Balancing the benefits and risks of immunization

In the Nov. 12 issue of The Lakeville Journal, my friend David Paton voiced some serious concerns about the risks associated with flu shots, and these concerns should not be taken lightly. Nor should they be taken too severely. Here are a few general and specific reasons:

All immunizations and indeed all pharmaceuticals are accompanied by a myriad of warnings of possible adverse reactions and side effects. These warnings are often written so they could put anyone off taking the shot or medicine at all. It is a question of balance between benefit and risk. The risks to an individual are difficult to estimate because every person is unique, and different persons’ immune systems react or overreact differently.

Yes, improved basic sanitation and living conditions helped reduce the incidence of poliomyelitis. No doubt about it. But it is irrefutable that it is the Salk and Sabin vaccines that have really controlled polio in the United States, Europe and other countries. If we stopped immunizing our children, polio would come right back, with devastating results.

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It was the very fact that most countries required (or “mandated�) smallpox vaccination that enabled the World Health Organization (WHO) and all nations to eliminate that dread disease from the face of the earth. Few persons raised a “constitutional� objection at the time.

I remember toward the end of the campaign in India and Somalia when we were still spending money going after the very last cases of smallpox, many people and officials thought we could spend more effectively and save more lives by using the money for food and nutrition for poor people in these countries. In the short run, yes, that would have been true, but in the long run hundreds of thousands of lives have been saved, with enormous continuing returns in reduced spending in the future. The annual savings to the United States alone exceed U.S. contributions to WHO.

WHO and its International Agency for Research on Cancer (IARC) study very carefully the patterns and risks associated with vaccines and viruses of every kind. There are many viruses that do contribute to, trigger or cause certain cancers. In the case of viral vaccines, the health risks may be associated with the viral particles used in the vaccine or with an adjuvant or other molecule used to stabilize the vaccine or accelerate its uptake. Every effort is made to reduce or eliminate these risks.

Guillain-Barré (GB) for example, is a syndrome caused by the overreaction of a genetically susceptible person’s immune system to a virus. Yes, this could be triggered by a virus contained in a vaccine, but it is statistically far more likely to be due to exposure to the actual viral disease itself, such as influenza. In the latter case, the syndrome tends to be all the more severe, due to the greater exposure to the virus. The patient and his doctor have to balance the risk of GB from immunization against the risk of contracting the full-blown disease. Some day we’ll have a reliable predictive test for susceptibility.

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Simian virus is a disease in monkeys that resembles and is transmissible in much the same way as HIV/AIDS. The main risk of both HIV and Simian virus in humans comes not from flu shots but from having unprotected sex, sharing dirty needles and engaging in other unsanitary practices. The measures necessary to control HIV/AIDS will control the risk of Simian virus as well.

The risks of genetic mutation or hybridization are always there, not so much from immunization as from biochemical processes with the body, and from human practices susceptible to public health measures and personal responsibility.

David Paton inadvertently misquotes me about the risks of mercury and autism. What I actually said was that WHO had advised the United States and other countries with secure “cold chains� (refrigeration) for vaccine delivery not to use mercury as a heat stabilizer in their vaccines, but this was sometimes not the case in African and other underdeveloped countries, where the “cold chain� is unreliable or nonexistent.

The risks of mercury are very real, but the main source is not vaccines but widespread unacceptable levels of toxic emissions from coal-burning power plants and other industries. We are all victims of that pollution. If we clean up the environment, we pre-empt the lion’s share of the problem.

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Seasonal influenza is a major challenge, as the virus mutates each year. Every February, WHO sets the overall design specifications for the nest season’s flu vaccine, based on continuing assessment of the worldwide experience with the genetic shift and drift and the emergence of new strains of influenza. It is against the law to manufacture or sell in the United States a flu vaccine not meeting the WHO specification. Pharmaceutical companies have until the next August to produce the next seasonal flu vaccine for clinical use starting in September or October.

This year, however, the new H1N1 swine flu strain emerged too suddenly and too late for inclusion in the regular wide-spectrum seasonal vaccine design, so a supplementary targeted vaccine had to be designed and produced hurriedly, with less opportunity fully to check out its safety and efficacy.

So far, the vaccine is performing well, and the main problem has been to grow the vaccine fast enough to meet current demand. The vaccine is being watched carefully for adverse reactions or side effects. If these are severe, the vaccine will be withdrawn from the market.

If you are in doubt about this, for yourself or your children, you should discuss the matter with your family physician, weigh the options and make the decision that best suits your situation. For most persons, the benefits will outweigh the risks. It’s a matter of sensible balance.

Sharon resident Anthony Piel is a former director and legal counsel of the World Health Organization.