Immunization: why such a disenchantment?

We are currently experiencing a flu epidemic period in France. Almost every day or so we hear from the media about the influx of patients to emergency departments, the fact that hospitals are overloaded and the deaths of some very old patients due to the flu.

Shooting window for effective immunization is over and most of the experts regret that many individuals have not asked for this immunization. Many explanatory hypotheses are formulated, but the mistrust of part of the population toward vaccines is part of it.

Personally I support immunization against the most serious diseases. My children had all the mandatory immunizations as well as those recommended (just like me since my childhood). I think that it would be unconscious to expose children to very serious diseasesthat have caused so many victims in previous decades, and even if the risk of catching these diseases is statistically lower today than it used to be, it is not worth taking this even small risk.

Regarding the flu immunization, I usually don’t do it. The only two times I was flu immunized was in 2009 for the H1N1 flu epidemic (when my whole family got immunization), and in 2014 when I was professionally involved in Baltimore, Md hospitals and I was forced to do so. I don’t think it is worth the risk of exposing myself to the flu virus and living the discomfort of an attenuated disease during 2 or 3 weeks (just after immunization). It is perhaps a little selfish toward the most fragile individuals but personally I don’t have any in my close relationship circles. And in fact I would change my mind if I thought it could really help the community.

I know that some people have medical conditions and can’t get vaccinated. However I think that vaccines are a great tool for public health and that vaccines save hundreds of thousands of lives each year around the world. I am fully convinced by the usefulness of vaccines, especially for the most serious diseases.

That being said, I am puzzled by several inconsistencies that I have observed:

– Differences in immunization policy for health professionals between France and the USA

I learned during the last few days media bustle that since 2006 healthcare workers in France, including in the hospital, are not obliged to get vaccinated against the flu! It seems that for example only 25% of physicians and 10% of paramedics at AP-HP (Public Assistance – Hospitals of Paris) are flu immunized. As a result, they may not only carry the virus from one patient to another, but also get sick themselves, and their position is then vacant or hardly replaced, especially during such periods of epidemic.

I remember that for my immersion stays in the hospitals of Baltimore, I was asked among other things to get vaccinated (2 injections). It was mandatory and there was no possible discussion.

– The immunization schedule and number of injections are different between France and the United States

Perhaps a little naively I thought that the immunization schedule was homogeneous and shared among all the countries. In fact it is not. I remember that in 2014, to get our children enrolled in school and childcare, we had to provide their immunization records. Mandatory vaccines are more numerous in Maryland than in France. By chance, as our children were also vaccinated for recommended vaccines (not only mandatory ones) in France, they were up-to-date.

However for one of the vaccines (I don’t remember which one, I would have to refer to my notes of that time) my children had received only 2 injections (according to the French schedule) and not 3 (according to the US schedule). Therefore, an American pediatrician had to certify that my children were properly immunized for school acceptance.

I must say that these differences between two similar countries like France and the United States left me puzzled.

– Different recommendations for the BCG vaccine

During my stay in Baltimore I was also surprised to learn that Americans do not get BCG vaccine. Apparently they believe that introducing this virus into the body of individuals can be dangerous. However I had been vaccinated in my childhood but in order to be able to be part of the hospital staffs, I had to react negatively to the test for the presence of the tuberculosis virus (PPD skin test). When vaccinated, this doesn’t happen. The CDC recommendation in this case (quite common among people of foreign origin) is to take a lungs x-ray. The hospital fortunately took in charge this x-ray for me.

Again this disparity in immunization policies surprised me.

– Different recommendations regarding chickenpox

In France, children don’t get immunization against chickenpox. The public health policy (which our children’s pediatricians have repeatedly told us) is that since we’ll never get 100% of individuals immunized AND the disease is not too severe, better let children catch chickenpox, because once it’s done, they are immune for their lifetime.

My first 3 children all caught chickenpox at childcare. It is a very annoying disease, as everyone knows, but they got through it like most children: pretty well.

It is also known that in the United States individuals get immunization against chickenpox. When we arrived in Baltimore my then 4 months old daughter had not yet caught the disease. At the childcare we were asked for a proof of immunization against chickenpox, but we delayed as much as we could, knowing that we would return to France after a year. My husband and I strongly believed that it was better for her, as we were told in France.

However, I was intrigued and somewhat disturbed by the numerous TV campaigns encouraging immunization against chickenpox, pointing out that the disease virus remains in the body even after the cure and can be transformed into shingles, very painful chronic disease and for which there is no treatment.

Back in France, our new pediatrician also never offered us immunization. But a year later I came across a French medical article talking about shingles with alarming figures: more than 50% of people over 70 suffer from shingles, a virus related to chickenpox! When I questioned the pediatrician she told me “Absolutely! I vaccinated my twins as soon as possible! Besides chickenpox can sometimes cause serious complications, but this is not said to new parents.”

When I told her that I was thinking of getting my daughter vaccinated, she encouraged me, whereas she had never offered it before!

She said that if Public Health Services don’t encourage chickenpox immunization, it is also a question of cost.

I am certainly a bit naive, but when I hear that our health is evaluated in terms of financial cost, while we are constantly told about the excellence of the French healthcare system, I feel frustrated.

Medicine is not an exact science but I think a little more consistency and homogeneity (especially between countries) could convert some skeptics. When a politician fails to convey his message, he usually says “we must do more pedagogy”. I hate this “suitcase” word which implies that people are too dumb to understand things on their own, but for once I think that a little “pedagogy” would be welcome!