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A few cases of measles this past spring – quickly downplayed as imports from neighboring Ukraine – nevertheless provoked an impassioned debate about vaccinations and their merits. From Euroradio.5 November 2018
Despite an extraordinarily high vaccination level in the country – one figure puts it at 95 percent – the episode has provoked discussions about the risk posed by those who refuse to vaccinate their children, and the balance between public health and personal freedom. Inquiries into the source of the anti-vaccination messages have also strengthened with one doctor, interviewed below, citing information flowing into Belarus from Russia and Kazakhstan.
In the spring of 2018, cases of measles were recorded in three regions of Belarus – Brest, Homel, and Hrodna. The Ministry of Health called them imported cases: those infected mostly turned out to be unvaccinated children who had holidayed with their parents in Ukraine. The news frightened parents, and pediatricians said many “anti-vaccinationists” reconsidered their convictions, and brought their children to the clinic to be vaccinated.
On 13 August, in the city of Hantsavichy, after a scheduled vaccination, a two-month-old baby died. The likely cause of death was anaphylactic shock. The story resonated widely because the child was vaccinated with the South Korean vaccine Eupenta, which is not registered in Belarus.
However, even without such tragic stories, many parents have a suspicious attitude toward vaccinations. Some even state openly that vaccinations can harm their children's health. Euroradio discussed the vaccination situation in Belarus, and the consequences of the refusal to vaccinate, with Maksim Ocheretny. He is the head of the anesthesiology and intensive care department in the Minsk municipal hospital of children's infectious diseases. Euroradio also heard arguments from two mothers of large families: one does not doubt the benefit of vaccinations, while the other does.
Euroradio meets Ocheretny, a 46-year-old intensive care doctor, in the department itself, which is where they're going to bring in a boy from Salihorsk, a city in Belarus – he's suffering from a meningococcal infection, which Belarus does not vaccinate against. Maksim shows a picture of the little boy on his smartphone: his appearance is shocking.
Maksim Ocheretny: This little guy is suffering from meningococcus. But hemophilic and pneumococcal infections can occur in exactly the same way. In Belarus, vaccination against them is carried out in the framework of the national vaccination schedule. But yes, we have children with Hib infection [Hemophilus influenzae type B] and pneumococcus, because the parents of these children refused vaccination. “Hot facts” are constantly appearing in the media, on the internet – for example, when they say that a child died from a bad-quality Korean vaccination, although the reason for the death was anaphylactic shock. We doctors aren't on a level playing field because we can't present our own “hot facts” to the press. We fall under the law on healthcare, and we do not have the right to reveal information. Of course there are situations in which you mustn't vaccinate children: there is a range of contraindications. But overall, it's necessary to vaccinate.
Euroradio: Are there data on how many Belarusians are unvaccinated?
Maksim Ocheretny: As far as I know, about 95 percent of the population is vaccinated. Therefore we don't have such a bad situation with measles as, for example, Ukraine or Serbia. The World Health Organization (WHO) reported that in Serbia, the illness led to a fatal outcome for 14 people. The conclusion was that this was a result of the refusal to vaccinate.
Euroradio: Were the outbreaks of measles – the ones that took place last spring in Belarus – also caused by the refusal to vaccinate?
Maksim Ocheretny: I wouldn't call them outbreaks. They were sporadic phenomena and the incidents were mainly imported: the measles was brought in from Ukraine, where the situation is unfavorable. We [in Belarus] have close family connections with Ukraine. It's easy to cross the border, and therefore we shouldn't be complacent – because measles is extremely contagious. In practically 100 percent of cases, if you are exposed to measles, you will catch it.
Euroradio: What if you're vaccinated against the illness?
Maksim Ocheretny: If you're not vaccinated, you'll catch it. If you are ... there's less likelihood. We need to understand that a vaccination does not give a 100-percent guarantee that a person won't get sick, either. If a person has had measles, this is good, but it's still necessary to re-vaccinate, because the level of antibodies gradually decreases.
Euroradio: Are there fatal cases from vaccination itself? Overall, how likely are vaccinations to cause deaths?
Maksim Ocheretny: Deaths after vaccination happen as a result of an allergic reaction, and only because of this. Anaphylactic shock occurs most often in reaction to a vaccination, antibiotics, or a local anaesthetic. When we hear horror stories about people dying at the dentist's after an injection, that's the exact same mechanism: that is also anaphylactic shock.
Vaccinations undergo serious testing, and the testing is a process with multiple parts: very complex and very accountable.
Euroradio: If deaths from anaphylactic shock – which can be provoked by vaccination – are unavoidable, why should parents risk it and vaccinate their children? Wouldn't it be simpler to refuse?
Maksim Ocheretny: People have every right not to be vaccinated. But among those who have been vaccinated, the number of deaths from the vaccination itself is several orders of magnitude less than the number of deaths – from the same disease – among the un-vaccinated.
