Sep 13, 2017
The following article is taken from Lutte de Classe (Class Struggle), the magazine of Lutte Ouvrière (Workers Struggle), the revolutionary workers group active in France. Although it raises an issue that is being debated in France today, in effect the same issue is discussed here. The names may be different, but the arguments are much the same.
French Minister of Health Agnès Buzyn’s project to make eleven vaccinations mandatory for children under two years old by the beginning of 2018, in place of the three that are now required, has rekindled a debate about vaccination. Those opposed have gotten a hearing in the media and through the internet, while health institutions are striving to convince the public of the necessity of this measure.
Vaccination is an important tool in the fight against infectious diseases and has contributed to the decline in mortality, particularly among children. The current questioning of its use is a reflection of the loss in confidence in health authorities and the pharmaceutical industry, a consequence of the many scandals that have struck the recent history of the health system.
Although two hundred doctors have signed a petition in favor of mandatory vaccination, basing themselves on the resurgence of illnesses like measles and whooping cough, those who have gotten the most attention, particularly on the Internet, are the opponents of this measure. Last September 9th, the opponents of this measure who demonstrated in front of the Health Ministry in favor of “vaccinal freedom” numbered only among the hundreds, but those who say that they distrust vaccination in general or a particular vaccine are far more numerous.
There has always been a fraction of the population opposed to vaccination, whether because they believe it is dangerous, because it would threaten individual freedom, or because it would be opposed to nature. However, this current has gained increasing strength in recent years, campaigning actively on the web and on social media, to the point that it appears to certain people like an anti-establishment force, since it attacks the pharmaceutical industry lobby.
In the United States, the Anti-Vaxxer movement is particularly well-represented among the Republican Party, especially in certain states like Texas. Donald Trump made an effort during his entire campaign to pay lip service to anti-vaccine groups, with declarations such as: “Vaccination is the biggest medical imposture of all times”; or “I don't like the idea of injecting bad stuff into my body.” Donald and Melania Trump, who have not had all the recommended vaccinations given to their 11-year-old son, are now posing as heralds against the “tyranny of vaccine policy.”
In France, different websites send visitors to pseudo-scientific studies, which cite each other and give credit to the idea of a conspiracy hatched by scientists and pro-vaccination laboratories.
One of the most emblematic figures of this anti-vaccine current is Professor Henri Joyeux, a former cancer specialist who is now disbarred by the French medical association. He is closely tied to the traditionalist right-wing organization Familles de France, and is known for his positions against abortion and gay marriage. He is also the head of an “Institute for the Protection of Natural Health” and has launched many open letters and online petitions attacking what he calls the vaccinal empire run by “Big Pharma.”
More well-known is the deputy in the European Parliament from the party “Europe Ecology – The Greens,” Michèle Rivasi. Last February, her own group disavowed her for having tried to organize a discussion in the European Parliament for Andrew Walkefield, the author of a completely fraudulent report about an imaginary link between autism and measles vaccination. Today she denounces mandatory vaccination as being opposed to the free choice of the individual, or in this case of parents, to have their children vaccinated or not.
Questioning the principle of vaccination is evidence of a real blindness. It has been thanks to vaccines, in combination with hygienic measures, that epidemics which had previously been a real scourge on humanity have nearly disappeared and that life expectancy has almost doubled over the span of one hundred years. Worldwide vaccination campaigns have allowed for the eradication of smallpox from the earth’s surface, and possibly soon for that of polio.
The first vaccine discovered was that of smallpox, or variola, an extremely contagious and often fatal disease. After a patient recovered from smallpox, they were marked by disfiguring scars but were also protected for life from the disease (today we would say that they had been immunized). This led to the idea of practicing “variolation” by inserting powdered smallpox scabs or puss into scratches made in the skin, or inoculating the patient. A much less severe form of the disease would then affect the “variolated” patient, and they would be protected from that point on. This procedure, which had been described in China as early as the 16th century, followed the Silk Roads across the Ottoman Empire before eventually reaching Europe, where it excited Enlightenment thinkers like Voltaire.
Inoculation against smallpox was far from being risk-free, since it could result in a serious or even fatal infection. At the end of the 18th century, an English rural physician who practiced this technique, Edward Jenner, observed that people who milked cows suffering from a milder disease similar to smallpox called cowpox were protected during smallpox epidemics. In 1796, he performed the first vaccination, or the first inoculation with cowpox, using pustules from infected cows. The word “vaccination” is derived from the word vacca, which means cow in Latin.
In 1808, the English Parliament voted to establish a national vaccination program. But it would not be until the Vaccination Act of 1853, and then that of 1867, before vaccination against smallpox truly became widespread in England, then in the rest of Europe, and before mortality began to drop.
