Categories
Uncategorized

‘Attitudes towards vaccinations are evidence of a disconnect between the public and healthcare professionals.’

By Ipshita Rishi

Published 6:00 EST, Sat November 13th, 2021

Discussion from the role play of a doctor.

Introduction

When the word “hero” is mentioned, people usually envision a mighty warrior vanquishing an enemy, or a firefighter rescuing children from a burning building. Though these are examples of courage and certainly qualify as heroes, so do some scientists and doctors. Researching quietly day after day, year after year, they work to find new ways to combat disease by creating vaccines. 

Vaccines play an important role in the application of scientific research; they help save millions of lives globally each year. They help to reduce the costs of healthcare and are a vital part of public health policy (Kassianos & Ramsay, 2019). 

According to the British Columbia (Immunize BC, 2018), vaccines are ‘products that protect people against serious and potentially deadly diseases.’ Now, as a doctor, this immediately attracts my attention. Protection against deadly diseases is the most obvious and well known advantage of vaccines. Since 1796, scientists and researchers have created 26 vaccinations (World Health Organization, 2020). 

Vaccines are one of the few medical interventions with which most people have a personal experience with, and as a result they are sometimes used as a proxy for trust in the broader healthcare system. Vaccines have not always been positive, having generated anxiety amongst people, but their uptake has generally been widespread enough that many infectious diseases such as cholera, diphtheria, and polio have disappeared in several countries. 

Returning to the original statement – the response is not that straight forward. The issues are multifactorial, and I am going to be discussing this controversial and interesting statement: “Attitudes towards vaccinations are evidence of a disconnect between the public and healthcare professionals.” In this discussion, I shall explore the various viewpoints of the public, experts, and healthcare professionals like me to understand people’s attitudes towards vaccines around the world. It is also to exploit and understand the strengths and flaws of the attitudes that exist about vaccinations in society and healthcare. I will also explain an approach to a beneficial lifestyle of better health, and an improved relationship amongst the public with healthcare professionals.

Vaccine Confidence and Herd Immunity

Over the past 10 years, there has been a significant increase in the number of studies that have documented an increase in the number of people in high-income and low-income countries who have been seen to lose confidence in vaccines, resulting in decisions to not vaccinate their children. As a doctor, this not only raises concern, but also questions as to why this is happening. Organizations such as WHO and UNICEF say that  there has been “gains in the world’s fight against vaccine-preventable diseases are at risk.” This is not only due to a severe lack of confidence in the safety and and effectiveness of vaccines and trust in the healthcare system, shortages of workers and supplies, depleted or destroyed health infrastructure, or poverty and difficulties to access the nearest clinic; these are just some of the reasons which threaten to disrupt the effectiveness of all vaccination projects. 

Vaccine hesitancy has been identified by the WHO as “one of the top ten health threats to the word”  in 2019; the organization defines it as “the delay in acceptance or refusal of vaccines despite the availability of vaccination service.” 

The Wellcome Global Monitor project in 2018 recorded some shocking statistics:

  • Globally 79% of people agree that vaccines are safe.
  • 92% of parents worldwide said that their children have received a vaccine. 
  • 6% said they did not let their children receive a vaccine. 
  • 2% said they don’t know if their child had been given a vaccine. 
  • In France, 1 in 3 people disagree that vaccines are safe; it is the highest percentage for any country worldwide. 

People who choose not to vaccinate, due to whatever reason, are not only taking a personal risk. It poses a threat to others as well. Being vaccinated protects an individual from being infected themselves; if enough people are vaccinated, it prevents the disease from spreading to the larger population. Many epidemiologists, experts in this field, refer to this as “herd immunity,” which is protection from the disease for the entire population,  including people who cannot be vaccinated due to medical reasons. (Bhargava, MD, 2016)

Society seems to have become less responsible these days. People have started to think more about themselves than for the community. Many who cannot be vaccinated against deadly diseases due to age or immunosuppression strongly rely on herd immunity and the help of others who are vaccinated for preventing them getting infected. It is hugely important for us to carry our weights for social responsibility.

