- [Narrator] Living longer living healthier living better than ever before.
Welcome to Mountain-Pacific's Healthy Living for Life, a weekly series that gives you the
information, education and expert insight you need to become an active participant in
today's ever-changing healthcare climate.
Here now is today's program host.
- Diseases we thought were gone, mostly gone or under control by vaccinations are making
a comeback.
Over the past decade, vaccine-preventable diseases have gained a new foothold, posing
a threat to our country's population health.
Welcome to Healthy Living for Life, a show dedicated to helping you do just that.
I'm your host Sara Medley.
Today we talk about the effects of the anti-vaccination movement.
Stay with us, we'll be right back.
- Welcome back.
Though vaccination has led to a dramatic drop in cases of certain contagious diseases in
this country, vaccine-preventable infections are still a threat to us and our communities.
Joining us this morning is Dr. Greg Holzman and Stacey Anderson from the Montana Department
of Health and Human Services.
Thank you both for being with us.
- Thank you.
- Thank you.
- I'm gonna start with you, Dr. Holzman, can you tell our viewers about your credentials?
What kind of a physician are you?
- I hope a good one, but I'll add in the credentials I have is I've actually done two residencies.
I'm boarded in two areas.
One is in family medicine and one is in preventive medicine, which is a lot of public health
and got my master's in public health through that residency program also.
- [Sara] Excellent.
How long have you been in Montana?
- This time around it's just about three years.
My first job out of residency for my family medicine residency was actually on the Blackfeet
Indian Reservation and that was the first time I'd ever touched foot in Montana.
- Excellent, thank you.
How about you, Stacey?
Talk about your background.
- So I have a background in microbiology, which is contagious disease and the study
of those diseases and then I have a master's in public health as well, from Westminster
College in Utah, and I've been in this position for about seven years now.
- Excellent.
Alright, now I'm gonna switch back to you and ask you to talk about vaccinations and
why are they so important?
- You know a lot of times when I talk about those, I like to talk about the history, because
it's just so amazing when you look at this and I can give you a lot of numbers.
Let's use measles as an example.
If you look at measles, the number of cases in the United States before the measles vaccine
was about four million a year, and then the measles vaccine came around in 1963.
Or if you look worldwide, it was estimated that there was about 2.6 million deaths a
year from measles prior to that vaccine.
Sadly, that vaccine has not gotten all around the world and we haven't gotten the immunizations
as well as we want, but the deaths from measles has decreased quite a bit and it's down at
80,000 to 90,000 a year, so still a lot, but it kind of lets us also here in the United
States, where we rarely see measles cases, just understand that this is a serious disease.
And I could give those kind of statistics for all sorts of different diseases and what
a difference vaccines have made in that.
What I would say is, seeing the decrease that has happened, I often like to tell stories
along with it because the numbers sometimes get hard to understand when you're talking
these kind of things and I think that often times my grandparents who were born 1890,
my grandmother was born and my grandfather was born, grandfather and grandmother on the
other side in 1908 and 1905.
Their average life expectancy at that time was 47 years.
That was at the turn of last century, going into the 20th century.
By the time we got to 2000, the average life expectancy in the United States was 78.1 years.
You have this huge increase and you think about well that's because all these things
that happened in medicine.
We got antibiotics, we can do better surgeries, we have insulin now that wasn't around beforehand,
but actually when you look at the data and everything, about 25 of those years are due
to public health.
And the CDC put out this great, CDC is the Centers for Disease Control and Prevention,
put out this great tribute at the end of last century called The 10 Greatest Public Health
Interventions in the Last Century that had the effect on that and vaccines is one of
those.
It's a big one in there.
There's things from workforce, decreased workforce injuries and deaths and the numbers are very
inspiring to see what a difference that made.
Vaccines are probably, two things, one is the control of infections disease that we
got much better at trying to decrease infection, like with refrigeration and just proper handwashing,
pasteurization, how many deaths happened from outbreaks from unpasteurized milk prior to
that.
