By Hillary Whonder-Genus
Whonder-Genus is board-certified pediatrician and medical director at the Virginia Premier Neighborhood Health Center in Roanoke.
As I read Dr. Bauer’s Op-Ed article, “All vaccines are not equally safe and effective” (Roanoke Times, July 11, 2019), I wondered if I had missed something in my decades of care as a pediatrician. I clearly remember the day I took the Hippocratic Oath, promising to “first do no harm.” Was I doing something wrong in my duty to ensure public health and safety by recommending vaccines to my patients? Vaccines have been proven to eliminate diseases that for generations caused much morbidity and death. Was Dr. Bauer right to imply that physicians around the world had been duped and turned their backs on that primal principle of do no harm, thus destroying the credibility of front line practitioners who tirelessly work to create trusting relationships with their patients? I would emphatically say no!
No doubt vaccines bring some risks along with the well-documented benefits. Proper vaccine consent includes a discussion of such risks and benefits. Since no practitioner can say with 100% certainty that any vaccine is totally safe for every individual, the informed parent makes their decision to vaccinate based on the trust they have nurtured with their practitioner as well as knowledge of the risks, benefits and the patient’s medical conditions.
Vaccine safety and efficacy is well studied through clinical trials and post marketing Adverse Events (AE) reporting. With these well documented, evidence-based studies, world regulatory agencies are able to confidently license and encourage national vaccination programs that have eradicated diseases such as smallpox, polio and until recently, measles.
The HPV program is on track to eliminate, or at a minimum, significantly decrease the world burden of HPV-related cancers. Early signs of its success in Australia is documented with a 77% reduction in HPV types responsible for almost 75% of cervical cancer and a 90% reduction in genital warts in heterosexual men and women under the age of 21 years (Cancer Council Victoria). As cancers usually develop over 10 years or more before detection, the role of the vaccine in reducing cervical cancer will not be evident for some time. International researchers are currently performing long term follow-up efficacy studies that will produce the critical evidence of HPV vaccine longevity of protection and the ultimate decline in the incidence of HPV-related cancers (Luxembourg A, 2017).
Let’s address Dr. Bauer’s concerns of vaccine harm from thimerosal and aluminum by looking at the facts. Yes, high doses of methylmercury (found in the body after long-term exposure through the consumption of certain fish and other foods) are toxic to the brain. Ethylmercury, a very different molecule, is a byproduct of thimerosal breakdown. Low level ethylmercury exposures from vaccines in multi dose vials was further decreased with the manufacture of a single dose preservative free formulation. Today no childhood vaccine used in the U.S. – except for some formulations of flu vaccine in multi-dose vials – use thimerosal as a preservative (Center for Disease Control, 2013). The World Health Organization also concurs that “there is no evidence to suggest that the amount of thimerosal used in vaccines poses a health risk (World Health Organization, 2011).
Adjuvants are commonly used in drug manufacturing to modify the effect of other agents. It is used to boost the body’s immune response to a vaccine so that more antibodies and longer lasting immunity can minimize the dose of antigen needed. In large doses, inorganic aluminum has been found to be toxic. Studies have shown that the aluminum containing adjuvants in HPV-4 have not shown toxicity or even the capability of stimulating an excessive harmful immune response.
The HPV vaccine is one of the most widely-studied vaccines with regards to safety and efficacy. While no one can predict who will have an adverse effect, the Vaccine Injury Compensation Program (VICP) has been set up to appropriately review and compensate those who have experienced an adverse effect from vaccination. To assume that the settlement of 49 cases implies proof that vaccines are not safe is incorrect. Countries around the world continuously re-evaluate vaccine safety and there are unequivocal endorsements from medical, regulatory and governing bodies that vaccines, including the HPV vaccines are safe and important to general public health and well-being.
Medicine continues to evolve. As practitioners endeavor to individualize care plans for their patients, let us remember to first do not harm while ensuring that those who are at risk, remain protected from preventable diseases. Let us keep focused on the available evidence and not get swept away with fear of the unknown.