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Why WHO has not eliminated chicken pox like smallpox?

Why WHO has not eliminated chicken pox like smallpox?



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Chicken pox is a viral disease, so why then has the World Health Organization (WHO) not eliminated chicken pox like smallpox?

Smallpox still exists in labs.


Eliminating a virus from the world is an immensely costly undertaking. As with most things in real life, cost vs. benefit (and feasibility) need to be taken into account. Unfortunately, there is a limited amount of money available to fight disease.

The overall mortality rate of smallpox is about 30%. That's a very high mortality rate, one that shaped history significantly.

By contrast, of a yearly 4 million people who contracted chicken pox (in the US, before the vaccine), only 100 to 150 died each year.

The death rate of smallpox: 30%. The death rate of chicken pox: .00375%

Maybe someday chicken pox will go the way of small pox. But our limited monies need to be devoted to eliminating viruses that cause greater harm, e.g. polio and others.

Also, not all viruses are equally "eliminatable", e.g. H1N1, HIV, etc.

Smallpox Vaccine: The Good, the Bad, and the Ugly
Monitoring the Impact of Varicella Vaccination


As well as the risk associated with the viruses (as explained in anongoodnurse's answer), chickenpox isn't a good candidate for elimination because of its lifelong carrier state. With smallpox (like polio and measles, which are also candidates for eradication) there is no carrier state, so eliminating the virus at one time point means the virus will not return. With chickenpox, you could eradicate every active case, and next week an adult carrier will start shedding the virus again and start new rounds of infection. There is as yet no way of eliminating the virus from carriers, so it's impossible to eradicate chickenpox or any other virus that enters a similar long-term latent/carrier state, which includes all the herpesviruses, HIV, adenoviruses, etc.


Decline of Chickenpox a Problem for Millennials?

Millennials don't have it easy, contrary to popular belief.

Globalization, automation, and other permanent structural shifts in the workforce have conspired against this generation. According to the advocacy group Young Invincibles, and reported in USA Today, "millennials earn 20 percent less than boomers did at the same stage of life, despite being better educated."

Quartz puts it even more starkly:

The American dream hinges on the idea that future generations will do better than the ones that preceded them. But a new study. is bad news for a whole generation: Only half of American 30-year-olds today earn more money than their parents did at the same age. That’s a steep drop from the early-1970s, when 30-year-olds were virtually guaranteed to outpace their parents’ generation in earning power.

Often heavily indebted from the soaring cost of higher education, Millennials are delaying marriage, families, and home ownership, as well. While financial conditions force many Millennials to live at home with their parents, older Americans mock them as entitled "snowflakes."

Now, there's yet another trouble to add to the Millennials' list of woes: Shingles.

Decline of Chickenpox a Problem for Millennials?

The year I turned 30 years old, something very bizarre happened: I broke out in shingles. That's a disease we normally associate with old people. What was going on?

Shingles is caused by the same virus that causes chickenpox. Chickenpox is a type of herpesvirus. And just like herpes, chickenpox is forever. After the itchy bumps disappear, the virus lives inside nerve cells for the rest of your life. Every once in a while, the virus is reactivated, triggering the painful rash we call shingles.

Why does the virus get reactivated? That's not entirely clear. Age, stress, and becoming immunocompromised play a role. But there's another possible explanation: Chickenpox vaccines.

According to recent data from the CDC, the percentage of children who have ever had chickenpox has fallen dramatically since a vaccine was licensed for use in the U.S. in 1995.

This is a resounding public health victory! Sitting in a gooey oatmeal bath no longer has to be a rite of passage during childhood. If chickenpox is one day eradicated, nobody will ever get chickenpox or shingles again.

Unfortunately, this victory may have come with a temporary unintended consequence. Because fewer kids have chickenpox, there is less virus circulating among the public. It is thought that exposure to the virus helps keep shingles in check. (Perhaps exposure to the virus triggers the production of antibodies which prevent outbreaks of shingles.) One study from 2015 predicted that 31- to 40-year-olds would be hit hardest by the uptick in shingles cases.

Other research published in the Annals of Internal Medicine disagrees. It found that there was an increase in shingles cases, but it did not believe that the chickenpox vaccine was to blame. Notably, however, the study only examined people aged 65 and over.

Regardless of the exact explanation, shingles cases are going up, and Millennials may be disproportionately affected by the increase. Hopefully, it won't be rechristened "Snowflake disease."


Smallpox is officially declared eradicated

On December 9, 1979, a commission of scientists declare that smallpox has been eradicated. The disease, which carries around a 30 percent chance of death for those who contract it, is the only infectious disease afflicting humans that has officially been eradicated.

Something similar to smallpox had ravaged humanity for thousands of years, with the earliest known description appearing in Indian accounts from the 2 Century BCE. It was believed that the Egyptian Pharaoh Ramses V died of smallpox in 1145 BCE however, recent research indicates that the actual smallpox virus may have evolved as late as 1580 CE. A type of inoculation—introducing a small amount of the disease in order to bring on a mild case that results in immunity—was widespread in China by the 16th century.