These type of things going on and then to get the immune system to get your own body
to fight a disease before you ever get exposed to it and that's where we see some great changes
with vaccines and you see things where you see numbers of measles cases decrease by 99
percent or even something in my lifetime has been haemophilus influenzae vaccination that
has gone down, a 99 percent of decrease in those infections or some diseases that we
don't see anymore at all in the world, like small pox, or even in the United States like
polio and hopefully gettin' close to eradicating that in the world, but still struggling with
a few countries where it shows up.
So made a huge difference and I could go on and on on that.
- That is amazing.
Well, let's switch to Stacey and Stacey, can you talk about how vaccines changed the landscape
for communicable diseases in Montana?
- Sure, so a good example to kind of take from what Dr. Holzman was saying is looking
at mumps.
Mumps is one of those communicable diseases that is currently protected by the MMR vaccine.
Measles is one of the other components.
Mumps is generally sort of a, or was considered a childhood disease.
It's usually pretty self-limited in that you recover fairly easily but can have some side
effects and some consequences including things like deafness and inflammation of the brain,
very rare, but it can happen.
Prior to the introduction or the recommendation to give that dose of MMR against mumps, we
would see hundreds and hundreds of cases in Montana and then within the first few years
after that first dose was recommended, the number of cases dramatically fell.
And then once the recommendation was given to add a second dose of MMR for all kids,
it even fell even smaller.
We have very few cases since then, pretty much sporadic activity.
Every once in a while, you'll see an uptick of these things, but generally speaking, it's
had a significant impact in the number of cases that we've seen in Montana in the intervening
years.
Another example that Dr. Holzman mentioned was haemophilus influenzae.
This is another bacterial disease that affects babies.
Since the introduction of that vaccine, we've seen very, very few cases so it's been a positive
impact.
- Oh, that's wonderful.
Great, well, we need to pause here and take a quick break, but coming up next, how did
the anti-vaccination movement start and are there really risks associated with the MMR
vaccine?
We'll talk about that and much more right after these messages.
Stay with us.
- Welcome back.
In the late 1990s, a study linked childhood vaccinations to autism.
Even though an investigation into the study proved the findings wrong and even though
the doctor who led the study had his license revoked for serious professional misconduct,
the study planted seeds of fear and set off an anti-vaccination movement.
Dr. Holzman and Stacey Anderson from the Montana Department of Public Health and Human Services
are still with us.
So, we're back.
- Yeah.
- [Sara] Gonna go to you, Dr. Holzman.
Let's talk about that anti-vaccination movement.
If vaccinations are so effective, why do people resist getting them?
- Yeah, it's interesting.
Since the first vaccine came about, which is actually 1797 was when the small pox vaccine
was first figured out, there's always been an anti-vaccine movement and that has gone
on, we just recently did work on the pandemic flu of 1918-1919 here in Montana and during
that aside thing, we saw that there was a big uproar about small pox vaccine in Butte,
Montana, of a group of people that went to the board of health.
It said no they had to get their vaccines.
It went all the way to the state board that supported them and the vaccines were given.
This issue has already gone all the way to the Supreme Court in 1905 about individual
liberties versus community protection and again, vaccines were supported in that ruling
of Jacobson versus Massachusetts.
So I think the issue is that's been around but I think the point even more that we need
to demystify in the myth is that it's big because if you look at a Pew survey that was
done in 2017 showed that 88 percent of Americans believe that vaccines are safe and the benefits
highly outweigh the risk to get vaccinated.
If we look at our own data in Montana that we'll see in many of our areas, polio vaccine
in kids about 88 percent.
We see things, you know, these areas that we see this constant increase in the numbers
of people getting vaccinated, so there is a small percentage and there's different reasons
that people choose not to get vaccinated or delay vaccinations, but overall, the movement
is actually fairly small and most people see and look at the data to say, "This is a good
thing."
- So let's switch to you, Stacey.
And tell us about that Wakefield study from the 1990s.
You know, why did it cause so much concern about the MMR vaccine?
- So the issue with the Wakefield study was Dr. Wakefield and some of his co-authors did
this study that was looking at young children who were developing signs of autism around
the same time that they were given their first dose of the MMR vaccine.
And so, you know, in science, one of the things that we have to look at is you can make a
connection like that, but can you truly establish what's called a causal relationship, meaning
does that event truly cause the outcome?
