Wednesday, October 22, 2014

The Next Big Epidemic - Anti-Vaccination ?



I have already taken on the Ebola scare and in doing so I seem to have stirred up a bit of trouble for myself.  It seems that there is a significant number of people who are still "anti-vaccine".  Although I had heard of this movement in light of news stories on autism issues, I was not aware just how broad the movement truly was.  It is a movement with a long and storied past. The 1802 cartoon above entitled "Cow Pock - or - the Wonderful Effect of the New Inoculation!" is an early example of public fear of vaccination.  Cow heads protrude from the recipients noses, arms, legs and rear ends.
But for me this movement is not just a historical curiosity, it hits much closer to home.

As a museum director dealing with 19th century medicine, prevention of diseases like Smallpox is a major issue for me.  During the Civil War there was robust response to outbreaks of Smallpox and vaccination was a major part of that response.  But this is not the only reason for my interest in preventative vaccination and inoculation.  My father had Polio as a child.  For my entire life, I never saw my father raise his right arm; that part of him never came back.  Later in life my father suffered from post-polio syndrome  Although both of his parents lived well into their eighties, my fathers lungs failed at age 72.  I watched polio slowly take my father back; weakening his muscles, taking his breath, slowing his pace.  He lived with Polio every day and I lived with my father's limitations and grandmothers words ringing in my ears: "always get your shots".

Growing up in the 1960's I can still remember getting my shots: Tetanus, Rubella, Smallpox, etc.  I also remember swallowing the oral Polio vaccine.  My grandmother once quizzed my mother asking if I was getting all my shots.  She related, with deep pain, a story she often told.  In 1955 when the Polio vaccine was made public,  my grandmother went to every door in her neighborhood begging the parents to get their children vaccinated.  One mother, whose daughter was a close friend of my father, refused.  My grandmother begged and pleaded, but no response.  Within one year her daughter was dead from a disease that is now nearing eradication.

Rebellion against vaccines is  nothing new.  The cartoon above shows peoples fears of Cowpox inoculation to prevent Smallpox.  In 1796 Edward Jenner developed this method with great success.  This first scientific attempt to control infectious disease would give credibility to the procedure and begin a world-wide effort to control other diseases as well.   Benjamin Jesty later vaccinated  his children successfully against Smallpox during an outbreak where they were regularly exposed to the disease.  They remained disease free. This first vaccination changed our world.

Now I am not one to set aside all fears of this life saving procedure.  There are certainly dangers in vaccination and history has shown this.  During the Civil War, vaccination using pulverised scabs of those either vaccinated or healing from mild cases of Smallpox, resulted in complications such as passing on Syphilis!! Such "spurious" vaccination was a known problem and much effort was was put forth after the war to make sure that such problems did not occur again.  And it worked.  Safer methods were developed and , like Polio, Smallpox is no longer the scourge it once was.

It is this point that brings me back to the beginning.  As I read the Facebook pages and websites of anti-vaccination proponents, I was surprised at many of their arguments. I posted a response on one article and was told that the reason Polio went away had nothing to do with vaccine, it had to do with improved water sanitation.  My problem with this argument is that water sanitation did not improve that dramatically between the 1952 record setting Polio outbreak and the 1955 vaccination effort.  Between 1955 and 1957 there is an 85-90% drop in polio cases.  The only substantial difference in frame was the introduction of vaccines, not a massive effort to build new water treatment plants.  The same can be said of many other diseases such as Smallpox.  Their disappearance coincides with effective vaccination efforts.

I am sure that some people have negative reactions to vaccines.  Just as some patients have complications from general anesthetics, joint replacements and aspirin.  If autism, which is so often blamed on vaccines, is on the rise, then why was it not on the rise from 1955 to 1970?  This is when so many of our vaccines were developed and given.  Some blame Thimerosal  ,but this ingredient is no longer in general use.  I cannot say whether there is a connection or not.  But I can say this: vaccination has helped control or eradicate some of the most dread diseases known to man.  Unfortunately, the next epidemic may come from something we already conquered but came back because we would not take the vaccine.