There is no record of a smallpox-like illness in the Americas before European contact, and the fact that Europeans brought pox with them was a major factor in their conquest and near-eradication of many of the indigenous peoples of North, South and Central America. Smallpox was the leading cause of death in 18th century Europe, leading to many experiments with inoculation. In 1796 the English scientist Edward Jenner discovered a vaccine. Unlike other types of inoculation, Jenner’s vaccine, made from a closely-related disease that affects cows, carried zero risk of transmission.

Many European countries and American states made the vaccination of infants mandatory, and incidents of smallpox declined over the 19th and early 20th centuries. Compared to other epidemic diseases, such as polio or malaria, smallpox eradication was relatively simple because the disease lives only in humans, making human vaccination highly effective at stopping its spread, and its symptoms appear quickly, making it easy to identify and isolate outbreaks.

Starting in 1967, the World Health Organization undertook a worldwide effort to identify and stamp out the last remaining outbreaks of the disease. By the mid-70s, smallpox was only present in the Horn of Africa and parts of the Indian subcontinent. The last naturally occurring case was diagnosed in Somalia in 1977. Two years later, doctors proclaimed its eradication. The elimination of smallpox is one of the major successes in the history of science and medicine.


Contents

Varicella vaccine is 70% to 90% effective for preventing varicella and more than 95% effective for preventing severe varicella. [17] Follow-up evaluations have taken place in the United States of children immunized that revealed protection for at least 11 years. Studies were conducted in Japan which indicated protection for at least 20 years. [17]

People who do not develop enough protection when they get the vaccine may develop a mild case of the disease when in close contact with a person with chickenpox. In these cases, people show very little sign of illness. This has been the case of children who get the vaccine in their early childhood and later have contact with children with chickenpox. Some of these children may develop a mild chickenpox also known as breakthrough disease. [18]

Another vaccine, known as zoster vaccine, is simply a larger-than-normal dose of the same vaccine used against chickenpox, and is used in older adults to reduce the risk of shingles (also called herpes zoster) and postherpetic neuralgia, which are caused by the same virus. [ citation needed ] The live zoster (shingles) vaccine is recommended for adults aged 60 years and older. [19] A recombinant zoster (shingles) vaccine is recommended for adults aged 50 years and older. [20]

Duration of immunity Edit

The long-term duration of protection from varicella vaccine is unknown, but there are now persons vaccinated twenty years ago with no evidence of waning immunity, while others have become vulnerable in as few as six years. Assessments of duration of immunity are complicated in an environment where natural disease is still common, which typically leads to an overestimation of effectiveness. [21]

Some vaccinated children have been found to lose their protective antibody in as little as five to eight years. [22] However, according to the World Health Organization: "After observation of study populations for periods of up to 20 years in Japan and 10 years in the United States, more than 90% of immunocompetent persons who were vaccinated as children were still protected from varicella." However, since only one out of five Japanese children were vaccinated, the annual exposure of these vaccinees to children with natural chickenpox boosted the vaccinees' immune system. In the United States, where universal varicella vaccination has been practiced, the majority of children no longer receive exogenous (outside) boosting, thus, their cell-mediated immunity to VZV (varicella zoster virus) wanes—necessitating booster chickenpox vaccinations. [23] As time goes on, boosters may be necessary. Persons exposed to the virus after vaccination tend to experience milder cases of chickenpox if they develop the disease. [24]

Catching "wild" chickenpox as a child has been thought to commonly result in lifelong immunity. Indeed, parents have deliberately ensured this in the past with "pox parties". Historically, exposure of adults to contagious children has boosted their immunity, reducing the risk of shingles. [25] The CDC and corresponding national organizations are carefully observing the failure rate which may be high compared with other modern vaccines—large outbreaks of chickenpox having occurred at schools which required their children to be vaccinated. [26]

Chickenpox Edit

Prior to the introduction of the vaccine in 1995 in the United States (released in 1988 in Japan and Korea), there were around 4,000,000 cases per year in the United States, mostly children, with typically 10,500–13,000 hospital admissions (range, 8,000–18,000), and 100–150 deaths each year. [23] [9] [27] Though mostly children caught it, the majority of deaths (by as much as 80%) were among adults. [ citation needed ]

During 2003, and the first half of 2004, the US Centers for Disease Control and Prevention (CDC) reported eight deaths from varicella, six of whom were children or adolescents. These deaths and hospital admissions have substantially declined in the US due to vaccination, [28] [29] though the rate of shingles infection has increased as adults are less exposed to infected children (which would otherwise help protect against shingles). [30] [31] [32] Ten years after the vaccine was recommended in the US, the CDC reported as much as a 90% drop in chickenpox cases, a varicella-related hospital admission decline of 71% [27] and a 97% drop in chickenpox deaths among those under 20. [33]

