Is vaccination a class/wealth issue?

[Pirogi]

With the information in another thread on the measles vaccination campaign in SE Asia between 2000-2008 that dramatically decreased the incidence of measles-related deaths in those countries, I started thinking ... has vaccination become a wealth/class issue? It's hard to argue with the numbers in this particular case - a decrease from 750,000 deaths to 164,000 deaths worldwide after the measles vax campaign. There were confounding factors (?) ie, campaigns to provide vitamin A, which decreases measles deaths. Still, can someone argue that the vaccination had NO EFFECT on bringing down the death rate?

Of course, I don't believe that those data should be pushed in US vax campaigns because our worlds are completely different. We have clean water, sanitation, nutrition, access to quality primary health care, no immediate threat from war, more equality in gender relations, etc, whereas "they" may not. I also believe that growing up and living in this system may build "healthier" adults that can withstand more, even when traveling to poorer areas. Simply, I believe that our risk from many diseases is very small in this country, and vaccination, while important in other times/places, is no longer quite so important here.

Do others feel this way? If so, how do you process this? We know the potential risks associated with vaccination, and because of our wealth/global class, we can choose to forego vaccination without much risk of harm. Other people in other countries probably should NOT make the decision to forego vaccination because the specific risk scenario in their country is different. I don't know about anyone else, but this makes me feel ... really crappy. I, a white American female, richer than the majority of people on the planet, choose to protect my child from the possible risks of vaccination, but I support injecting toxins into other, less wealthy people?

[Annie Mac]

I think it comes down to a basic risk/benefit equation. When you live in an area where the risk from the vax is much less than actually contracting the disease, the choice is simple. North American families have different risk factors to consider. And yes, that is ultimately down to wealth differential between the countries, not necessarily the individuals.

[Xerxella]

I agree with what Annie Mac said. For every vaccine, for me, it comes down to a risk/benefit analysis. If there was a small pox outbreak in the US, I wold get my children vaccinated. The risk of the disease is greater than the risk of the vaccine, IMO. If my family was going to live in SE Asia, I would get everyone vaccinated.

In some ways, vaccines are already a class issue. Statistically, the unvaccinated in the US are middle class and educated.

[Turquesa]

Originally Posted by Xerxella

In some ways, vaccines are already a class issue. Statistically, the unvaccinated in the US are middle class and educated.

Moreover, I've noticed that two of the poorest states in the nation--WV and MS--have the most draconian vaccine laws, (i.e. medical exemptions only, and even those are supposedly really tough to get!)

I also remember when I lived in Mexico and there was an OBSESSION among public health authorities with targeting poor populations for vaccination.

It's all anecdotal, and there's no way to qualify what I'm saying. But I've often wondered if it's fear and prejudice of poor people that drives a lot of the more extreme vax campaigns. There's a long-upheld stereotype that the poor and homeless "spread diseases." Actually, it's the crappy water and living conditions that spread many of those diseases, (while other diseases, such as small pox and measles, don't care what tax bracket you're in), but it's so much easier to patch over the problem with vaccines than to take serious steps to lift them out of poverty.

[caned & able]

Please think the issue through.

These UN, Peace Corps and similar groups go in to refugee campa and other impoverished third world areas, burn the affected bedding and upholstery, wash the people and clothes, provide clean water and irrigation, wash the pots and pans, provide clean eating utensils, teach hygiene, demonstrate proper cleaning techniques, teach nutrition, provide vitamins to the malnourished, and many other useful living practices that improve the people's living standards.

And then everyone is put in a queue for vaccines that are brought in.

And what gets the credit for the long term improved living standards?

Do vaccinations really deserve all of the credit that they are given?

What if one group was cleaned up with the vaccines and another group was cleaned up the same way and not given vaccines and the outcomes compared? That would be an excellent study that should be done but never will be done because the vaccine manufacturers are not interested in a study that may show that the vaccines are not as effective as is commonly claimed.

[Turquesa]

Originally Posted by caned & able

Please think the issue through.

Are you saying that I didn't? I happen to agree with your post:

it's so much easier to patch over the problem with vaccines than to take serious steps to lift them out of poverty.

ETA: There are definitely non-profit charities working hard. But the only POLICIES that that may go into place involve vaccine distribution and not fair wages, taxes funding clean drinking water, etc.

[ema-adama]

I do not think there is an easy, straightforward answer to this question.

I do think that there are issues that are not openly discussed regarding relying on vaccination as something being done to help people who live in poverty.

Central to the discussion is this question (IMO anyway):

How sustainable is the vaccine solution?

For instance, with measles. When mass vaccination is initiated, it leaves the next generation more at risk as women who are relying on vaccine immunity have lower antibody titres to pass across the placenta, leaving already vulnerable infants more vulnerable.

Through introduction of mass vaccination, society comes to rely on the vaccine for immunity, and requires boosters.

Provision of services to administer the vaccines is also challenging. Very limited health resources are used in initiatives to provide vaccines, or donated money supports these initiatives (again raising the questions of sustainability). Often this is the only contact a child has with medical professionals. Receiving a vaccine when the mobile clinic comes to the village. Children who might need other medical care or who are starving cannot have their needs met by a mobile clinic trained and equipped to deliver vaccines.

Injected vaccine carry the risk of contaminated needles being used.

In the developing world the storage of vaccines is challenging. This can affect the safety and efficacy of the vaccines being delivered.

Also, when the numbers of deaths prevented by measles vaccine are counted, it does not necessarily reflect lives saved. A child who has enough stacked up against him or her (as in is malnourished, no access to medical care, living in a war zone etc) is also likely to die because of pneumonia or diarrhea from other causes. Children living in poverty do not die from the rash or fever associated with measles - they die of the complications that arise when a malnourished child contracts measles.

