© 2011 E.A. Koreneva
Key words: vaccination, diagnostics, immunoprophylaxis, quality of vaccines, education of people on the subject of vaccines, Russian vaccines, post-licensing overseeing of vaccines
Abstract: Following the discussion opened in Issue 2011 №1 with the article “Vaccination in the Context of Bioethics” (by A.A. Ozhiganova), this paper puts forward a professional immunologist’s opinion on the issue of vaccination.
The Board of the Journal suggests authors to continue discussion on the subject of “Vaccination in the Context of Bioethics” and invites not only people who work in the field of bioethics, but scientists and practitioners from various fields: medical doctors, lawyers, sociologists, psychologists, biochemists, and public health and other officials whose goal is to preserve life on Earth.
Although there are different opinions on the issue of vaccine prophylactics, at present international experts and governments of most countries consider this measure as the most available and economic health protection and promotion strategy. Vaccine prophylactics should be taken as a nation-wide program, because only vaccinating most citizens we could prevent epidemics of infectious diseases.
For instance, as a result of vaccination of 95% of children in their early years poliomyelitis has been almost totally eradicated. While there were 150 000 cases of diphtheria in 1932, only 655 cases were registered in 2003. Similar changes were seen with measles: in 1964 there were 1 250 000 people sick with measles, while in 2003 – only 3 291. In 1993-1996 influenced by anti-vaccination messages coming from the media, the number of children getting the vaccine decreased. As a result, 104 000 became sick with diphtheria.
For last forty years there have been registered 72 new types of infections, and each year two or three new dangerous infections are found. Only 5 to 10% of all viruses are studied, and we are going to face many unexpected consequences, as no reliable anti-virus drug has been invented so far. The only effective means of fighting with viral infections is vaccine prophylactics.
However, although there is no doubt that vaccination is effective, it does not always come without complications. Its success depends mainly on two factors: 1) the quality of a vaccine; and 2) qualification of a doctor who gives the shot.
Surprisingly, there was no manual or information book on these issues in Russia twenty years ago, and the curriculum of medical students (generalists) included only one hour of time devoted to vaccination. Nowadays the situation has changed, but still medical doctors need to take vaccination more seriously.
Qualification of a pediatrician, their knowledge about qualities of modern vaccines, contraindications of each particular vaccine, case-to-case approach to vaccination of each kid – these factors influence safety of vaccination procedure. For instance, to ensure that a kid with contraindications against a vaccine will not suffer from exacerbation of their existent condition, the doctor should carefully choose a safe period for giving them a shot.
Another important aspect of vaccine prophylactics is quality of vaccines. For each vaccine there are characteristics that influence quality and efficiency of vaccination: purity of a vaccine, antigen life span, number of protective antigens, dosage and frequency of antigen administration.
Modern vaccines differ greatly from their predecessors in composition, properties of antigens and safety range. Using inactivated, split, subunit, and DNA-vaccines allows to give shots to patients who could not have been vaccinated before: people with immunodeficiency, grave chronic conditions, etc. In this regard we should talk about quality of vaccine production: non-compliance with vaccine production standards could nullify all the useful properties of a vaccine and compromise the vaccine and vaccination in general in the eyes of a patient.
This applies especially to the vaccines produced in Russia. Compliance with standards of Good Medical Practice(international guidelines for production of quality vaccines, control of pre-market clinical trials of a vaccine on the part of the State Committee for Epidemiological Surveillance) could ensure the high quality of Russian vaccines. These days the number of complications due to low-quality vaccines has decreased to a minimum. Today more attention should be drawn to post-market oversight of vaccines, when a vaccine has already proved to be safe, it is sold on the market – and still its effects on people are being studied.
Vaccine prophylactics is one of the mechanisms of control and prevention of epidemic spread of infectious diseases. Invention of new effective and safe vaccines is a one of the leading areas of international clinical trials. The arguments against different vaccines or vaccination in general speak more to the fact that we should pursue a more serious approach to vaccination and education of people about this matter both on the part of the State and each doctor in particular.
The topic of vaccination was raised lately in view of the initiative of G.G. Onishchenko, Head of Federal Service for the Oversight of Consumer Protection and Welfare, proposed in January 2011 to deprive parents of the opportunity to freely decide whether to vaccinate their children. The news has been widely discussed in media these days. Turned into a social debate this problem sometimes becomes groundless and vague. There is no unanimous agreement on the issue of vaccination among representatives of medical science. Specialists take different stances: some insist on the ‘authoritarian’ and high-pressure decision to vaccinate all children; some declare total rejection of vaccines (at least, for children) due to a lack of direct benefit and obvious harm inflicted on growing children bodies. Apparently, common people have very different opinions too.
An attempt to bring the debate into the plane of bioethics does not promise to lead to a consensus. However, we hope that such a discussion will give authors a chance to express balanced views on what is happening in medicine, public health and society in relation to the vaccine issue. We are also planning to bring these views to the notice of the Russian Ministry of Public Health and Social Development.