And the problem with that study is that that was the conclusion that Wakefield wanted to
draw, that people who were getting MMR vaccine were developing autism.
And in fact, that was incorrect, and as you said earlier, that study was eventually revoked,
it was reviewed, found to be that some of that data for that study was not only a very
small number of individuals, which is very hard to study.
You need larger samples, basically, to study something well, but also the data was falsified
and future studies could never reproduce that same result.
In fact, future studies have shown that there is no link between the MMR vaccine and the
development of autism and so as you mentioned, Dr. Wakefield lost his license, the study
was pulled back and discredited.
I'm here to say there is no link, there is no link between receiving an MMR and the development
of autism in the scientific body of knowledge.
- So to follow up on that, he was discredited, the study was discredited, yet there are still
naysayers who are not vaccinating, so why would that be all these years later?
- Well, it did take some time for that study to be discredited.
There was quite a period of years between the study's results and the following retraction
of the study.
That resulted in a lot of discussions with people talking about how these were definitely
connected and of course if you're a parent and you're seeing this happen, you know, it's
scary.
You wanna know why your child developed these symptoms and you wanna make sure you educate
people around you as to well, this is what happens, so I don't want it to happen to you.
A lot of that kind of continued on until the study was officially retracted and then sometimes
it's hard to change those modes of thinking all these years later.
- I think there's some other aspects that I would add onto what Stacey talks about here
is the sense that one, autism is scary and we're seeing it go up in numbers and we wanna
understand why.
I think it's sad that we continue to pay so much time in trying to revoke this kind of
going over and over again on that where we should be putting it towards trying to understand
autism and see if there's ways we could do better on prevention and better treatments
of that.
The other thing that I think, social media probably has an effect, too.
I mean we all go to the sources that we feel best and so sometimes we will go to a source
that I use the word "data" and I use that loosely that we have the data that supports
our pre-held belief instead of being able to continually to look at the bigger picture
and look at the other side's viewpoints to come to those answers.
- So we've got about 30 seconds left and in that time period, can you briefly describe
the types of people that shouldn't get vaccinations?
Who are they?
- It's very minimal, but there are sometimes that you'll find a medical reason not to get
vaccinations.
Just to give you an idea, in Montana, about point four percent of children have a medical
reason and that might be because of an allergy that they have to a component within the vaccine
or it might be that they have a decreased immune system or reasons that they can't get
a specific vaccine.
Sometimes it's so that they can't one or two different vaccines, but they can get the others,
so talk to your provider and go through that.
- We need to pause here and take a quick break, but coming up next we'll talk more about the
impact the anti-vaccination movement is having on public health and what's being done to
overcome it.
Don't go away.
- Welcome back.
The anti-vaccination movement is playing a big role in the resurgence of diseases that
can be prevented by vaccines.
Dr. Holzman and Stacey Anderson are still with us.
That's great.
So I'm gonna go to you, Dr. Holzman.
We talked about vaccine hesitancy before the break.
How do you move forward with messaging to really get more people to immunize?
- I like that you used the word hesitancy 'cause sometimes they put 'em all into this
anti-vaccine movement and a lot of it is hesitancy.
There's a great article in the Atlantic by Julie Beck and I've stolen from her, but I
think she really does it well to categorize us into four different types of people.
One, she talks about the complacent.
We don't see the diseases around us all the time anymore so we're not always in a hurry.
We're not against the vaccine by any means, but it's like, you know, I can't to the doctors
this week to get, I'll get it next week and you know it just gets put off and so there's
that delay and delay and delay and so we see people miss opportunities to get vaccinated
and be up to date with their vaccines and see this with children too.
The other one would be the inaccessible and I think that happens in some of the areas
that this group goes to where it might be a long drive to get to a provider that can
give the vaccine or the cost and stuff like that.
The ACA has helped with that, the Affordable Care Act, but that's another reason that people
might not get vaccines, so we need to encourage the importance of that and also give them
ways to try to decrease those obstacles.
This next person would be the ones that are real contemplative, I mean, they are the ones
that have calculated everything.
We call them the calculators.
