The Critical Ingredient to the Success of Vaccination Programs

By William B. Miller, Jr, M.D.

Only a few weeks into a new administration and with it comes unwelcome medical news. The age-old debate about the safety and appropriateness of vaccination has been renewed and a vocal stage has been delivered to a small group of anti-vaccination zealots.

Reports have circulated that Robert F. Kennedy, Jr, a highly visible critic of vaccination, has been invited to chair a commission on vaccination safety by the new administration. If it comes to pass, one result can be accurately predicted. It will become a confused platform of ideological rhetoric that will diminish trust in those scientific bodies charged with making sound judgments for the public welfare. This inevitable outcome is particularly unfortunate since there has never been any advance in medical history that has had a more positive impact on our lives than vaccination.          

Humanity has been in eternal conflict with infectious disease throughout history. Perhaps no disease better illustrates the vast range of impacts of epidemic disease than smallpox, which resulted in the deaths of more than 7 million people. Similar horrific mortality was experienced with smallpox. In 18th Century Europe, at least 400,000 people died annually from smallpox. One-third of the survivors went blind. Mortality rates were as high as 60% in some communities. Infant mortality was even more frightening, approaching 80%.      

The ultimate success of smallpox vaccination is credited to Sir Edward Jenner in England. In 1796, he successfully introduced the technique of cowpox vaccination demonstrating its subsequent protective effect against smallpox. Today, due to the effectiveness of worldwide smallpox vaccination programs, that disease has been effectively eradicated from the planet.

However, this is not the case for other consequential infectious diseases. Two years ago, a whooping cough epidemic swept through California where vaccination rates are steadily lagging. Contrary to any ordinary expectation, it is often the most affluent parents who are shunning immunization. Some of these anti-vaccine proponents are highly educated people being misled by social media. The trend appears to have originated with a fraudulent report in a British medical journal linking vaccination with autism. This report was subsequently revealed to have been based on fraudulent research and was retracted by that scientific journal. Similar rumors that vaccine stabilizers, such as thimerosol, contribute to autism have also been refuted.  Nonetheless, damage has been done by ill-informed repetition.            

There is no doubt that those parents that refuse to vaccinate their children are well meaning. However, their actions are ill advised on two levels. The first is that refusing to appropriately vaccinate themselves or their child exposes both of them to the risks of deadly infections that can be entirely avoided. Yet, although vaccination is safe and highly effective it does have its limits. This links to the other critical factor that makes universal vaccination so crucial. No vaccination ever devised provides 100% protection and some individuals in any population cannot be vaccinated. This includes very young infants whose immune systems are not yet mature enough for vaccination and members of our community that are immunosuppressed due to diseases that weaken their immune system from a variety of illnesses including cancer. Their protection is through our actions. When there are high levels of vaccination within any community, the infectious agent is unable to find enough hosts to reproduce and sustain itself within that population. This level of community-wide protection is termed herd immunity. It is our joint responsibility, all of us together, to be part of the process of achieving this level of immunity both in our own interests and for the protection of the other members of our community.

The next outbreak of a preventable infectious disease with its incumbent tragedies is always lurking. A political committee to examine the evidence based on ideological biases is not needed. Instead, our policies should rely on the expertise of already existing scientific organizations such as the Global Advisory Committee on Vaccine Safety (GACVS), an independent expert clinical and scientific advisory body, as well as our own Centers for Disease Control and the National Institutes of Health.

The critical ingredient to the success of vaccination programs is education. Therefore, there needs to be a concerted program to recover our eroded memories of the consequences of now distant epidemic diseases that have been conquered or reduced through vaccination. The success of vaccination programs depends on being familiar with the bitter lessons of our continuous struggle with epidemic disease.  Such an educational process must be ever ongoing.

Dr. Bill Miller has been a physician in academic and private practice for over 30 years. He is the author of The Microcosm Within: Evolution and Extinction in the Hologenome. He currently serves as a scientific advisor to OmniBiome Therapeutics, a pioneering company in discovering and developing solutions to problems in human fertility and health through management of the human microbiome. For more information,