A needed shot in the arm?: Despite disease worries, many resist the idea of vaccination

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Marc Meyer is director of pharmacy services and infection prevention for Southwest Health System.

Marc Meyer is director of pharmacy services and infection prevention for Southwest Health System.

The thought of a needle piercing your skin and pushing a foreign substance into your body is unnerving to a lot of people.

Of course, we all put foreign substances into our bodies on a daily basis – by eating – but that seems natural, whereas needles do not. People have to overcome their in­stinctive negative reaction to needles in or­der to get vaccinated. Both locally and state­wide, many don’t do so, particularly when it comes to vaccines against COVID-19.

“This is sort of an anti-vax area,” Marc Meyer, director of pharmacy services and infection prevention for Southwest Health System in Cortez, told the Four Corners Free Press. “Interestingly enough, I would con­sider Colorado an anti-vax state.”

Statistics for the 2017-18 school year had Colorado with the lowest rate in the nation for kindergarteners’ vaccinations against measles, mumps and rubella, according to the Centers for Disease Control. Eighty-nine percent of Colorado’s kids had re­ceived the MMR vaccine, against a nation­wide median of 94.3 percent.

In most states, parents can receive an ex­emption for their children being vaccinated for school if they cite religious reasons. Ac­cording to 2016-17 data on the Colorado Department of Public Health and Environ­ment website, the Montezuma-Cortez Re-1 school district had an overall vaccination rate of 91.4 percent, with an exemption rate of 7.9 percent. The Dolores Re-4A school district was at 92.8 and 7.2 percent. Those numbers put the districts somewhere in the middle of the pack statewide.

As long as the percentage of children who do get vaccinated stays high, there’s little danger to the unvaccinated, because “herd immunity” has been achieved.

The concept is somewhat similar to that contained in an illustration the Colorado Springs Gazette newspaper used to run fre­quently on its opinion page. The graphic depicted one or two people trying to pull a wagon loaded with other people. The mes­sage was anti-socialism, saying that if too many folks expect a free ride, there won’t be enough left to pull the wagon, but it could also be applied to vaccinations. As long as just a few people want a free (unvaccinated) ride, all is well, but if too many jump on board, the system collapses.

That concern is being raised about the current effort to quell the COVID-19 pan­demic.

Smallpox

More than a century ago, an outbreak of smallpox in the city of Boston raised a furor over the ethics and efficacy of vaccinations that has similarities to the debate going on today over vaccinations against COVID-19.

Smallpox was a horrific disease that killed about 30 percent of its victims and left many survivors with permanent, disfiguring scars.

From 1901 to 1903, 1,596 known cases of smallpox were seen in Boston, which at the time had a population of more than half a million. According to an article pub­lished in the New England Journal of Medicine in 2001 marking the hundredth anniversary of the breakout, 270 people who contract­ed the disease in the city died – a fatality rate of 17 percent.

About half the pa­tients had been vacci­nated and 11 percent of them died of the disease, while 22 per­cent of the unvacci­nated died, according to the article.

The vaccine against smallpox was devel­oped by Dr. Edward Jenner in the late 18th century after he noticed that people who’d contracted a similar but milder disease, cow­pox, seemed to be resistant to smallpox. It was the first actual vaccine to be created to fight a contagious disease, though people around the world had for centuries been immunizing themselves against smallpox by breathing in powdered smallpox scabs or similar methods.

Many Bostonians voluntarily got the vac­cine in 1901, but others chose not to, lead­ing the city’s Board of Health to order that everyone be vaccinated or face a fine or jail time. Many citizens saw this as a violation of their civil rights.

In January 1902, according to the NEJM article, one doctor who contended that healthy people were not at risk for get­ting smallpox and who had refused vacci­nations all his life asked to visit a hospital of smallpox patients. He was allowed to do so, ac­companied by some vac­cinated phy­sicians. Two weeks later, he became gravely ill with smallpox (he eventually recovered). None of the vaccinated doctors got sick.

But oppo­sition to the vaccine man­date contin­ued, though even those opponents admitted the one doctor’s visit to the smallpox patients had been foolish. A legal challenge against the Cambridge Board of Health went all the way to the U.S. Supreme Court, which in 1905 ruled 7 to 2 that laws mandating vaccinations were legal in order to protect the public from a com­municable disease.

Vaccinations continued and in 1903, the Boston outbreak was considered to be over.

A worldwide battle was launched against smallpox, through vaccinations and the quarantine of people who had the disease. The last case of smallpox in the United States occurred in Texas in 1949, the last in the world in Somalia in 1977 (except for two cases resulting from lab contamination in 1978). The deadly disease has been wiped out.

Old Yeller

Vaccines have so changed the landscape for human beings that it’s difficult for many people to imagine the world as it was before they were developed.

Children regularly died of diphtheria, ru­bella, even measles. People died of tetanus from puncture wounds. Rabies epidemics among animals, as vividly depicted in the children’s classic Old Yeller, posed grave dangers to humans before pets were rou­tinely given rabies vaccinations.

The Spanish flu of 1918 and 1919 (a misnomer, since it didn’t originate in Spain) killed tens of millions of people, perhaps as many as 100 million — many of them young and healthy, with no pre-existing conditions. There was no vaccine available against it.