Vaccines are less effective among high-risk patients, as well as being more dangerous because they contain attenuated live virus. In a study performed on children with an impaired immune system, 30% had lost the antibody after five years, and 8% had already caught wild chickenpox in that five-year period. [34]

Herpes zoster Edit

Herpes zoster (shingles) most often occurs in the elderly and is only rarely seen in children. The incidence of herpes zoster in vaccinated adults is 0.9/1000 person-years, and is 0.33/1000 person-years in vaccinated children this is lower than the overall incidence of 3.2–4.2/1000 person-years. [35] [36]

Adult shingles cases may increase after introduction of varicella vaccine, but evidence is unclear. [25] [31] [36] [37] While research using computer models has tended to support the hypothesis that vaccination programs would increase incidence of zoster in the short term, the evidence from epidemiological studies is mixed, [38] [39] and increases observed in zoster incidence in some studies may not be related to vaccination programs, as the incidence increases prior to the varicella vaccine program being initiated. [40]

Regarding herpes zoster, the US Centers for Disease Control and Prevention (CDC) stated in 2014: "Chickenpox vaccines contain weakened live VZV, which may cause latent (dormant) infection. The vaccine-strain VZV can reactivate later in life and cause shingles. However, the risk of getting shingles from vaccine-strain VZV after chickenpox vaccination is much lower than getting shingles after natural infection with wild-type VZV." [41]

Schedule Edit

The World Health Organization (WHO) recommends one or two doses with the initial dose given at 12 to 18 months of age. [9] The second dose, if given, should occur at least one to three months later. [9] The second dose, if given, provides the additional benefit of improved protection against all varicella. [42] This vaccine is a shot given subcutaneously (under the skin). It is recommended for all children under 13 and for everyone 13 or older who has never had chickenpox. [ citation needed ]

In the United States, two doses are recommended by the Centers for Disease Control and Prevention (CDC). For a routine vaccination, the first dose is administered at 12 to 15 months of age and a second dose at age 4–6 years. However, the second dose can be given as early as 3 months after the first dose. If an individual misses the timing for the routine vaccination, the individual is eligible to receive a catch-up vaccination. For a catch-up vaccination, individuals between 7 and 12 years old should receive a 2-dose series 3 months apart (a minimum interval of 4 weeks). For individuals 13–18 years old, the catch-up vaccination should be given 4 to 8 weeks apart (a minimum interval of 4 weeks). [43] The varicella vaccine did not become widely available in the United States until 1995. [44]

In the UK, the vaccine is only recommended in people who are particularly vulnerable to chickenpox. [45] As there is an increased risk of shingles in adults due to possible lack of contact with chickenpox-infected children providing a natural boosting to immunity, and the fact that chickenpox is usually a mild illness, the National Health Service cites concerns about unvaccinated children catching chickenpox as adults when it is more dangerous. [45]

The varicella vaccine is not recommended for seriously ill people, pregnant women, people who have tuberculosis, people who have experienced a serious allergic reaction to the varicella vaccine in the past, people who are allergic to gelatin, people allergic to neomycin, people receiving high doses of steroids, people receiving treatment for cancer with x-rays or chemotherapy, as well as people who have received blood products or transfusions during the past five months. [46] [47] Additionally, the varicella vaccine is not recommended for people who are taking salicylates (e.g. aspirin). [47] After receiving the varicella vaccine, the use of salicylates should be avoided for at least six weeks. [47] The varicella vaccine is also not recommended for individuals who have received a live vaccine in the last four weeks, [47] because live vaccines that are administered too soon within one another may not be as effective. [47] It may be usable in people with HIV infections who have a good blood count and are receiving appropriate treatment. [9] Specific antiviral medication, such as acyclovir, famciclovir, or valacyclovir, are not recommended 24 hours before and 14 days after vaccination. [48]

Serious side effects are very rare. From 1998 to 2013, only one vaccine-related death was reported: an English child with pre-existent leukemia. On some occasions, severe reactions such as meningitis and pneumonia have been reported (mainly in inadvertently vaccinated immunocompromised children) as well as anaphylaxis. [35]

The possible mild side effects include redness, stiffness, and soreness at the injection site, as well as fever. A few people may develop a mild rash, which usually appears around the injection site. [49]

There is a short-term risk of developing herpes zoster (shingles) following vaccination. However, this risk is less than the risk due to a natural infection resulting in chickenpox. [50] : 378 Most of the cases reported have been mild and have not been associated with serious complications. [51]

Approximately 5% of children who receive the vaccine develop a fever or rash. Adverse reaction reports for the period 1995 to 2005 found no deaths attributed to the vaccine despite approximately 55.7 million doses being delivered. [52] Cases of vaccine-related chickenpox have been reported in patients with a weakened immune system, [53] [54] but no deaths.

