More Questions, Answers, and Comments on Vaccinations

More Questions, Answers, and Comments on Vaccinations

I’ve recently (re)posted two blogs, “Vaccine Safety and Loving Our Neighbors” and “FAQs about Vaccine Safety,” which I hope you’ll take the time to read. But here I want to address two more issues that often come up as I talk with others about vaccine risks and safety and loving our neighbors.

People Are Different

One thing to always keep in mind is that people are quite different, both in what they think but also in their physiology. Some people have allergies. Others may have asthma. Some unfortunate ones may suffer from both. Allergies and asthma are disorders of components of our immune responses. Some of us may have mild allergies to such things as peanuts or bee stings. Others may have no allergic reaction to these things. A few people may be put at imminent threat of death by either of these if immediate medical treatment is not available (epinephrine injections).

In a similar way, the variability of our immune systems accounts for why one person may be infected with the flu and run a mild temperature and have moderate aches for a couple of days, and another person may run a high fever and miss several days of work or need hospitalization. Others may get infected with influenza and be completely asymptomatic. People are different.

When someone receives a vaccination, components of viruses (or sometimes bacteria, if it’s a vaccine against a bacterial infection) are being introduced to that person’s immune system. The vaccines trigger an immune response that is much less severe than if the person were to be infected with the actual virus (or bacteria). For a vaccine to work well it needs to solicit a relatively robust immune response.

Many vaccines elicit such a response by merely introducing our fabulous immune systems to a single protein or a set of proteins from the target virus. This type of vaccine stimulates the humoral arm of the immune system, which involves antibody production by B-cells. If the antibodies produced in response to the vaccine are able to bind to the whole live virus and neutralize its ability to infect cells, then the vaccine will offer high levels of protection. For various reasons, sometimes this type of vaccine doesn’t work well enough. Sometimes the cell-mediated immunity provided primarily by T-cells also needs to be primed or stimulated if our immune systems are to effectively fight off a subsequent virus infection.

If a person is immunized with a recombinant protein vaccine or a killed-virus vaccine, then the vaccine is priming the antibody response for future defense and protection. If one is immunized with a live-attenuated vaccine, then the cell-mediated and antibody responses are both being primed for future protection and defense. Live-attenuated vaccines have been rendered less dangerous or weakened, but they still undergo minimal replication in the immunized individual. Both types of vaccines are stimulating an immune response. And as we noted before about allergies, asthma, and natural infections, people respond differently. This is true following vaccinations as well. Some people will have swelling at the injection site. Some might run a fever or feel a little achy after receiving immunizations. These are actually good signs. It means the vaccine is triggering an immune response. (However, absence of these signs does not mean that the immunization is not working. It’s just another sign that people’s immune responses are different.)

Vaccine preclinical and clinical evaluations involve testing in animal models and in increasing populations of human volunteers, respectively. Only after rigorous safety testing in diverse demographics are human vaccines approved for licensure. But keep in mind, even though every vaccine has been tested and shown to be safe, people are different, and as indicated by VAERS data, a very small percentage of people will have reactions that qualify as severe. Like any biological or chemical substance—for example, peanuts, bee stings, aspirin, sodas—entering the human body, people will react differently. For the vast majority of people these substances pose little or no risk and possibly even offer great benefits. In the case of vaccines against viruses that cause a range of symptoms including hearing loss, blindness, paralysis, seizures, spontaneous abortions, or even death, the immense benefits of immunizations cannot be overemphasized.

Some of you may be saying, “Yes, but what about viruses that aren’t that great of a risk? Like, let’s say, influenza.”

Not All Vaccines Necessarily Rise to the Level of “Loving Others”

What about the annual flu vaccine or this year’s flu vaccine, for instance? Do I need to get the flu vaccine every year as an act of love? Possibly, yes . . . and possibly, no. In other words, well, maybe. Flu vaccination is a bit different in regard to the amount of risk we pose to other more vulnerable populations than say, the measles vaccination. Why? Well, influenza can also be treated effectively after infection with antiviral drugs like Tamiflu (oseltamivir), Relenza (zanamivir), and Rapivab (peramivir). These drugs target a virus protein (neuraminidase, the “N” in H3N2) that, when inhibited, greatly impedes the virus’s ability to spread in the infected individual and allows the immune system time to clear the virus before disease severity becomes an issue. Although there are not enough of these drugs for the majority of the American population, they are usually available for the most vulnerable. So, your immunization may not be as critical to helping protect them. But it still might be worth it.

Let me unpack my answer a bit. The CDC lists recommendations for who should get the annual flu vaccine. Some of us should get the flu vaccine to care for ourselves. See if you find yourself on the CDC list and if so, plan to get the vaccine to care for yourself.

I first started receiving annual flu vaccines when I worked in the respiratory virus section of the National Institute of Allergy and Infectious Diseases. I did this because if I ever became sick, protocol required that we be able to rule out a more likely infection with influenza virus caught in the general population. At about that same time, I found out that I am borderline asthmatic. This puts me at higher risk of serious illness if I were to encounter natural infection with the flu virus or other respiratory pathogens. So to take better care of myself, I now get the flu vaccine every year. What about this year, where the estimated efficacy of the vaccine is 10–30%? I would still get it; in fact, I did when it was first made available in October 2017.

I want to draw your attention to the last category of people on the CDC list: “Caregivers and contacts of those at risk.” (See below.) This may mean you, even if you didn’t see yourself in one of the previous categories.

Caregivers and Contacts of Those at Risk

  • Health care personnel in inpatient and outpatient care settings, medical emergency-response workers, employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients;
  • Household contacts and caregivers of children aged ≤59 months (i.e., <5 years), particularly contacts of children aged <6 months, and adults aged ≥50 years; and
  • Household contacts and caregivers of persons who are in one of the high-risk categories listed.

If you are frequently around small children or the elderly or infirm or think you may cross paths with them, then you may want to get the flu vaccine as an act of love to help these individuals. Young children cannot receive some versions of the flu vaccine. The elderly can receive vaccinations but their immune responses, on the whole, are less robust, leaving even the vaccinated elderly more vulnerable to infection. The other reason to consider getting the flu vaccine anyway is that you never know who might be immunocompromised in the circle of people you encounter.

Loving Our Neighbors

On this topic there are other very practical things you can do to demonstrate love to those around you, such as:

  • staying at home when and if you feel sick
  • keeping sick children at home; i.e., not sending them to school or play dates or Sunday school, or taking them to the grocery store with you when they are sick, especially if they are unvaccinated
  • checking your child’s temperature and keeping them at home if they are running a fever

Despite the evidence supporting the immense benefit of vaccinations, some parents will still choose to opt out of vaccinating their children. Certainly, they have the freedom to make such a choice. As the saying goes, with freedom comes responsibility. Those who exercise their freedom not to vaccinate can still love and protect others from possibly debilitating or life-threatening diseases by responsibly following the practical steps above. Loving one another according to the example of Jesus is more than responsibility borne from our freedom. Love requires sacrifice. Implementing the above suggestions will cause some to incur financial expense and/or sacrifice time. I urge, by way of stirring up to love and good deeds, those brothers and sisters in Christ who choose not to vaccinate their children to follow them diligently as an expression of Christ’s love.

Please check my other blogs on this topic, as there I address many other important questions about vaccine safety and other associated fears and concerns.