I am not saying these reasons nullify any benefit that could be gained by vaccinating. I am saying it is not black and white.

I know that I would put my time and money into programs to alleviate poverty rather than into a vaccine drive. I have been there, done that. I know exactly what goes on in developing communities. I have seen the programs in action, and it did not leave me with a warm fuzzy feeling.

Yes, great minds are working to find a solution to alleviating the suffering of those living in poverty. But it is not as simple as a great mind finding the solution. Top down decision making for other communities with vastly different values and social structures has it's own pitfalls.

I have not seen successful projects where an outsider walked in and told the community they need 'x' and gave it to them and it was sustainable. It just does not work like that.

[caned & able]

For instance, with measles. When mass vaccination is initiated, it leaves the next generation more at risk as women who are relying on vaccine immunity have lower antibody titres to pass across the placenta, leaving already vulnerable infants more vulnerable.

This is a problem that many top researchers are quietly concerned about and they envision the year 2040 as a peak.

[EdnaMarie]

These UN, Peace Corps and similar groups go in to refugee campa and other impoverished third world areas, burn the affected bedding and upholstery, wash the people and clothes, provide clean water and irrigation, wash the pots and pans, provide clean eating utensils, teach hygiene, demonstrate proper cleaning techniques, teach nutrition, provide vitamins to the malnourished, and many other useful living practices that improve the people's living standards.

I'm going to go out on a limb and suggest that you have very little experience with what is going on in aid and development, based on what you wrote.

Burning bedding?

Please no lectures on international development unless you've worked in it. If you think there is a single person involved that says, "Oh, don't bother with clean water, we'll just vax 'em all," you are dead wrong. I mean, there's no vaccine for giardia! But sometimes, there IS NO WATER. Nothing more than the bare minimum for survival.

And if you want to give up your car and your clothes for their water, great.

Someone has to pay for that water, though. Who's lining up to do it?

[Otto]

Originally Posted by caned & able

This is a problem that many top researchers are quietly concerned about and they envision the year 2040 as a peak.

Cite?

[caned & able]

Apologies, wrong date, it is 2050.

American Journal of Epidemiology (1984 – Vol. 120, No. 1: 39-48)

<Quote:>
“A computer model was created to study the effect of the measles elimination program in the United States on the number of susceptibles in the population. The simulation reveals that in the prevaccine era, approximately 10.6% of the population was susceptible to measles, most of whom were children less than 10 years of age. With the institution of the measles immunlzation program, the proportion of susceptibles in the population fell to 3.1% from 1978 through 1981, but then began to rise by approximately 0.1% per year to reach about 10.9% in the year 2050. The susceptibies at this time were distributed evenly throughout all age groups. The model did not consider the potential effect of waning immunity.” <UnQuote>

also

http://www.medbroadcast.com/health_n...hannel_id=1000
http://www.cdc.gov/vaccines/pubs/pin...loads/meas.pdf

[caned & able]

Originally Posted by EdnaMarie

I'm going to go out on a limb and suggest that you have very little experience with what is going on in aid and development, based on what you wrote.

Burning bedding?

Please no lectures on international development unless you've worked in it. If you think there is a single person involved that says, "Oh, don't bother with clean water, we'll just vax 'em all," you are dead wrong. I mean, there's no vaccine for giardia! But sometimes, there IS NO WATER. Nothing more than the bare minimum for survival.

And if you want to give up your car and your clothes for their water, great.

Someone has to pay for that water, though. Who's lining up to do it?

You are missing my point, but that is OK. I have worked in these situations. Bedding is whatever someone sleeps on, it does not have to be a mattress. Someone pays for the vaccines, so why not the water and irrigation system? That would be a better solution in the permanent, big picture, long term.

[amnesiac]

I am returning this thread for now. Please remember to remain focused specifically on the vax issues. This is not the appropriate place to debate other activities performed by aid & relief agencies or to discuss strategies to improve global heath so please continue those discussions via PM or post a new thread in the appropriate forum.

[Karamom]

I really don't believe vaccines are good for even the 3rd world. Better access to food, clean water and better hygiene is the only way IMHO.

[noobmom]

Originally Posted by caned & able

Apologies, wrong date, it is 2050.

American Journal of Epidemiology (1984 – Vol. 120, No. 1: 39-48)

<Quote:>
“A computer model was created to study the effect of the measles elimination program in the United States on the number of susceptibles in the population. The simulation reveals that in the prevaccine era, approximately 10.6% of the population was susceptible to measles, most of whom were children less than 10 years of age. With the institution of the measles immunlzation program, the proportion of susceptibles in the population fell to 3.1% from 1978 through 1981, but then began to rise by approximately 0.1% per year to reach about 10.9% in the year 2050. The susceptibies at this time were distributed evenly throughout all age groups. The model did not consider the potential effect of waning immunity.” <UnQuote>

also

http://www.medbroadcast.com/health_n...hannel_id=1000
http://www.cdc.gov/vaccines/pubs/pin...loads/meas.pdf

From that abstract, it sounds as if the models say that measles suspectibility will return to prevaccine levels in 2050. The difference is that the 10% will be spread among all age groups instead of just children under 10. Although that's not great, it certainly is no worse then if the vaccine had never been introduced, unless I'm missing something?

[Otto]

Originally Posted by noobmom

From that abstract, it sounds as if the models say that measles suspectibility will return to prevaccine levels in 2050. The difference is that the 10% will be spread among all age groups instead of just children under 10. Although that's not great, it certainly is no worse then if the vaccine had never been introduced, unless I'm missing something?

There's a spin-off thread here, if anyone's interested.