For nearly a century, the smallpox vaccine was the only available vaccine. Its discovery owed a great deal to empiricism, since the virus itself was unknown. This changed in the final years of the 19th century, when the work of teams led by Louis Pasteur in France and Robert Koch in Germany allowed them to link different microbes with various infectious diseases, and then to isolate the microbes, to grow and modify them in a laboratory to reduce their potency and to inoculate them for protective ends. Was it better to decrease the microbes’ potency by heating them or with different chemical agents, better to kill them or to modify the toxins that they secrete? All of these options were explored and discussed … on the basis of a Franco-German rivalry.
Throughout the twentieth century, new human and animal vaccines were discovered. The typhoid vaccine was used in the muck of the trenches of World War One. The Bacillus Calmette-Guérin (BCG) vaccine against tuberculosis, which was developed from a bovine tuberculosis bacillus was tested for the first time in 1922. Vaccines against diphtheria (a disease that can result in death among children due to suffocation), tetanus, and whooping cough became available in the 1920s and 1930s.
It was also at this time, almost a century ago, that people began to use aluminum salts as adjuvants, or substances acting to increase the effectiveness of vaccines, which allowed them to inject much smaller doses and to decrease the necessary number of boosters.
After World War Two, public health agencies targeted viral diseases. In 1952, a major polio epidemic swept the United States, which accelerated the search for a vaccine. The vaccine was tested in major U.S. cities in the first truly mass clinical trial, from 1954 to 1956.
Next, researchers were able use cell cultures to develop vaccines for childhood viral infections: measles (1962), mumps (1967), rubella (1969), and chickenpox (1974). The rubella vaccine was the first to target a specific population, that of women before pregnancy. This was because rubella, a mild childhood illness, can cause severe birth defects. Incidentally, the reason that the U.S. government decided to officially recommend that young women get the vaccine before puberty was to avoid a large number of abortions due to suspicions of rubella.
During the past thirty years, we have seen the development of so-called cancer vaccines. This is an imprecise term, but it means that these vaccines target infectious diseases that can cause cancer over the course of their evolution, often decades later. This is the case with the vaccine developed in the early 1980s against hepatitis B, a disease that can cause liver cancer. It also includes the vaccines the papillomaviruses responsible for cervical cancer, which have been on the market since 2006.
Today, the three mandatory vaccinations in France are those against diphtheria, tetanus, and polio. These are the oldest vaccines, required by law in 1938, 1940, and 1964 respectively, at a time when infectious diseases were a major public health problem and caused numerous deaths. The eight other vaccines which are on track to becoming mandatory in 2018 for children under two years old – those against whooping cough, measles, mumps, rubella, hepatitis B, Haemophilus influenzae, pneumococcus, and meningococcus C – are currently recommended. This is not because these diseases are less severe or because their vaccines are less important or effective – just the opposite. It is simply because they were developed later, at a time when the need for vaccination no longer required proof and when the government considered that it was no longer necessary to require them, since the strong support of the population and the medical profession could be counted on to assure that all children would be vaccinated.
Today, vaccination has in a manner become a victim of its own success. Vaccines have allowed for a decline in the number of illnesses, to the point that their benefit is perhaps no longer as visible and that certain people in the wealthier countries have ended up questioning their validity. How can one have a sense of the usefulness of the vaccines against measles or whooping cough when these diseases strike only a few rare victims in France today? Among people younger than 50, who personally knows anyone infected with diphtheria or polio?
For all that, the absence of sick people does not mean that diseases and the microbes that cause them have disappeared. These microbes continue to circulate and can affect people who have not been vaccinated or who have been poorly vaccinated. This is why pretending that getting vaccinated or not is a personal choice and talking about “vaccinal freedom” is irresponsible. By its very nature, one cannot reason individually in terms of vaccines. With the exception of certain vaccines like tetanus, which only confers individual protection – since it is not possible to eliminate the supply of tetanus bacilli from the ground – the majority of vaccines have a collective goal, aiming to protect a group or a population.
The sole objective of the flu vaccine is not to protect oneself, but also to protect others, particularly those who are too fragile to be vaccinated, such as newborn babies or people suffering from immunodeficiency. Epidemiologists call this a “group effect.” A large part of the population must be vaccinated – the immunization coverage must be high enough – in order to prevent the microbe from propagating. For example, a very contagious disease like measles needs an immunization coverage of 95%. Today in France, it is less than 80%, a level well below that needed to protect the entire population.
Far from having disappeared, infectious diseases continue to take victims, particularly in poor countries. It has been estimated that 10 million children less than 5 years old die every year from infectious diseases. Half of these deaths could be prevented with vaccination. In this way, measles remains one of the most important causes of death in young children, even though a safe and effective vaccine exists. 134,200 people in the world, a majority of whom are children under 5 years old, died from measles in 2015 … but this number was 2.6 million in 1980, before the introduction of the vaccine.
