An introduction for doctors to the documentary JABBED
JABBED – love, fear and vaccines is a documentary on vaccination, screening on SBS One at 8.30pm, Sunday 26 May 2013.
Vaccine-preventable diseases are still a problem in our community. While more than 90% of Australians support vaccination, some people are delaying or refusing vaccines. Whooping cough and measles in particular are appearing again. Meanwhile, some parents are anxious about the rare cases of serious reactions to vaccination.
JABBED explores these issues. Well-known medical leaders in the area worked with us to ensure the material in the film is evidence-based. They include acclaimed immunologist Sir Gustav Nossal, the co-inventor of the cervical cancer vaccine Gardisil, Professor Ian Frazer, and Professor Ingrid Scheffer, who has explored the link between the genetic basis of Dravet syndrome and vaccines. Jabbed acknowledges the risks of vaccines, but reminds us of the far greater consequences when community protection to communicable diseases breaks down.
Your patients and clients, however, may come to you with questions about what they or their friends have seen in the film.
The Commonwealth Department of Health has kindly given me permission to write to you to brief you on the film and the case studies we highlight. This will be the only email you receive from me unless you ask me for more information. I have also included links to background information about the film, comments from experts and information on Frequently Asked Questions.
Cases explored in the film include:
- Osman Chandab, an infant at the Royal Children’s Hospital in Melbourne with whooping cough. He was hospitalised after contracting the disease before his first vaccination at eight weeks. The film shows the impact of whooping cough on Osman and the emotional toll on his family—particularly his mother Joumana—and the nursing team. Osman has fully recovered, but more than 38,000 cases of whooping cough were reported in Australia in 2011, and about one in 250 of the babies hospitalised, dies.
- Kristina Leatherbarrow from Liverpool in England, a 26-year-old nurse and mother, who wasn’t vaccinated against measles as a child because of concerns about her allergies. She is one of more than a thousand people who contracted measles in England and Wales in the past year. She became seriously ill and was hospitalised for two weeks. She made a full recovery and seems to have suffered no long-term effects, but she remained weak and itchy for months.
- Luke Philbin, a six-year-old boy from Melbourne who had a fever and a seizure within hours after his six-month routine vaccinations. He developed severe, ongoing epilepsy and has intellectual impairment. At first his parents believed that vaccination caused his epilepsy and felt guilty about it. They now know, however, that Luke carries a gene mutation which makes him susceptible to Dravet syndrome, a rare form of epilepsy (about one case in 30,000 births). The seizures can be triggered by fever. If a child’s first fever is caused by influenza then the flu virus is blamed. If the child’s first fever is triggered by a vaccine, the vaccine appears responsible… but it’s not. The vaccine can be a trigger, but is not the cause of the epilepsy. Now we know the real genetic cause of Dravet syndrome.
- David Salamone from Virginia in the US contracted polio in the early 1990s from an oral vaccine containing live, weakened polio virus. Before vaccination for polio the US had thousands of cases a year with many deaths. Vaccines have now eradicated polio from that country. The weakened poliovirus used in the oral vaccine, however, is capable of mutating and causing disease in about one case in 2.4 million individuals. And David had an undiagnosed genetic condition that meant part of his immune system did not function properly. Nevertheless, in the film David says, “I’m not against vaccinations. I’m pro-vaccinations. We had thousands of people contracting polio prior to the vaccinations…and that number decreased significantly…And that’s a good thing, whatever way you look at it.” He and his family successfully campaigned against the use of live polio vaccines in the US, which in 2000 went back to using an earlier injectable form containing dead virus. Australia stopped using live polio vaccines in 2005.
- Abigale Peterson from Minnesota in the US. Within 10 hours, at the age of five, she went from playing with her brother to dying in her mother’s arms on the way to hospital. She had received most of her vaccinations, but not the one for pneumococcal disease. Her doctor thought it unnecessary. Unknown to all, she had a rare immune disorder, and needed the vaccine more than most.