But in order for herd immunity to function, a large proportion of the population needs to be vaccinated. The size will vary on how contagious the disease is, for example, approximately 90-95% of the population will need to be vaccinated against measles for herd immunity to work. For less contagious diseases such as polio, the vaccination uptake needs to be 80–85% of the population. For influenza, the figure is closer to 75% for vulnerable groups (very young children, people with chronic illnesses and the elderly). If enough people choose not to be vaccinated and only rely on herd immunity for protection, then outbreaks of preventable diseases become more common, seen recently with measles in several countries including US, India, Brazil, and Ukraine.

Failure: Victim of Vaccinations

Maintaining high vaccination rates is highly dependable on public confidence. This is why, much of the recent studies and analysis on attitudes towards vaccinations has primarily focused on vaccine hesitancy, especially in scenarios where vaccines are declined even when they are available. As an experienced doctor, I have heard and come across many horrific stories, some of which are true and some simply to scare the people on social media. Recently, I had spoken to the mother of a victim of a poor vaccine reaction, Rachana Sinsinwar, and she had a sorrowful story to narrate.  

“I took my son , then 14 months old, to the doctor and he gave two vaccinations (one 2 months before stipulated time) within weeks his body was covered with bruises. Doctors immediately saw and hospitalised him. Platelets in his body dropped to 6000 (normal levels are 150000-450000) at one point counts were lower than the least count of the measuring machine and manual counting was done – 800 platelets. The fear of internal bleeding was looming large.

The vaccine played with the immune system which has a directory of its own body items and platelets went out of this directory after vaccination. Now the strong and healthy baby’s immune system started attacking its own platelets and that would mean he was bleeding without injuries internally and externally.

Nine hospitalisations in three months and treatments later with no improvements seen, the doctors told us they could have surely cured him if it was cancer but not Idiopathic Thrombocytopenia (ITP) Idiopathic meaning the origin is not known. Well the origin was “not owned” is how I see it.

Who will own it ? The doctors, the pharma industry that is trialling new and advanced vaccines, often cosmetic purpose vaccines on children with parents unaware of the consequences? Collateral damage of a business model devised to scare make anxious parents try to save their children’s future health by contaminating their natural healthy immune systems.

I never vaccinated my daughter beyond DTP and polio, she is doing fine!’’

Being a doctor, you must be reading this and questioning why I have presented this real life story to you. You must be immediately shocked and disturbed by the article, or you may not understand why a doctor who is attempting to change the attitudes of the public is scaring them about vaccines. 

Reading it again more closely you should realise that Mrs Sinsinwar’s son was given a vaccination 2 months before the stipulated time, this could have been the doctor’s mistake, but it was not a blame to be taken on its own. The lack of education is another primary reason that some experiences with vaccinations are failures rather than a success. 

Educations vs Confidence

In most regions, people who have high trust in doctors and nurses are very likely to consider that vaccines are safe. However, this is less true in Western and Eastern Europe in a recent study, proving that the solution isn’t as easy as we think.  In 2015, a part of the Wellcome Global Monitor Project also carried out a questionnaire based on the Vaccination Confidence Index to measure public trust in the safety, effectiveness, and importance of vaccines. 

Before fully implementing the questionnaire in over 140 countries, it was tested in 10 countries in local languages to “establish whether the terms used were broadly well understood and interpreted across countries and different socio-economic groups.” (Wellcome.ac.uk, 2018). One of the findings from the testing was that it is important to provide simple definitions of technical terms to ensure that people understand what they are being asked about, and whether they have previously heard of the term.

The first question in the Wellcome Global Monitor Questionnaire defined the word vaccine, and then asked people about their familiarity with the term, as follows:

“A vaccine is given to people to strengthen their body’s ability to fight certain diseases. Before today, had you ever heard of a vaccine?”

