BORN in 1949, I was a generally healthy child, apart from experiencing several of the then common communicable diseases of childhood – as an infant I had whooping cough and in primary school hepatitis A, mumps, chicken pox and measles. Each of these diseases can kill or cause serious complications for some of the children who catch them. At that time, none of these illnesses could be prevented by vaccines.
The sickest I have been as an adult was with a severe bout of dengue fever in 2009 – I felt like I could have died but, with good supportive nursing and medical care, obviously I didn’t. While this disease does not yet have a vaccine that has been proven both safe and effective, mosquito management and other public health measures are keeping it under control for now in northern Australia.
In the mid-1950s, our entire primary school in Canberra was lined up for the injected polio vaccine because the whole community was frightened by an epidemic of “infantile paralysis” (poliomyelitis) that was sweeping through many countries. You may have seen the old black and white photos of iron-lung breathing machines.
In 1949, about 4% (one in 25) of children born in Australia died before the age of 10 years. The latest Australian Bureau of Statistics data from 2017–2010 show that less than 0.5% (one in 200) of all children die before the age of 10 years.
A significant proportion of this dramatic improvement is due to the prevention of communicable diseases by vaccination.
So, apart from we older persons, most people alive today have no memory of what it was like to be sick with a potentially life-threatening contagious illness. Few of us understand the experience of watching sick relatives struggle, and perhaps die, from what has now become a preventable disease. But suddenly, death from COVID-19 is on every television screen and we are being dragged back from worrying about the potential side effects of vaccines to the realities of life without them.
Vaccination works for two reasons. First, an effective vaccine for a particular illness reduces the risk of most individuals of catching and/or getting sick from that disease.
The second reason is that vaccinations stop epidemics by halting transmission. If one person develops a disease in a community where most people are immune, either because they have been vaccinated or have already had the disease, it is unable to spread rapidly and widely through the community. Fewer people are infected and other measures such as quarantine are more effective. This is what is known as herd immunity.
Herd immunity protects those people who do not or cannot develop immunity because they have a disease or a treatment that stops their body from responding to the vaccine – they are immunocompromised. Others may be unable to have a vaccine because they have a known true allergy to one of its components. Such people rely on the rest of us being vaccinated to protect them from the spread of disease within our community.
However, if too few of us agree to be vaccinated and our community fails to achieve herd immunity, epidemics can re-emerge. Then all unvaccinated and vulnerable people are unprotected.
In 2019, a measles epidemic killed over 80 children in Samoa after vaccination rates fell (here, here and here). Cases of whooping cough increase in infants too young for vaccination when adults refuse vaccination for their slightly older children. These are the reasons health care workers and governments encourage immunisation.
Indeed, those who choose not to accept vaccination without a valid medical reason can get a free ride as they are protected by the vaccination of others, but only when most of the rest of their community accept vaccination.
Many people have expressed concern about the safety of vaccines for COVID-19. Vaccines against COVID-19 cannot cause COVID-19 because they do not include the information necessary to make a whole virus.
Around the world, many millions of people have been vaccinated against COVID-19 and, even including the very small numbers of cases of serious blood clotting, reports of severe reactions are very rare.
Some people report minor local discomfort at the site of the injection and others have flu-like symptoms for a day or so. It is also very important to realise that when millions of people are being vaccinated every day, some will, by coincidence, become ill from other diseases on that or subsequent days.
Others have expressed the view that they are old or have a life-limiting illness and would prefer to let nature take its course. This is a valid expression of personal values and the right to make choices. At the same time, it is important to remember that because we live in communities, a person with COVID-19 poses a threat to those who care for them, their family who visit, and, in the case of the residents of aged care facilities, other residents.
We must respect the difficulty of decision making in such circumstances which reflects the need to find a balance between our rights and our responsibilities – the rights of the individual to choose which medical interventions they will accept and the responsibility that we all have to act in the interests of the all the individual members of our community, upon which we all depend.
As a doctor, I have always described decision making about the risks of many of the activities of daily life, and particularly whether to accept a particular medical risk, as being based on an understanding of the balance of risks. If, for example, I were talking with a patient who had appendicitis I would discuss the low risks of the surgery and the anaesthetic against the higher risk of them not having their appendix removed. I will accept the known risks of cataract surgery in order to improve my vision and quality of life. I drive to visit family even though there is a risk of being killed on the highway, but “if it’s flooded, forget it”. These are calculations that we make every day.
COVID-19 vaccination has a very low risk and a broad range of benefits.
At 71, I am a “1b” in the prioritisation for a COVID-19 vaccine. Early last week, before the latest advice, I accepted my first dose of the AstraZeneca vaccine. I would have made the same decision this week, and for several reasons:
- because I feel that I have a moral and civic responsibility to contribute to the wellbeing of the community to which I belong;
- to protect myself from getting sick and possibly dying, and because I am a carer myself;
- to reduce the risk that I might transmit COVID-19 to my family, friends and colleagues who work in health care; and
- because I would like to be able to re-engage in the activities that have been curtailed by COVID-19 and will likely be permitted sooner as a consequence of a successful vaccination campaign. Without vaccination we will, for a long time, remain unable to travel to visit family and friends in other places, and they can’t visit us.
Without a broad uptake of the vaccine, COVID-19 will eventually just have to run its disastrous course across our community, as we have seen in the UK, the US and many other places. With vaccination leading to herd immunity, we can protect many people from dying, restore the social connections that are at the heart of our being, avoid the damage to the health care system that has been seen in many other countries, and start to repair the damage that has been done to so many businesses and the lives of people who work in them.
In the 1950s and 1960s, few parents refused to have their children vaccinated. They had experienced the risks first hand and were hugely relieved when science offered a way to minimise the clear dangers of at least some infectious diseases. We need to remember the lessons of our not so distant past and consider what we are seeing elsewhere in the world.
One of the most significant individual contributions that most of us can make to the lives and security of all the members of our community is to get vaccinated against COVID-19.
Dr Will Cairns OAM is a Consultant Emeritus Palliative Medicine at Townsville University Hospital.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.