SURVEY – The epidemic is coming, but 70% of French people do not intend to be vaccinated against the flu. The anti-vaccine discourse is progressing in the population, fueled by crises such as that of the A H1N1 influenza in 2009. Why actor investigated the reasons for this crisis of confidence which goes beyond the circle of the anti-vaccine leagues and which sows confusion among the doctors themselves.
“Our goal is to raise awareness of the epidemiology of the diseases affected by vaccination. Jean-Pierre Auffret, president of the National League for the Freedom of Vaccinations (LNPLV), handles the figures with caution when talking about vaccination. This is precisely one of the characteristics of skeptical discourse away from this medical gesture: it uses the same weapons as doctors: scientific studies and epidemiology. More rational arguments that are convincing since, according to an Odoxa survey carried out in June 2015 for the National Hospital Mutual Fund, 1 in 10 French people would systematically refuse to be vaccinated. Why actor deciphers the arguments put forward by critics of vaccination.
Diseases declined before vaccination
Tuberculosis receded before its vaccine, BCG, was released. This is the main argument of vaccine skeptics. “An article published in Pediatrics concludes that over the twentieth century, the regression of quite a few epidemics is not as linked to the practice of vaccinations as some propaganda supports it ”, advances Jean-Pierre Auffret. In the case of tuberculosis, in fact, the discovery of Koch’s bacillus made it possible to set up an effective fight against the disease. However, vaccination remains the only option to protect the most vulnerable against serious forms of the disease.
Prof. Christian Perronne, infectious disease specialist: ” BCG is an excellent vaccine to protect young children against severe forms which have completely disappeared. This is the only example of a vaccine that is not perfect, but everyone is saying it. “
Compulsory vaccination diseases have disappeared
Now that certain diseases have disappeared, would it not be time to review the vaccine obligations? This is the second argument defended by opponents of vaccination: opening up the possibility of choosing. This is the most fashionable, and this is precisely what happened with smallpox, eradicated by vaccination (see box), and tuberculosis. Today, vaccination is “strongly recommended” for children living in Île-de-France and Guyana, but no longer compulsory. Opponents demand that this measure be extended to DT-Polio, which protects against diphtheria, polio and tetanus, the only vaccine still compulsory in France.
Jean-Pierre Auffret, president of the LNPLV: ” Diphtheria, polio: no case in France for 30 years. The risk of contagion is extremely low. The tetanus vaccine, which is not contagious, is not immunizing. “
But tetanus remains very present in France: a dozen cases occur each year, in unvaccinated people. And if skeptics respond that it is impossible to eliminate them, even with 100% vaccination, the threat is very real. And for good reason: the bacillus that causes tetanus is in the earth. Unlike smallpox, the disease cannot therefore be eliminated, hence the importance of maintaining good vaccination coverage. “If you stop vaccinating, you will see cases of tetanus again,” warns Christian Perronne. There were thousands of deaths from tetanus in the 1950s, and there aren’t any more today. “
Vaccinating everyone is not necessary
MEP Michèle Rivasi (Europe-Ecology-Les Verts), who regularly expresses reservations about vaccination, goes further in her argument: vaccinating everyone is not necessarily necessary, or even useful.
Michèle Rivasi, MEP: ” If people are credible, when there is a measles epidemic – maybe we can do without it first – then the doctors will get vaccinated. But just because you vaccinate everyone does not mean that epidemics will not develop. “
However, that vaccine coverage is declining, and epidemics are re-emerging, contrary to what opponents claim. This is the case in Spain, where a child recently died of diphtheria – the first case since 1987 -, but also in Alsace, where a measles epidemic broke out after a trip to Berlin (Germany). Across the region, of the 150 cases reported in June, 136 were unvaccinated.
Aluminum additives are dangerous
But the argument to which skeptics adhere most is that of the possible toxicity of adjuvants. “To be effective, the vaccine must first stimulate the mechanisms of innate immunity which have the role of activating the cells which produce the acquired adaptive immune response: this is the goal of adjuvants”, explains the Academy of medicine in a summary report. Aluminum, used in two forms (hydroxide and hydroxyphosphate) is suspected of being toxic to the body. But the studies in question are controversial.
