The final week of April each year marks World Immunization Week. The theme this year is “Protected Together: Vaccines Work”.

Screen capture from the WHO webpage on World Immunization Week this year.

I have not written much about vaccinations in the past, simply because this is not one of my particular interest areas, and there are others who are far more competent in this regard. But in the past couple of years, there has been a dramatic surge in the anti-vaccination movement, coupled with a general loss of trust in government, institutions and experts by the public. The World Health Organization has placed vaccine hesitancy (the term that encompasses all forms of reluctance/refusal to vaccinate) on its list of top ten global threats for the first time this year, because the results are clear to see.

Wild-type polio cases fell to a global low of 22 in 2017, before rising to 33 cases in 2018. There are 9 cases reported this year so far, and concern that the gains of the past decades may be eroded, with the goalpost of eradication shifted further away.

But the disease that has seen the greatest resurgence as a consequence of the anti-vaccination movement is measles. This was covered in a previous post 2 months ago, but bears mentioning again. The US CDC reported 626 cases as of 19th April, with no signs that the outbreak is abating. As can be seen from the chart obtained from the CDC website, the number of measles cases in the USA for the first 3+ months of the year is already far higher than recent years, except for 2014.

Chart from the US CDC website. In 2014, over half (338) of the cases were attributed to a single large outbreak occurring in Amish communities believed to be triggered by missionaries bringing the disease back from the Philippines.

In neighbouring Philippines, there have been close to 30,000 cases and 389 deaths reported as of 5th April this year. In Singapore, 43 cases of measles have been reported to MOH this year as of 20th April – more than twice the number (17) reported over the same period in 2018. However, this potentially still falls within the upper range of cases in recent years (141, 42, 136, 70, and 34 cases in 2014, 2015, 2016, 2017, and 2018 respectively).

Incidence of measles in Singapore. Screenshot from the 2017 edition of Communicable Diseases Surveillance in Singapore.

I will end with a long but unexpectedly interesting quote (about smallpox and vaccinations) by one of the fathers of modern medicine, Sir William Osler, in 1910 during a service held for the students of the University of Edinburgh: “Here I would like to say a word or two upon one of the most terrible of all acute infections, the one of which we first learned the control through the work of Jenner. A great deal of literature has been distributed, casting discredit upon the value of vaccination in the prevention of small-pox. I do not see how any one who has gone through epidemics as I have, or who is familiar with the history of the subject, and who has any capacity left for clear judgment, can doubt its value. Some months ago I was twitted by the Editor of the Journal of the Anti-Vaccination League for maintaining a curious silence on the subject. I would like to issue a Mount Carmel-like challenge to any ten unvaccinated priests of Baal. I will take ten selected vaccinated persons, and help in the next severe epidemic, with ten selected unvaccinated persons (if available!). I should choose three members of Parliament, three anti-vaccination doctors, if they could be found, and four anti-vaccination propagandists. And I will make this promise—neither to jeer nor to jibe when they catch the disease, but to look after them as brothers; and for the three or four who are certain to die I will try to arrange the funerals with all the pomp and ceremony of an anti-vaccination demonstration.”

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About hsuliyang

I am an infectious diseases physician based in Singapore.

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Infectious diseases, Public Health, Singapore

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