The literature contains several reports of adverse reactions following varicella vaccination, including vaccine-strain zoster in children and adults. [55]

The Varicella zoster vaccine is made from the Oka/Merck strain of live attenuated varicella virus. The Oka virus was initially obtained from a child with natural varicella, introduced into human embryonic lung cell cultures, adapted to and propagated in embryonic guinea pig cell cultures, and finally propagated in human diploid cell cultures. [4] [5] [6] A live attenuated varicella vaccine, the Oka strain, was developed by Takahashi and his colleagues in Japan the early 1970s. [12] This strain was further developed by pharmaceutical companies such as Merck & Co. and GlaxoSmithKline. [56] American vaccinologist Maurice Hilleman's team at Merck invented a chickenpox vaccine in 1981, based on the Oka strain which was licensed by Merck in the United States. [13] [14] [15]

Japan was among the first countries to vaccinate for chickenpox. The vaccine developed by Hilleman was first licensed in the United States in 1995. [13] [57] Routine vaccination against varicella zoster virus is also performed in the United States, and the incidence of chickenpox has been dramatically reduced there (from four million cases per year in the pre-vaccine era to approximately 400,000 cases per year as of 2005 [update] ). In Europe, most countries do not vaccinate against varicella, though the vaccine is gaining wider acceptance. [ citation needed ] Australia, Canada, and other countries have adopted recommendations for routine immunization of children and susceptible adults against chickenpox. [ citation needed ]

Other countries, such as the United Kingdom, have targeted recommendations for the vaccine, e.g., for susceptible health care workers at risk of varicella exposure. In the UK, varicella antibodies are measured as part of the routine of prenatal care, and by 2005 all National Health Service personnel had determined their immunity and been immunized if they were non-immune and have direct patient contact. Population-based immunization against varicella is not otherwise practised in the UK. [58]

Since 2013, the MMRV vaccine is offered for free to all Brazilian citizens. [ citation needed ]

Catholic Church Edit

The Catholic Church has indicated that “it is right to abstain from using these vaccines [produced using aborted fetal tissue]”. However, this right should only be exercised if children and the population as a whole are not thereby subjected to significant health risks. [59]


4 Diseases Making a Comeback Thanks to Anti-Vaxxers

M easles has made a comeback, at least in New York City, where as many as 19 cases have been confirmed.

New York City isn’t an anomaly, though. Diseases that are and have been avoidable in the U.S. thanks to vaccines, are resurfacing all across the country. Measles, for instance, was considered wiped out in 2000, but there have been several outbreaks in the past few years. This map shows outbreaks of vaccine-preventable diseases since 2008 (click on “Map” and select which diseases and regions you want to see).

The emergence of these diseases &mdash especially measles &mdash is alarming, and mostly due to parents in the U.S. not vaccinating their kids. “If you are unvaccinated and you come in contact with measles, there’s a 90% chance you will get it,” says Jason McDonald, a spokesperson for the Centers for Disease Control and Prevention (CDC).

Though measles outbreaks are primarily linked to unvaccinated people, McDonald notes that some vaccines aren’t foolproof. For example, the whooping-cough vaccine may lose its efficacy over time. And, overall, most people do get their vaccinations. A CDC report looking at children entering kindergarten for the 2012&ndash13 school year in all U.S. states found that more than 90% of these kids had their vaccines.

Still, there are people &mdash including public figures and celebrities &mdash who don’t vaccinate their kids and promote their choices. Most infamously, Jenny McCarthy has espoused her antivaccination position because she believes vaccines are full of toxins and cause autism. When she recently posed a question on Twitter about finding a mate, the vaccination backlash was loud and clear.

Just how harmful are these notions, though? Below are some preventable diseases making a vicious return thanks to people not getting their vaccinations.

Measles
According to the CDC, for every 1,000 children who get the measles, one or two will die. Currently, public-health workers are worried about the situation in New York, but just in the past three months, there have been reported cases of the disease in Massachusetts, Illinois and California. The CDC reports that from Jan. 1 to Feb. 28, 2014, 54 people in the U.S. have reported being infected with measles. On average, there are about 60 cases reported in the U.S. every year. Most people in the U.S. are vaccinated against the measles, but since measles is still around in other countries, those who travel outside of the U.S. can contract it if they are not vaccinated. New York City has not been able to confirm the source of the disease.

Mumps
As recently as Monday, health officials confirmed 23 cases of mumps at Ohio State University. In 2011, there was a mumps outbreak on the University of California at Berkeley campus, with 29 reported cases confirmed by the CDC. The source of the outbreak was thought to be an unvaccinated student who had spent time traveling in Western Europe where there is still a presence of mumps. In 2013, a slightly smaller outbreak of the disease broke out among students at Loyola University in Maryland. The last major occurrence was in 2006, when there was a multistate outbreak of 6,584 reported cases. Less than 20 cases a year was considered usual at the time.

Whooping Cough
Whooping-cough outbreaks are thought to be spurred by waning immunity from the vaccine. However, a 2013 study published in the journal Pediatrics reports that California&rsquos worst whooping-cough outbreak, which infected more than 9,000 people, was also encouraged by a large number of kids who were unvaccinated.

