I REFER to the letter urging the government to go on an aggressive campaign to educate people, particularly in rural areas, and set up multiple vaccination centres in light of a measles threat looming large in South-East Asia, “Measles threat must be dealt with swiftly” (The Star, Feb 18).In public discussions about the vaccine controversy, the parents themselves tend to be left out, so I would like to take readers through the decision-making process of one such parent. This might provide some reassurance for other parents and some issues for doctors to ponder over.I shall call the disease “Disease A” and vaccine for the disease “Vaccine A”. I won’t discuss the need for a particular vaccine, just the issue that frightens parents the most, namely severe adverse effects (AE).The human body does not ordinarily self-injure in response to external antigens. Hence, it is very unlikely that the small amount of external antigen we receive in vaccines can cause severe injury. Indeed, numerous studies have shown that vaccines are extraordinarily safe medical interventions.

The case is summed up in an article “Vaccines and Autism Revisited – The Hannah Poling Case” published in The New England Journal of Medicine, May 15, 2008.The Vaccine Injury Court (VIC) in the United States compensated this child using the Vaccine Injury Compensation Programme (VICP).However, lost in the fine print were a few details. Firstly, VICs usually depend on three conditions being fulfilled: The child was 1) vaccinated, 2) did suffer the specific injuries listed in the “Table of Injuries”, and 3) suffered injuries within the specified time frame.These courts apparently do not make the determinations of cause and effect conclusively: For example, the vaccine caused injury, or another concurrent event contributed towards injury after vaccination, or injury caused by underlying illness.In short, the court does not actually have to declare that the vaccine caused the adverse effects to award compensation.

In Hannah’s case, her father Dr Jon Poling (a neurologist), upon investigation, discovered that she had an undetected underlying mitochondrial disorder. It was postulated that the antigen in “Vaccine A” “triggered” the disease to “unmask and manifest” itself.This is what many parents are worried about. Parents accept that vaccines are safe in and of themselves, but will vaccination “trigger and unmask” a dormant disease?The somewhat reassuring answer to that was partly provided by Dr Andrew Wakefield of the United Kingdom. Notwithstanding the controversy surrounding him, his 1998 Lancet paper (now retracted) provided some startling insights. The “dormant underlying condition” seemingly can be triggered by “Vaccine A” as well as “Disease A”. This would be entirely in keeping with what we know of our immune system. In order for the vaccine to trigger a protective immune response, the antigen in both has to be identical.

So, basically, in cases such as Hannah’s, it is likely that the “underlying mitochondrial disorder” would have been “unmasked and manifested” either by Disease A or Vaccine A. It is just that she encountered Vaccine A first so she became entitled to the VICP payout. Had she been injured as a result of contracting Disease A itself, she would not have received the payout. This is one of the benefits and persuasive arguments for the vaccination+VICP+VIC programmes.While this in itself may not be fully reassuring to parents, it does give them something to research further. Fortunately, these genetic disorders are extremely rare.Another reason for resistance to vaccination may be the arguments forwarded by doctors, namely “herd immunity”. Here, the principle is if a critical mass of the population has immunity to the disease (usually via vaccination), the disease will eventually peter out, ie be more or less eradicated, in the community. This is a laudable goal and in the community’s best interest.

But how do you get parents to buy into the idea of “community good” while they are grappling with and are frightened of the issue of possible serious vaccine AE to their own child? I can’t think of any parent who will put the interest of the community before that of their own child.The “herd immunity” argument only becomes attractive/palatable to parents in countries which have a Vaccine Injury Compensation Programme and Vaccine Injury Courts. Malaysia seems to have neither. It is high time these are established in Malaysia to encourage the voluntary uptake of vaccination.

DR MANIMALAR SELVI NAICKER

Histopathologist and statistician

Subang Jaya

Read more at https://www.thestar.com.my/opinion/letters/2019/02/22/why-parents-fear-vaccines/#6GXA7b13LE2zWc2u.99