that your child could get a serious disease is a potent one and, if the matter is bought up for consideration, the fear that immunisations themselves could cause adverse reactions and harm your child is also a potent one.

'Anti-vaxxers'

Alongside the fear is a globally growing sense of outrage, even hatred, directed towards anyone who chooses not to vaccinate their children, especially as they are perceived as putting others at risk by reducing the 'herd immunity'. So called 'anti-vaxxers' are seen as fair game for the deepest contempt and condemnation, particularly in social media. Their concerns are dismissed as baseless, anti-scientific and stupid. Popular calls to ostrasice anti-vaxxer's children from normal society are being increasingly answered by legislative measures.

Grace

So, what could possibly weigh in the balance against such intensity of conviction with such popular support from everyone in the mainstream medical system?

For me personally it is the first hand experience, very early in my practice in 1990, where I met a profoundly distressed mother with a toddler called Grace who suffered permanent brain-damage immediately after her 6 month vaccinations. Grace had been experiencing a mild cold with blocked nose and sneezing for about a week up until when she got her jab but within 48 hours she was experiencing uncontrollable seizures in hospital and never regained normal brain function or her sight. The event was described as happening because of a viral meningitis and the worst thing for the mother was that no-one she spoke to would accept that the vaccination had anything to do with it and it was never reported into the system as an adverse reaction.

Of course, we all understand that the chances of such a catastrophic reaction are extremely low but how low are they if they are not reported or at least questioned, and how common is it for other issues, such as allergies or other immune imbalances, to stem from adverse response to vaccination? Grace's case was by far the worst I ever met personally but I heard other stories of negative health change following soon after vaccinations from other parents over the years and it was a consistent theme that their concerns were always dismissed as speculative and never acknowledged or reported.

Informed choice

All that said, New Zealand has an exceptionally high immunisation rate by international standards and by far the most of the parents I work with choose to go with the status quo. I never try to persuade my patients one way or another, or am even the one to bring the subject up! When parents ask, I usually say something along the lines of what I wrote at the beginning to convey a kind of warning about what a treacherous topic this is, and then explain that I emphatically do not advise parents to either immunise or not immunise.

What I instead suggest to the parent who genuinely does want to explore this matter from more than one angle is that they consider the subject as deeply as they need in order to make an informed choice based on what they think is best for them and their children. That said, they must understand that whatever they choose will have risks and that there is no path through this matter where you get to have no fear of what might happen.

The conventional advocacy of immunisations is fairly guaranteed to have been heard in a variety of formats (nurses, doctors, pamphlets, other parents, grandparents, friends etc.) however for most people the other side of the coin has not even been tossed let alone heard but there are voices out there if you want to hear their point of view. For example, in New Zealand the group who advocates against immunisation can be heard at http://wavesnz.org.nz/

Proceed with caution

The basic principle behind vaccinations have been understood by some of the old traditions of medicine for thousands of years, but it is an inherently risky business. You make a child slightly sick so they will be much less sick when they meet that same enemy the next time. It's a good idea in principle, the risk is all around those words 'slightly sick'. Not everyone at the same age is ready for the same challenges at the same time, but we treat them as if they were.

What I do recommend is that, if and when parents are going to get their children immunised, that they be careful to ensure that the child is in good health at the time and to not rush into doing too many over a short period. As much as it might suit an overburdened medical system I do not think that multiple vaccinations in short succession are a good idea for any child who is in anything but excellent health.

I also personally think that it would be better to wait until children are older to do so much vaccinating, even though babies are more vulnerable to serious disease (they aren’t born with any immunity to begin with) at the same time they are also more vulnerable to side effects from vaccines and the substances that are injected along with them.

Children's health links

I work a great deal with children of different ages with various health problems, most of them involving their immune systems in one way or another. Many of the approaches that I have found to be the most helpful are summarised in an article on children's health here and for an overview of the vital subject of immunity there is a detailed article that goes into many key areas written up here.

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Andrew Bentley’s story:

For another viewpoint on this difficult subject I have copied below a letter from an excellent and experienced American herbalist, Andrew Bentley, that originally came to me as part of an online discussion about the relative merits of tetanus vaccines; it is included here with his permission.

The "fear factor" is a pretty big force in human judgement, especially about diseases. Anyone who has seen another person or many people die from a sickness is likely to have some anxiety about it. It seems like just about every culture and time period have come up with some sort of culturally ingrained answer to that fear. In our culture, inoculations have become that deeply ingrained answer to the ancient fear of pestilence. This is why it is often a highly emotional discussion when people talk about them-- it is almost considered impious in many social circles.