- Dorji Om from Bhutan is a 30-year-old mother of three dying of cervical cancer, the biggest cancer threat to Bhutanese women. Bhutan is the first developing nation to inoculate schoolgirls with a vaccine developed by Prof Ian Frazer at the University of Queensland against the human papillomavirus virus (HPV) which causes cervical cancer. Meanwhile, next door in India 70,000 women die of the disease each year. But in 2009 the preliminary roll-out of HPV vaccinations were stopped in India, after claims of four deaths due to the HPV vaccine. The outcry was massive. Government reports now indicate that of the four, two died by poisoning, one by drowning and the fourth of a fever of unknown origin. Nevertheless the vaccine remains suspended in India. Bhutan, in contrast, decided to continue with the HPV vaccines to help protect its people.
In the film we also explore people’s attitudes to vaccination. In order to do so, we worked with the NCIRS (National Centre for Immunisation Research and Surveillance) to conduct a national survey – the highlights are now available.
In summary, the survey showed that 93% of Australian parents are in support of vaccination for children, and less than 2% are opposed. Although a majority of the parents, 53%, have (mostly minor) concerns about vaccines, most go on to authorise vaccination anyway. The concerns of 8% are serious enough so they delay immunisation, or select alternative vaccination schedules.
From 20 May, more on this national survey, plus other background briefing materials and a trailer will be available on the JABBED website at www.sbs.com.au/jabbed. Feel free to share anything you find there with your friends and patients.
After broadcast, the film will be viewable online at SBS on Demand at www.sbs.com.au/ondemand.
Some comments from doctors and researchers who have seen JABBED
“A triumph! JABBED is a thoughtful, beautiful and powerful documentary on one of the most important public health issues of our times. This film is timely and vital – it deserves the widest possible distribution. I recommend viewing for all who care about the future of global health.”
Emeritus Professor Sir Gustav Nossal, University of Melbourne
“JABBED is a thrilling ride through the turbulent vaccine debate that has caused some parents to refuse vaccines for their children. The movie walks a careful line by at once showing the anguish of parents confronted with the choice of injecting a biological fluid into their children’s arms and the science that supports vaccines as the right thing to do. The movie also shows what can happen–and what is happening–to communities that now suffer outbreaks of diseases like measles and whooping cough because too many people are more frightened of vaccines than the diseases they prevent.”
Dr Paul Offit, University of Pennsylvania and Children’s Hospital of Philadelphia
“A refreshingly well balanced and informative look at vaccination. JABBED doesn’t’ shy from the small risks of serious complications following immunisation, yet clearly highlights these risks are minor when compared to the risks of living in an under-vaccinated community. I hope that every parent facing a decision about whether to vaccinate their children will take the time to watch this, and think it through.”
Professor Ian Frazer, University of Queensland
“JABBED doesn’t just make you think – it makes you feel! It’s a subtle, compassionate and deeply compelling film about a remarkably complex subject. JABBED reminds us that it’s perfectly normal to be afraid of disease and afraid of vaccines, at the same time. At its’ core, JABBED reveals that vaccines may not be perfect, but they are vitally important and the best option we currently have. JABBED is an extremely important film; one of the most nuanced, yet concrete explorations into vaccines in the modern world. We need more films such as these!”
Dr Brian Zikmund-Fisher, University of Michigan
An overview of JABBED
In the past month, more than 800 people have contracted measles in Swansea, Wales. Most of them are aged between 10 and 18. Yet across the Atlantic in the US, a vaccination program had eradicated the disease by 2000.
The difference? Many commentators are blaming the British outbreak on mistrust of the measles-mumps-rubella (MMR) vaccine generated by a paper published in 1998 in the medical journal The Lancet claiming MMR vaccine triggered autism. It was enough to prevent parents from having their children inoculated. But the paper was erroneous and was later withdrawn and its author struck off the Medical Register. Several studies since—the latest and most definitive published last month by researchers from the US Centers for Disease Control—have demonstrated no such link.
Why vaccination still remains so controversial—even after its staggering impact in reducing the threat of infectious diseases over the past three-quarters of century—is the subject of the latest documentary by Emmy Award-winning Australian film maker, Sonya Pemberton. JABBED – love, fear and vaccines will be shown nationally on SBS One from 8.30pm on Sunday 26 May.
Fashioned around a series of real stories illustrating the complexities of vaccination, interviews with world experts and the latest evidence from medical research, JABBED pulls no punches. It comes out in favour of vaccination, but tells it like it is, like the immunologists in the documentary say it is. Despite genuine and potentially serious risks, the advantages of vaccination far outweigh them.
