« Your shotcrete Saturday open thread | Main | the verdict »

July 13, 2013

Comments

I had measles and rubella around 1960-63. My doctor had to come to the house, although that was still something doctors did at that time. I was lucky and it wasn't bad. But one of my schoolmates was horribly ill with "regular" measles. He was out of school for 2 weeks and had to be kept in a totally dark room so that his eyesight would not be affected. I can not believe the damage the anti-vaxers have done. These diseases are really dangerous. On another note, my best friends mother ended up suffering from shingles because she had chickenpox as a child and she got it before the shingles vaccine. I turn 60 this month and the first thing I'm doing is getting vaccinated for it. Sadly, my daughter got chickenpox a year or two before the vaccine for it had been approved, so she will have to get the shingles vaccine as well. I can't imagine leaving my child unvaccinated, except in the rare case where there are actual reasons (allergies, compromised immune system) that make it inadvisable.

Japan is the oddest case, because it's an island nation. That *should* give the Japanese people a long historical memory of horrible epidemics coming from overseas, and make it easier to have a "get disease out of Japan and keep it out!" policy.

Instead, MMR vaccination in Japan has gone in its own, highly inefficient direction. Japan was using a distinctive MMR vaccine in the early 90s, and there were problems with side-effects, even deaths.

I believe that what happened is a bit more complicated. There were a number of deaths due to meningitis among children who were administered the MMR and when the vaccine was first introduced in 1989, I read that one out of every 900 children was experiencing problems. A different variety was tried in 1991, but it came with similar problems. The problems seem to have been with the Urabe mumps strain. This suggests to me that there were licensing issues, and because Japan often protects its domestic health products industry, that may have been a major cause for Japan's particular path.

The other might be a general mistrust of the Health Ministry. In regards to the vaccine, the ministry, which surveyed each prefecture for these kinds of problems, found that in some prefectures, side effects were 1 out of 600 or worse, but they reported the results for the lowest prefecture, saying it was 1 out of 28,000, and dismissed the problems if meningitis. Unfortunately for the government, this was right at the advent of the new information laws, and lawyers representing the families of children who had died won several court cases against the government. (link)

This was roughly concurrent with another Health Ministry scandal, where they imported AIDS tainted blood from overseas which was used with hemophiliacs, so there was (and I think continues to be) a suspicion of Health Ministry directives.

Of course, this is nothing particularly new, the Minamata case of industrial mercury poisoning which was first noted in the late 50's, is still having court cases litigated, so for the government to be the initiator of an action, it runs into a culture of mistrust. I think this overrides any sort of historical memory of epidemics from overseas.

I had a similar experience with strep as a child. Remarkable how fast that ice water bath give you the clarity to realize you're freezing, isn't it? But certainly preferable to brain damage from a high fever.

LJ, thank you for your insights.

In the US, a major factor in health scandals like the ones in Japan is regulatory capture, where agencies such as the FDA are doing the bidding of the pharma industry. What you're describing in Japan sounds like regulatory capture with no countervailing forces from other companies, lawyers, scientists, or even regulators trying to do their actual job.

Look at Vioxx, for instance. It was a really messy business, but the messiness is maybe part of why the system kind-of worked.

Part of the problem is, I suspect, that most of the country is too young to remember those childhood diseases. So you have a large part of the voting-age population which simply doesn't have the experience that would tell them, first hand, why eradication is a very good idea.

That means, unfortunately, that what it will take to "kick measles to the curb" is a round or two of epidemics. We will have to see lots and lots of children getting very sick, and probably a fair number dying, before the urge to "do something" overcomes the reluctance to "waste tax money" on a threat that just doesn't seem real.

I suspect that what will "kick measles to the curb" is not a traditional eradication program, though it would be good to pursue one. As our understanding of the immune system deepens, we're starting to grasp why some people don't get diseases like measles in the first place. I think soon we'll be able to engineer improvements to the human immune system. Starting with bringing the average person up to the level of the exceptional, and later improvements nobody enjoys today.

But the microbes will always find new ways too, that's nature.

@Brett Bellmore:

Count me as skeptical of immune reprogramming of the kind you're describing. I'm not an immunologist, but I do work with immunologists in a Department of Immunology, and it makes me very suspicious of suggestions that we can easily eliminate disease by figuring out why some people are immune in the first place. For things where we know how to produce vaccines, that's the easiest and most sensible approach to giving people immunity. We may have to figure out how to give people innate immunity to HIV, but that's a very special case.

And remember that the main limit to measles eradication is social, not technological. We could eradicate measles in relatively short order if we could convince everyone to get vaccinated. If people come up with all kinds of crazy scare stories about vaccines, which have been used for decades with an excellent safety record, why should we expect them to adopt a new, more invasive approach with no substantial safety record?

My experience was with Pertussis, though I was too young to remember. My mother said that I could not keep anything down and coughed until I was too exhausted to cough any more. This was in about 1953 when I was around 18 months old. She always claimed that it changed my personality from happy and outgoing to quiet and introverted.
I can't speak for before, but the after description is accurate.

The comments to this entry are closed.

Blog powered by Typepad