vaccines

see also:

• microbiology

• vaccines are man made substances which are designed to elicit an immune response against certain pathogens
• they may be:
  • a live attenuated pathogen which causes a relatively asymptomatic infection yet creates a broader immune response against similar but more pathogenic strains (eg. polio)
  • a protein from the pathogen combined with adjuvants (often as a nanoparticle) to make it attractive to the immune cells and to stimulate an immune response in these cells
    • examples of adjuvants are:
      • Matrix-M
• community uptake of vaccines is dependent upon:
  • individual perceived risk-benefit of vaccine vs disease which is informed by:
    • perceived prevalence and severity of disease
    • percieved benefits of vaccination - vaccination effectiveness
    • perceived risks of vaccination and media portrayal
    • religious, socialogic and philosophical attitudes to vaccination
    • costs of vaccination - time and money
    • game theory - the selfish concept that as long as everyone else gets vaccinated, herd immunity will mean one both can avoid the disease and the risks and costs of vaccination
  • availability of vaccine for a given population
• critical level of vaccination to create “herd immunity”
  • this is usually considered to equal (1-1/R0)/effectiveness of the vaccine

• see also: https://www.historyofvaccines.org/timeline#EVT_100602

• see also: smallpox
• smallpox inoculation
  • for thousands of years people in Africa and Asia appear to have practiced the inoculation method to create immunity to smallpox which had a 70% mortality rate in children and the inoculation method was very effective in preventing this but was unpredictable with some developing fatal disease and it risked spreading infections.
  • when this practice was brought to Europe in the middle of the 17th C, it was called variolation (variola = smallpox) and eventually it was used in England in 1721.
• smallpox vaccination
  • English physician Edward Jenner (1749–1823) who had practiced smallpox inoculation of patients noted that farmer locals had become aware that milkmaids seemed to be relatively immune to smallpox as they were inoculated by cowpox, a related virus, and thus they had been practicing cowpox inoculations from about 1770.
  • 1796: Jenner injected matter from a cowpox pustule into a subject and started a new preventive measure that his friend Richard Dunning called vaccination (vacca = cow) which proved to be more reliable and safer than variolation
  • 1840: Britain banned variolation;
  • 1853: Britain made smallpox vaccination of children mandatory (in the US, some states made it mandatory as early as 1855, while Germany made it mandatory in 1874)
  • 1891: English physician S. Monkton Copeman showed that adding glycerin to lymph acts as a germicide and thus glycerin became to be added to these calf lymph extracts
  • 1898: due to concerns of transmission of syphilis, Britain bans arm-to-arm smallpox transmission. Lymph from calves was safer than human lymph, which sometimes contributed to the spread of diseases such as syphilis and hepatitis.
  • 1905: The U.S. Supreme Court in the case of Jacobson v. Massachusetts upheld the constitutionality of mandatory smallpox vaccination programs to preserve the public health.
  • 1922: many United States schools required smallpox vaccination before children could attend.
  • 1948: The newly established World Health Organization issued a report praising the freeze-dried vacuum-packed smallpox vaccine from the Vaccine Institute in Paris. Production of the vaccine soon spread around the world.
  • 1949: a Boston team showed that they could grow polioviruses in non-nervous tissue—namely human embryonic skin and muscle tissue
  • 1949: last case of naturally occurring smallpox in the US
  • 1965: a bifurcated needle was developed which allowed for lower doses to be given
  • 1972: recommendations for routine U.S. smallpox vaccination, previously recommended at age 1, ceased.
  • 1975: the last wild human case of variola major occurred in the village of Kuralia, Bhola Island, Barisal district, Bangladesh.
  • 1978: Janet Parker, a photographer employed by the University of Birmingham Medical School in Great Britain, died of smallpox acquired from a lab.
  • 1979: smallpox is eradicated

• Louis Pasteur produced the first laboratory-developed vaccine: the vaccine for chicken cholera (Pasteurella multocida)
• Pasteur’s large study of anthrax vaccination in livestock in 1881 was successful
• 1884: Louis Pasteur developed an attenuated rabies virus vaccine successfully tested on dogs and a year later on a shepherd boy who had been bitten
• 1911: Almroth Wright unsuccessfully tests a killed whole-cell pneumococcal vaccine on 50,000 South African gold miners with efficacy found to be inconclusive
• 1918-1921: many bacterial-based vaccines were created for the Spanish Flu but none were successful as the cause was influenza virus which would not be discovered until the 1930's.
• 1918: freeze-dried vaccines developed for the tropics and these continued to be used for decades and became crucial to widespread vaccination programs in tropical areas in the 1970s.