“Jabbed is a thoughtful, beautiful and powerful documentary on one of the most important public health issues of our times,” says one of the fathers of modern immunology, Emeritus Professor Sir Gustav Nossal.
“A refreshingly well balanced and informative look at vaccination,” says the developer of the human papilloma virus (HPV) vaccine, Professor Ian Frazer. “I hope that every parent facing a decision about whether to vaccinate their children will take the time to watch this, and think it through.”
But parents are patients and clients of doctors and other healthcare professionals. After seeing JABBED, they may well have important questions to ask. To help answer them, a Frequently Asked Questions information sheet accompanies this flyer and is available on the JABBED website at www.sbs.com.au/jabbed.
“We are witnessing a global wave of mistrust, fuelled by a powerful new force – the Internet,” says Sonya Pemberton. “Never before has such conflicting and confusing information been so readily available.” So she went on her own search to the frontlines of fighting communicable diseases in Australia, the US, Bhutan, the UK, and the Ukraine. And what she found surprised her.
You’ll see the anguish of parents in Minnesota whose child died of febrile meningitis for lack of vaccination; the serious consideration the authorities in Bhutan needed to give the question of injecting the nation’s girls with HPV vaccine to protect them against cervical cancer; an interview with a victim of the very vaccine designed to protect him from polio; a mother struck down by measles because she believed vaccination was too risky.
JABBED is an intelligent and factual response to a serious issue of our time.
Expert consultation: JABBED was made with the involvement and advice of key scientists and medical researchers including Emeritus Prof Sir Gustav Nossal of the University of Melbourne, Prof Ian Frazer of the University of Queensland, Prof Ingrid Scheffer of the Austin Hospital and the University of Melbourne, and Prof Paul Offit of the Children’s Hospital of Philadelphia and the University of Pennsylvania.
Scientific advisors also include Prof Robert Booy and A/Prof Julie Leask of the National Centre for Immunisation Research and Surveillance and the University of Sydney.
The filmmakers: Writer, director, producer and co-executive producer Sonya Pemberton is a three-time winner of Australia’s Eureka Award for Science Journalism. In 2012 she won an Emmy Award for Immortal, her documentary on Australian Nobel Prize winner, Elizabeth Blackburn and her work on ageing and telomeres. Sonya works with her husband, director of photography, Harry Panagiotidis.
For further information, contact Info@genepoolproductions.com
Frequently asked questions about vaccination
The big picture
- Concerns about vaccination are normal.
- No medicine is without risks.
- Understanding risk helps many people feel more confident and empowered, not less.
- GPs, health practitioners and immunisation teams are the key source of information and advice, and most influential
- The key to effective communication is openness, acknowledging concerns and risk
How does the immune system work?
We live in a world alive with germs of different shapes and sizes—bacteria, viruses, moulds and parasites. They can be found almost everywhere and inhabit a large variety of environments: in dirt, water and air; in the droplets of a sneeze, on your skin, on your cat’s fur, on your teeth, in yoghurt and beer and on kitchen cutting boards; on your computer keyboard, toilet seat and mobile phone. There are more germs living in your gut than there are cells in your body.
In terms of our health, some germs are harmless, some are helpful and some can make you very sick and even kill you. For every germ you encounter in your life, you are likely to have a cell in your body that will specifically bind to it. This is what keeps us healthy most of the time.
Because our body knows how to defend itself, we don’t often become ill. The body can tell when it’s being invaded, and can fight back and destroy the invader.
Our skin can stop most germs from getting into our body in the first place. Those that do get in then encounter ‘defender’ cells – immune cells that are found in our blood, bone marrow, lymph nodes and spleens. These defenders can recognise and destroy germs.
Some of these immune cells act quickly to kill any germs they find and recognise. But they are not able to defeat every invader. They’re important to keep infections at bay until our body produces and sends in the more specialised ‘defender’ cells.
Very powerful ‘defender’ cells, known as B and T cells are able to recognise each particular germ, destroy it and remember it, so that next time around it is recognised and destroyed even more quickly. But initially it takes about a week until these cells are able to ‘kick in’ and fight the invader.
