August is National Immunization Awareness Month, a chance for Americans to pause and consider the benefits of vaccinations, and the lives that have been saved by taking this simple preventative measure against diseases that have plagued humanity for thousands of years.
Barely over a half century ago, outbreaks of polio, smallpox, measles, and other diseases with high fatality rates were common in America, resulting in thousands of deaths — many of them children — as well as costly and disruptive quarantines, community lockdowns, school shutdowns, and more. Since the 1950s, when the science underlying vaccines began rapidly advancing, and both federal and the state governments launched aggressive vaccine campaigns to bring diseases under control, vaccine-preventable diseases have either vanished from our shores or become so uncommon that a single case makes national news.
“Vaccinations are probably one of — if not the — safest things that we do in health care. And they are probably the most effective tool that we have, besides clean drinking water, at promoting the public’s health and improving health,” said Anne Zink, chief medical officer for the state of Alaska. “They’ve been transformational over the last hundred years,” she added. “We have been able to live in a world where we have not seen the impact of viruses and bacteria in the same sort of way as we did a hundred years or two hundred years ago.”
Alaskans, like just about everyone these days, have been giving a lot of thought to vaccinations this year. After more than a year of dealing with a global pandemic, transmission of Covid-19 in the United States has plummeted as a national immunization effort has reduced new infections drastically, leading to the slow return of normal life. “Covid-19 is becoming a vaccine-preventable disease,” Zink stated matter-of-factly.
Matt Bobo, the immunization program manager for the state of Alaska, has been at the forefront of Alaska’s push to get residents immunized against a disease that brought the entire world to a near halt. Vaccines, he stressed, don’t just protect the individuals who receive them. When enough people are vaccinated, they slow and can even stop the spread of deadly diseases from circulating in communities, where vulnerable people in particular depend on the good health of others for their own wellbeing.
“The more people that we have vaccinated, the better, and the less disease we see likely to spread in the community,” Bobo said, explaining the methodology behind immunization campaigns. “That’s something we talk about in immunizations as herd immunity. Each vaccine, or each disease, there’s an amount of immunizations you need within a given society. And that’s been well studied. So we try to make sure that we get people vaccinated so that they’re protected against disease.”
Bobo is an epidemiologist who works in public health. Before coming to Alaska, he spent time overseas, and recognizes America’s good fortune in being able to avoid diseases still seen in other countries. He credits vaccinations for this.
“These diseases do decimate places” he said. “Americans tend to forget that these vaccines protect us from getting sick.” He added, “A lot of these diseases, we haven’t seen. We don’t see a lot of measles in the country, and we really want to increase coverage rates so everyone is protected.”
Vaccines are “an easy way to teach your body’s immune system how to take down a virus if it gets exposed to it,” Zink said. Different vaccines work in different ways she explained, but they all have the same objective. “They show your body either a part of the virus — a virus that has been killed or changed in a way that it can’t make you sick — or teach your body how to make a part of the virus, like the spike protein from the coronavirus. And it does it in a way that then teaches your body how to be able to take down that virus if it sees it. So essentially it’s an instruction for you body on how to take apart the virus.”
While the science has evolved tremendously, training the body to reject a virus has been the way vaccines have always worked. This goes back to 1796, when British doctor Edward Jenner demonstrated that exposing a person to the irritating but benign disease of cowpox would prevent them from contracting smallpox. Jenner coined the term vaccination for his process.
Smallpox, a disease that killed 300 million globally in the 20th century alone, was fully eliminated from the planet by 1980, thanks to a worldwide vaccination campaign. More recently, ongoing immunization programs have nearly eliminated polio as well, saving millions more from death or permanent disfigurement.
Most diseases can’t be fully extinguished owing to the ability of many viruses to develop variant forms. However, they can, through vaccinations, be managed to the point of not hindering society. This has been shown by the steep drop off in new Covid-19 cases in America since vaccines were approved, production ramped up, and people began getting immunized.
Zink welcomes how vaccines have turned the tide against a disease that was killing over 1,000 Americans a day just one year ago. Vaccinated people, she said, “are less likely to get an active infection that can spread to other people, less likely to get sick, less likely to get hospitalized, and less likely to die.”
“It looks like you get better protection from the vaccine than you do from natural infection itself,” she added. “That’s why we recommend even people who have gotten Covid-19 to consider getting vaccinated.”
How the vaccine works
While many older vaccines entailed injecting people with a dead or weakened version of the virus being targeted, the two main coronavirus immunizations are part of a newer approach called messenger RNA, or mRNA, that sends a message prompting cells to make a piece of the spike protein that is found on the surface of the Covid-19 virus. Recognizing the protein as foreign to the body, the immune system breaks it down, in the process developing the antibodies needed to prevent infection if the person is exposed to the disease.