• 1890: Shibasaburo Kitasato (1852-1931) and Emil von Behring (1854-1917) immunized guinea pigs with heat-treated diphtheria toxin.
• 1895: Mulford Company of Philadelphia (later Merck Sharp & Dohme) began to produce and test diphtheria antitoxin in the United States.
• 1901: Thirteen St. Louis children died from contaminated diphtheria antitoxin derived from a tetanus infected horse. This incident, along with a Camden, New Jersey, tetanus outbreak linked to contaminated smallpox vaccine, led to federal regulation of biologic products.
• 1902: US Biologics Control Act
• 1905: serum sickness recognized by Schick and Pirquet who observed that children treated for diphtheria with large quantities (up to 200 mL, almost 7 ounces, or almost 1 cup) of antitoxin derived from horses often went on to experience symptoms such as swelling, fever, rash, and joint pains.
• 1905: Franklin Royer (1870-1961), from Philadelphia’s Municipal Hospital, published a paper urging timely treatment for diphtheria and adequate doses of antitoxin without waiting for culture confirmation.
• 1906: Ernst Lederle, who was formerly New York City Health Commissioner, founded Lederle Laboratories in New York City to make diphtheria antitoxin, and later moved out to a farm in Pearl River, New York. Lederle Laboratories later became a part of Wyeth Laboratories.
• 1907: Emil von Behring published a paper showing that a mixture of diphtheria toxin and antitoxin produced safe and lasting immunity to diphtheria in humans.
• 1913: Bela Schick developed the Schick test to determine if a person had developed some immunity to diphtheria which he brought to New York in 1923 and it became widely used to ascertain who should be vaccinated.
• 1914: William H. Park studied the use of diphtheria toxin-antitoxin mixtures - his method was used for immunizing humans until toxoid immunization replaced it.
• 1916: French researchers Nicolle and Conseil showed that measles patients have specific protective antibodies in their blood and then demonstrated that serum from measles patients could be used to protect against the disease.
• 1919: Dozens of Dallas, Texas, children were sickened and five died from a contaminated batch of diphtheria toxin-antitoxin mixture (TAT).
• 1921: US records 206,000 cases of diphtheria resulting in 15,520 deaths (a case-fatality ratio of 7.5%). This was worst year for diphtheria in the United States in the 20th century. William H. Park launched a massive program in New York City to Schick-test schoolchildren and immunize the unexposed children with diphtheria toxin-antitoxin mixture (TAT).
• 1923: Gaston Ramon (1886–1963), a veterinarian at the Pasteur Institute in France, developed diphtheria toxoid. This breakthrough provided the simplest and most effective means to prevent diphtheria.
• 1926: Alexander Thomas Glenny (1882-1965) increases the effectiveness of diphtheria toxoid by treating it with aluminum salts.
• 1926: Despite vaccination’s successes against smallpox, opposition to vaccination continued through the 1920s, particularly against compulsory vaccination.
• 1928: Bacterial contamination of diphtheria toxin-antitoxin mixture in Bundaberg, Queensland, Australia, led to the deaths of 12 children. Five others became critically ill but recovered. A multi-use bottle of TAT, containing no preservative, was improperly stored and reused.
• 1948: In Kyoto, Japan, 68 of 606 children died after diphtheria immunization as a result of improper manufacture of toxoid. Toxoid in the preparation reverted to toxin.
• 1964: American Academy of Pediatrics recommend use of an aluminum-precipitated form of DTP vaccine to enhance the body’s antibody response
• 1974: WHO includes DTP in the list of vaccines recommended for its new Expanded Programme on Immunization for developing countries. Fewer than 5% of children worldwide were immunized by age 1 against diphtheria, polio, tuberculosis, pertussis, measles, and tetanus.