- B cells produce tag molecules called antibodies and deal with germs outside cells, and
- T cells are specialised to attack the germs that invade cells, such as viruses.
It’s the B cells that play a role in most vaccines. The antibodies or tag molecules they generate only stick to a germ that matches the shape of the tag, like a ‘key that fits into a lock’. This tag tells other cells – the macrophages – to destroy the germ.
What is a vaccine and how does it work?
The idea of a vaccine is to give the immune system a sneak preview of a specific, disease-causing organism or germ without it leading to illness. This can provide us with protection or immunity against the actual disease.
Unlike a real infection, the germ in a vaccine is weakened or dead, so that it does not make you sick. A vaccine may also use only of a piece of the germ that cannot cause disease, but carries features that allow the immune cells to recognise the real thing when encountered.
The whole purpose of a vaccine is to create immune system memory by activating the B cells to produce the tag molecules or antibodies. The so-called memory cells that are created through this process protect us from the real threat of the actual germ. By retaining a memory of the shape or the molecules on the coat of the germ, they can respond quickly to tag it for destruction upon re-infection. In this way, our body acquires specific immunity against a disease.
The most common way of administering vaccines is by injection, but some are given orally or by nasal spray.
What is vaccination or immunisation
Immunisation is the process whereby a person is made immune or resistant to an infectious disease, typically by administering a vaccine. It is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to prevent between 2 and 3 million deaths worldwide each year.
Vaccination is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups, can be delivered effectively through outreach activities, and does not require lifestyle changes.
What are the benefits of vaccines?
Vaccines are designed to combat diseases for which we have no effective cure. They prevent diseases, as opposed to other kinds of medication that treat diseases that have already taken hold.
Individuals benefit by being spared the distress of illness, disability and/or death of themselves or family members, as well as the personal financial loss of work days missed through being sick or caring for a family member. Society benefits because vaccines protect the general health of the population, including those vulnerable individuals who may not be able to be inoculated.
Vaccines also reduce healthcare costs arising as a result of hospitalisation, or expensive treatment.
They save lives, particularly in the developing world, and particularly those of babies and small children. Immunization prevents between 2 and 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles in all age groups. It is one of the most successful and cost-effective public health interventions. [WHO, 10 Facts on immunization http://www.who.int/features/factfiles/immunization/facts/en/index.html]
What are the risks of vaccines?
As with all medications, there are risks.
Vaccines are administered to healthy individuals, particularly children, so vaccine safety is of paramount importance. Only low levels of adverse reactions can be tolerated.
All vaccines are required to undergo rigorous safety testing, which means that it can take decades before some of them are allowed to be used. Their safety is also monitored by local, national and global networks of health professionals and government bodies. Despite this, the risk of adverse reactions to vaccines remains.
The majority of adverse reactions to vaccines are mild, short-lived and harmless. It is common, for instance, to experience fever or some pain at the injection site. Severe adverse reactions are very rare.
Common adverse reactions (generally mild):
- Injection site reactions
- Fever and in severe cases, febrile convulsions
- Allergic reactions
- Gastroenteritis, following rotavirus vaccination
- Screaming (e.g. used to be common with the cellular DTP vaccine)
Severe, but rare adverse reactions:
- The disease itself, e.g. polio from live vaccine
- Anaphylaxis allergic reaction, e.g. where vaccine is grown in egg (people with egg allergy)
- Trigger of underlying genetic predispositions to epilepsy or auto-immune diseases, e.g. Guillain–Barré syndrome
- Intussusception (serious bowel obstruction), following rotavirus vaccination
What is herd immunity?
‘Herd immunity’ is another way of saying ‘community immunity’. The more people immune against a particular infectious disease, such as whooping cough or measles, the less likely it is for those who are not immune to catch the disease.
For an infectious disease to spread, it needs susceptible hosts close by that will catch the disease-causing germ, allow it to multiply and pass it on to other susceptible individuals.
If the population is largely immune to the disease, this immunity serves as a barrier or firewall to its spread. The disease-spread ceases at the last infected, susceptible individual. So the effectiveness of vaccination to protect against the spread of disease depends on the proportion of the population vaccinated
Vaccination rates in Australia
More than 92% of Australians support immunisation, and less than 2% are opposed to it. Even so, about 53% of Australians express some (mostly minor) concerns about vaccines, although the vast majority become vaccinated anyway.