Chicken Pox
In 2012, a county in Indiana experienced a major chicken-pox outbreak of more than 80 cases, which was thought to start from an unvaccinated child. The vaccine is 90% effective, so it’s possible for people who have been vaccinated to contract the disease.


Chicken Pox Eradicated? Varicella Vaccine Proven To Do The Job

Varicella vaccine has been in the market since 1995 and new studies show that it has nearly wiped out deaths from chickenpox in the United States. With only two diseases officially fully eradicated in the world, this is good news and signs of progress in the bio tech community.

Deaths from chickenpox have diminished by 88% in all age groups and by 97% in young people 20 and under, according to the study from the National Center for Immunization and Respiratory Diseases.

Chickenpox led to about 105 deaths a year during the pre-vaccine years of 1990 to 1994. Between 2002 and 2007, the annual average number of chickenpox deaths was the lowest ever reported, with 14 deaths recorded in 2007 and just 13 the year before.

In fact, double shots are really doing the trick. In 2006, a second dose was added to the vaccination roster which really eliminates casualties, but the decrease in deaths occurred largely during the time when just one shot was recommended. Chickenpox related deaths are now extremely rare.

Chickenpox is a common illness among kids, particularly those under age 12. An itchy rash of spots that look like blisters can appear all over the body and be accompanied by flu-like symptoms. Symptoms usually go away without treatment, but because the infection is very contagious, an infected child should stay home and rest until the symptoms are gone.

Chickenpox is caused by the varicella-zoster virus (VZV). Kids can be protected from VZV by getting the chickenpox (varicella) vaccine, usually between the ages of 12 to 15 months. The Centers for Disease Control and Prevention (CDC) also recommends a booster shot at 4 to 6 years old for further protection. The CDC also recommends that people 13 years of age and older who have never had chickenpox or received the chickenpox vaccine get two doses of the vaccine at least 28 days apart.

A person usually has only one episode of chickenpox, but VZV can lie dormant within the body and cause a different type of skin eruption later in life called shingles (or herpes zoster). Getting the chickenpox vaccine significantly lowers kids&rsquo chances of getting chickenpox, but they might still develop shingles later in life.

Experts said they hope the findings will reassure anxious parents and alert them to the life-saving benefits of varicella vaccination.

Dr. Gail Demmler-Harrison, professor of pediatrics-infectious disease at Baylor College of Medicine in Houston comments:

&ldquoWe don&rsquot see severe varicella anymore. There is a common misconception that chickenpox is a benign inconvenience of childhood and a rite of passage, but it almost always leaves lasting foot prints and there is a lot of suffering with plain old chickenpox as well as how it [affects] the family. The risks of varicella and its complications are real, and the risks of vaccine are minimal.&rdquo

Anyone who has had chickenpox (or the chickenpox vaccine) as a child is at risk for developing shingles later in life, and up to 20% do. After an infection, VZV can remain inactive in nerve cells near the spinal cord and reactivate later as shingles, which can cause tingling, itching, or pain followed by a rash with red bumps and blisters. Shingles is sometimes treated with antiviral drugs, steroids, and pain medications, and there&rsquos now a shingles vaccine for people 60 and older.


Chickenpox, the Vaccine and the Outbreak?

Chickenpox is the lesser weaker cousin of the smallpox. People who contracted smallpox had a fever and a progressive skin rash. Most people who contracted smallpox lived with the scars from it but 3 out of every 10 people that got the disease died from it. Smallpox was officially declared eradicated in 1980 by the World Health Organization due to the understanding of the benefits of vaccinations. The smallpox vaccine was introduced by Edward Jenner in 1796.

Chickenpox is a derivative of smallpox. A typical case of the chickenpox includes symptoms such as 5 to 10 days of fever, loss of appetite, headaches, feeling run down, and pink or red bumps that turn to small blisters and usually become scabs because of how itchy they are. This rash first shows up on areas like the face chest or back and subsequently spreads to the rest of the body. But for some people, the chickenpox has really severe complications. These complications can be things such as pneumonia, encephalitis, cerebellar ataxia, bleeding problems, sepsis, bacterial infections of the skin, soft tissues, bone and blood and sometimes even death.

Chickenpox, scientifically known as Varicella, is one of the many diseases that most Americans choose to vaccinate their kids for. Varicella is not as dangerous as conditions like measles, hepatitis B, the flu, mumps, or rubella, however, it has serious consequences. Even if your child is generally pretty healthy by not vaccinating your child, you risk your child coming into contact with diseases such as the chickenpox which have generally unpleasant side effects. By a parent not vaccinating their perfectly healthy child, they are putting other perfectly healthy children at risk. Parents who choose not to vaccinate their children are also putting children whose immune systems have been compromised in danger.

News broke in November 2018 that the largest chickenpox outbreak in decades had broken out at a North Carolina school. So far there have been thirty-six reported cases of chickenpox in the population of 152 students enrolled at the Asheville Waldorf School in Asheville, North Carolina. As crazy as this situation might be, this is not the first chickenpox outbreak in this county of North Carolina. Other schools in this county have had chickenpox outbreaks as well in recent years, just none effecting as many children as this outbreak. These previous chickenpox outbreaks had no more than five to eleven children.