• cholera
  • 1885: Spanish physician Jaime Ferrán (1852-1929) developed a live, attenuated cholera vaccine. His vaccine was the first to immunize humans against a bacterial disease. He vaccinated about 50,000 people in Valencia during a cholera epidemic. Ferrán would later develop vaccines for plague, tetanus, typhus, tuberculosis, and rabies.
  • 1893: Waldemar Haffkine arrived in India to conduct tests of his cholera vaccine.
  • 1896: Wilhelm Kolle (1868-1935) developed a heat-inactivated cholera vaccine that came to serve as a model for cholera vaccines for the next century.
  • 1911: Waldemar Haffkine developed a heat-killed cholera vaccine which was easier to prepare and standardize.
• typhoid
  • 1898: Almroth E. Wright the first to develop an effective typhoid vaccine
  • 1899: The British Army used early forms of the typhoid vaccine during the Second Boer War in southern Africa. Nearly 15,000 soldiers were immunized and which reduced typhoid by 2/3rds.
  • 1907: Mary Mallon became the first identified healthy carrier of typhoid and was later dubbed “Typhoid Mary” by the American media and later was officially blamed for 10 outbreaks totaling 51 cases of typhoid fever, and three deaths from the disease.
  • 1909: U.S. Army physician Frederick F. Russell developed the first U.S. typhoid fever vaccine and this was used widely in American soldiers in WWI with great benefit
  • 1914: typhoid vaccine made available to the broader US public not just for military and advocated for those traveling overseas
  • 1989: Ty21a oral typhoid vaccine
• tuberculosis
  • 1921: Albert Calmette and Camille Guérin (hence BCG vaccine) began their first tests of their attenuated tuberculosis bacilli in humans.
  • 1928: The Health Committee of the League of Nations adopted BCG as a recommended tuberculosis vaccine. While BCG does prevent disseminated infection and meningitis, BCG does not prevent primary infection nor reactivation of latent pulmonary infection, the principal source of bacillary spread in the community.
  • 1929-30: Contaminated BCG results in 72 babies dying from tuberculosis out of 252 vaccinated. Many other infants were made ill as a result of vaccination. The vaccine used was later found to have been contaminated with a human tuberculosis strain being studied in same lab where the vaccine was produced.
  • 1974: WHO includes BCG in the list of vaccines recommended for its new Expanded Programme on Immunization for developing countries. BCG has never been recommended for routine use in US.
• polio
  • 1929: iron lung developed to manage polio victims who couldn't breathe
  • 1935: early tests of polio vaccine were disastrous, several subjects died of polio, and many were paralyzed, made ill, or suffered allergic reactions to the vaccines.
  • 1936: Peter Olitsky, and Albert Sabin, demonstrated a new cultivation method for poliovirus. They were able to grow the virus in human embryonic brain tissue.
  • 1938: Roosevelt’s creation of the National Foundation for Infantile Paralysis
  • 1941: Sabin and Ward discovers polio virus entered the body through the mouth, passed into the digestive system, and was then distributed by the blood to the nervous system.
  • 1950: Koprowski at Lederle Laboratories conducted the first human trial of his attenuated oral poliovirus vaccine
  • 1952: Salk and team, with the support of the National Foundation for Infantile Paralysis, began its first tests on humans of their killed-virus polio vaccine and in 1953 gives it to his family
  • 1952: massive surge in polio cases in US
  • 1954: large scale testing of Salk's vaccine in US and results in 1955 showed 80-90% effective
  • 1955: vaccine-induced paralytic arm polio noted - most of the cases of paralytic polio occurred in children inoculated with vaccine produced by Cutter Laboratories in California - changes were made to vaccine preparation to ensure more reliable killing of the virus by formaldehyde, despite this the US suspended the polio vaccination program in order to investigate the safety of all six manufacturers’ vaccine. 11 people died from the vaccine and hundreds were paralyzed.
  • 1959: Sabin’s oral polio vaccine (OPV) is fed to 10 million Soviet children without comparative trials
  • 1960: Merck researchers, under Maurice Hilleman’s direction, detected a simian virus in the monkey kidney cells used to grow poliovirus for Merck’s IPV Salk-type polio vaccine. Hilleman later showed that the simian virus, SV40, caused tumors in hamsters. Merck then withdrew their vaccine and in 1963, US government screening programs began to look for simian viruses in poliovirus vaccines.
  • 1960: Sabin’s live poliovirus vaccine was recommended by the U.S. Surgeon General to be licensed.
  • 1963: new Sabin vaccine combines all three polio types not just Type 1 as previously
  • 1968: US phases out usage of Salk's IPV polio vaccine.
  • 1997: low polio prevalence rates in US along with the 1 per 750,000 dose rate of OPV-induced polio following 1st doses leads to the US phasing out OPV over the next 13yrs and replacing with an improved version of Salk's IPV
  • 2000: OPV no longer used in US.
  • 2002: polio eliminated in Europe
  • 2014: polio eliminated from SE Asia
  • 2016: decision to cease use of type 2 OPV globally to allow type 2 virus to die out
• yellow fever
  • 1936: Max Theiler and his colleagues developed a live attenuated vaccine for yellow fever using tissue cultures prepared from embryonated chicken eggs.
  • 1942: thousands of cases of hepatitis from human serum used in a batch of yellow fever vaccine given to US soldiers
• Japanese encephalitis
  • 1944: Hilleman’s vaccine used on US soldiers but never tested, later replaced by other vaccines
• pertussis
  • 1939: effectiveness of a pertussis vaccine demonstrated
  • 1948: first combined DTP (diphtheria, tetanus, and pertussis (whooping cough)) vaccines became available in the United States.
  • 1999: A combined diptheria, tetanus and pertussis vaccine, DTaP, that used an acellular pertussis vaccine, replaced the DTP vaccination on the U.S. Recommended Childhood Immunization Schedule
• pneumococcal vaccine
  • 1945: tetravalent pneumococcal vaccine created but did not gain much traction as penicillin had just been discovered
  • 1977: Merck licenses a polysaccharide vaccine protecting against 14 types of pneumococcal bacteria
  • 1983: Merck licenses a polysaccharide vaccine protecting against 23 types of pneumococcal bacteria
  • 2000: PCV7 vaccine licensed for children and protected against seven pneumococcal serotypes.
• influenza
  • 1933: influenza virus discovered and discovery of antibody production
  • 1940: existence of different types of influenza virus recognized
  • 1945: first influenza vaccine (a whole-virus, inactivated influenza A and B vaccine) was approved for military use in the United States (and civilian use in 1946)
  • 1957: new influenza A virus, Type A2, Asian influenza causes a pandemic causing 2 million people deaths
  • 1968: Hilleman and colleagues develop a Hong Kong flu pandemic vaccine, Merck manufactured 9 million doses.
• measles
  • 1958: 1st measles vaccine tested but caused too many symptoms and required more attenuation
