Counterintuitivity

http://web.ebscohost.com.ezproxy.rowan.edu/ehost/detail?sid=221bdc31-1598-43ee-bd92-a46ac0956119%40sessionmgr14&vid=25&hid=12&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN=29307828

“The unfounded belief that polio vaccine can cause infertility has limited acceptance in the Islamic regions of Nigeria. And who are we to judge them, given the anti-vaccine superstitions endemic even in our ”sophisticated” society, where vaccination rates for toddlers hover well below 90 percent.”

-This is a quote from a letter to the editor concerning a New York Times article on the opposition of polio vaccination in Nigeria. In my last post, I used a quote that ridiculed and vilified opponents of vaccination and I expressed my feeling that they must not have the peoples’ best interest in mind, but after reading this letter, and consequently, the original article, I’m convinced that at least some of the public figures who speak out against vaccination truly believe that the vaccine causes infertility and health problems. This letter brilliantly compares the concerns of suspicious Nigerians to  those of our own countrymen, who  believe that vaccines cause problems from autism to cancer, making the Nigerian anti-vaccination sentiment seem much more understandable and less malicious. But I still wouldn’t object to vaccine crop-dusting them.

The source I found on Academic Search Premier was “SOME ETHICAL ISSUES ARISING FROM POLIO ERADICATION PROGRAMMES IN INDIA,” written by Yash Paul and Angus Dawson and published in the August 2005 issue of Bioethics.

The claim behind my original white paper polio article was that while the risk of paralysis from the OPV (oral polio vaccine) exists, and the alternative vaccine IPV (innactivated polio vaccine)  that does not carry this risk exists, the WHO and similar organization should switch to using that to vaccinate the countries where polio is still a threat. Paul and Dawson’s paper both supports and refutes this claim.

The paper clarifies that the does of polio contained in the oral polio vaccine (OPV) can mutate and cause polio in recipients. It is also possible to spread this mutated polio to others through the same process that creates herd immunization (fecal-oral transmission transmits the same benefits as taking the OPV directly), which has the risk of causing paralysis in both those with and without prior polio vaccinations. It also gives evidence that implies that the OPV is not effective, noting thatfrom 1998 to 2003, at least  33% of those who developed polio had recieved 4 or more doese of OPV, although they also note there is a variety of reasons why this could occur. The report also provides detail on how this information regarding the risks of OPV is given out — it is not, with WHO specifically requesting that it only be discussed in academic circles. This results in a lack of informed consent from the parents, which Paul and Dawson theorize could backfire and cause people to actively campaign against vaccinating their children, should this withholding of information become known. Despite this, Paul and Dawson also stress that the herd immunity effect passed through from those vaccinated to those who have not been is an important part of eradicating polio, and also that the costs of using the less risky inactivated polio vaccine (IPV) may not be reasonable.They also tentatively conclude that, if it is indeed possible to eradicate polio through OPV vaccination and appropriate compensation is provided to those paralyzed as a result of OPV, then the benefits necessarily outweigh the costs.

This new information poses a number of difficult questions. Is it better to sacrifice some people to eradicate polio than to allow the virus to continue infecting people? Is the herd immunity benefit of OPV worth the increased risk of paralysis? Is it even possible for the virus to be eradicated at all? Information in the paper notes that it is entirely possible that the current OPV dosing scheme has done little to actually decrease polio cases, noting that the change in defining a polio case and not counting polio paralysis from VAPP (vaccine associated paralytic poliomyelitis) arising from a result of the vaccine may skew the numbers.

This new information makes my original claim look stronger. With the doubt cast on the effectiveness of OPV and the lack of informed consent about the risks, my belief that OPV should stop being used is reinforced. However, at the same time, their conclusion that OPV and its herd immunity effect might be necessary to eliminate polio entirely goes contrary to my claims. More research will be needed to fully justify my position.

The first time i decided to research the effectiveness of the polio vaccine (Sabin), the source i found explained how it reduced the violent effect of the disease. Using the ASP source i typed “Sabin doesnt work” in the search box and looked for the best article to describe what i was looking for. The article was called “The global introduction polio vaccine can circumvent the oral polio vaccine paradox.”

This OPV has been tested and throughout the article it explain the different problems that was found. One of the problems that stood out to me was how people who did not have polio got the vaccine began to have the symptoms of polio. Its considered a infection but their is no type of therapy or anything for it.

Link

Using the Academic Search Premier, I found an article that addresses some issues with current methods of eradicating polio from the world by using OPV.

The link to the source

“Moreover, the possibility of vaccination with OPV causing VAPP, cVDPV and iVDPV leads to what is called the “OPV paradox”: OPV is necessary to eradicate the virus, but as long as OPV is in use, eradication cannot be achieved [12]. The majority of high-income countries and an increasing number of middle-income countries have switched to the use of full IPV or IPV–OPV sequential immunization schedules to avoid the risks of VAPP [13]. However, for developing countries, IPV use is not recommended in the WHO position paper published in 2003 [6]. The reason for this position was the insufficient data available on IPV effectiveness and logistical implications, preventing fully informed long-term policy decisions on the introduction of IPV for routine immunization in tropical developing countries [7]. A supplement to the WHO position paper from 2006 states that the continued routine use of OPV is ultimately incompatible with eradication of polio”

Although my other post supported the argument that Polio eradication is indeed achievable, this new information suggests the contrary. With the current means of immunization, OPV, global eradication of Polio is not achievable. It is likely that a mutated form of the virus, immune to antibodies, will infect the recipient of the OPV and spread that mutant strain.

