AS90926 - Report on a Biological Issue - 3 credits

This report will look at the biological issue of the vaccination for Measles, Mumps, and Rubella and discuss
the question, ‘Should the MMR vaccine be compulsory in New Zealand?’ We will provide information about
what a vaccine is and how the body becomes immune, as a base to further understand the various
viewpoints, of which there are two, those for and those against vaccinations.

Measles, mumps, and rubella are all viral diseases. Measles starts as a fever, cough, runny nose, pink eye, and
rash which begins on the face and later spreads to the rest of the body. There are 1 in 20 children infected
with measles who get pneumonia, due to the measles weakening the immune system so much that bacteria,
which usually would get destroyed by our immune system don’t and can now infect the lungs. Pneumonia is
the most common cause of death from measles in young children. This virus also can cause inflammation of
the brain (Encephalitis) which can cause seizures and brain damage. Mumps can have serious complications
for people which can cause swollen testicles or ovaries, deafness, and meningitis. Although, the symptoms
can appear mild such as swollen salivary glands (at the side of your face), headache and fever. Rubella is also
known as German measles. It is a typically mild infection but very serious if a pregnant woman becomes
infected when they are in their first 20 weeks of pregnancy. The health problems it can cause impact the
baby’s growth in the womb such as eye problems, deafness, heart abnormalities, and brain damage. The
MMR vaccine is a live vaccine made from the weakened Measles, Mumps, and Rubella viruses. Once
vaccinated the virus activates the body's immune system which then starts fighting the virus. Two doses are
given, the first gives you 95% immunity and the second gives the final 5%. The MMR vaccine is not the only
way to build up the necessary immunity against these diseases.

Immunity is defined as the body’s ability to protect itself from an infectious disease. When you are immune
to a disease, your immune system can fight off infection by itself. Immunity against measles, mumps and
rubella can be achieved in two ways. Active Immunity and Passive Immunity. Active immunity provides the
body immunity by permanent antigenic memory for a lifetime whereas Passive immunity only gives the
body immunity for a short period. Passive immunity is gained by introducing someone else’s antibodies
through medication or colostrum e.g. mother to newborn. The received antibodies help the immune system
fight infection straight away. The person will remain immunised for as long as the antibodies are circulating
within their immune system. Active immunity is when the body is naturally exposed to a pathogen or
intentionally introduced by receiving an antigen (vaccination.). This stimulates the body's natural response
and produces antibodies without suffering the effects caused by the infection. Once exposure occurs the
person will be immune. The main difference between these two types of immunities is one gives life long
immunity the other gives temporary immunity. This report will only cover how active immunity to measles,
mumps and rubella can be achieved.
Active immunity against measles, mumps and rubella can be achieved in two ways. Natural and Vaccinated.
The first, Natural immunity, is where those who got sick with measles, mumps and rubella earlier in life
become immune through the primary immune response. Vaccine-based immunity is where those who have
been vaccinated with 2 doses of MMR vaccine have long-term immunity to the three diseases.

One of the significant side effects of natural immunity is that you have the virus and have to suffer the
symptoms and infection which could be severe or even fatal. The risk of spreading the virus due to its
contagiousness is also a risk particularly for those in the community that are particularly vulnerable, elderly,
pregnant and those with low immune systems. In contrast, vaccinated immunity also has risks that some
people may suffer side effects however most don't. Also, if the body's immune system is going into overdrive
to produce antibodies in response to the vaccine it can make the body susceptible to other pathogens while
the immune system is recovering. The MMR vaccine is considerably safer than getting measles, mumps and
rubella, especially measles. For 1 in every 24,000 doses of the MMR vaccine, it can cause a skin rash of small,
bruise-like spots, 6 weeks after vaccination. These spots are called Idiopathic Thrombocytopenic Purpura or
ITP). In comparison, 1-3 out of 1000 people infected with measles will die in developed countries. These
statistics prove that catching any of the viruses is much more dangerous than the MMR vaccine.

