Why dont we just leave it to antimicrobials?

This post was chosen as an Editor's Selection for ResearchBlogging.orgIn the last of my vaccine sub-series (the others can be found here, here, here and here) I wanted to talk about why vaccines trump therapeutics every time or at least just a few reasons why.

Something I hear occasionally when talking about vaccines is that they are not required as we have drugs to deal with sickness. It’s true we have developed everything from cold and flu meds to antibiotics and chemotherapy but vaccines are still, in my opinion, the greatest advancement in public health after improved sanitation.

The first thing that jumps to mind is cost. According to the CDC the cost per dose of most vaccines to the patient is between $5 and $100 through the CDC depending on the vaccine and at most double that through a private sector reseller. That presumably means that as many vaccines require boosters shots for approx $300 you could generate a lifetime of immunity. This is compared to antibiotic prescriptions of $10-$40 each time you are sick. Neither of these include doctor consultation fees or but nor does it include government subsidies. So even if the government wont subsidise a particular vaccine its likely you will end up paying as much or more to treat it in the long run anyway.

That’s just in the first world. In the third world vaccines have the potential to save millions of lives. Therapeutic treatments are simply too expensive to roll out into these communities. Vaccines however, subsidised by the WHO in many cases, can be and are used extensively to save lives. Unfortunately it always comes back to cost but fortunately the best option for long-term relief from infectious disease is also the cheapest.

There is also better ‘coverage’. A great example here would be the vaccines available for S. pneumococcus, Pneumovax and Prevenar. These vaccines are different in many ways but both were designed to maximise ‘effective serotype coverage’. The problem with the Pneumococcus (as I have mentioned before) is that while the underlying bug remains somewhat consistent its outermost structure consisting of polymerised bacterial sugars (its capsule) has over 80 different variations. It’s the capsule your immune system ‘sees’ and so the vaccine is designed to protect you from 23 or 7 (to varying efficacies) different capsular variations. That’s multiple vaccines in one against the same bacteria, which results in less sickness overall.

Or there are the vaccines mixtures containing multiple vaccines against multiple agents. MMR vaccines take care of measles, mumps and rubella, all of which were enormous problems until very recently when incidence started to fall as the vaccines were released. In fact at a WHO meeting this year the delegates set targets of 95% global vaccination rates by 2015 for measles with the aim to eventually eradicate this disease.

The final benefit to make my top 3 reasons is that with vaccines there is no ‘bystander effect’. One of the biggest problems with antibiotic treatments is that in military terms they can be thought of as trigger happy Special Forces teams charged with taking out an offender but the only description they have is that the offender is ‘bacterial in appearance and may be armed’. Anyone that matches that description is taken out, including the bacteria that normally live in your gut and in fact have a role in keeping you healthy. Antibiotics cant discriminate good from bad bacteria and so you suffer. I have read that some doctors even suggest people try eating yogurt or similar products during and after a course of antibiotics to replenish the good bacteria lost (although the benefit of this has not been established beyond all doubt). Vaccines don’t have the ability to do this. Vaccines, as we have mentioned, train the immune system to detect foreign invaders faster and more effectively by exploiting the immune systems own training systems.

In the end vaccines are the best options for many reasons, cost, coverage and specificity are just three. I’ve deliberately left off other major reasons such as the development of antibiotic resistance as they form larger topics and would be better served by their own separate posts in the future (which I guess means we will never really this little vaccine sub-series). Its impossible to calculate the numbers of live saved by vaccines but we can say its many millions. Almost any disease for which an effective vaccine has been made has seen a reduction in incidence in the years following its introduction. Its also important to remember that vaccines have allowed us to remove smallpox from our planet, we can do this with other pathogens, like measles, that can only survive in humans. All it takes is the right vaccine, patient compliance and the right time.

At this time the anti-vaccination movement is getting stronger. My own opinion is that these movements will continue to grow as a result of vaccines remaining effective. The effectiveness of vaccines may be there undoing as the community forgets what polio does to a child and that measles can kill. As these diseases have faded people have become more concerned with the side effects of the drugs. As parts of Australia and the US (and undoubtedly other places around the world) start to refuse vaccines for their children we are and will continue to see vaccine preventable diseases come back.

This year 10 children have died due to Whooping Cough in California and there is an ongoing epidemic in Adelaide, Australia that claimed its fourth victim earlier this year. This is an ongoing tragedy and the people and families involved have suffered greatly. Whilst I desperately hope that another pandemic does not occur it seems that while the vaccine side effects seem more dangerous than the targets of the vaccines themselves these movements will continue to grow. My hope is that if you don’t believe in vaccines or are not sure you talk to an expert like your doctor and if you do believe in and understand the power of vaccines you engage with people without alienating them. Informing the community is now the best way to prevent infectious diseases coming back and devastating the human population in a world where even the most useful therapeutics are waning in effectively.

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References

Bartlett, J. (2002). Antibiotic-Associated Diarrhea New England Journal of Medicine, 346 (5), 334-339 DOI: 10.1056/NEJMcp011603
Hooper, L. (2001). Commensal Host-Bacterial Relationships in the Gut Science, 292 (5519), 1115-1118 DOI: 10.1126/science.1058709
Conway, S., Hart, A., Clark, A., & Harvey, I. (2007). Does eating yogurt prevent antibiotic-associated diarrhoea? A placebo-controlled randomised controlled trial in general practice British Journal of General Practice, 57 (545), 953-959 DOI: 10.3399/096016407782604811

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3 Comments

Filed under James' Corner

3 responses to “Why dont we just leave it to antimicrobials?

  1. Pingback: Quick Links | A Blog Around The Clock

  2. “trigger happy” :)
    beautiful point there

  3. Jacob

    “My own opinion is that these movements will continue to grow as a result of vaccines remaining effective.”
    It’s amusing (in a dark kind of way) that the fact vaccines work so well makes people forget just how important they are.

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