A House of Cards: Vaccine-Induced Herd Immunity

House of Cards: a structure, situation, or institution that is insubstantial, shaky, or in constant danger of collapse [*]
 

 

In the 17^th century, John Milton, a poet and writer, was the first to use this idiomatic expression and it has changed little in meaning over the centuries.
 
If you’ve ever attempted to build a house out of cards you know that it has the outward appearance of strength and  stability – all the while, the house is threatened by imminent collapse by a simple puff of air or a slight tilt of the foundation. 
 
This House of Cards analogy is ideal for understanding what herd immunity refers to when encompassing an introduction and reliance on a vaccine (and boosters) for protection throughout life.
 
*Incorporating a vaccination schedule (whether select, delay or on schedule) into your healthcare practice is your decision and, in my humble opinion, should be made on the grounds of examining data that both supports its use and challenges it. Vaccine induced immunity must be explored in further detail to ensure we are making the most sound choice for our children.
 
 

The Manipulation of Pre-existing Herd Immunity

 

Fundamentally, herd immunity exists/existed prior to vaccination.
 
With each national vaccine campaign, epidemiology (and herd immunity) is modified, benefiting some while actually placing another group at higher risk than before.[*][*][*][*]

While it is perceived beneficial that some vaccinated diseases have diminished over time (such as measles, chicken pox), it is very likely that these infections existed in a precise biological niche that was very much intentional – benefits in which our current understanding cannot yet comprehend.[*]

This massive disruption of previously acquired immunity results in a destabilization of epidemiologic patterns for many years.[* p297]
 
It also results in a precarious House of Cards - a reliance on vaccine-induced herd immunity.
 
 

Acquired immunity:  occurs as a result of exposure to an infectious agent or its antigens or of passive transfer of maternal antibody or immune lymphoid cells, renewed throughout life from continual cyclical re-exposure to the disease.[*]

 

Artificial immunity:  acquired immunity produced by deliberate exposure to an antigen.[*]

 
 
Infectious systems are highly complex biological structures.
 
In reference to herd immunity, a system may contain hundreds of demographic and epidemiological variables (which can be seen as the puff of air or tilt of the foundation in the House of Cards)  – all of which influence a population’s immunity to a virus/bacteria.
 
The science and intuition built on decades of practical epidemiological experience still often fail to predict outcomes/implications of vaccination programs. Below, is a brief list of some factors that may be considered threats to the house of vaccine-induced immunity.[*]
 
 

Dependence on Boosters Throughout Life

 
Currently, US vaccine recommendations target 17 “vaccine-preventable” diseases across a lifespan.
 
The U.S. Department of Health and Human Services’ Healthy People 2020 (which provides a 10-year national objectives for improving the health of all Americans) state that:
 

“As the demographics of the population continue to shift, public health and health care systems will need to expand their capacity to protect the growing needs of a diverse and aging population.”[*]

 
This means the House of Cards (vaccine-induced immunity) depends on you, me and grandma to get our booster vaccinations throughout life to maintain this newly invoked herd immunity.
 
Currently, we have boosters for young children, for preteens, for teens, for adults, for pregnant women, for college kids, for healthcare workers, for seniors – oh, and don’t forget your annual flu shot.[*]
 
The list is growing, not diminishing – this should raise concerns.
 
When vaccination initially began, the administration of a vaccine and the immunity to follow was thought to be similar to the naturally acquired immunity. However, we now know vaccines offer waning and incomplete protection which may lead to resurgence and epidemic outbreaks.[*]
 
Booster dose vaccination is not a pinch-hitter, rather boosters throughout life is just one of many fundamental keys to maintain vaccine-induced herd immunity within a population.
 
 

A Traveling Population

 
In 2012, over 30 million Americans traveled internationally, at the same time welcoming 67 million international visitors.[*][*] 
 
International travel (business/leisure) and migration represent a risk to herd immunity, particularly vaccine-induced herd immunity.[*]
 
According to the CDC, exposure to diseases brought into the US by American who travel abroad or from incoming visitors may overcome vaccine protection.[*][*]
 
Unfortunately, the manipulation of existing epidemiology does not change globally when a national vaccine program is implemented.  Unless we restrict international travel and migration, this pillar in the House of Cards will always be at risk of crumbling.
 