How does an infectious disease infect the body? Measles infects the body in a similar way Mumps and
rubella does. Measles is a virus, which requires a host to survive and cannot reproduce by itself. The way the
virus enters the human body is through the nose, eyes, or mouth with the infection beginning in the lungs.
The measles virus infects the lungs first by attacking the Macrophages cells which defend the lungs from
other pathogens or bacteria. The measle virus attacks these cells taking control of them, using them to
produce measles virus. The cell begins filling with the virus, once full the virus is released into the body and
the cycle repeats. The body's response is for the T cells to seek out these infected cells and tell them to
self-destruct. The Macrophages signal to the Dendritic cells who take a sample of the virus back to the
Lymph nodes where the B cells are activated.
The measles virus uses this process to its advantage, enabling it to travel throughout the body infecting T
and B cells and then further spreading using the lymphatic system and the bloodstream affecting organs
(spleen, intestines, lungs, and liver). It takes an average of 10–12 days from exposure to the first symptom,
which is usually fever. The measles rash doesn't usually appear until approximately 14 days after exposure,
2–3 days after the fever begins.
The immune system has been weakened and symptoms will start presenting themselves (very high fever,
headaches, Sickness, bronchitis, and rash). The virus continues to attack the lungs' defense until it is
overcome and the spreading of the virus through coughing begins. Statistically, for people there is a 90%
chance of catching the virus if you have not been vaccinated. Measles is very contagious and without the
protective cells in the lungs, other pathogens can enter the lungs and develop. Parallel infections can occur.
Infections such as pneumonia are the most common way to die from measles.
As the infection grows in the body the dendritic cells signal the anti-virus plasma cells in the lymph nodes
for help and billions of antibodies are produced. Then they find infected cells and identify them for the
body's T cells to destroy. The immune system needs time to recover after an infection that may take weeks
or months however from this process the body has learnt how to fight this specific pathogen so it has
become immune if infected again.
Infectious diseases like the measles are a real danger, if left uncontrolled in the community. It has the ability
to become widespread very quickly, strengthening the viewpoint of why to vaccinate.

How does the body become immune? The body's immune system has two types of responses to infections.
The Innate response and the Adaptive response. The innate immune response reacts rapidly upon
recognizing certain molecules found on certain pathogens. The immune cells are also signaled by other cells
released by the body in response to the infection. The innate immune cells begin fighting the infection which
results in inflammation. The cells involved in attempting to kill the pathogen can also help activate the cells
involved in adaptive immunity. The adaptive immune response is slower than the innate immune response
but is able to target known pathogens specifically. The two main cells in this response are the T cells and B
cells. Some T cells kill the pathogen and the infected cells whilst others support the adaptive immune
response. The B cells' function is to produce antibodies against specific antigens. Antibodies
(Immunoglobulins) are proteins that attach to the pathogen which identifies the cells the immune cells
needed to destroy. T and B cells require time to respond to a new pathogen causing an infection. The cells
create a memory of the pathogen once introduced making them ready for the next infection. As part of the
adaptive immunity response memory cells are formed from changing T and B cells. These cells stay in the
lymph nodes and the spleen and remember the antigens. If infected again with the same pathogen the
immune system is able to quickly react and begin fighting the infection.

The MMR vaccine contains (Attenuated) a weakened form of the virus which triggers the body's immune
system by imitating an infection generally without illness. The immune system produces T-lymphocytes and
antibodies as it would if it was fighting the virus. The knowledge learned is kept in memory cells used to
fight the infection if infected again.

The reason for vaccinating on the basic level is to prevent the spread of the illness. Measles, Mumps, and
Rubella are contagious viral infections that occur all over the world. These infections are spread from person
to person through inhalation of or contact with infected respiratory droplets. The infections can make you
very sick, and cause complications such as pneumonia, seizures, and swelling of the brain which can be fatal.
By preventing people from catching the illness it is also stopping the spread of the illness.

The World Health Organisation (WHO), promotes vaccinations. Dr. Tedros Adhanom Ghebreyesus,
Director-General World Health Organisation, was quoted in a report on the WHO website supporting
vaccinations to prevent infectious disease. “Vaccines are one of our most important tools for preventing
outbreaks and keeping the world safe. While most children today are being vaccinated, far too many are left
behind. Unacceptably, it's often those who are the most at risk - the poorest, the most marginalized, those
touched by conflict or forced from their homes - who are persistently missed.”. Why is vaccinating supported
by organisations like WHO? The facts are that vaccination prevents deaths. Between 2000 and 2018,
measles vaccination prevented an estimated 23.2 million deaths, which was a 73% drop in deaths (536 000 in
2000 to 142,000 in 2018).