When I was a teenager, I was traveling around trying to learn about different traditional systems of healing in the world. In one of the places I went, people believed that it was absolutely necessary to keep a blue glass representation of an eye above a child's bed or around their neck, to prevent the child falling prey to illnesses. Almost everyone I talked to believed this was the case. And these were not barbarians in some remote village, they were people who drove cars, talked on phones, had jobs and lived in a city of half a million people or so. Many of them were well educated or had travelled to other places, and held this opinion just as strongly as the people who weren't well educated or travelled.

I couldn't make this work with my understanding of how the world operated, so I questioned it. This actually upset people, because they felt I was trying to undermine how they kept their children safe. When I asked about evidence, I got all kinds of stories about this or that child, or a whole orphanage full of children, whose caretakers didn't provide them with blue glass eyes, and who met with terrible illness or untimely demise. I had people tell me about how they worked in the hospital, and after you've seen a small child dying or hooked up to a ventilator you just would never want to take the risk of not providing a child with a blue glass eye to watch over them. It was the culturally accepted way of warding off pestilence, and to deviate from it could cause harm not only to one's own child, but to any children around them who might catch their disease. It was like leaving the door open for death to walk in, and as such it was considered highly irresponsible.

But like I said, for me, it didn't seem like something that would work. I thought of disease in terms of bacteria, viruses, genetics, and things like that, because of where I came from, and could not conceive of a plausible mechanism of action whereby a blue glass eye would impact the aetiology of illness. But to them and to their way of thinking on illness (which I do not understand fully, but which had a lot to do with probability and respect and the will of god) it made perfect sense. And they had been using them since time out of mind.

In the end, a tearful old woman pressed one into my hand, giving it as a gift that I could not refuse without causing grave offense. And she begged in exchange that when I had children of my own, that I would hang it above their bed or around their neck. SO I took it and I went home, and years later I did have kids of my own. And it was hanging on the window over the bed (just as a souvenir of my journeys) when my first daughter was a baby. And she was healthy. And somewhere along the line, moving house I suppose, it got lost, and I forgot all about it, and didn't have it when my second daughter was born. And she had serious, life threatening respiratory problems that she struggled with for years. I imagine that everyone who told me about the blue glass eyes would sadly shake their heads and say that they told me so. I STILL don't think the glass eye had anything to do with it, but I might be wrong.

Vaccines fill this same cultural role for most of our society, regardless of whether they work or don't, or are safe or not. --I'm not saying that they do or don't work, or are safe or not safe, as a group. Really there are a lot of them and they are all very different substances and even have different proposed mechanisms of action. Speaking specifically of the tetanus shots, they appear to work pretty well and also have the highest reported rate of adverse events of any vaccine according to the government's Vaccine Adverse Events Reporting System (which is not very high quality data, but it is the data that exists).-- What I am saying is that when clinicians consider these interventions or discuss them with patients and other professionals, it is important to take into account not only the scientific information, but also the fact that these are the culture's charms against pestilence, and as such many people are extremely emotionally invested in them.

And yes, Tetanus was and is a very bad disease to come down with. Once it gets to the point where it is producing neurotoxins and making spasms happen, it is dangerous and difficult. Hygiene and proper wound care are extremely important for this and many other reasons, since no one is claiming that the vaccine offers perfect protection (actually the horse serum vaccine appears to offer pretty close, based on a large retrospective epidemiological study of soldiers who were given it, and also based on numbers from the Cuban health department, but it is so dangerous that it isn't used much anymore). It was pointed earlier out that the chance of getting tetanus is related to how long a wound remains dirty. The environment that tetanus really likes is a burn or penetrating wound that is co-infected with some other organism, in a part of the body that doesn't get much oxygen (like a joint, extremities, or the umbilicus of a newborn). Extra points if the injured person is immunosuppressed, very old, or very young. Many people even on this list of healthcare professionals seem to correlate rusty metal with tetanus, which is largely a myth perception. Tetanus lives in the alimentary canal of animals and in the soil; so bites and injuries from soiled objects (or injuries later contaminated by soil of faeces) are what introduces it into the body, and the rust is just there because metal left in the dirt tends to rust.

Andrew Bentley, Clinical Herbalist
Lexington Ky, USA
http://kentuckyherbalist.com

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