So what is going on in this area that chicken pox outbreaks are occurring? Hasn’t there been a vaccine for chicken pox since 1995? This county and the Asheville Waldorf School in particular have extremely high religious exemption rates from vaccinations. Of the 152 children enrolled in the Asheville Waldorf School, 110 of them have religious exemptions from having to be vaccinated. This school in particular had one of the highest rates of religious exemptions in the entire state. In the 2017-2018 school year at the Asheville Waldorf School, two out of three children in the incoming class of kindergarteners was not vaccinated due to a religious exemption.

There are laws to prevent things like this from happening. All 50 states have laws requiring vaccinations for children in schools. Forty-five states and the District of Columbia allow for religious exemptions for vaccinations in schools. Additionally, eighteen states allow parents to seek personal or philosophical exemptions from vaccinating their children. Some states permit both personal and religious exemptions. States that permit both personal and religious exemptions are far more likely to suffer from outbreaks of the chickenpox and other previously eradicated viruses like Polio, Mumps, and Measles.

North Carolina only allows for religious exemptions. If religious exemptions or exemptions in general from vaccinations are this widely used it puts entire schools, and clearly entire counties at risk. Now granted there are people who have a legitimate medical reason for not being vaccinated. Babies have to have their vaccines spaced out so they may not be vaccinated at any given time. Additionally, people with severe life-threatening allergies, pregnant people, people with weakened immune systems due to disease or medical treatments, people who have recently had a blood transfusion or people with tuberculosis are medically exempt from the Chickenpox vaccine.

There are also people who cannot afford access to a doctor to get their children necessary vaccinations. The Patient Protection and Affordable Care Act sought to rectify this by making preventative services like immunization free with insurance coverage. However, many people in the United States still do not have adequate access to healthcare. Sick people and people who cannot access a doctor still benefit from compulsory vaccination laws. The concept of herd immunity still works to protect us all if everyone who is healthy and able to get vaccinated, does.

Many people that choose not to vaccinate do not fall into either of these categories. Many people who choose not to vaccinate are believing in “alternatives to science” and false claims that vaccines cause Autism. These alternatives include things like supplements, herbs, essential oils, homeopathic remedies, and chiropractic adjustments. These alternatives do not work. The best way to protect a child from falling ill with a virus that could have been eliminated by now is to actually vaccinate them. Scientific study after study has proven that vaccines do not cause Autism, yet anti-vaxxers continue to grasp at the straws of a medically disproven study by a British doctor whose medical license has since been revoked.

Bridget Reardon is currently in her second year at Suffolk University Law School where she concentrates in Health and Biomedical Law and works as a Staffer for the Journal of Health and Biomedical Law. She is writing a note on education as healthcare for students with Autism Spectrum Disorders. Her interests include education, health and insurance law.


The Doctor Who Helped Defeat Smallpox Explains What's Coming

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Larry Brilliant says he doesn’t have a crystal ball. But 14 years ago, Brilliant, the epidemiologist who helped eradicate smallpox, spoke to a TED audience and described what the next pandemic would look like. At the time, it sounded almost too horrible to take seriously. “A billion people would get sick," he said. “As many as 165 million people would die. There would be a global recession and depression, and the cost to our economy of $1 to $3 trillion would be far worse for everyone than merely 100 million people dying, because so many more people would lose their jobs and their health care benefits, that the consequences are almost unthinkable.”

Now the unthinkable is here, and Brilliant, the Chairman of the board of Ending Pandemics, is sharing expertise with those on the front lines. We are a long way from 100 million deaths due to the novel coronavirus, but it has turned our world upside down. Brilliant is trying not to say “I told you so” too often. But he did tell us so, not only in talks and writings, but as the senior technical advisor for the pandemic horror film Contagion, now a top streaming selection for the homebound. Besides working with the World Health Organization in the effort to end smallpox, Brilliant, who is now 75, has fought flu, polio, and blindness once led Google’s nonprofit wing, Google.org co-founded the conferencing system the Well and has traveled with the Grateful Dead.

We talked by phone on Tuesday. At the time, President Donald Trump’s response to the crisis had started to change from “no worries at all” to finally taking more significant steps to stem the pandemic. Brilliant lives in one of the six Bay Area counties where residents were ordered to shelter in place. When we began the conversation, he’d just gotten off the phone with someone he described as high government official, who asked Brilliant “How the fuck did we get here?” I wanted to hear how we’ll get out of here. The conversation has been edited and condensed.

Steven Levy: I was in the room in 2006 when you gave that TED talk. Your wish was “Help Me Stop Pandemics.” You didn't get your wish, did you?

Larry Brilliant: No, I didn't get that wish at all, although the systems that I asked for have certainly been created and are being used. It's very funny because we did a movie, Contagion—

We're all watching that movie now.