The last source I used talked about the efficiency and success of the polio vaccine. This source describes the problems caused by the vaccine by taking it orally.

The source i used was http://web.ebscohost.com/ehost/detail?vid=7&hid=14&sid=a955be99-1942-4f64-82f5-1d3f3cfe4453%40sessionmgr11&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN=34303450.

“Oral polio vaccine (OPV) has been used safely and efficiently for more than 40 years in preventive medicine. Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse event of OPV due to reversion of the vaccine strain virus to a neurovirulent strain. VAPP can occur in healthy recipients or their close contacts. However, persons with primary humoral immunodeficiencies are at a much higher risk. X-linked agammaglobulinemia (XLA) is a prototypic humoral deficiency caused by mutations in the Bruton’s tyrosine kinase ( BTK) gene. In addition to susceptibility to bacterial infections, patients with XLA are especially prone to enteroviruses. Here, we describe the occurrence of VAPP in a 15-month old Iranian boy. The child had received four doses of OPV, administered at birth, 2, 4, and 6 months of age. The patient’s infectious history was unremarkable. Laboratory evaluation revealed low levels of immunoglobulin G and CD19⁺ B cells of less than 1% of the lymphocyte population. A novel insertion (c.685_686insTTAC) in the SH3 domain of the BTK gene was detected as the underlying cause. Immunodeficient recipients of OPV can excrete poliovirus vaccine strains for a long period and are at risk of developing flaccid paralysis.”

To sum up this quote, It states that the child with the mutations to his BTK gene effected him when receiving the oral polio vaccine. The mutations combined with the vaccine caused paralysis to the boy. This shows the bad consequences of the polio vaccine. The oral vaccine being cheaper makes it more cost efficient for people in poor countries, which is where the biggest polio problems are. These mutations of the BTK gene makes it so that the people can’t receive the oral vaccine without becoming most likely paralyzed. They must take the injection vaccine instead, but it happens to be more expensive. This creates a huge problem in the effectiveness of the polio vaccine to eradicate the disease. This source is a good source to show the problems in eradicating the polio disease and how the oral vaccine can cause many problems if the person has a humoral immunodeficiency such as the BTK gene mutation. This claim is a consequential claim showing the problems caused by the oral vaccine. It’s cause of paralysis to people with the mutations to their BTK gene put a huge road block in the eradication of polio. Until we can figure out a way around this road block the ultimate eradication of the disease is at a stand still.

“Though oral polio vaccine has succeeded in polio eradication from many countries but there is high incidence of vaccine failure in India. Oral polio vaccine (OPV) has failed to provide full protection to many children who have developed paralytic polio even after taking 10 or more doses of OPV. In some children, OPV has caused paralysis-vaccine associated paralytic polio (VAPP). Number of children developing polio due to vaccine is high and on increase. Reasons for this could be that even immunocompromised children are being administered OPV because IPV is not available. Vaccine failure has exaggerated the problem of VAPP. No efforts have been made to find the causes for high incidence of vaccine failure and VAPP.”

This refutes the arguement of the first factual evidence that I have posted, which gave the number of death cases in the United States of the years and how the are being reduced because of the vaccination. In this arguement it tells that the vaccine only really works in the U.S and not in other places such as India.

I did obtain this information from the Academic search premier and i understatnd how to use it fully and it heloped alot looking for this certain type of information.

From looking at this information I conclude that the polio vaccine does not work for all polio cases, India needs better vaccination for this polio disease, the U.S numbeers might have been reduced but all cases weren’t cured.

• I did a Google search for conspiracy theories revolving around the international efforts for vaccinations for the polio virus. I found an article from the newspaper The Guardian titled “Vaccines, the CIA, and how the War on Terror helped spread polio in Nigeria,” that discusses why complete public trust in the polio vaccine is unattainable because of fear of alternate viruses being included in the vaccine. It reveals three different conspiracy theories about the possible malicious intent of the distribution of the vaccine in the Middle East and Africa.
• The article can be found here: http://www.guardian.co.uk/science/the-lay-scientist/2011/jul/15/1
• “In Nigeria, as in Pakistan, Muslim clerics played a key part in driving these rumours, playing on anti-American sentiment and fears that America’s wars were part of a wider war on Islam.” — This is a consequential claim, saying that Muslim clerics caused the public to believe that vaccination of the disease is really a broader attempt at a war with Islam, making citizens less apt to accept vaccinations for fear of underlying viruses intended to eradicate them from the area.
• “In a male-dominated culture with a strong tradition of polygamy (in the Islamic north at least), where children are seen as gifts from God, the power of men is measured by the size of their families, and different political, ethnic and religious groups compete to be the most populous, fertility is an especially sensitive issue.” — This is also a consequential claim, saying that because “the power of men is measured by the size of their families,” fertility is crucial so that people can have more children, increasing their social ranking. The belief that the polio vaccine may cause infertility greatly reduces the chance of vaccination being accepted.
• “From a Nigerian’s perspective, to be offered free medicine is about as unusual as a stranger’s going door to door in America and handing over $100 bills.” — This is a categorical claim, saying that a stranger offering free medicine door-to-door is unusual. The fear of uncertainty and lack of recognition of those delivering the medicine would cause Nigerians to be reluctant to accept vaccination.