After breastfeeding and loving up, the best thing you can do for a child is making sure it gets all its vaccinations. Up to now, almost every mother in T&T believes in vaccinations, few question it, it’s a way of life, baby born, breastfeed, hug up, vaccinate.
Yet the process is not without its dangers, small as they are. The problem with trying to prevent a disease by injecting a foreign substance into the body of a child is that you have to be sure that what you are going to do is not worse than the disease itself.
The first thing you have to do before making a vaccine is decide whether the disease deserves a vaccine. That means looking at three things. One, the mortality (the deaths that the disease causes). Two, the morbidity (the side effects of the disease) and three, the socio-economic effects of the disease.
If you have a disease like yellow fever, which kills about half the people it attacks, one would say, yes, we need something to prevent this disease. If you have a disease that does not kill much, e.g. chickenpox, then you might say no need for a vaccine, unless there is another factor involved, which, in the case of chickenpox, might be the economic fallout from the parents having to stay home for a couple of weeks to care for the child.
Then you have a disease like measles that does not kill very much, one death for every 10,000 cases, but has a high morbidity, hearing loss, pneumonia and brain damage. Or German Measles that kills almost nobody but damages the unborn child, causing severe brain damage, blindness, deafness and heart disease. Mumps also never killed anyone but did cause some sterility when men got it. Or hepatitis B, which is usually innocuous in childhood but responsible for nearly 1 million cases of liver cancer in later adulthood. Or the Human Papillomavirus virus (HPV), which has a similar effect on various other cancers of men and women.
If a childhood illness has either high mortality or high morbidity, or seriously disturbs society, then you need to do something about it. Since these illnesses have no treatment, you need to prevent them, i.e they need vaccines.
You can apply this simple sort of analysis of mortality and morbidity to any of the childhood diseases and excepting the socio-economic outcomes (anxiety, depression, suicide, educational regression, increase in poverty, decrease in GDP etc), which are much more difficult to compute, come up with sensible answers to the question of whether a vaccine is needed.
The traditional illnesses that we vaccinate against all developed against this background and have served us well over the past 50 years. The oldest are DPT (Diphtheria Pertussis or whooping cough & Tetanus) and polio.
Diphtheria had a mortality of 5 to 10 per cent before the vaccine was introduced in the 1920s. It used to kill up to 20 per cent of children under five and was known as the “strangling angel of children.”
Tetanus mortality was even worse, 30 to 50 per cent died. The effect, up to the 1970s, of watching little bodies agonise in uncontrollable spasms before dying, is indescribable.
By contrast, whooping cough mortality was on the lower side, 1 to 3 per cent in the under three-month-olds. Its morbidity, however, was spectacular, as anyone who remembers babies struggling to breathe as late as the 1970s and early 1980s will testify. Lingering brain damage and convulsions from hypoxia, as well as chronic lung damage from pneumonia, was common.
We needed vaccines for these diseases and by 1945, all three vaccines had been combined into one jab. Unfortunately, it took years before the vaccine reached colonial peoples.
How little has changed.
Polio, well the name rings a bell, a very nasty disease and we still have people hobbling around who had polio as children, so not many will object to polio being a mandatory vaccine. Like the previous pathogens described, the virus is still with us.
Then there are the serious bacteria that cause meningitis (5-10 per cent mortality plus brain damage and hearing loss) and epiglottis (70 per cent deaths) and pneumonia and ear infections (innumerable people with “weak” lungs and more “hearing loss”), for which we have the Hib and Prevnar vaccines.
All of these 13 vaccines have side effects but society has decided that the benefits of these vaccines far outweigh the occasional, even serious, side effects. Some of these have correctly been made mandatory.
We need to apply these equations to the COVID vaccines. So I can see a place for offering the Pfizer to children with comorbidities over the age of 12 but not to make it mandatory. However, at the present moment, I disagree with vaccinating the under twelves. The mortality and morbidity in COVID in children is not enough to do this. In addition, the figures behind Pfizer’s study of the under twelves are not compelling. There were only 2,268 children in a six-month trial. Only 1,000 children were tested with the vaccine. This is not enough data to recommend that millions of children take this jab. Compare this with the recently approved malaria vaccine, which was tested in 800,000 children over ten years.
When there is little or no mortality and morbidity from a disease among healthy children, unless someone comes up with a compelling socio-economic argument, there is no need for a vaccine. And that’s quite apart from the lack of data about its acute and longterm side effects.