I do not get paid by pharmaceutical companies, I am not paid by insurance companies either.  I am not a lobbyist.   I am s simple historian who can read and understand historical events.  I am also a witness who saw my father die because a vaccine was still six years away.  And,  I am a father and grandfather.  I do not want to see us return to a world where Yellow Fever, Whooping Cough, Smallpox, Polio and Rubella come back to haunt my grandchildren.  I look forward to a world where Ebola can be eradicated as well....but only if we are willing to take the vaccine when it comes about.


Monday, October 13, 2014

Ebola Lessons from the Civil War



Like so many Americans these days, I am deeply concerned with the spread of Ebola.  I have been following the stories of efforts to control the disease in Africa as well as the stories of patient's right here in the US.  I have listened to pundits, doctors, politicians, social commentators, social activists and news anchors push each of their views.  My conclusion, we will not get a handle on Ebola until we stop the politicizing of the issue.

We should not really be surprised, in this day and age we politicize everything.  And not just politicize, we blame anyone who can take the spotlight off the real issue.  The Democrats are blaming the Republics for the Ebola spread and I am sure Republics somewhere are blaming Democrats.  Jesse Jackson Sr. is involved claiming sub-standard care for Mr. Duncan who recently died in Dallas. Some nursing advocates are blaming the hospitals and the CDC for a lack of training. Some are even blaming  the CIA and white demon worshipers for spreading Ebola . All of this confuses the issue and makes getting the epidemic under control harder.

As the director of a medical museum I am confronted daily with the history of past mistakes and successes in dealing with public health issues.  To be successful, we need to rely on the medical professionals, scientific research community and government authorities to do their jobs.  This is very hard in the current political environment and harder still in a 24 hour news cycle.

The Civil War gives us some insight into doing this the right way.  If we think that we politicize today, we are slackers compared to our ancestors from the 1860's.  Yet, they too were going through a massive public health crisis as they went through the war.  More soldiers died of Typhoid Fever  and Diarrhea than bullets.  Many thousands more were overcome by venereal diseases. These diseases not only attacked soldiers, but in the aftermath of battle they also attacked local civilian populations with disastrous consequences.  Yet, despite the outcry and ridicule of the military medical establishment by the  press and politicos, science succeeded.

During the Civil War, sanitation in the camps dramatically improved thanks to both military officials and organizations like the US Sanitary Commission seriously improving general health and cutting deaths from disease.   Army  officials began public health efforts to license prostitutes in Nashville and create medical examinations and special venereal hospitals in order to cut the spread of STD's with very good results. Dr. M. Goldsmith used blind studies to bring gangrene under control in Union hospitals with dramatic results.  Dr. Jonathan Letterman developed a system of emergency medicine and ambulance based evacuation that is the basis for emergency medicine today.  These and many other innovations came out of medical system in crisis that overcame the crisis to save countless lives and began a tradition of military medical excellence that continues to this day.

For those attacking our nation for sending military medical professionals into Africa, I must disagree.  Our military is equipped to fight this battle.  Ebola and other diseases have been on the radar of the military for years.   They have the labs, the equipment and the training to treat and slow the spread of the disease. They have over 150 years of success in fighting major diseases.  From the Civil War struggles with Typhoid, Smallpox and Dysentery, and the  Yellow Fever work done by Dr. Walter Reed to the current work by the U.S. Army Medical Research Institute of Infectious Diseases, our military medical professionals have proven themselves again and again.    In fact, they may be the most qualified responders in the world today.

I realize that I am likely a voice crying out in the wilderness, but, we need to keep informed, ignore the hype and filter what we hear in the television and radio very carefully.  We cannot allow ourselves to be sucked into the panic that our politicos, activists and news media would wish.  They have an agenda - get ratings and votes.  We have a much more important agenda - stay alive.   In order for us to do that, we need to let science and medicine lead the way.