The fact that people in much of the world are healthy today is not so much the result of good diets and plenty of exercise, though those certainly help, but because of advances in medicine – particularly vaccina­tions. According to the CDC, more than 15,000 Americans died from diphtheria in 1921, before a vaccine against it existed. “Only two cases of diphtheria have been reported to CDC between 2004 and 2014,” the CDC says on its website.

Older people among us bear scars from smallpox vaccinations and remember the relief and joy that greeted the arrival of po­lio vaccines.

But vaccines are not completely without risk. Every year while smallpox vaccines were being given, six to eight people died of complications from the shots, according to the NEJM article. It’s a tiny number versus the overall mortality rate from the disease, but it wasn’t tiny for those few victims. So in 1971, routine vaccinations against smallpox were ended in the United States, because the disease was no longer occurring here.

Childhood diseases

Then, as other childhood diseases were virtually eliminated, many parents began wondering why they were still necessary.

In 1998, an article published in the Lancet medical journal posited a link between the MMR vaccine and autism. The journal later retracted the article, saying it was based on false conclusions, and the American Acad­emy of Pediatrics cited numerous studies that had found no link between the vaccine and autism, but parents were understand­ably worried and the number of people seeking exemptions for their children from vaccine requirements increased.

That has led to sudden sporadic out­breaks of diseases that seemed to have van­ished. In 2013, Texas saw nearly 4,000 cases of pertussis (whooping cough). In 2015, measles – which in 2000 had been declared eliminated from the United States – broke out at Disneyland in California and spread to 147 people before it was contained. Most of the people who came down with the dis­ease had not been vaccinated against it.

There were 1,282 confirmed cases of measles cases in 2019 in 31 states, accord­ing to an article by Fox 10 News in Phoenix. That number plummeted to 13 cases na­tionwide in 2020, as the pandemic kept chil­dren out of schools and socially distanced.

There have been cases of whooping cough in Montezuma, Archuleta and La Plata counties in recent years; there were more than 40 in La Plata County in 2015.

The CDC recommends that adults have booster shots against pertussis every five years.

“La Plata and Montezuma County do tend to have whooping cough,” Meyer said. “We recommend the DTaP (diphtheria, tetanus, and pertussis vaccine). Adults are probably the reservoir for pertussis because many aren’t getting that vaccine for years.”

To help guard against that, the hos­pital doesn’t offer tet­anus-only vaccines. If people need a tetanus shot, they get the full DTaP vaccine.

Weighing the odds

The question for parents becomes one of weighing the very slight chance of a bad reaction to a vaccine against the chance of a child coming down with a disease that hasn’t been seen for some time.

Meyer said the vac­cines are the better op­tion.

“Vaccines are probably the medication category that has the least side effects,” Meyer said.

“Antibiotics and car wrecks are probably two of the biggest reasons kids end up in the hospital. Vaccines are much safer.

“The side effects are extremely low. Vac­cines are pretty well tolerated.

“We had this whole autism debate for years and I think it’s pretty much debunked. There are children that will develop some autistic-like diseases that may be triggered by fever.

“But we don’t have these epidemic of childhood diseases – smallpox, polio, group B streptococcus, chicken pox, measles, mumps, rubella. There still are outbreaks, though, because a few people aren’t vacci­nated.”

Rare side effects

Of course, the debate over the vaccines against COVID-19 has different aspects. Reluctance to be vaccinated against (it) COVID-19 is not confined to committed anti-vaxxers, though there is some overlap between anti-vaxxers and people who have doubts specifically about the coronavirus vaccines.

Many people are wary of the COVID shots because they were developed quickly and are being given under emergency au­thorization rather than with full approval by the FDA. The push to develop and test them came under the Trump administra­tion, though it was the Biden administration that launched an all-out effort to get the nation vaccinated. Donald Trump – who expressed sympathy for the anti-vax move­ment before the pandemic began – nearly died of the novel coronavirus and has since been vaccinated against it.

People fear the COVID vaccines may have unknown long-term side effects. Some believe the shots might somehow cause infertility. Others would rather take their chances with the coronavirus, saying their bodies will probably fight it off. And there are general libertarian sentiments against being vaccinated at the urging of the gov­ernment.

News reports about rare side effects of the Johnson & Johnson one-dose vaccines have contributed to worries. A small num­ber of women experienced major blood clots after the J & J vaccine, though the per­centage of people with clots was less than 0.003 percent of those given the shot.

The Johnson & Johnson vaccine has also been mentioned as a possible cause for Guillain-Barré syndrome, a reaction in­volving numbness, weakness, and pain that usually goes away but can cause long-term problems. The rate of those coming down with Guillain-Barré syndrome after receiv­ing the vaccine is about 0.008 percent, according to various reports. However, people can also get Guillain-Barré without receiving any vaccines, simply as a reaction to viruses and fevers.

“Guillain-Barré is extremely rare,” Meyer said “The natural cases and the cases associ­ated with J & J are relatively the same. Why J & J decided to include it in their data, I don’t know.”