In the world of microbes, the shattering of an equilibrium is enough to cause diseases that we believed had disappeared to reappear. In Syria, up until 2010, 95% of children were vaccinated against polio, but once the war cause hygienic conditions to deteriorate, children became less well-vaccinated, often becoming refugees. The result has been that a polio epidemic struck Syria in 2013.
Diphtheria has resurfaced in Russia and the countries of the former Soviet Union, with a significant epidemic striking between 1990 and 1997, directly linked to the breakup of the Soviet Union. The diphtheria bacillus continues to circulate in Europe. In 2015, a non-vaccinated Spanish child died in Barcelona.
Several European countries, including France, have recently seen epidemics of measles. Between 2008 and 2016, 24,000 cases of measles were declared in France, which has led to hospitalizations, medical complications, and 10 deaths. Since the beginning of 2017, more than 150 children were hospitalized for severe forms of the disease, and one sixteen-year-old woman died in Marseille last June. These severe cases were all in children who had not been vaccinated or who had been poorly vaccinated.
This measles epidemic is obviously one of the reasons that led the governments of different countries like France to review their vaccination policies.
In France, the vaccine schedule – mandatory or recommended vaccines, the age for different injections and boosters – is devised by the Technical Vaccination Committee (TCV), which in turn relies on various international guidelines, such as those of the World Health Organization (WHO). This vaccine schedule changes regularly and is not the same across the European Union. Thirteen European countries require at least one vaccine by law, while fifteen confine themselves to recommendations of vaccination … which can sometimes be just as necessary as obligations. In Germany, for example, even though there is no vaccination requirement, during the middle of a measles epidemic in 2015, the government demanded that the directors of childcare centers and preschools report to health authorities the parents who refused to have their children vaccinated – with those who refuse subject to fines worth up to 2,500 euros. As for the rate of immunization coverage, it varies a lot depending on the country. In Sweden, where no vaccines are required, 96% of children are vaccinated with all of the recommended vaccines, and this has been the case for several years.
The problem is therefore not whether a given vaccine is mandatory or recommended, but that it is understood and carried out. It is clear that a large part of the population never had or no longer has confidence in vaccines. This tendency follows the declining curve of confidence in the pharmaceutical industry over the course of the scandals that have dotted its recent history. These have included the treatment of children with tainted human-growth hormones, hundreds of deaths from the weight-loss drug Mediator, the knowing distribution of blood products contaminated with HIV to hemophiliacs, and cancer-causing silicone breast implants.
Clearly, the episode that has most significantly tarnished the reputation of vaccination is that of the H1N1 flu vaccine in 2009. H1N1 was a new variant of the flu virus that caused fears of a pandemic, meaning a global epidemic. Nobody had been immunized against this new virus. The French Health Minister at the time, Roselyne Bachelot, ordered 94 million vaccines from the drug companies Sanofi-Pasteur, GSK, and Novartis, which profited from this fortunate occasion by fixing them at an elevated price, under the pretext of time constraints. The government promised them a total of 896 million euros, the equivalent of the total budget deficit of all public hospitals. It quickly turned out that the virus was fortunately less aggressive than had been thought, that only one dose and not two or three was enough, and that all the vaccines that had been purchased and stocked would not be needed – only 6 million were actually used. Never mind that – the government paid a high price for a large part of the doses it had ordered and gave a compensation of 48 million euros to the drug companies in order to care for their shareholders.
Another reason that the vaccination skeptics invoke is the fear of side effects, which are always difficult to prove. As opposed to normal drugs, the goal of vaccines is not to cure but to prevent. They are administered to millions of people who are in good health. And so when certain people who have been vaccinated fall ill, the proof that the vaccine had nothing to do with this can be difficult to establish.
This is what took place between 1994 and 1998, when a massive campaign was carried out to vaccine the population against hepatitis B, a serious disease that is primarily transmitted through contact with blood and sexual contact. In the space of four years, one third of the French population was vaccinated, a worldwide record. This record became the subject of debate, as cases of multiple sclerosis began to surface among people who had recently been vaccinated. The number of post-vaccine cases of multiple sclerosis went from 36 in 1992 to 246 in 1996. But correlation does not mean causation. Multiple sclerosis is a disease that affects the nervous system with poorly understood causes. Its symptoms generally begin to show in young adults, which is exactly the main part of the population that was vaccinated, which would explain the correlation observed. Since then, it has been proven that there is no causal link between vaccination against hepatitis B and multiple sclerosis, but this affair ended up forming a long-lasting suspicion of this vaccine.
Today, aluminum adjuvants are coming in for scrutiny. They have been used in many vaccines since the 1920s with no problems. However, certain teams of researchers have implicated them in causing a muscle disease called Macrophagic Myofasciitis, which can result in a chronic fatigue syndrome, while other scientists are opposed to these conclusions.
