Vaccination: Foundations Of Medicine Essay

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Foundations of Medicine Essay

Introduction

Vaccination is a preventative measure for diseases. It is when your body receives an inactive strain of a pathogen or the antigens of that pathogen (Usually via inoculation) which your immune system recognises and fights, creating memory cells for if it encounters it again. [1] An example of this is the MMR vaccine, which builds immunity for measles, mumps and rubella. The vaccine introduces a weakened version of the live forms of each of the diseases, too weak to cause symptoms or be infectious in most cases, for your immune system to fight and produce immunity. [2] In this essay, I will be discussing symptoms and outcomes of having measles in non-vaccinated individuals, how vaccination, as well as herd immunity, helps prevent infection in communities and factors linked with societal resistance to mass vaccination.

Signs, Symptoms and Possible Outcomes in Non-Vaccinated Individuals

Measles is an afebrile (Meaning it causes fever) viral disease that is extremely contagious and the cause of over 100,000 deaths annually. [3] There are two stages: Stage one is the pre-eruptive and catarrhal stage, and stage two is the eruptive (Also known as exanthematous) stage. [4] During the pre-eruptive stage, patients suffer with fever (Known as pyrexia), malaise, a cough, rhinorrhoea (Coryza, but also colloquially known as a runny nose), conjunctivitis and Koplik’s spots (Which are located specifically in the buccal mucosa) which tends to last 14 days with a range of 7 to 21 days before the eruptive stage. [4, 5, 6] Koplik’s spots are irregular and small, grey in colour and occur around one to two days before the rash forms. [4] During the eruptive stage, the maculopapular rash forms predominantly on the forehead of the patient and then spreads down to the rest of the body, sometimes to below the torso in extreme cases. [4, 7] This rash then fades after approximately a week, but a brown mark is left behind where it was located. [4]

There are a plethora of complications that can arise from having measles. Some of these can be fatal such as encephalitis, pneumonia and meningitis. [2] For every 1,000 reported cases of measles, there is roughly one case of encephalitis caused by the viral infection and 2-3 deaths. [7, 8] A very rare type of encephalitis that can occur from having measles is subacute sclerosing panencephalitis. [3, 9] There is a possibility that a measles infection can impair B and T memory cells which in turn would increase the risk of infection from opportunistic diseases. [9] Blindness can also be a result of a measles infection in severe cases too as mentioned in the leaflet Mary received from a fellow mother at her “baby and you” group. [3]

How Vaccination Aids in Prevention of Disease on Macro Levels via Herd Immunity

Vaccines have greatly helped the prevention of disease from a public health point of view by drastically reducing rates of disease as well as deaths caused by them. For example, with measles there was a 79% decrease in global deaths caused by measles from 2000 to 2015 due to increased usage of vaccinations through the implementation of inoculation programmes that became procedural and with the help of mass vaccination campaigns too. [3] People who have an infectious disease also would infect others (Known as secondary cases) after obtaining the disease. The average number of people infected second-hand is called the basic reproductive number (R0) and vaccinations would severely reduce this by stopping one person from getting the disease in the first place, therefore, stopping them from creating secondary cases. For example, in terms of measles, the R0 has been estimated to be between 9 and 18 depending on people’s susceptibility. [3, 9, 10] Therefore, by having the measles vaccination, approximately 9 to 18 secondary cases are potentially being thwarted as well as the initial case too. This be applied to all infectious diseases and is a major part in the concept of herd immunity.

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Herd immunity is when a sufficient number of the population within a community has been inoculated for a particular disease. [11] This leads to a significant reduction in its infection rates, via prevention of secondary cases, and potentially eradicating it without the entire population of the community receiving a vaccination. [11] The more infectious a disease is (Defined by how large the R0 value is), the higher the number of people within a community need to be vaccinated in order to achieve herd immunity. [11] Using measles as an example, 96-99% vaccination rates are required within communities to achieve herd immunity due to the infectious nature of the disease and it is suggested that patients receive two doses of the vaccine, with a lagging period in between, to optimise and obtain these immunization rates. [12, 13] In the area that Joe and Mary live in, the rates of the MMR vaccination dropped below 80% which suggests the community do not have herd immunity and therefore is at an increased risk of experiencing an outbreak.

Psychological and Sociological Factors associated with Societal Resistance to Mass Vaccination

A popularized yet falsified paper was written by Andrew Wakefield, a British doctor who has since been struck off because of his unethical paper, claiming he found a causal link between the MMR vaccine and autism, but he had no evidence-based research to make this conclusion. [14, 15] This has had huge effects on public health as many members of the public were and still are unaware that this paper was not true and has been retracted. It led to an 8% decrease in vaccination rates between 1996 and 2002 [16] and a reduction to 61% in some parts of London in 2003. [17] So a sociological factor would be the distribution of incorrect information, hence Mary finding it on twitter and being conflicted with regards to vaccinating her children.

Another sociological factor associated with societal resistance to mass vaccination may be conformity within friendship groups as well as the general public, as getting vaccinated is the social norm. The status of someone may be elevated by agreeing with their group’s ideology and disagreeing may lead to social exclusion. In Mary’s case, being anti-vaccination could lead her to being socially isolated from her toddler and “baby and you” groups due to them being pro-vaccination but if she was in a group that believed in anti-vaccination, Mary’s reputation would be increased significantly as she would be agreeing with them.

These sociological factors closely relate to psychological factors. For example, as Mary is a part of pro-vaccination groups and would be more likely to be social rejected from the groups due to disagreeing with them, it may lead to a decline in Mary’s mental health. Therefore, a psychological factor to consider is the fear of social rejection, as it would have an effect on decision making with regards to vaccinating your children. Mary would be more likely to get her children vaccinated rather than go against the norms of the group to reduce social pressure on her, known as normative social influence, which would make her feel less socially anxious. [18]

Another psychological factor that may influence Mary and Joe’s decision to get their children vaccinated would be the social and psychological effects their children would experience themselves. For example, in the leaflet Mary received, it talked about unvaccinated children being considered a risk to society and banned from attending school which would have a huge negative impact on their children’s mental health and most likely their education.

Ethical Factors Associated with Societal Resistance to Mass Vaccination

An ethical factor linked with societal resistance of mass vaccination would be consideration of the NHS’ finite resources from the justice pillar of ethics, but more specifically distributive justice. The cost of a vaccination compared to the cost of treatment for patients with measles, along with the potential complications they may suffer with is huge. By not having the vaccination, if Mary’s children got infected with measles the cost of the hospital admission and treatment could be considered a waste of money or an unfair allocation of the NHS’ resources as it was preventable. You could argue that the money used to pay for this could have paid for treatment or diagnostic tests for a patient who had a disease which was not preventable.

Another ethical factor would be looking at resistance from the autonomy pillar of ethics, which states everyone should have a choice with regards to accepting or rejecting treatment offered to them. If the government made it compulsory for everyone to be vaccinated it would directly oppose this pillar as no one would have any choice which is unethical.

Conclusion

To conclude, the health advisor should describe all health benefits of vaccination to Mary and Joe as well as the negatives that can occur. When giving this advice, the health advisor should ask Mary and Joe what research they have collated beforehand and delicately address any false information they read, such as the tweets Mary had found, as to not offend them and provide them with the correct knowledge. Herd immunity should be a topic of discussion too, to clarify what Mary and Joe already know about it and to aid them in making their decision. Finally, the consultation should finish with all of their concerns discussed, so that the couple are no longer left feeling confused and are fully informed when making a judgement of whether to vaccinate Jess and Matty or not. 

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