  • 1962: a killed measles vaccine fails to be effective
  • 1962: Maurice Hilleman and colleagues developed an attenuated measles vaccine by passaging John Enders’s measles virus strain over 80 times through different cell types and this was commercialized as Rubeovax and given with a dose of gamma globulin antibodies to reduce reactions
  • 1968: Merck began to distribute an improved vaccine using John Enders’s measles strain, developed by Maurice Hilleman and colleagues which they called the Moraten strain (More Attenuated Enders). This Attenuvax did not require use of gamma globulin as he weakened it further by passing the virus through chick embryo cells an additional 40 times.
• mumps
  • 1965: Maurice Hilleman and colleagues begin to test their experimental mumps vaccine at institutions for the mentally retarded children
  • 1966: Hilleman arranged to for his daughter, Kirsten, to receive his experimental mumps vaccine, developed from the virus isolated from her half-sister, Jeryl Lynn.
  • 1967: FDA licenses Merck's mumps vaccine, developed by Maurice Hilleman. Within five years, more than 11 million doses of Mumpsvax would be distributed.
• rubella
  • 1967: Hilleman shifted his work on an attenuated rubella vaccine by abandoning the Benoit strain of rubella virus and adopting the Division of Biologics Standards’ HPV-77 strain
  • 1969: Merck and Hilleman licence their rubella vaccine for commercial use in 1969-1970.
  • 1971: the Merck's MMR vaccine was licensed, and protection against measles, mumps and rubella was provided at the same time, via one shot.
  • 1979: Plotkin’s newly licensed RA27/3 rubella vaccine introduced into US and replaces the rubella component within MMR
• rabies
  • 1971: Koprowski and team develop an inactivated rabies vaccine after testing it on themselves
  • 1976: rabies vaccine produced at the Wistar Institute, called HDCV (human diploid cell vaccine) is licensed in Europe (and in the US in 1980) and has the benefit that the vaccine is given in five injections rather than the course of 14-21 injections as used in the older vaccines.
• chickenpox/varicella
  • 1974: Michiaki Takahashi, MD, successfully attenuated a strain of the varicella zoster virus.
  • 1981: Takahashi's 'Oka'strain is further attenuated by Merck and used to develop a U.S. chickenpox vaccine
  • 1995: Merck's chickenpox vaccine licensed by FDA
• meningococcus
  • 1974: Hilleman introduces a series of meningococcal polysaccharide vaccines to licensure (group A, group C, combined groups A+C, and then a quadrivalent vaccine against groups A, C, Y, and W-135) including a vaccine that was effective against meningococcal group A, one of five major types of meningococcal bacteria.
  • 2005: Sanofi’s quadrivalent meningococcal polysaccharide-protein conjugate vaccine is licensed in US
  • 2014: group B meningococcal vaccined approved by FDA
• hepatitis viruses
  • 1981: Hilleman’s human-blood-derived hepatitis B vaccine, Heptavax-B is licenced by FDA. It was the first subunit viral vaccine developed in the United States.
  • 1986: Due to concerns over HIV, Heptavax-B was superseded by a product that did not use human serum but used the new technology of recombinant DNA
  • 1995: Hilleman’s hepatitis A vaccine is licensed by the FDA
  • 2006: Advisory Committee on Immunization Practices (ACIP) recommended routine hepatitis A vaccination of all children older than age 1 in a two-dose schedule.
• Haemophilus influenzae (HiB)
  • 1968: Anderson et al begin work on extracting and purifying the polysaccharide outer coating of the bacteria
  • 1975: Finnish trial of vaccine showed that toddlers, but not infants, mounted a protective response
  • 1985: 1st HiB vaccine (HbPV polysaccharide) against Haemophilus influenzae type b (Hib) disease was licensed in US
• rotavirus gastroenteritis
  • 1998: 1st vaccine for rotavirus but was withdrawn in 1999 after some children developed intussusception
  • 2006: US recommend routine infant immunization with three doses of the recently licensed Rotavirus Vaccine (RotaTeq) which is a live, oral, pentavalent virus
  • 2008: US FDA licenses another vaccine, Rotarix
  • 2010: concerns of pig virus and pig viral DNA in rotavirus vaccines but FDA continues to recommend them after a brief suspension
• HPV
  • 2009: US approves bivalent HPV vaccine invented in Australia and recommended for females, protecting only against cancer-causing HPV types
  • 2014: nine-valent vaccine is licensed in US
• Covid-19
  • Pfizer-BioNTech's vaccine BNT162b2
    • mRNA-based vaccine needs to be kept in dry ice and stored at -70degC
    • has been tested on 44,000 participants in the US, Germany, Argentina, Brazil and South Africa and said to be 90% effective with effect commencing within 10 days and requires a 2nd booster shot 19-42 days after
    • some have developed allergic reactions hence advised not to be used on those with PH severe allergic reactions
    • starts being rolled out in UK on 9th Dec 2020 UK had ordered 40million doses, while Canada and USA are also set to approve and roll out this vaccine
    • Australia has pre-purchased 10 million doses and these may be rolled out by March 2021 primarily to high risk populations such as elderly, indigenous and then emergency/healthcare workers/quarantine staff and in June those aged 40-49yrs became eligible
    • it seems 1 in 1250,000 young adults (mainly men) may develop pericarditis or myocarditis, esp. in 1st week after 2nd dose
  • Moderna:
    • similar mRNA technology to Pfizer
    • it seems 1 in 125,000 young adults (mainly men) may develop pericarditis or myocarditis, esp. in 1st week after 2nd dose
  • University Queensland's vaccine trials halted in Dec 2020 as some false positive HIV tests were detected
  • AstraZeneca/Oxford University vaccine
    • only needs to be stored at 2-8°C (ie. a normal fridge)
    • said to be 70-90% in those under 55yrs (90% if booster given) effective in preventing symptomatic infection, none required hospitalisation although only 30 became infected in the trial of over 11,000 studied
    • Aust. has ordered 3.8million doses
    • around 1 in 100,000 will develop thrombosis with thrombocytopenia syndrome (TTS / VITT / VIPIT)
    • less than 1 in 10 million may develop capillary leak syndrome (systemic capillary leak syndrome) - mainly women with a PH SCLS - 6 documented cases including 1 death from 78 million doses
  • Johnson and Johnson Covid-19 vaccine
    • similar to Astra Zeneka
    • around 1 in 100,000 will develop thrombosis with thrombocytopenia syndrome (TTS / VITT / VIPIT)
  • Sputnik V vaccine
    • Russia announced roll out of vaccination on 10th Dec 2020
    • India to produce 300million doses in 2021
  • Chinese Sinopharm vaccine
    • emergency use authorisation in China allows 1 million Chinese to be vaccinated in Nov 2020
  • Chinese company Sinovac's vaccine
    • Indonesia received its first shipment of a 1.2million dose order on 6th Dec 2020
  • Sanofi-GlaxoSmithKline vaccine
    • hundreds of millions of doses pre-ordered by the EU, United States and Britain
    • however insufficient immune response in clinical trial results

