Roughly through to 1980, vaccines were public goods. They were mostly made by national bodies who were publicly funded, although pharmaceutical companies were dipping their toes in the water.
They were used for diseases that a national community thought were serious and worth getting vaccinated against – like polio.
Few national communities would have prioritized an investment in anything other than exceptional vaccines if the state of their health services were otherwise rudimentary and in need of developing.
As of 1980, vaccine development was picked up by pharmaceutical companies. It became a business venture rather than a public good. Companies cannot readily tolerate loss making, where for a country some losses can be tolerated, even desirable.
A business venture means sales on a greater than national scale.
There have been few diseases that a majority of any national population have believed really needed a vaccine. As a result, people have had to be persuaded in the case of measles, mumps and influenza.
There is acknowledgement at the highest level that the harms of influenza, measles and mumps have been hyped as part of strategies to persuade populations who might otherwise be unwilling to engage with vaccination campaigns.
There are vaccines that many willingly take if travelling to an affected area such as Yellow Fever or Hepatitis B.
Owing to general support for the idea of vaccinations, there are many vaccines that many of us can be persuaded to go along with from influenza to shingles.
There are others like rotavirus for children and HPV vaccines that are received ambivalently.
There is a gap between what is vaccine preventable and what individuals might opt to have for themselves and when they might think it reasonable to prioritize a vaccine option over others.
Trust in Institutions
The regulatory institutions that now manage vaccines have been managing drugs since 1950.
Since the 1980s, there is increasing evidence regulators look over company submissions rather than scrutinise them closely.
They do not check to see if all subjects in a trial exist.
Do not check to see if all data is transcribed from worksheets to final reports.
Do not check with subjects who have been designated as having adverse events or who have dropped out of trials as to what their experience has been.
Regulators tolerate a situation in which articles written in leading journals portray drug treatments as effective and safe when regulators have reviewed them as ineffective.
Do not register safety issues in a meaningful way.
Are a core part of a system that makes it impossible to get a treatment induced injury recognized.
Institutions and Vaccines
The significant harms that pertussis and swine flu vaccines in the 1970s caused opened up the prospect that new vaccines might cause damage on a great scale. Pharmaceutical companies stepped back from vaccine development.
Against a background of rising autism rates, for the pharmaceutical industry public concerns about thimerosal in vaccines raised a further prospect of escalating liabilities.
Governments stepped in to protect the pharmaceutical industry from having to shoulder the costs of compensation. Stepped in to support a market.
Since then, a series of vaccines have caused substantial harms. These include dengue, swine flu and HPV vaccines.
Investigating these has shown that companies do not run placebo-controlled trials.
The trials avail of a variety of maneuvers to hide harms.
A variety of methods have been used to enhance impressions of vaccine efficacy.
The current drive to develop vaccines has called unelected and unaccountable supra-national institutions such as GAVI into being.
The influence of bodies like GAVI is difficult for pretty well anyone to assess.
Vaccine policy has begun leaning toward supporting coercion. If a national community willingly embraced a vaccine, requiring others to vaccinate has a certain legitimacy. Forcing people to take a treatment that a significant proportion of the population feel ambivalent about is a different matter.
For the coercion to stem at least in part from bodies beyond a national community is a new development.
The emergence of pandemics potentially linked to climate change, and spread by transport and migration, has also introduced new elements into the equation that few of us have had time to assess.
Mothers and the Rest of Us
Other than in the case of older people getting Shingles, Influenza or Covid vaccines, many vaccines, if mandatory or semi-mandatory, bump into a very primitive force, a mother’s right to decide what is best for her child.
In some cases it faces her with demands to accept vaccinations in pregnancy, when many women opt to forego life-saving treatments if pregnant. The latest best-selling book, The Push, brings out how primal the issues are.
A religious belief, for instance in circumcision, can shape this parental force, as can a threat from a disease like polio.
It is unclear how mothers will respond to a body like GAVI intervening in matters like this in the case of conditions they view as relatively harmless or better managed by other means.
A core feature of healthcare is that a medicine should not produce disproportionate problems; a sleeping pill should not cause peripheral neuropathy or birth defects.
Some recent vaccines have produced disproportionate problems.
The trend toward vaccinating ever less life-threatening conditions increases the hazard.
In matters like this, individuals differ in their assessment of risks. Some will opt to take a chance and others not. Applying a rule that forces us all to behave the same way in the case of something, that unlike masks, comes with risks is likely to generate resistance.
Labelling a business problem (people who because they were pro-vaccine have taken or had their child take a vaccine and who had to deal with injuries as a consequence) as Anti-Vaxx looks like a use of the same playbook as blaming Anti-Fa for the Capitol Hill damage.
There is a companion post on RxISK about reporting vaccine effects