Once again the Gallic village prevails over the clarity of science. The proven efficacy and safety of the 11 vaccines that are now mandatory in France are unmatched in drugs. However, some parents are confused and, in Pasteur's country, the treating doctors do not always engage.
Logically wanted, but bravely carried by the Minister of Health, Agnès Buzyn, the passage of three to eleven compulsory vaccines concerns children born from January 1, 2018. In addition to the 3 already compulsory vaccines (diphtheria, tetanus and poliomyelitis or DT -Polio), 8 vaccines already recommended become mandatory: whooping cough, measles-mumps-rubella (MMR), Haemophilus influenzae b, pneumococcus, meningococcus C and hepatitis B.
These eleven vaccines will be essential for the child to be admitted to the community (nursery, school ...). To allow time for compliance, the first checks will only take place on June 1st. In the country of "vaccino-septicism", some parents are confused about the avalanche of contradictory information generated by anti-vaccine lobbies.
Anti-vaccines that consider them dangerous (especially because of their adjuvants, especially aluminum) and are wary of laboratories, accused of favoring cost-effectiveness to children's health. No anti-vaccine information is based on a real scientific basis but it must be recognized that even some doctors seem lost. The government, which has long neglected this problem, has taken the measure of the problem. In any case, access to transparent information is simpler.
Why make these 11 vaccines mandatory?
The main argument for the move to 11 compulsory vaccinations is the drop in immunization coverage for vaccines so far non-mandatory and the resurgence of certain diseases. However, with improvements in hygiene and water quality, immunization has been the most effective public health intervention against infectious diseases.
Immunization is quite satisfactory in France for the diseases for which it is obligatory (polio, tetanus, diphtheria) or for those whose vaccines are almost systematically (whooping cough, Haemophilus influenzae b) combined with the compulsory vaccines.
On the other hand, for other diseases, especially measles, vaccination coverage in France is notoriously too low to protect the entire population against the disease: children die or have measles after-effects in France in 2017.
The vaccine threshold is not reached for all infections
There is a minimum threshold of vaccination coverage for "group protection" to work for those who can not be vaccinated (newborns, immunocompromised ...). This threshold depends on the contagiousness of the disease.
In France, with a vaccination coverage of nearly 97% for diphtheria, the threshold for group immunity is exceeded, and the entire national community is protected, even in the case of infection by a migrant. . Likewise, Haemophilus influenzae b, rubella or mumps infections have almost been eliminated in the country because coverage rates for their vaccines exceed the group immunity threshold for these 3 diseases.
On the other hand, the current level of immunization coverage against measles (79%) is still insufficient to allow group immunity (group immunity threshold = 94%), and epidemic outbreaks of the large-scale disease are thus occurring. : more than 23 000 cases reported in France between 2008 and 2012, more than 1500 serious pneumonia and more than 30 encephalitis with 10 deaths). It's unbearable.
Similarly, insufficient coverage with meningitis C vaccine (70% at age 2, but low for adolescents and young adults) is responsible for the majority of nearly 800 cases and 100 deaths. since 2011.
A Franco-French controversy
In the framework of the extension of the vaccination obligation, the vaccination becomes a debate in the opinion and a controversy, fully fueled, as much by the scientifically unsubstantiated and demagogic arguments of the anti-vaccine lobbies, as by the lack training of the medical profession and the public on the subject. France, yet the homeland of Pasteur, has become one of the countries in the world where the immunity defiance is the strongest with more than 40% of French people who think that vaccination is not safe.
This controversy, which is unique in Europe, occurs even though the vaccination obligation corresponds to the current vaccination schedule (mandatory and recommended vaccines) and does not add any additional vaccine. It simply aims to ensure that all children actually receive the vaccinations they should have received if the immunization schedule was respected for all children.
However, the experience of some European countries, such as the Netherlands, shows that we can almost eliminate diseases such as meningococcal C infections thanks to a very high immunization coverage in children from 1 to 18 years old.
Efficacy and safety demonstrated
The 11 vaccines that are now mandatory are very effective. They protect children more than 90% against diseases and adverse effects, when they exist, are usually minor and short-term.
Some minor side effects are common to all injectable vaccines: injection site reaction (pain, redness, swelling) in approximately 10 cases in 100 vaccinated children), some general effects, also short-term (fever, muscle or joint pain) ) in 1 to 10 cases out of 100 vaccinated.
Serious allergic reactions are extremely rare (less than one case out of 450 000 vaccinated), but they are mentioned in the majority of the certificates of convenience of compliant treating physicians. But other adverse effects, sometimes attributed to certain vaccines, are scientifically unfounded and the entire scientific data has been reviewed independently by INSERM to establish the proven facts on vaccination.