• for most vaccines in most people there is NO evidence to support that harm outweighs benefit
• clearly some people should NOT have certain vaccines such as:
  • pregnant women - especially live attenuated virus vaccines are generally contra-indicated
  • immunosuppressed people
    • live attenuated virus vaccines are generally contra-indicated
    • other vaccines may not generate an immune response
  • past history of a severe reaction to that vaccine or related vaccine
• some people have very low risk of harm even if not vaccinated
  • if a disease is not endemic in your region or has extremely low prevalence without ongoing widespread vaccination you probably should not have a vaccine for that disease eg. smallpox
• some vaccines did cause harm
  • 19th and 20th century vaccines sometimes transmitted diseases as they were created using human material which had risks of contamination with hepatitis or syphilis, this led to humans being removed from the process
  • early 20th century diphtheria vaccines did kill children sometimes due to defects in the manufacturing process in certain batches but these appear to be rare and remedied with modern manufacturing standards
  • some children died due to inadequate killing of viruses in making certain batches of vaccine
  • rotavirus vaccine was withdrawn after it caused intussusception in a small minority of children
  • A-Z Covid19 vaccine rarely caused thrombosis with thrombocytopenia syndrome (TTS / VITT / VIPIT)
  • mRNA Covid-19 vaccines rarely caused pericarditis/myocarditis in young people
  • rarely, vaccines may cause autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome) such as subacute thyroiditis
• prevalence and risk to individuals of some conditions is very low even without vaccines
  • tetanus is quite rare
  • many infections cause only mild disease to most young adults (eg. influenza, pertussis) and the public health benefit in saving lives of those who are vulnerable (the elderly, the very young, the immunosuppressed) may not be an immediate concern of some individuals