Those who answered ‘yes’ were asked specific questions about the safety, effectiveness and importance of vaccines. Before the survey, 89% globally had heard of vaccines. The findings show that in only 2 of the 18 global regions (Southern Africa and Southeast Asia) a significantly higher proportion of people say that they have not heard of a vaccine, 54% and 26% respectively. 

In general, people seemed to understand what a vaccine does when shown the action of administering one, even if they did not recognise the word itself. Levels of education influence confidence in vaccines differently across the world. 

Although there is no direct relationship between the levels of education and vaccine confidence globally, in many places like Northern Europe and Northern America, people with higher levels of education are less likely to believe that vaccines are not safe. A stark contrast is seen in places like Eastern Europe, Central Africa and Southern Africa, as people with lower levels of education are more likely to believe that vaccinations are not safe. In Western Europe, 63% of people who have “a lot of” trust in doctors believe vaccines are safe. Western Europe, however, has among the highest levels of trust in doctors and nurses of all regions, suggesting attitudes to vaccines are somewhat separate from overall healthcare perceptions.

In developed countries with free healthcare (UK), there could be a broken system with less resources. In a country with poverty and harder access to health care (India), there can be less awareness and knowledge and access. In countries with better access but paid health care (US), there could very well be a lack of trust and confidence in the health care system and doubts if the healthcare professionals are in it. 

In my personal opinion as a doctor, social media has a major role to play in the poorer uptake on vaccines. More people are happy to take medical advice from personal experiences of strangers unknown on social media than a healthcare professional. Dr. Google has become more popular than any medical doctor. There are two sides to any coin, so people always need to understand to take this with a pinch of salt. 

Conclusion

The health secretary of the UK, Matt Hancock, who has expressed interest in mandatory vaccinations for children before they are allowed to go to school, said,  “Falling childhood vaccination rates are unacceptable. Everyone has a role to play in halting this decline. The loss of our measles-free status is a stark reminder that devastating diseases can, and will, resurface. We need to be bold and I will not rule out action so that every child is properly protected.”  

My research has allowed me to believe that confidence in vaccinations is generally very high globally, particularly in LICs. Whereas people living in HICs have less confidence, most people in these regions think vaccines are effective at preventing infectious diseases, approximately 50% of people in Eastern Europe have concerns over safety. As we also know, levels of education are greatly associated in some of these regions with less confidence in vaccinations. This is clearly evident that putting out more scientific information, or trying to educate more people, will not be enough to change minds on this issue.

“In France, 1 in 3 people don’t agree that vaccines are safe, but only 19% disagree that they are effective. Just 10% disagree that it is important for children to be vaccinated – although if 10% of people remain unvaccinated against measles, for example, that can be enough to allow the infection to spread and cause dangerous outbreaks.” – Wellcome Global Monitor 2018

People with better trust in the healthcare system tend to be more likely to agree that vaccines are safe. Conversely, those who have sought information about science, medicine, or health recently appear to be less likely to agree. There is no evidence of what information people were seeking, but is there something about people who actively seek information that have the tendency to be sceptical about vaccines?

More than 90% of parents globally say their children have been vaccinated, including countries like France. However, recent outbreaks of measles in the US, Brazil, and India suggest that we cannot take herd immunity for granted – it is vital to keep understanding trends in people’s attitudes towards vaccinations in order to maintain public health in the years ahead.