No link between autism and measles immunization
The scientific evidence of the lack of link between vaccination against measles (or measles-mumps-rubella type MMR vaccines) and inflammatory bowel disease or autism are now numerous and very high scientific level.
The only study that suggested a link between MMR vaccination and autism involved 14 children and was a scientific fraud by one of its authors. The co-authors have all retracted. The article was removed from the Lancet. The fraudulent doctor has been struck off the order of the British doctors.
No link between multiple sclerosis and vaccination against hepatitis B
Numerous and very large studies were conducted between 1996 and 2004: they all eliminated the suspected link between vaccination against the hepatitis B virus and autoimmune adverse effects in adults such as neurological lesions like sclerosis in plaques or other autoimmune diseases. These diseases can unfortunately occur quite by chance after vaccination in young adults, the age group where these diseases are most often reported. This is an additional reason for vaccinating infants because no link to multiple sclerosis has ever been observed during infant vaccination.
No toxicity of admixtures such as aluminum
Of the 11 vaccines that will be mandatory in France, with the exception of the MMR vaccine (which is a live vaccine), all contain aluminum salts, an adjuvant essential to enhance their effectiveness.
In view of the data available to date worldwide, with 90 years of use and hundreds of millions of doses injected, the safety of aluminum salts contained in vaccines can not be questioned. . Aluminum injected with mandatory vaccines represents only 4 and 5 milligrams in total of aluminum, a drop of water compared to what it receives in drinking water and food. A team of French researchers had suggested a link between the lesion at the site of injection called "macrophage myofasciitis", which contains traces of aluminum (as a tattoo contains ink) and the existence of non-specific chronic symptoms. such as fatigue, muscle or joint pain or cognitive impairment. The independent analysis by other teams of their results has not yet made it possible to demonstrate the existence of this link. In addition, this disease has hardly been observed outside France, whereas vaccines containing aluminum are used everywhere. Finally, the MMR vaccine does not contain it and yet, it is not more accepted in anti-vaccines.
No dangers with combination vaccines
Combined vaccines have the main interest of facilitating the vaccination of infants (fewer injections, fewer medical appointments for parents).
The immune response obtained for each of the infections is not inferior to that observed when the different vaccines are administered separately. Adverse effects are no more common with the combined form than with separate (and concomitant) administration of different vaccines.
Finally, the arguments developed by the anti-vaccine lobbies, which claim that the combined vaccines would cause a "depletion of the immune system" of the infant, are not based on any scientific basis.
The stimulation of the immune system induced by a vaccine, even if it is hexavalent, is in fact negligible compared to its capacity of response and compared to the many numerous daily environmental stimulations that an infant receives from its birth (less than 0,01% d use of theoretical immune capacity according to some experts.
The natural protection transmitted by the mother is not enough
Anti-vaccines regularly rely on antibody immunity, naturally transmitted by the mother to her baby during pregnancy or breastfeeding. This natural protection is not enough because it is on the one hand temporary and too partial: the maternal antibodies diminish quickly because of their short life cycle: it is estimated that an infant loses half of the maternal antibodies every 3 weeks . Moreover, if the mother herself has not been properly protected, she may not transmit anything at all.
Protection is better after illness
Some parents consider that it is more natural and better for the child to acquire protection alone during each illness.
Besides leaving children with repetitive infections and diseases such as measles, whooping cough or mumps is very cruel, it poses a risk to other children, who could not be vaccinated because they are sick and immunocompromised. Above all, the immunity conferred seems no better and having measles, like other diseases, is a life-threatening risk and a risk of sequelae for all of life.
What is the risk of refusing vaccination?
Children born from 1 January 2018 and who will not be in compliance with their mandatory vaccinations will not be able to return to nurseries and school, so as not to expose other children, immunocompromised or not, to potential risks related to diseases.
Until now, parents who refused compulsory vaccination risked an administrative conviction that could lead to six months' imprisonment and a fine of 3,750 euros. A sentence that was never applied and this rule of the Public Health Code (article L 31116-4) was therefore abolished.
A deceptive decision because any health professional or para-school can always warn the public prosecutor if they find that parents put at risk their child, and here we go to criminal: Article 227-17 of the Penal Code punishes with two years imprisonment and 30 000 euros fine "the fact, by the father or mother, to evade, without legitimate reason, his legal obligations to the point of compromising the health, safety, morality or education of his minor child ".
Regarding doctors, the Council of the Order will be ruthless and a doctor has just been struck off for false certificate of contraindication to vaccination.
Compulsory vaccination is certainly not the ideal method and it mainly signifies the failure of public health policies that have failed to convince society and parents of the importance of vaccination. But this obligation is now necessary to move forward. It does not dispense public debate, on the contrary, but by remaining in the field of quality scientific studies.