• use of adjuvants
  • Thimerosal-containing vaccines (TCVs) contain ethyl mercury (EtHg) and aluminium
    • Thimerosal has been removed from many paediatric vaccines in US since 2001 as a precautionary measure
    • Thimerosal has never been included in Measles, mumps, and rubella (MMR) vaccines, varicella (chickenpox), inactivated polio (IPV), or pneumococcal conjugate vaccines¹⁾
    • early life exposure to both EtHg and aluminium have not been adequately studied and risks are perhaps higher for vaccines given to pre-term neonates ²⁾
    • mercury
      • Thimerosal contains ethylmercury, which is cleared from the human body more quickly than methylmercury, and is therefore less likely to cause any harm and was used in vaccines to prevent the growth of bacteria.
      • the most common environmental mercury exposure in early life is methylmercury which is from:
        • maternal fish-eating and pregnancy and breast milk exposure
        • rice
      • the EtHg dose in vaccines is usually about 25 x lower than the aluminium dose
      • EtHg is eliminated from infant blood more rapidly than MeHg
      • once de-alkylated, the brain-retained Hg2+ species has a half-life of several years to decades following exposure³⁾
  • aluminium
    • since 1926, aluminium has been used in many vaccines as an adjuvant to increase the immune response
    • there is no evidence to support harm outweighs this benefit HOWEVER, some feel that aluminium may be neurotoxic to neonatal brains and contribute to autism, etc
    • the current CDC schedule appears to administer a total of 3.7mcg to infants in their 1st 6 months
    • BUT to put this in perspective, aluminium is the MOST abundant metal on earth and we are ALL exposed to much larger amounts than this through:
      • ingestion of water or food
        • drinking water may contain high levels of aluminum (up to 1,000 µg/L) - that means EACH litre of water we drink could give over 200x the dose of aluminium in all these childhood vaccines and the average adult ingests 3-5mg per day of which 0-3-0.5% is absorbed into the body (15mcg each day) and nearly all of this is excreted by the kidneys ⁴⁾
        • breast milk contains around 10mcg per litre (thus 75L would equate to same amount of body aluminium as that given by vaccinations), soy milk contains around 1,500mcg per litre (thus half a litre would equate to same amount of body aluminium as that given by vaccinations)!
        • aluminum cans, containers, and cooking utensils, as well as aluminum-containing medications, are also potential sources of oral intake of aluminum
      • deodorants and antiperspirants but there is very limited absorption through skin
• “too many vaccines”
  • the dramatically increasing size of recommended vaccination schedules creates concern we are being over-vaccinated and that perhaps this causes harm
• inadequate testing of vaccines rushed to market
  • this is particularly a concern during pandemics as time does not allow exhaustive testing
  • this becomes a risk-benefit issue based on past vaccine performance, preliminary studies and the potential for massive reductions in mortality and morbidity and the economic system and ability to reduce restrictions on personal freedoms that were introduced to contain the pandemic