Prof. Christian Perronne : “ I calculated how much aluminum there is in a kilogram of food that we eat every day. This is the equivalent of what a child gets in vaccines if they did them all, which is rarely the case. “
Pharmacovigilance to supervise vaccines
Since 1975, France has had a pharmacovigilance system. It consists of “monitoring adverse effects resulting from the use of drugs”, according to the public health code. This system takes advantage of regional centers and the National Medicines Safety Agency (ANSM). Health professionals are on the front line to ascertain side effects. Since 2011, patients can also report side effects to which they are victims. This system is now supplemented by a risk management plan (RMP). It applies in particular to vaccines, the large-scale use of which may raise the problem of rare side effects. Such a plan has been put in place in the case of Gardasil.
Decision-makers have conflicts of interest
Michèle Rivasi also denounces a France that is too “Pasteurian”, which clings to its vaccines with the energy of despair. “Who proposes, who recommends, who obliges vaccination? It is these people from the technical committee on vaccinations who are full of conflicts of interest, she denounces. For the general public, they are not credible. It is not possible, we can no longer accept it. You can find independent experts. “
Michele Rivasi : ” We must not imagine that for all diseases there will be a vaccine. Girls are made to feel guilty by telling them to get vaccinated with Gardasil. I saw girls whose lives were ruined. But there was a possibility, it was the cervical smear! “
On the lack of transparency of laboratories, Serge Blisko, president of MIVILUDES (Interministerial mission for vigilance and the fight against sectarian aberrations) concedes a gap: the laboratories must be unassailable. “The person who only wants to vaccinate his child on the compulsory vaccinations can do so. What is surely only an industrial stock shortage suddenly becomes the proof of a vast conspiracy, ”he explains. Because it is well known, all the conspiracy theories circulate on Internet. The example of DT-Polio risks becoming a textbook case: the original three-valent vaccine is no longer available. A stock shortage that occurs at the very moment when the GSK laboratory is releasing its 9-valence version. What feed some suspicion. On the other hand, in terms of defending Gardasil, Christian Perronne is happy to show up.
Christian Perronne : ” I would like the people who say that now to be prosecuted in 20 years, when thousands of young women in France will have cervical cancer. It is shameful. We see in Australia and Great Britain a drop in the rate of precancerous lesions. “
The ball is now in the court of the doctors, fundamental players in vaccination. “In the end, the freedom to vaccinate, we don’t really have it, since if we want to enroll our child in nursery or school, we are forced to take certain vaccines. They are strongly recommended to us, and when the pediatrician insists, we do not want to pass for the bad mother, ”summarizes Sonia Delomel, young mother of a little girl of two and a half months. It is only by helping physicians to better dialogue with their patients that the crisis of confidence can be resolved.
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What 50 years of vaccination have brought
Vaccines save 2-3 million lives each year according to the World Health Organization (WHO). This effective strategy made it possible to eradicate smallpox. At the start of the 20th century, however, it was still endemic. It was in 1966 that the WHO developed two strategies for the control of infectious diseases. The first is to minimize the incidence of those that cannot be eliminated, such as tetanus. This is the elimination strategy. 83% of newborns are protected in 2014.
The second strategy aims at eradication, thus reducing the incidence of diseases to zero and eliminating the pathogen. In 1966, the smallpox eradication strategy was initiated. WHO doctors vaccinate massively, isolate endemic regions. In 1980, the last case was declared. More recently the United States succeeded in eradicating rubella from their soil.
The Organization does not stop there: it intends to eradicate polio by 1988. In 2015, the goal has still not been reached. But in the meantime, the disease has declined by 99% worldwide. Only 3 countries are endemic: Afghanistan, Nigeria and Pakistan. Thanks to the global vaccine action plan, 82% of the population is protected against hepatitis B, 85% against measles. It will now be necessary to fight against regional disparities. Because in 2014, 18.7 million infants did not have access to routine immunization, especially in conflict zones.
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