Euroradio: Where has Belarus's anti-vaccination movement come from?
Maksim Ocheretny: We have a very big Russian-speaking population [and] we receive anti-vaccination information out of Russia and Kazakhstan. You look at it and it's just terrifying. The saddest thing is that doctors are spreading it – with names, with professorial titles ... I would strip them of their qualifications. I think that they gain some kind of material benefit from promoting alternative cures; otherwise it wouldn't happen.
In 2009, there was a serious epidemic of influenza in Belarus. People were buying up [anti-viral drug] Arpetol; people were wearing masks on the trolleybus. The situation throughout Minsk and Belarus was serious. The WHO issued a warning about this epidemic, because usually flu epidemics start in the countries of Southeast Asia and spread to Europe. When an epidemic begins in Asia, the WHO knows what virus it will be, what its antigenic structure is, and they prepare vaccines, and the entire world’s population gets ready to face this virus. Before the start of the epidemic in August 2009, people started going to the doctor, saying: “There's something about the WHO that we really don't like; it seems like they're lobbying for the interests of vaccination companies and corporations.” And this had a strong effect on the doctors. And we started thinking, “Maybe they [WHO] really are lobbying for the interests of the pharmaceutical companies?” And then there you are – you’ll get what happened [here].
Euroradio: I know doctors who don't vaccinate their children.
Maksim Ocheretny: I have four children. All of them quite properly went to the clinic, stood in line, and got their injections. No problems whatsoever.
Euroradio: Could an epidemic arise in Belarus because of the “anti-vaccinationists”?
Maksim Ocheretny: I do fear this, but I hope it won't happen. In any case, the medical community comes to the defense of those who vaccinate. You have to understand that a vaccination is not just a vaccination. This is a defense against deadly infections. No one is going to create a vaccine against commonplace infections, which have no complications and which the human immune system can deal with. Rather, we are talking about deadly infections. An excellent example is smallpox: in the 1970s, humanity eradicated this disease thanks to vaccinations. People born before 1975 were vaccinated against smallpox: I had the BCG vaccine [against tuberculosis] in my right shoulder, and the smallpox shot in my left.
Euroradio: Measles – is it a deadly disease? When I was a child, all of us in our courtyard had measles, and we all survived.
Maksim Ocheretny: Measles is a deadly disease. It is dangerous because of pneumonia and encephalitis, which arise as a consequence of the measles virus. The trouble is that there is no medicine against the measles virus. And if a person falls sick with viral encephalitis or viral pneumonia [from measles], you can expect grief.
Euroradio: Only 5 percent of our population is not vaccinated. Is there a risk of infection spreading from them, if the majority of the population is vaccinated?
Maksim Ocheretny: It all depends on the infection. As regards measles itself, it is sufficient for 95 percent of the population to have been vaccinated, for the population to be safe.
Euroradio: Ukraine's Ministry of Education and Sciences, together with the Ministry of Health, issued a decree, barring unvaccinated children from schools and nurseries. Do you think this is right?
Maksim Ocheretny: I understand your question. I support this, although I was called a fascist on social media networks when I expressed a similar opinion. I would not like my children and grandchildren to go to pre-schools with children who are not vaccinated. And I have the right not to want that.
Euroradio: But “anti-vaccinationists” could say the same thing.
Maksim Ocheretny: I agree that this is a dilemma that arises. But there is a good example. A few years ago in Australia, there was a campaign to strictly enforce vaccination. The first slogan was “No Jab [shot], No Play,” which meant not admitting unvaccinated children to childcare. The second slogan was “No Jab, No Pay,” and that meant parents who had not vaccinated their children lost their child benefits. The vaccination status of the population was very quickly regulated. For some reason, some took this as a kind of fascism. I take that as a personal insult.
Euroradio: We spoke with a woman who selectively vaccinated her children, and said this was because her cousin became epileptic after her second DTP shot. Have you encountered such cases through your practice?
Maksim Ocheretny: I work with the consequences of vaccine refusal. In my department, I have not encountered children with diseases of the nervous system where there is a clear causal relationship between vaccination and illness.
Euroradio: Do children often end up in hospital with complications from vaccinations?
Maksim Ocheretny: There are reactions, and there are complications. Most often, they come to us because their temperature has risen, and a rash has appeared. But these are not complications: they are a reaction to the vaccination. There can be a reaction, but this is not dangerous. Complications are something dangerous.
What happened with the child in Hantsavichy was anaphylactic shock, which does constitute a complication. With anaphylactic shock or Quincke's edema, as a rule, they don't come to us; they are helped on the spot, since each vaccination room has special allergy response kits and personnel trained in first aid. Naturally, such children are taken to the hospital. There is a cohort of children with certain pronounced allergic reactions. Because our hospital houses a municipal vaccination clinic, such children are admitted to hospital directly, into the intensive care department, and are vaccinated under the observation of a resuscitator. We perform the vaccination, observe for at least two hours, and then send them home.