Information on diseases mentioned in the film and vaccination
For the latest information on Australian immunisation programs refer to the Immunise Australia Program website at http://www.health.gov.au/internet/immunise/publishing.nsf/Content/home or call 1800 671 811
Whooping cough or pertussis is caused by the bacterium Bordetella pertussis. It is spread through droplets in the air and can develop from a nose, throat and windpipe infection into pertussis pneumonia, a lung infection.
Whooping cough is highly infectious and most serious in babies under the age of 12 months. Babies are at greatest risk of infection until they have at least two doses of the vaccine (minimum 4 months old) as the mother’s antibodies do not provide reliable protection.
It takes between 7 to 20 days for symptoms of this disease to show after infection. Symptoms include coughing and whooping, which can continue for a few months. Complications of the disease include lack of oxygen to the brain, which can lead to brain damage and possibly death.
Pertussis is a vaccine preventable disease. Pertussis vaccination is recommended as part of routine childhood immunisation.
Australia is currently experiencing an upsurge in pertussis. There is evidence of waning immunity. In light of this, some states and territories are offering free booster vaccines against pertussis for parents and, in some jurisdictions, other close family members.
Worldwide, it is estimated there are 30–50 million pertussis cases and about 300,000 deaths a year. This makes whooping cough one of the leading causes of vaccine-preventable deaths worldwide. Most deaths occur in young infants who are either unvaccinated or incompletely vaccinated. Ninety per cent of all cases occur in the developing world where vaccination coverage is low.
Measles is a highly infectious disease caused by the Morbillivirus. The virus is spread from person to person through droplets in the air.
Symptoms take between 10 and 14 days to show after infection and include:
- runny nose; and
- inflammation of the eye.
Complications of measles include ear, brain and lung infections, which can lead to brain damage and death. About one child in every 1,000 who contracts measles will develop inflammation of the brain (encephalitis). For every 10 children who contract encephalitis, one will die and up to four will end up with permanent brain damage.
Measles is a vaccine preventable disease. Measles vaccination is recommended as part of routine childhood immunisation. Doses are given at 12 months and 4 years of age.
Measles was declared eliminated from the United States in 2000, and appears also to have been eliminated from Australia. But, the disease is still common throughout the world, including some countries in Europe, Asia, the Pacific, and Africa. For instance, there have been recent outbreaks in England, France and Romania.
In 1998 a study by former British surgeon and medical researcher Andrew Wakefield and published in the respected medical journal, The Lancet suggested there was a link between MMR vaccine and autism. Since that time the supposed connection has been disproven, the paper retracted by the journal and Wakefield struck off the Medical Register. The latest study published in April 2013 in the Journal of Paediatrics by researchers from the US Centers for Disease Control, showed no causal link between autism and multiple vaccines. There was the same rate of development of autism in vaccinated and unvaccinated children.
Dravet syndrome, also known as Severe Myoclonic Epilepsy of Infancy (SMEI), is a rare and catastrophic form of intractable epilepsy that occurs in roughly one in every 30,000 births. Between 70 and 80% of cases it is associated with a mutation of the gene SCN1A.
Epileptic seizures related to Dravet syndrome typically start in the first year of life—often just at the time that children are being vaccinated—and are often accompanied by fevers. In fact, fever is considered to be one of the key triggers for Dravet syndrome, as is vaccination which sometimes leads to a mild fever.
Given the rareness of the condition, a child is “more likely to be hit by lightning” than for vaccination to trigger Dravet syndrome. Professor Ingrid Scheffer, the director of paediatrics at Melbourne’s Austin Hospital is one of the researchers who unravelled the genetic links of Dravet Syndrome.
There is a genetic test available for Dravet’s Syndrome, but it is costly, and there is no known way of preventing onset of the disease at this stage.
Poliomyelitis or polio is an acute illness following a stomach and gut infection by one of the three types of polioviruses. The virus spreads between people through contact with infected faeces and throat secretions. Polio can cause meningitis (brain infection) and paralysis. About 5% of people hospitalised with polio die from it, and about half of those who survive suffer permanent paralysis.