People say Contagion is prescient. We just saw the science. The whole epidemiological community has been warning everybody for the past 10 or 15 years that it wasn't a question of whether we were going to have a pandemic like this. It was simply when. It's really hard to get people to listen. I mean, Trump pushed out the admiral on the National Security Council, who was the only person at that level who's responsible for pandemic defense. With him went his entire downline of employees and staff and relationships. And then Trump removed the [early warning] funding for countries around the world.

I've heard you talk about the significance that this is a “novel” virus.

It doesn't mean a fictitious virus. It’s not like a novel or a novella.

It means it's new. That there is no human being in the world that has immunity as a result of having had it before. That means it’s capable of infecting 7.8 billion of our brothers and sisters.

Since it's novel, we’re still learning about it. Do you believe that if someone gets it and recovers, that person thereafter has immunity?

So I don't see anything in this virus, even though it's novel, [that contradicts that]. There are cases where people think that they've gotten it again, [but] that's more likely to be a test failure than it is an actual reinfection. But there's going to be tens of millions of us or hundreds of millions of us or more who will get this virus before it's all over, and with large numbers like that, almost anything where you ask “Does this happen?” can happen. That doesn't mean that it is of public health or epidemiological importance.

Is this the worst outbreak you’ve ever seen?

It's the most dangerous pandemic in our lifetime.

We are being asked to do things, certainly, that never happened in my lifetime—stay in the house, stay 6 feet away from other people, don’t go to group gatherings. Are we getting the right advice?

Well, as you reach me, I'm pretending that I'm in a meditation retreat, but I'm actually being semi-quarantined in Marin County. Yes, this is very good advice. But did we get good advice from the president of the United States for the first 12 weeks? No. All we got were lies. Saying it’s fake, by saying this is a Democratic hoax. There are still people today who believe that, to their detriment. Speaking as a public health person, this is the most irresponsible act of an elected official that I've ever witnessed in my lifetime. But what you're hearing now [to self-isolate, close schools, cancel events] is right. Is it going to protect us completely? Is it going to make the world safe forever? No. It's a great thing because we want to spread out the disease over time.

Flatten the curve.

By slowing it down or flattening it, we're not going to decrease the total number of cases, we're going to postpone many cases, until we get a vaccine—which we will, because there's nothing in the virology that makes me frightened that we won’t get a vaccine in 12 to 18 months. Eventually, we will get to the epidemiologist gold ring.

That means, A, a large enough quantity of us have caught the disease and become immune. And B, we have a vaccine. The combination of A plus B is enough to create herd immunity, which is around 70 or 80 percent.

I hold out hope that we get an antiviral for Covid-19 that is curative, but in addition is prophylactic. It's certainly unproven and it's certainly controversial, and certainly a lot of people are not going to agree with me. But I offer as evidence two papers in 2005, one in Nature and one in Science. They both did mathematical modeling with influenza, to see whether saturation with just Tamiflu of an area around a case of influenza could stop the outbreak. And in both cases, it worked. I also offer as evidence the fact that at one point we thought HIV/AIDS was incurable and a death sentence. Then, some wonderful scientists discovered antiviral drugs, and we've learned that some of those drugs can be given prior to exposure and prevent the disease. Because of the intense interest in getting [Covid-19] conquered, we will put the scientific clout and money and resources behind finding antivirals that have prophylactic or preventive characteristics that can be used in addition to [vaccines].


Disease Eradication

When a disease stops circulating in a region, it’s considered eliminated in that region. Polio, for example, was eliminated in the United States by 1979 after widespread vaccination efforts.

If a particular disease is eliminated worldwide, it’s considered eradicated. To date, only one infectious disease that affects humans has been eradicated.* In 1980, after decades of efforts by the World Health Organization, the World Health Assembly endorsed a statement declaring smallpox eradicated. Coordinated efforts rid the world of a disease that had once killed up to 35% of its victims and left others scarred or blind.

Smallpox eradication was accomplished with a combination of focused surveillance—quickly identifying new smallpox cases—and ring vaccination. “Ring vaccination” meant that anyone who could have been exposed to a smallpox patient was tracked down and vaccinated as quickly as possible, effectively corralling the disease and preventing its further spread. The last case of wild smallpox occurred in Somalia in 1977.

Smallpox was a good candidate for eradication for several reasons. First, the disease is highly visible: smallpox patients develop a rash that is easily recognized. In addition, the time from exposure to the initial appearance of symptoms is fairly short, so that the disease usually can’t spread very far before it’s noticed. Workers from the World Health Organization found smallpox patients in outlying areas by displaying pictures of people with the smallpox rash and asking if anyone nearby had a similar rash.