Example: 2010 Mumps outbreak in New Jersey and lower New York

Source of infection: 11-year-old boy at the camp. He had recently returned from the United Kingdom

Vaccine Protection: 88% had received at least 1 dose of mumps-containing vaccine, and 75% had received 2 doses[*][*][*]

 
 
The response to an outbreak such as the one in 2010: administer another booster.[*]
 
 

A Mother’s Protection (or Lack Thereof)

 
There’s nothing quite like a mother’s love and protection, particularly in the case of humoral and passive immunity.
 
Prior to vaccination, it was a newborn’s birthright to receive his/her mother’s antibodies to disease (intended to last long enough to prevent infection until immune function is mature enough).
 
Prior to the vaccination campaigns we see today, a newborn received antibodies against infectious diseases from their mother, who themselves had been infected as children (and re-exposed to the diseases later in life). Today, babies born to mothers who were vaccinated and never exposed to these diseases lack this protection.  
 

(2013) Babies born to unvaccinated mothers maintain their antibody protection about 61% longer than vaccinated mothers. That’s significant, a clear indication that vaccinations reduce newborn babies’ immunity to measles, and very likely to other infectious diseases for which vaccinations are given.[*]

 

(2001, 1994) Maternal antibodies erode faster than previously estimated, especially in infants who were born to mother’s that have been vaccinated.[*][*]

 
The protection this newborn population had prior to vaccination is being eroded with each national vaccine campaign.
 
One answer to alleviate this threat: targeting new vaccines for pregnant mothers.[*]
 
 

The Catch 22 of Disease Elimination and Wild-type boosters

 
An infectious disease has the ability to offer lasting protection. Even with natural immunity waning over time, subsequent enhancement (boost) is provided by asymptomatic encounters with the infection. [*]
 
However, when vaccination is introduced the prevalence of infection declines, which in turn reduces the amount of boosting and hence the level of immunity. What is more surprising is that the interaction between vaccination and waning immunity can lead to pronounced epidemic cycles.[*]
 
This data leads researchers to rest their hope of eliminating vaccinated diseases (‘vaccine-preventable disease’) by relying on protection promoted by circulating wild-type viruses.[*]
 
Nonsensically, that means we hope to attain elimination of disease while depending on the continuation of the wild-type disease.
 
??
 
How can you have elimination if the disease if it is still in circulation boosting vaccine-induced herd immunity?
 
 

Evolution

 
From the rise in methicillin-resistant Staphylococcus aureus (MRSA) causing deadly skin infections to the bacterial colonies on your hands evolving to resist your antibacterial soaps and hand gels, evolution is present in our daily lives.[*]
 
The two strongest examples of evolution in disease within our current vaccination programs is influenza and pertussis.
 
Of the former (influenza), everyone is well aware of – every year, starting in early September, we are reminded that the old vaccine we administered last year is useless and we need to get the updated vaccine to protect ourselves, our children and our community.[*]
 
The influenza virus experiences constant single-point mutations which renders the prior vaccine unidentifiable, requiring a new one every year.[*][*][*]         
 
Unfortunately, data continues to support that annual  influenza vaccination inhibits our body to fight other strains of flu not included in the vaccine and other respiratory virus infections.[*][*][*][*]
 
With the less discussed pertussis vaccine (the ‘ap’ part of the Tdap booster and the DTaP vaccine), mutation is more apparent than ever before but receives a lot less buzz.
 

If I had to render a guess as to why, it could be because of the key role the vaccine plays in the mutation of the bacteria.

 

 
Pertussis (aP) vaccination not only makes a person more susceptible to B. parapertussis infection but it also enhances the performance of the pathogen. Research completed in 2010 illustrates a 40-fold increase in B. parapertussis lung colony-forming units after vaccination of aP injections.[*][*]

(2012) Study completed by Kaiser Permanente Medical Center concluded that pertussis occurs more among vaccinated children than children not vaccinated for pertussis with the DtaP vaccine.[*]

 

The answer to alleviate this problem: earlier or more numerous booster doses of acellular pertussis vaccine.[*]
 

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It seems the continual response to any weakness or flaw in vaccine-induced herd immunity is an increase in booster doses, occurring earlier and more often throughout life.
 
It is clear that each infectious system that has a current national vaccination program hold their own complex biological structure with numerous variables.