In 90 per cent of cases, the illness has no symptoms. If symptoms do occur they can take between 3 and 21 days after infection to show. Where symptoms do occur they can include:
- nausea and vomiting;
- neck and back stiffness;
- severe muscle pain; and
Polio is a vaccine preventable disease. Polio vaccination is recommended as part of routine childhood immunisation. Doses of vaccine are given at 2, 4 and 6 months of age, with a booster dose at 4 years.
Polio remains endemic in three countries – Afghanistan, Nigeria and Pakistan – and re-established itself in three countries which were previously polio-free (Angola, Chad and Democratic Republic of the Congo). Several other countries had outbreaks in 2011 due to importations of poliovirus.
The oral polio vaccine (OPV) or Sabin vaccine consists of a mixture of live, weakened poliovirus strains of all three poliovirus types. It protects against all of them and against the spread of poliovirus to the nervous system.
OPV is administered orally, and does not require trained health workers or sterile injection equipment to administer it. It is also relatively inexpensive.
Although safe and effective, in extremely rare cases (about 1 in 2.7 million doses) the live weakened virus in OPV can cause paralysis. This extremely low risk is well known and accepted by most public health programs in the world because without OPV, hundreds of thousands of children would be crippled every year.
OPV is not provided in Australia. Because of the small risk of paralysis, since 2005 only inactivated polio vaccine (IPV) has been used in Australia, where polio has been eradicated.
Pneumococcal disease is caused by the bacterium Streptococcus pneumonia. It can spread between people through infected droplets in the air and by touching an infected person. Some types of the bacterium are commonly found in the noses, throats and windpipes of healthy people.
The disease can cause:
- meningitis (infection of the membranes that enclose the brain and spinal cord);
- pneumonia (lung infection);
- septicaemia/bacteraemia (blood system infection); and
- middle ear and sinus infections.
The World Health Organization (WHO) says that pneumococcal disease is the world’s number one vaccine-preventable cause of death among infants and children younger than 5 years of age. It is responsible for over half a million deaths in this age-group each year, which is more than malaria and HIV/AIDS combined.
Source: GAVI Alliance Factsheet on Pneumococcal disease
Pneumococcal meningitis symptoms may include high fever and headache, which may develop as rapidly as a few hours or over 1 to 2 days. Other symptoms may also include:
- sensitivity to light;
- neck stiffness;
- poor appetite;
- irritability; and
Pneumococcal pneumonia symptoms may be vague and include fever, coughing and difficulty breathing.
Pneumococcal blood system infections can cause symptoms such as fever, chills, irritability, drowsiness and rash.
Pneumococcal middle ear infections cause ear pain and a red and swollen ear drum, difficulty sleeping, fever and irritability.
Most pneumococcal infections are vaccine preventable. Pneumococcal vaccination is recommended as part of routine immunisation for children, older Australians and Aboriginal and Torres Strait Islander people. From 1 July 2011, a newer vaccine which provides protection against additional types of the bacteria was introduced in Australia
Rotavirus is the most common cause worldwide of severe gastroenteritis in infants and young children, responsible for about half of all hospitalised cases of gastroenteritis in children less than 5 years of age. Rotavirus spreads by contact with infected faeces and probably through faecal contamination of food, water and respiratory droplets. Children can be infected with rotavirus several times during their lives.
The illness can begin abruptly with vomiting 1 to 3 days after infection, often before the onset of diarrhoea. The spectrum of illness ranges from mild, watery diarrhoea of limited duration to severe, dehydrating diarrhoea with vomiting, fever, and shock. Symptoms generally resolve in 3 to 7 days.
Rotavirus is a vaccine preventable disease. Vaccination is recommended as part of routine childhood immunisation. The safety of the vaccine has not been tested in older babies or children. It is important, therefore, to ensure that a child receives this vaccine as close to the recommended age as possible (2, 4 and 6 months).
New evidence has shown there is a slightly increased risk of intussusception, a bowel condition, with rotavirus vaccination. But the Australian Technical Advisory Group on Immunisation (ATAGI) and Therapeutic Goods Administration (TGA) have reviewed recent evidence and found that the benefits of rotavirus vaccination outweigh the risks associated with it.
These materials were created by Science in Public, for Genepool Productions Pty Ltd.