Second, only humans can transmit and catch smallpox. Some diseases have an animal reservoir, meaning they can infect other species besides humans. Yellow fever, for example, infects humans, but can also infect monkeys. If a mosquito capable of spreading yellow fever bites an infected monkey, the mosquito can then give the disease to humans. So even if the entire population of the planet could somehow be vaccinated against yellow fever, its eradication could not be guaranteed. The disease could still be circulating among monkeys, and it could re-emerge if human immunity ever waned. (The discovery of an animal reservoir for yellow fever was in fact what derailed a yellow fever eradication effort in the early 1900s.) Smallpox, however, can infect only humans. In effect, aside from the human population, it has nowhere to hide.

Equally important is the ability to protect individuals against infection. People who survived smallpox naturally developed lifelong immunity against future infection. For everyone else, vaccination was highly effective. WHO trained vaccinators quickly, and they could immunize large groups of people in a short time.

The eradication of smallpox raised hopes that the same could be accomplished for other diseases, with many named as possibilities: polio, mumps, and dracunculiasis (Guinea worm disease), among others. Malaria has also been considered, and its incidence has been reduced drastically in many countries. It presents a challenge to the traditional idea of eradication, however, in that having malaria does not result in lifelong immunity against it (as smallpox and many other diseases do). It is possible to fall ill with malaria many times, although individuals may develop partial immunity after multiple attacks. In addition, although promising steps have been made, no effective malaria vaccine yet exists.

Other diseases present additional challenges. Polio, though it has been reduced or eliminated in most countries through widespread vaccination, still circulates in some areas because (among other reasons) many cases do not present easily recognizable symptoms. As a result, an infected person can remain unnoticed, yet still spread the virus to others. Measles is problematic in a similar way: although the disease results in a highly visible rash, a significant period of time elapses between exposure to the virus and the development of the rash. Patients become contagious before the rash appears, and can spread the virus before anyone realizes they have the disease.

Guinea worm disease is likely on the verge of eradication. Only 30 cases were reported in 2017, from just 2 countries (Chad [15 cases], Ethiopia [15 cases]). [1] Though the case count increased from 2016, experts are still hopeful about the possibility of eradication. The Carter Center International Task Force for Disease Eradication has declared six additional diseases as potentially eradicable: lymphatic filariasis (Elephantiasis), polio, measles, mumps, rubella, and pork tapeworm. [2]

*Rinderpest, a disease that affected livestock, has also been eradicated, largely due to vaccination.


Diseases On The Verge Of Being Eradicated (Globally)

Poliomyelitis (Polio)

Polio is a debilitating disease caused by the poliovirus. The disease has been eliminated from several parts of the world including the Americas, Southeast Asia and India, Europe, the Western Pacific region, and the Indo-West Pacific. In 1960, the first country to eradicate polio was Czechoslovakia. The development of the vaccine against the viral disease in the 1950’s helped in controlling the disease to a great extent. Several international organizations like the WHO, the UNICEF, CDC, Rotary International, and others launched the Global Polio Eradication Initiative in 1988 with the aim of eradicating polio by 2000. Although cases of polio are still diagnosed in some parts of the world, the lowest annual prevalence of wild polio was seen in 2017. Only 22 cases were reported this year.

Dracunculiasis

Also known as the Guinea worm disease, dracunculiasis, is a disease caused by a parasite that is spread by drinking contaminated water. The disease is very disabling and painful. Like in the case of polio, several organizations have joined hands to eradicate the disease from the world. The Carter Center plays the leading role in this initiative along with the WHO, UNICEF, CDC, and others. Since no vaccines are available against this worm, success is largely dependent on ensuring clean drinking water supplies. Today, the global annual incidence of the disease has been reduced to 30 cases in 2017 down from 3.5 million in 1986. 180 countries are today free of dracunculiasis. Three African countries, Ethiopia, Chad, and South Sudan still continue to suffer from it.

Another infectious disease called yaws is on the verge of being eradicated from the world. It is caused by a bacterium, Treponema pallidum pertenue. Although fatality rate is low, yaws is a highly disfiguring disease. A program called the TCP program was launched on a global scale to eliminate the disease and significant progress was made in this regard. The number of cases of yaws decreased from 50 million in 1952 to 2.5 million in 1964. However, after the program was stopped, the disease continued to remain at a low prevalence in different parts of the world. WHO believes it will be possible to completely eradicate the disease if proper measures are adopted by 2020.

Malaria

Another deadly disease, malaria, has largely been brought under control in many parts of the world. It is caused by the malarial parasite with the mosquito acting as the vector of the disease. Malaria is spread through bites from infected female Anopheles mosquitos. The disease has been eradicated from most parts of the continents of the world. As per WHO, 28 countries have successfully eliminated the disease. Nine countries are in the elimination stage. The eradication of malaria from many parts of the world has been possible due to large-scale programs launched by the various international organizations. The Global Malaria Eradication Program was launched by WHO in 1955 but due to a lack of sufficient support, it had to end in 1969. However, in the present century, support for malaria eradication has poured in from all parts of the globe. The global rate of mortality from malaria fell by 60% between 2000 and 2015. According to Bill Gates, the disease can be eliminated by 2040.