Vaccination: The Controversial Prick (Part 1)

by Wiebke Heiss/MEDICA.de

The opinions regarding vaccinations are very different: They cover a wide spectrum reaching from people totally opposing vaccines to those advocating it in any situation. However, who is right? A guideline could be true to the motto: As much as necessary, as little as possible.15/05/2009

Sunday afternoon, coffee klatsch, the young mothers lose their temper due to a dispute. The topic: Vaccinations Yes or No. The points of view could not be more opposed: Beate Schneider* refuses her child to get vaccinated against anything. She is afraid of the prophylaxis harming her son - straight away or later in life. Katrin Beimer* on the other hand wants her child to be inoculated against everything the German Immunization Commission (Stiko) of the Robert-Koch-Institute in Berlin recommends – she not only confides in the official guidelines, she also blames her friend of being entirely irresponsible. Opinions clash ever more often in German living rooms regarding immunisation.

The dispute is reflected also in the world of experts: The spectrum reaches from the completely convinced medic, that admittedly sometimes participates in ongoing immunisation studies, to opponents, some ignoring scientific facts and rather tending to anthroposophical arguments. The virology expert Hermann Schätzl from the Technical University Munich in Germany says: „People opposing immunisation base their opinion on some kind of question of belief." People supporting inoculations on the other hand relied on scientific knowledge.

Breeding grounds for vaccines:
the chicken egg; © PHIL

In fact, there are no doubts about the efficacy of vaccines. Thanks to them life threatening diseases such as polio or tetanus have lost their terrifying effects. The WHO and other health organisations in 1980 even declared the world being free of smallpox. „The prophylaxis due to immunisation truly is a blessing“, says Schätzl. The immunisation benefit is a simple calculation for many infectious diseases: Regarding the example measles one out of 10,000 falling ill die but only one out of half a million having received the vaccine will be affected by a complication due to the vaccine. „That way, it is to count how many people have been protected by immunisation.“

On the other hand „one should not pretend that everathing around the topic vaccination was perfectly alright“, Schätzl points out. Klaus Hartmann, for example, deals with patients that suffer from vaccination damage. The medic had been working many years for the Paul-Ehrlich-Institute (PEI) that is in charge of the approval of vaccines and other biomedical drugs. Now he acts as an expert in court for potential cases of vaccination damage. He also draws a clear conclusion: „Intervening with the immune system could cause problems.“ Hartmann does not want to criticise the method of immunisation in the whole but "I advise everybody to get extensive consultation in order to then decide what to do“.

The principle of indiscriminate distribution is not justified

When Hartmann got his own children inoculated he did not follow the guidelines of the German Stiko which recommends a combination of six vaccines for babies from the age of two months. The prick into the upper leg protects against diseases such as tetanus, diphtheria and pertussis but also against hepatitis B - an inflammation of the liver that is being triggered through a virus that is being transmitted through body fluids like sperm, vaginal secretion or blood. Unless the mother has already been infected - prevention programmes for pregnant women covers a screening for hepatitis B – „the HepB component for little children is totally unnecessary“. It is possible to just catch up on it later in life. “I am reluctant to offer this vaccine to all babies following the principle of indiscriminate distribution“, says the expert. Against the background of the fact that this component caused relatively many complications „one could decide for a combination vaccine against five diseases without HepB.“

Since 2001, the German Federal Ministry of Health increasingly tries to accomplish a data pool concerning vaccination problems. Every doctor is obliged to report suspicious cases which means according to the RKI „every health damage that extends the usually expected reaction to the immunisation process“. This information is collected in a database of the PEI. „That way we get an overview if apparently isolated cases start to accumulate in order for us to be able to then act“, Susanne Stöcker say, press officer at PEI. A study of PEI and RKI published last year showed that „the analysis of the reports from 2004 and 2005 did not give indications on a change of the risk-benefit ratio of the vaccines currently being on the market in Germany“.

However, Hartmann suspects that most of the complications caused by immunisation do not emerge because doctors could fear the trouble since they often do not clarify their patients properly about vaccines. „That is the way it works in reality.“ Therefore, the medic estimates, only "five to ten percent of all complications with vaccines will be reported, the rest of the information gets lost“. Which would mean that hard facts could still be missing.

* name changed by editor

- Part 1: The Controversial Prick
- Part 2: The Problem Kids Influenza and HPV

Part 2: The Problem Kids Influenza and HPV


When considering the potency of vaccines, sometimes a lack of reliable data becomes evident. Stiko recommends a yearly immunisation against influenza in all people older than 60. However, a study that appeared in the Lancet showed that the benefit of an influenza vaccination in the elderly appears to be overrated. The vaccine does not significantly or only marginally protect the elderly from pneumonia - the main complication with influenza. A current publication from the Cochrane Collaboration systematically analysing past influenza immunisation studies indicated a similar tendency: It definitely makes sense to vaccinate seniors living in care homes against influenza, but the benefit for old people in the community was rather moderate.

Dieter Klenk from the Institute of Virology in Marburg, Germany still insists on an influenza vaccination. „Even though the amount of protection from this inoculation decreases when comparing old people to young ones“ - the immune system's ability to respond decreases -, the medic sees no reason to take a closer look and reconsider the state of affairs. Klenk stresses to continue immunising as was recommended so far. "Since the influenza vaccine is safe, we even benefit when the risk of suffering from pneumonia and death is decreased only slightly." The PEI agrees with this and considers a reassessment of the yearly influenza vaccination as not necessary.

The usefulness of HPV vaccination needs to be reconsidered

Since March 2007 the Stiko recommends a vaccination for all 12 to 17 year old girls in order to prevent cervical cancer. This now needs to be checked again regarding its efficiency. The Federal Joint Committee (GBA) summoned the Institute. A critical letter from 13 German scientists initiated the reassessment of the serum against Human Human Papilloma Virus (HPV). In November 2008, the experts expressed doubts on the efficiency and criticised the rather fast introduction of the vaccine - a drug hardly ever entered the market so quickly and also was so expensive.

„The guidelines of the official recommendations do have weak points“, Hartmann says. The Stiko recommended relatively submissively what is new. According to Hartmann this is the reason why citizens needed a detailed consultancy in order to resort to proper decision guidance. Which could also contain a danger: „If one really always explain the benefits and risks, the rate of the population getting inoculated would probably drop“, Hartmann points out. However, the majority needs to take part in immunisation programmes in order to wipe out highly infectious and dangerous infectious diseases. Hartmann gets his point across: "It is nonsense to flatly denounce vaccinations.“ However, a critical discussion about the impact and side-effects, benefits and efficiency of vaccines is a measure to reduce the uncertainty that lingers in Germany's population.

Wiebke Heiss/MEDICA.de

- Part 1: The Controversial Prick
- Part 2: The Problem Kids Influenza and HPV