They've sat down and go, "Well, we haven't seen polio" "in this country in a long time."
"So while there's very, very little risk," "I think I will not get my kid vaccinated"
"because everybody else is vaccinated around them."
The wrong problem is that too many people start doing that, these diseases are appearing
right away and then we do have these problems.
The last one is the group that's just completely unconfident.
They might be not trust government, they might not trust doctors, they might not trust the
pharmaceutical companies or whatever.
Those people are really gonna be hard to switch over and I will still talk with them and give
them my information and listen to them with respect when they come in, but I realize the
chances that they're gonna change over is probably very little unless sadly one of their
children gets the disease, which we highly hope doesn't ever happen or the other area
is their friends and families around them really convince them and that does make a
difference, people that they have built trust with and hearing it from them so it's good
for people that even believe in vaccines to talk about the importance to those around
them.
- So clearly the need for multiple messaging.
- Multiple messaging and a lot of listening, respecting what other people have to say,
too.
- Absolutely.
So I'm gonna turn to Stacey.
You both work for the Montana Department of Public Health and Human Services, we know
that, and I understand that there is a rather famous individual from Montana who's responsible
for a lot of what we see positive about vaccines, so Stacey, tell us about Dr. Maurice Hilleman.
- Right, so Dr. Maurice Hilleman actually is a native of Mile City, Montana, which not
too many folks know about you know when we learn about the history of vaccines, he's
not one of the names that usually pops up, but he has contributed to the development
as well as the safety and efficacy studies of more than 40 vaccines in his career and
has been credited with saving millions of children's lives.
His body of work has been very powerful and very positive for vaccinations.
An interesting story about him is that he was one of the folks that worked on the MMR
vaccine for measles, mumps and rubella.
His daughter came down with the mumps and he was a scientist working in a lab and so
he took a swab of his daughter's cheek and then grew up the mumps virus that she was
infected with and used that virus to improve the preparation of the MMR vaccine and that
strain is called the Jeryl Lynn strain and it's still in the vaccine that we use today
to protect our children.
And to even make it more of an interesting story, years later, his younger daughter was
one of the first kiddos that was inoculated using this new preparation of the vaccine
and there's an iconic photo out there of the two siblings helping each other through that
process of getting vaccinated.
So we credit him with the positive things that have happened to protect kids against
these diseases that were terrible many, many years ago.
- Another example of a Montanan making a big difference
- absolutely.
- in healthcare, right?
- Yes.
- Let's switch to Dr. Holzman.
So really interesting history, but let's talk about the future.
What does the future hold for vaccinations for all of us?
- Yeah, I'd love to see some more studies and some more vaccines come about because
I think they're huge successes.
But we're seeing things with new diseases.
They confirmed we now have an Ebola vaccine that's going through trials at this point
in time, but they're actually using it right now in the Congo with an outbreak that's going
on there.
Hopefully someday we'll get an HIV vaccine, so there's these infections.
We now have therapeutic vaccines.
This is a little bit different.
So the first vaccine that came out like that was the hepatitis B vaccine.
This is a vaccine going at a virus, but we know that virus has a big effect on having
things like liver cancer so trying to prevent that or HPV trying to prevent cervical cancer,
penile cancer and other issues there, so we have that aspect coming about.
The other thing that we've seen a lot with is some work and I think Stacey and I would
both love to see this is a universal flu vaccine so we don't have to try to guess what's coming
next year and put the strains in there, but finding an antigen
aspect on that that we could give once or once with a booster and then you'd be covered
for flu for the rest of your life.
And then the last thing I think is some of the new areas of how do we give those vaccines.
We have oral vaccines, we have nasal vaccines, but the newest one that's coming about is
what we call microneedles and it's like a little stamp with the antigens on it and
they just push it on there and then they pull back and the antigens stay there and all the
sudden, you start to get a response to that, so wouldn't that be great not to see your
child be screaming when getting those shots and being able to feel that way, so that'd
be awesome.
- I will look forward to that day for sure.
Thank you both so much for being with us today.
And thank you for watching.
Be sure to join us again next week.
Until then, stay fit, stay well and stay healthy for life with Healthy Living for Life.
Take care.
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