“No parent should be in any doubt of the devastating impact of these diseases. It’s vital that everyone recognises the value of vaccines and takes up this life-saving offer.” – Anonymous

Ipshita Rishi, Youth Medical Jorunal 2021

Bibliography 

  1. Nardo, D. (2002). Vaccines. San Diego, Calif.: Lucent Books.
  2. Ballard, D. (2006). From cowpox to antibiotics. Oxford: Heinemann Library.
  3. Immunize BC. (2017). How do vaccines work?. [online] Available at: https://immunizebc.ca/how-do-vaccines-work 
  4. Wellcome.ac.uk. (2018). Chapter 5: Attitudes to vaccines | Wellcome. [online] Available at: https://wellcome.ac.uk/reports/wellcome-global-monitor/2018/chapter-5-attitudes-vaccines 
  5. World Health Organization. (n.d.). Global Vaccine Safety. [online] Available at: https://www.who.int/vaccine_safety/en/ 
  6. World Health Organization. (n.d.). Vaccines. [online] Available at: https://www.who.int/topics/vaccines/en/ 
  7. Peretti-Watel, P., Verger, P., Raude, J., Constant, A., Gautier, A., Jestin, C. and Beck, F. (2013). Dramatic change in public attitudes towards vaccination during the 2009 influenza A(H1N1) pandemic in France. Eurosurveillance, [online] 18(44). Available at: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES2013.18.44.20623 
  8. Nour, R. (2019). A Systematic Review of Methods to Improve Attitudes Towards Childhood Vaccinations. Cureus.
  9. Ballard, C. (2007). Fighting infectious diseases. London: Franklin Watts.
  10. The Vaccine Confidence Project. (2020). VCP Mission — The Vaccine Confidence Project. [online] Available at: https://www.vaccineconfidence.org/vcp-mission 
  11. Janeway, C. and Travers, P. (1994). Immunobiology. Oxford: Blackwell.
  12. Bhargava, MD, H. (2016). Immunization Exemptions: The Rules & Laws Explained. [online] WebMD. Available at: https://www.webmd.com/children/vaccines/what-are-the-rules-on-vaccine-exemptions 
  13. Kassianos, G. and Ramsay, M. (2019). Increasing vaccine uptake: Strategies for addressing barriers in primary care – Public health matters. [online] Publichealthmatters.blog.gov.uk. Available at: https://publichealthmatters.blog.gov.uk/2019/05/16/increasing-vaccine-uptake-strategies-for-addressing-barriers-in-primary-care/ 

Categories
Neuroscience

The Neurological Effect of Illegal Substances and Alcohol on the Brain

By Ipshita Rishi

Published 1:07 PM EST, Tues Aug 10, 2021

Introduction

The brain is unarguably the most complex organ in the human body, as it is still an organ yet to be fully understood. The brains’s complex structure & composition continues to be the topic of academic research & composition. 

Surrounding the world of alcohol and drugs lies a huge psychological illness, addiction. Seen as a taboo in many societies, addiction causes more than 750,000 deaths globally each year. Addiction is an individual’s compulsive behavior towards a substance or activity that includes pleasure and enjoyment, later suffering from withdrawal and tolerance issues, it is classed as a medical disorder – rather than a habit – and requires treatment just like other diseases and illnesses. The most common type of addictions include: drugs, gambling, alcohol, smoking, sex and food. According to the charity Action on Addiction, 1 in 3 people struggle with addiction. 

But what has addiction got to do with the brain? When someone develops an addiction, the brain craves the reward of the substance or activity. This is due to the intense stimulation of the brain’s reward system, known as the mesolimbic dopamine pathway. It is located in the cerebrum in the brain and is a set of structures that deals with emotions, memory and basic instincts. The brain is responsible for regulating temperature, emotions, decision-making, breathing and coordination. This major organ also impacts physical sensations in the body, emotions, cravings, compulsions and habits. Under the influence of powerful substances such drugs and alcohol can cause alterations in the brain. The substances react with the mesolimbic system in order to release strong feel-good emotions which affect the body and mind. Our brains reward us when we do something that brings pleasure, to illustrate for a drug addict the pleasure would be substance use thus creating a cycle of drug use and intense highs. This eventually leads to them taking drugs for the release of hormones that make us feel happy, such as dopamine, oxytocin, serotonin and endorphins (these are known as D.O.S.E chemicals).