Our goal here is not to take a side in this debate. But if other studies are carried out and alternative adjuvants are tested, one should not forget that as far as vaccination is concerned, the problem is to calculate the difference between the benefits and the risks and to do this for each vaccine.
One clear mathematical principle is that the rarer a disease is, the more side effects are attributed to the vaccine. In the 1960s and 1970s, one was more likely to die from complications from the smallpox vaccination than from the disease itself, since smallpox was in the process of disappearing. However, it would have been foolish to stop vaccinating at that moment.
It is hardly obvious how to come up with a policy of vaccination. The international opinions of doctors, pharmacists, microbiologists, and epidemiologists are needed. And yet the current and legitimate distrust of the pharmaceutical industry and government institutions is such that scientists’ responses fail to convince people, and a section of the public has come to reject scientific reasoning, challenge the given data, and pick up rumors and false information without criticism.
In 1955, when journalist Edward R. Murrow asked Jonas Salk, the inventor of the polio vaccine, about the subject of money and his interest in patenting the vaccine, he replied that, “There is no patent. Could you patent the sun?” For years, public or semi-public institutions produced vaccines on behalf of the World Health Organization, such as the Pasteur Institute in France. Until the early 1990s, the USSR was the largest producer of vaccines shipped to Eastern Europe and Africa. Today, almost all vaccines produced worldwide come from a handful of giant multinational corporations. The four main pharmaceutical companies, Merck, Sanofi, GSK, and Pfizer account for 65% of global revenue for this sector. For their part, a handful of Chinese, Brazilian, and Indian companies essentially produce the basic vaccines at low cost.
The prices of vaccines, like those of other drugs, are negotiated with government bodies. In France, this is done through the Economic Committee for Health Products (CEPS). Each time a new vaccine is brought to market, rounds of haggling take place to determine the sale price and the rate at which the Social Security system will reimburse it. The oldest vaccines are sold at a relatively moderate price – about 6 euros for the flu vaccine, 14 euros for the measles, mumps, and rubella vaccine – but those that just hit the market are significantly more expensive – more than 100 euros per dose for the vaccine against papillomavirus. This is clearly a far cry from the astronomical prices that the drug companies charge for certain cancer treatments or for Sovaldi, a treatment for hepatitis C with a price fixed at 28,700 euros after hard negotiations. Guaranteeing profits for private companies with public money, in this case that of Social Security, is a characteristic of the capitalist economy, whether for tollway and construction companies or for the pharmaceutical industry.
Some people consider that the government’s only goal in extending the vaccination requirements is to benefit the drug companies. This is probably not the main reason, even if it is obvious that the pharmaceutical industry is extremely profitable and that in this society, everything ends up in the pockets of the capitalists, regardless of whether what they produce has any usefulness.
At the moment, 13.5% of Sanofi’s revenue comes from its vaccine division (4.58 billion euros out of a total of 33.8 billion in 2016). This sector is thriving, mostly due to its exports to countries like the United States, China, Brazil, or Australia. The government's project will not result in a major increase in Sanofi’s sales volumes within France, since most French children have already been vaccinated with the vaccines that today are only recommended. By the age of two, 96% of all French children have been vaccinated against whooping cough and Haemophilus influenzae, and 91% have been vaccinated against pneumococcus. On the other hand, only 78% have been sufficiently vaccinated against measles, mumps, and rubella, and 69% against meningococcus C.
“Vaccination is not up for discussion,” former Health Minister Marisol Touraine declared in 2015. Probably not. But such declarations are not enough to convince people. Criticizing individualism in the name of the general interest is one thing, but this criticism tends to fall on deaf ears when it comes from successive governments that have imposed drastic cuts in public health services and in public research budgets. One should not be surprised when appeals to solidarity get a poor reception when social solidarity is being attacked from all sides, from pensions to unemployment insurance to Social Security.
Health Minister Agnès Buzyn defends the extension of vaccination requirements as “a public health imperative.” The paradox is that this measure runs a high risk of reinforcing reflexes of distrust even further and of fueling conspiracy theories. In this field as in others, the retreat of communist ideas, and even simply of the idea that science is a force for progress, results in the defense of frankly reactionary theories. After the criticism of mandatory vaccination, how long until the debate over compulsory education, which is far from being perfect? Criticizing “Big Pharma” without attacking the root of the problem, without wanting to confront the overthrow of capitalism, is useless at best, harmful at worst.
Scientific discoveries and their application – of which vaccination forms a part – have allowed for humanity to make extraordinary progress, and we are convinced that they will carry on at an even greater scale in a communist society, freed from capitalists, those of the pharmaceutical industry like all the rest.