The majority of people support the MMR Vaccine. The intention of the MMR vaccine is to protect people
against measles, mumps, and rubella, and prevent the complications caused by these diseases. The CDC
(Center for Disease Control) recommends all children get two doses of MMR (measles-mumps-rubella)
vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years
of age. Children can receive the second dose earlier as long as it is at least 28 days after the first dose. People
who receive MMR vaccination in line with the schedule are considered protected for life against measles and
rubella. Being protected means they will not catch or spread the virus throughout the community.

A smaller group of people are against the MMR vaccination. Fueled by the misunderstanding that exists
around vaccines and how they work and the fear of the remote chance of having serious side-effects which
could be fatal. Dr. Jayne Donegan, GP, Homeopath is very outspoken and promoted an anti-vaccination
stance in the UK. A statement posted on Dr. Donegans LinkedIn page openly disagreed with vaccinations. “I
vaccinated both my children with the MMR jab, but this was before I started my research into the problems
associated with it. Knowing what I know now, I would not vaccinate my children and run the risk of them
getting diabetes, asthma, eczema, becoming more susceptible to meningitis, and ending up chronically
disabled.” – Dr. Jayne Donegan, GP, Homeopath. Dr. Donegan was the subject of an article written by an
undercover journalist writing for The Times newspaper. DR Donegan was found to be giving parents advice
on how to falsify vaccination reports and suggested that homeopathy could be used as an alternative.
There is no substantial proof supporting her beliefs or has work been published in any credible notifications.

In an article on her web page (www.jayne-donegan.co.uk) an attempt to justify not vaccinating in the USA or
UK because the stats published on the WHO website state 95% of child deaths due to measles are in
countries that aren't wealthy, have porter living conditions and where kids are malnourished. Dr. Donegan
argues these problems don't exist in the USA or UK so vaccinated healthy kids aren't required. She is
currently under investigation by the General Medical Council which may result in her practicing license
being revoked.
Social media and mainstream media have contributed to people's fear by publishing articles that link
conditions such as allergies, asthma, retardation, autism, and down’s syndrome to vaccines, even though
there is no scientific evidence and in most cases isolated opinions not supported by the wider medical
community. In the late 90s, there was an article written by a British doctor that claimed that the measles,
mumps, and rubella (MMR) vaccine causes autism. This influenced people and the number of them getting
the vaccination (in England and parts of the USA) declined which resulted in an increase in cases of people
catching the infection in those places. Many studies have been conducted that show no evidence of any
connection between autism and the MMR vaccine. It was also later discovered that the British doctor had
changed a patient's information to help support his argument.

Through my research of the MMR vaccine, I have formed the opinion that I believe the MMR vaccine should
be compulsory in New Zealand. I feel by vaccinating we protect the wider community and align with the
WHO views on the importance of vaccinating to prevent deaths from these infectious diseases. The risk this
brings is to a small percentage of people that may suffer side effects or in extreme and very rare cases death.
By achieving herd immunity we are able to control or eliminate the virus and protect those more vulnerable
in the community unable to take the vaccine such as the very young, people undergoing chemotherapy,
people with HIV, people who are allergic to the vaccine, and pregnant women.

My future recommendation is to make the MMR vaccine compulsory in New Zealand, for those capable of
having it. The MMR vaccine becoming mandatory will mean that children without the MMR vaccine will be
unable to attend school and/or their parents face fines or even imprisonment. These consequences will be
expected to ‘encourage’ parents to vaccinate their children aged between 6 months and 5 years. Parents of
children that doctors have confirmed are unable to receive vaccines, due to chemotherapy, allergies, etc. will
not receive any of the previous consequences. This will be enforced by the government through police, etc.
By making the MMR vaccine compulsory we can reach ‘herd immunity’ making the spread of disease from
person to person unlikely. As a result, the whole community becomes protected — not just those who are
immune. This occurs when approximately 95% of the population is vaccinated. Over the last 12 month period
up to 31st March 2021. The percentage range of immunization of children turning an age between 6 months
and 5 years was between 72% and 92% far off the 95% required.

In conclusion, the MMR vaccine is a much safer way to build immunity against measles, mumps, and rubella.
Compared to the risks that come with building immunity through natural exposure to the three diseases.
The vaccine is readily available to the masses of people capable of taking the vaccine. By making the MMR
vaccine compulsory in New Zealand, the country will be able to vaccinate 95% percent of the community will
achieve Herd Immunity. The achievement of herd immunity will protect the vulnerable people in New
Zealand who are unable to be vaccinated or are vulnerable for other reasons.