It is important to classify the different types of drugs and understand them on a molecular level in order to understand its neurological effects. In order to classify drugs, we must first  understand what drugs are. The dictionary definition of drugs are: “a medicine or other substance which has physiological and psychological effects when ingested or introduced to the body.” Although not commonly seen as one, alcohol is also classified as a drug, except it is not an illegal substance under UK laws. However, commonly known substances Such as as heroin, opium and cannabis are illegal substances. Illegal substances refer to drugs forbidden for consumption, possession and exchange by the law. There are 8 main categories that drugs can be classified into: depressants, stimulants, hallucinogens, dissociative anaesthetics, narcotic analgesics, inhalants, agonists, antagonists and reuptake inhibitors. It is important to also remember that a single drug can overlap, meaning that a drug could be a stimulant, hallucinogen, inhalant and agonist!

So how does the NHS manage people with addiction? The first steps to tackling and seeking help for addiction usually starts either with your GP or local addiction treatment services. In most circumstances the patient will be assigned to a key worker who helps work with the patient to plan the right treatment. Treatments include: therapy (such as CBT), medication, detoxification and self-help. Rehabilitation is not an easy process on the NHS, and it is only granted in severe and critical cases of addiction. Funding is difficult to obtain and the process involves applying to the government for a lump sum of an individual patient’s treatment. With funding and budgets getting tighter, only chronic and the most deserving cases are encouraged to apply. So should the NHS increase the funding for addiction patients?

Drug Misuse and the Neurological Effects

So what do the different classifications mean? Depressants slow down the CNS and decrease the speed of synapses to transmit responses. Examples of depressants include alcohol, opioids and heroin. Stimulants are the opposite of depressants, they stimulate the CNS and increase the speed of synapses to transmit responses, examples are: caffeine, nicotine and ecstasy. Hallucinogens alter the perception of reality and change sense of smell, taste and sight, examples are: ketamine, magic mushrooms and LSD. Dissociative anesthetics include drugs that inhibit pain by cutting off or dissociating the brain’s perception of the pain. PCP, its analogs, and dextromethorphan are examples of dissociative anesthetics. Narcotic analgesics relieve pain, induce euphoria, and create mood changes in the user. Examples of narcotic analgesics include codeine, morphine and oxycontin. Inhalants include a wide variety of breathable substances that produce mind-altering results and effects. Examples of inhalants include Toluene, paint, gasoline, hair sprays, and various anesthetic gases. Agonists causes a brain chemical that stimulates the receptor associated with a particular neurotransmitter, elevating its effects. Antagonists are molecules which do the opposite of agonists, they inhibit the action of receptors associated with a neurotransmitter. Reputable inhibitors are chemicals which stop a neurotransmitter being reabsorbed by sending neurons, thus causing antagonistic responses. To put it in context, let’s take the example of dopamine antagonists. Dopamine antagonists block the action of dopamine. They have profound importance in several antipsychotic diseases such as schizophrenia, bipolar disorder, and psychosis. They are also used in non-psychotic illnesses such as orthostatic hypotension, vomiting, and nausea.

Common, well-known “street drugs” contain heavy amounts of carbon, hydrogen and nitrogen, they are referred to as alkaloids. Alkaloids are any class of nitrogenous organic compounds of plant origin which have pronounced physiological actions on humans, such as drugs and poison. 

The brain is made up of more than 100 billion nerves that communicate in trillions of connections called synapses. The brain’s reward system evolved because it helped us seek out things that are important for our survival, but if this system is hacked, it leads to addiction. The reward pathway can be divided into 6 steps: stimulus, urge, desire, action, reward and learning. These are how the 6 steps work:

Stimulus: the initial stimulus can originate outside the body, such as the sight of drugs, or from within, such as falling dopamine levels. 