Euroradio: How often do you encounter unvaccinated children?
Maksim Ocheretny: We rarely get children without vaccinations, because, in my opinion, the process of vaccinating the population is well-regulated by the state. For example, the children of Minsk are vaccinated against Hib infections or hemophilus bacillus, as it is still called. This bacterium, which causes very serious infections – pneumonia, meningitis, epiglottitis [inflammation of the epiglottis], and otitis [inflammation affecting the ear] – occurs in the form of necrosis, amputations, and sepsis. Over the last 10 years, we have not seen any Minsk residents with this infection. We have had children with this diagnosis coming in from the provinces, where they don't vaccinate. Meanwhile, we are in a favorable position, although the medical community is concerned that it will start to appear.
Tatiana Yaroskaya, 37 Years Old, Mother of Four Children
I think that vaccinations are one of the great achievements of medicine, which helps [us] avoid terrible illnesses. Therefore, the question as to whether or not to vaccinate my children never arose. I always performed the vaccinations according to schedule. Deferring [vaccinations] due to illness hasn't caused me any anxieties, either; some people say that something terrible will happen if you vaccinate a child two months late, but it won't.
I'm easygoing about those who don't vaccinate – it's their life, their health. They have the right to benefit from the achievements of medicine or not. I protect their children, and how other people act with regard to their health or their children's upbringing is completely their responsibility.
I know that in France, it is forbidden to go to school if you are not vaccinated. There is no violation of human rights in this ... There is a common phrase that the rights of one person end where the rights of another person begin. If there are medical grounds for not letting an unvaccinated child attend a childcare setting, if there is a risk for other children, then this is exactly the case in which your rights end where the rights of another begin.
Before now, I hadn't worked out any special philosophy for how to vaccinate my children and against what. That is to say, we do whatever vaccinations they suggest at the clinic. I never did extra immunizations against the flu, and I don't think vaccination is a panacea for everything, vaccinating left and right ... The exception is the vaccination against Human Papilloma Virus [HPV – which can cause cervical cancer], which in our country is only available on a paid basis. I deliberately got this vaccine for my daughters, and I recommended it to relatives and friends. This has been shown to provide real protection against HPV, which – it has also been shown – causes cancer.
Alexandra Grablevskaya, 45 Years Old, Mother of Three Children
My cousin was born healthy. They vaccinated her according to the schedule, and everything was fine. But after the second DTP [Diphtheria-Tetanus-Pertussis (whooping cough)] injection, the child began having epileptic seizures. My aunt took her daughter to consultations with professors in Moscow and St. Petersburg, but they said development had stopped, her brain cells were dying. This girl lived for 32 years, if you can call that life ... In my husband's family, something similar also happened ... Over all that time, there were no doctors who could be charged with anything, and it's usually impossible to prove that this happened because of the vaccinations.
The decision not to vaccinate my children arose by itself. When our children came along, each time, my husband and I prepared ourselves for a fight. It's good that we ended up with doctors who understood our position. We weren't aggressive in expressing our thoughts. No. However, we stated clearly: “We don't need it. This happened with us.” Somehow, straight after this, the conversation [always] turned in a non-belligerent direction, and any conversations like: “You aren't thinking about your children” stopped. I want to say that, in fact, those parents who think about and care for their children will think 10 times whether to perform this vaccination.
I'm not exactly against vaccinations. I can't say that I am so much of what the doctors call an unenlightened person in these matters – after all, they try to exert influence in different ways. They are intelligent; they have had a medical education. Of course they can deploy all their arguments, but only arguments on the side they need. They won't tell you that this number of children were sick after vaccination ... But I'd say that you need to think everything through carefully.
Our children are partially vaccinated. First, we put off all the vaccinations – deciding that if we were to do them, it could be after the child turned one. We fought to have the pertussis [whooping cough] component taken out of the diphtheria-tetanus-pertussis combination, because we'd read that it was the pertussis vaccine in particular that provoked epilepsy. Of course, no one went for that … I don't know the risks of whooping cough at this moment. I don't have a single friend whose child had whooping cough. But watching my cousin laying there, a vegetable for 30 years – I think that whooping cough in comparison is just a runny nose.
I can't say that I'm very afraid of the illnesses my children aren't vaccinated against. Viruses are mutating all the time and if measles has become a terrible illness ... well, it might be. Let that be on my conscience.
I think there should be freedom of choice. And doctors should have the same attitude to everyone – although maybe they've changed now, I don't know. I'd like a preliminary diagnosis for children before they're vaccinated, so each child would be treated like an individual.
School and nursery school accepted my partially vaccinated children without any questions. Why should it be any other way?
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