• the independence of public health and medical experts from financial influences of the manufacturing industry is difficult to secure and this undermines public confidence

• the history of vaccine research has been plagued with ethical issues which today are not likely to be acceptable
  • testing vaccines on those who cannot give informed consent such as orphans, mentally retarded children in institutions, children in the African colonies
• some would see the use of fetal tissues and cells as unethical and many vaccines were developed using these

• some believe that naturally acquired immunity is more important to themselves and their children
• much of this is based on emotion and belief systems which may trump the evidence of benefit, particularly in a world where few rarely see the terrible diseases which have essentially been eradicated thanks to past vaccination
  • the 72% mortality rate in children infected by smallpox is no where to be seen
• they may also argue that even those who have not had vaccines can live to a health ripe old age
  • but then they did not see the many who died from or were seriously disabled from these infections by viral encephalitis, cancer in later life, the chronic pain of shingles, etc.

• ever since vaccinations were made mandatory in the 1850's there have been objections on the grounds that the state cannot enforce this on people
• however, the right to live in a society requires one to be a responsible citizen and not cause harm to others
• this is why we do not allow drink driving or we have speed limits where you may kill children if you are reckless, yes these are imposed mandatory impacts on personal freedom too but for society to function are required.
• people expect their doctors or nurses will not pass on disease to them as patients and thus expect health care workers to be appropriately vaccinated or they shouldn't be working in that field
• some people cannot be vaccinated and refusal of those who could be vaccinated to have vaccination increases risk to those who are vulnerable
• in the end, it comes down to a balance between freedom of an individual weighed against public interest and risk-benefits for a given vaccine

• vaccines have been shown to be very effective in creating herd immunity and either eradication disease, or severely reducing disease, particularly in vulnerable persons.
• vaccination of certain occupational groups such as health care workers substantially reduces risk to others eg. hepatitis B, influenza, etc.

• Health Services Amendment (Mandatory vaccination for Healthcare Workers) Act 2020
  • came into effect 20th March 2020 at the start of the Covid-19 pandemic
  • it inserted sections into the Health Services Act 1988 and Ambulance Services Act 1986 that enable the Secretary of the Department of Health to direct health and ambulance services to require vaccination against selected vaccine-preventable diseases to better protect Victorians and create a safer healthcare system.
  • Secretary Directions are issued when a vaccine is required for certain healthcare workers.
  • These directions generally include annual influenza vaccinations by June 30th for Category A and B healthcare workers (eg. those in emergency departments)
  • see https://www.health.vic.gov.au/immunisation/vaccination-for-healthcare-workers
• Mental Health Act 2014
  • allows the Minister for Mental Health to issue a written direction on any matter that the Minister is satisfied as necessary, including requirement for vaccinations including Forensicare workers.

• acquiring infections results in high chance of passing that on to your family and friends - vaccination can dramatically reduce this

• vaccines dramatically reduce risk of infections and thus significantly reduce risk of premature death and chronic disability
• some vaccines will significantly reduce the risk of cancers in later life eg. HPV vaccine