While mRNA vaccines have been studied for decades and their safety and efficacy have been documented, public unfamiliarity with them has resulted in a lot of misunderstandings. This has led to unwarranted concerns and the misperception that the Covid vaccines are “experimental” and will cause longterm side effects. Zink sought to clarify why this belief is not founded on facts.
“These mRNA vaccines are only in your body for a few hours,” she explained. “They just teach your immune system to respond. The way that vaccines work is teaching the immune system, so we’re going to see adverse effects of the vaccine within the first couple minutes to couple weeks. But we don’t see it months to years later. We really see it in that shorter window. And that’s why these studies were done. To look at that two month time frame, and then ongoing monitoring from there.”
“It’s for those reasons that I have no concerns about the longterm safety or efficacy of these vaccines,” she continued. “Particularly when you’re balancing the risk of Covid-19. We see huge longterm consequences of Covid-19 and long Covid. Even asymptomatic men are more likely to have strokes if they’ve had Covid-19. I don’t think people think a lot about the long Covid aspect. There’s a kid I know who, everything he eats and drinks still tastes like sewage a year later. Or the marathon runner who’s still on oxygen. Or the EMS provider who’s still so weak she can’t really do her job.”
Zink said, “when you look at the risk of clotting, you look at the risk of Covid, you look at the risk of long Covid, you look at the risk of strokes, all associated with the disease itself, versus the vaccine, I think that it’s incredibly clear that the benefits strongly outweigh the risks. We’ve had more than 300 million doses given worldwide, and I think we’ve had a lot of information at this point.”
The speed of trust
While getting people vaccinated against Covid-19 is a priority for the Division of Public Health, other diseases should not to be forgotten. Alaska, which has long lagged behind the national average for vaccination rates, followed a countrywide trend of seeing those rates fall last year, as people steered clear of clinics unless they required aid.
“We did see a drop in our pediatric immunizations when the pandemic first started,” Bobo said. “But I would say that our pediatricians were great at getting that coverage back up after that beginning of the pandemic.” Now that things are much closer to normal, he added, “We really want to encourage those folks that might have been delayed or not gone to the doctor, to get them up to date on their immunizations so we’re all making sure there’s no disease spreading around when school goes back into session.”
Part of encouraging people to get vaccinated involves overcoming the fears and misinformation that spread quickly online. Both Zink and Bobo stressed that the underlying causes for those fears are rooted in people misunderstanding the science behind immunization. Both said the best way to talk to people who are vaccine hesitant and help them clear up their misconceptions is to be empathetic, not confrontational.
“We have to move at the speed of trust,” Zink said. “I think most people really want to be healthy, they want to be well, they want their communities to be healthy. And unfortunately there’s a lot of misinformation out there about vaccines and about the disease itself that can make it hard for people to make an informed decision about vaccines.” And while there are a few dissidents, she added, “I think the scientific and medical communities have become pretty unified on the fact that these vaccines are incredibly safe and efficacious. I try to share that information with patients as I’m talking with them about their fears and their concerns.”
“It’s trying to understand people and where they’re at,” Bobo advised, “and to provide them with information that’s from an accredited source, like the CDC. And just making sure they are aware of the benefits. And then having a conversation of why they might feel mistrust or what stories they know.”
Reflecting on her work as a physician, Zink said, “I like to ask every patient that I see in the emergency department if they have any questions about vaccines. I’m not here to judge their decisions, I’m here to support them as a clinician and let them know the risks they have related to Covid-19, as well as the risk and benefits associated with vaccines.” Emphasizing how people often don’t recognize those risks and benefits, she added, “I just admitted a patient to the emergency room the other day who said, ‘Man, I wish would have known how sick I would have gotten from Covid. I wish I would have gotten vaccinated.’”
“I wouldn’t recommend anything to Alaskans that I wouldn’t do myself, or recommend to my family. My children are now fully vaccinated, as well as my family,” Zink pointed out. “I would encourage Alaskans to look at trusted resources. Talk to their primary care provider or their health care provider about the opportunity to get vaccinated, and consider protecting themselves, their family, and their community.”
Zink said she doesn’t think Covid-19 will mutate quickly enough to require annual boosters like the flu does. But she said that slowing and stopping mutations from developing means getting the outbreak under control, and that makes every Alaskan part of a global effort. As America marks this year’s National Immunization Awareness Month, Zink said, “I’m just excited to be on the offense against this disease, and essentially move into it being a preventable disease.”
“Vaccines are amazing,” she concluded. “They work.”
David James is a freelance writer who lives in Fairbanks. He can be emailed at email@example.com.