He said he has never seen a single case of Guillain-Barré syndrome, whether resulting from a vaccine or a virus, but it was some­what more common a few decades ago.

Most of the vaccines administered in Montezuma County were either the Pfizer or Moderna vaccines, which haven’t been linked to blood clots or Guillain-Barré.

Both the Pfizer and Moderna vaccines require two doses to reach full effectiveness.

Delta takes over

The arrival of the Delta variant of the novel coronavirus has considerably changed the picture. One of about a dozen muta­tions of COVID-19 that are of particular concern, the Delta variant has proven to be highly contagious and potentially more seri­ous.

It has already become predominant in the local area, Meyer said.

“Delta dominates here. We’re having trouble getting results back [from tests] because they’re getting so many. We just assume somebody we see with COVID is Delta.” He said about 89 percent of na­tional cases and more than 90 percent in the Rocky Mountain region are the Delta strain.

Delta is believed to be dominant in La Plata and Archuleta counties, according to an article in the Durango Herald. The San Juan Basin Public Health Department did not return a phone call from the Free Press.

The Delta strain, first identified in India in December, has been a factor in a resur­gence of COVID-19 nationwide and lo­cally, along with a general loosening of re­strictions and a return to normal socializing.

According to statistics posted by the Montezuma County Public Health Depart­ment, Montezuma County had 465 active cases of coronavirus as of Feb. 10, just as the vaccines were beginning to be offered. By April the number of active cases in the county was regularly down to numbers in the 80s or 90s.

However, the number began climbing in May, just as the Delta variant was beginning to appear, and was up to 161 by July 14. It had declined to 99 as of the July 28 posting.

Bobbi Locke, director of the county health department, did not return a phone call from the Free Press seeking more infor­mation.

Meyer said the Delta variant will replace the Alpha variant. “It’s just more conta­gious. People get much higher viral loads early, so they’re more contagious, which is problematic.”

Since the end of April, Southwest Me­morial Hospital has consistently had one or two patients in the hospital with COV­ID-19, sometimes as many as four or five.

“We do fly quite a few people out to Den­ver, Colorado Springs, Grand Junction, or other places for specialized care,” Meyer said.

Not a single person has been admitted to the hospital because of a bad reaction to a COVID vaccination, he said, though there were three who had reactions of concern, most with nausea or vomiting.

“They were never admitted to the hospital tal. They were observed for a couple hours,” Meyer said. “There have been some people with fever or who were feeling awful for a couple days” after being vaccinated.

“It is a new vaccine,” he said, although the technology that produced the vaccines has been around for about 10 years. MRNA vaccines “teach our cells how to make a protein—or even just a piece of a protein—that triggers an immune response inside our bodies,” the CDC website says.

“You might even see an mRNA flu vac­cine this year,” Meyer said. “We’ve moved away from the egg-based flu vaccine be­cause there were some side effects.”

COVID-19 vaccines are about as effec­tive as MMR vaccines, Meyer said, “in the 85 to 95 percent range.”

By comparison, flu vaccines are only about 50 percent effective, partly because the egg-based flu shots take a long time to develop, so they have to be formulated according to researchers’ best guess about what flu strain will be dominant in the com­ing season.

Annual boosters?

At press time, the level of vaccinations was picking up nationwide, according to the Washington Post, because of concern about the Delta variant.

Vaccines aren’t a guarantee against get­ting the disease, the Post reported, as a sci­entific analysis published at the end of July found that three-quarters of people infect­ed during an outbreak in Massachusetts had been fully vaccinated. Researchers are saying vaccinated people appear to be able to spread the Delta variant.

However, the vaccines offer strong pro­tection against death and serious illness from coronavirus. Just 0.001 percent of vaccinated people have died of COVID, according to published reports, and just 0.004 percent of the vaccinated were hos­pitalized.

The Post reported that a CDC internal document estimated that 35,000 vacci­nated people a week in the United States were contracting breakthrough infections. This has led to a CDC recommendation that even the fully vaccinated wear masks if they are in an area of substantial or high transmission.

Meyer said about 15 percent of peo­ple tested for COV­ID-19 by Southwest Memorial Hospital test positive, which is a high rate.

He said it’s likely that at some point, vaccinated individu­als will need booster shots.

“I’m sure we will have boosters,” he said. “I would almost bet we go to an annual COVID shot. I don’t think it’s ever going away.”

But vaccines offer hope that someday COVID will be manageable – no longer a raging pandemic, but a disease to be guard­ed against.

Meyer, who’s gotten flu vaccines every year, said that’s his hope.

“I’m obviously a big vaccine proponent, especially since we have the more modern vaccines now.”

People of all persuasions will almost always choose actions that benefit them­selves individually over measures intended to help society as a whole. Whether more individuals decide to be vaccinated against COVID-19 will largely depend on whether they see it as a good idea for their own health.

The CDC maintains that the vaccine is indeed a help to individuals.

“Getting vaccinated prevents severe ill­ness, hospitalizations, and death,” says the agency’s website.

“Unvaccinated people should get vacci­nated and continue masking until they are fully vaccinated. With the Delta variant, this is more urgent than ever.”

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From August 2021.