Immunisation- Should I, or shouldn't I?
Most parents have this recurring and nagging concern about how justified the vaccinations that they subject their children to are, especially regarding their effectiveness, safety and price. Let me try and address some of the important issues, point by point. (Dr. Naveen Kini)
Let me begin by trying to explain how vaccines work, as plainly as possible. The human body has the fantastic ability of mounting a defence against anything that it recognises as not belonging to the body, via its defence mechanism i.e. the immune system. Without going into the details, the immune system first recognises the foreign substance (antigen), processes it, and then produces its ammunition (antibodies) against the antigen. Next time the same antigen enters the body, the antibodies attack the antigen, and prevent it from producing its harmful effects.
In the context of immunisation, microorganisms (bacteria and viruses) are the antigens against which the body has to produce antibodies. The principle of immunisation is to introduce the virus or bacteria into the child’s body, either killed, or attenuated (suppressed so that it cannot cause disease, but can still stimulate the immune system), or as a subcomponent (only a part of the microorganism). The body takes about 1 month to start producing antibodies, and may need 2, 3 or 4 doses of the antigen before the protective level of antibodies is reached.Therefore, the introduction of antigens is done early in life so that by the time the child is actually exposed to the virus or bacteria, the body has already started producing antibodies, which nullify the efforts of the microorganism which is trying to harm your child. In other words, your child is adequately prepared and ready for a fight with the virus or bacteria.
Now coming to the common concerns:
1. Why does my child need to take so many vaccines?
While agreeing that it is not pleasant for parents to see their child poked so many times, like a pincushion, let me assure you that these vaccines are for your child’s own good. Most diseases are most deadly when they affect infants, and so it is all the more important that the little ones are given every possible help available to fight infections. Our aim is to see that by the time the child reaches the age of 6 months, around which time the child is increasingly taken outside the house and thereby more socially exposed and vulnerable, the child has an adequate level of immunity against common infections.
2. How effective are these vaccines?
No vaccine is 100% effective. Most range about 80% in effectiveness, some more and some less, so about 20% of the children can still get the disease against which they have been vaccinated against, but in a milder form. But still, having some protection is better than having no protection at all!
3. How safe are these vaccines?
Again, no vaccine is 100% safe. Some children can develop adverse reactions to vaccines. Thankfully the serious side effects are rare, and most of the distressing effects of vaccines are limited to pain, fever and sometimes vomiting, rashes etc. Media outbursts of fatal reactions to vaccines are mostly due to human error in administration, and not due to the vaccine itself. Moreover, the benefits of vaccination far outweigh the adverse effects, and no child should be denied vaccines on this count.
4. Do vaccines justify the cost?
Most vaccines take decades to develop, and companies that produce them spend billions of dollars on their development, and take years just to start breaking even. This is one of the reasons why only a few companies have actually ventured into vaccine development, and also for the high prices of some of the vaccines. But the cost incurred in actually treating a child unfortunate enough to contract a vaccine preventable disease is considerably more, and so a vaccine is a prudent health care investment. In fact, in the United States, cost-benefit analysis indicates that every dollar invested in a vaccine dose saves US$ 2 to US$ 27 in health expenses, and the scene is becoming increasingly similar in India.
5. Many vaccines are ‘optional’. Why should my child take them?
In a country like India, some of the vaccines are beyond the reach of a section of the population because of the high cost, and hence they were earlier categorised as optional. All vaccines are safe, quite effective and are routinely administered in most of the western countries. So if the price is not a constraint, I would strongly suggest that all presently available vaccines should be given to your child. No disease is worth suffering, and there should be no scope for regrets or soul-searching later.
6. Why is it that so many children fall sick in spite of taking all the vaccines?
Vaccines are organism specific, and do not confer blanket protection against similar diseases caused by other viruses and bacteria. For example, the pnuemococcal vaccine prevents pnuemonia and meningitis caused by the only the strains of pnuemococcus bacteria that are included in the vaccine, and not by others. Many deadly illnesses like Malaria, Dengue etc. still cannot be prevented by vaccination, and continue to take a heavy toll on the lives of children in our country.