Urge: dopamine released from the VTA to the nucleus accumbens drives us to seek out and work for the reward that is linked to the stimulus. 

Desire: the urge may be registered as a conscious desire in the cortex, but sometimes it goes undetected, or even opposes our conscious desires. 

Action: a region of the frontal cortex weighs the inputs and decides whether to seek the reward, the body then acts to reach it. 

Reward: the reward triggers parts of the brain known as “hedonic hotspots” to release opioid-like neurotransmitters, giving a sense of pleasure. 

Learning: if the reward is better than expected, the brain relaxes more dopamine, strengthening the connection between the stimulus and reward.

Research and experiments have shown that substance and alcohol abuse can cause severe symptoms both neurologically and physiologically. Common physical symptoms include  changes in appetite appearance changes sleeplessness, injury or disease caused by substance abuse and increased tolerance to the source of addiction. Excessive and prolonged usage has also shown disruption of nutrients reaching the brain needed by brain tissue, direct damage and apoptosis of brain cells, including neurotransmitter receptors,  alterations to brain chemicals and concentrations and deprivation of oxygen to brain tissues.

Conclusion

A study done in 2013 showed that alcohol shrinks the hippocampus and the use of methamphetamine shrinks the amount of great matter in the brain’s frontal cortex, among other areas leading to a decline in mental function. Such long term effects can cause permanent brain alterations and future health problems such as slurred speech, physical imbalance caused by an inefficiency cerebellum cortex, brain atrophy, memory loss, cognitive decline and as discussed before, addiction. Although the effect of substance abuse on people is different, it can still lead to a very bad lifestyle and harmful effects. Your body will react differently to substances based on the type of drugs, strength of drugs, how it is being taken, what is present in your bloodstream during absorption, existing health condition and how many different types of drugs are taken at once. 

Although a treatable illness, addiction took hold of the UK and cost the NHS millions of pounds. In 2016, the National Treatment Agency (NTA) estimated the cost of the NHS of treating drug misuse at around £500m a year and alcohol misuse as much as £3.5bn a year. Substance abuse and alcohol abuse are seriously harmful, and it is vital that the government increase the funding for education and awareness of sensitive topics such as addiction. If you know anyone who needs help with substance abuse or addiction, please contact a health care worker as soon as possible. 

Ipshita Rishi, Youth Medical Journal 2021

References

Addiction Helper. (2018a). 10 Most Common Addictions. [online] Available at: https://www.addictionhelper.com/addiction/10-most-common-addictions/ [Accessed 3 Feb. 2021].

Addiction Helper. (2018b). Search. [online] Available at: https://www.addictionhelper.com/treatment-rehab/questions-and-answers/what-are-the-nhs-options/.

AddictionCenter. (2019). Addiction and the Brain – How Drugs Affect the Brain. [online] Available at: https://www.addictioncenter.com/addiction/addiction-brain/.

American Addiction Centers. (2019). Brain Damage from Drugs and Alcohol. [online] Available at: https://americanaddictioncenters.org/alcoholism-treatment/brain-damage.

Dk (2020). How The Brain Works. S.L.: Dk Publishing.

my-ms.org. (n.d.). The Lobes and Limbic System. [online] Available at: https://my-ms.org/anatomy_brain_part2.htm.

NHS Choices (2019). Healthy body. [online] NHS. Available at: https://www.nhs.uk/live-well/healthy-body/addiction-what-is-it/.

Ritchie, H. and Roser, M. (2018). Opioids, cocaine, cannabis and illicit drugs. [online] Our World in Data. Available at: https://ourworldindata.org/illicit-drug-use [Accessed 3 Feb. 2021].

Theiacp.org. (2019). [online] Available at: https://www.theiacp.org/7-drug-categories.

Wikipedia Contributors (2018). Drug. [online] Wikipedia. Available at: https://en.wikipedia.org/wiki/Drug.

Ipshita Rishi, Youth Medical Journal 2021