Translator: Gisela Giardino Reviewer: Romina Pol
One of the first patients I had to see as a pediatrician was Sol,
a beautiful month-old baby
who was admitted with signs of a severe respiratory infection.
So far, I had never seen a patient worsen so fast.
In just two days she was connected to a respirator
and on the third day she died.
Sol had whooping cough.
After discussing the case in the room and after a quite distressing catharsis,
I remember my chief resident said to me,
"OK, take a deep breath, wash your face,
and now comes the hardest part,
we have to go talk to her parents."
At that time, a thousand questions came to mind.
From: "How a month-old baby could be so unfortunate?
To: "Could we have done something about it?"
Before vaccines existed,
many infectious diseases killed millions of people per year.
During the 1918 flu pandemic
50 million people died.
That's greater than Argentina's current population.
Perhaps, the older ones among you remember the polio epidemic
that occurred in Argentina in 1956.
At that time, there was no vaccine available against polio.
People didn't know what to do. They were going crazy.
They would go painting trees with lime.
They would put camphor bags inside their children's clothes
as if that could do something.
During the polio epidemic thousands of people died.
And thousands of people were left with very important neurological damages.
I know this because I read about it,
because thanks to vaccines my generation was lucky
to not live through an epidemic as terrible as this.
Vaccines are one of the great successes of the twentieth century's public health.
After drinking water,
they are the interventions that have most reduced mortality,
even more than antibiotics.
Vaccines eradicated from the planet terrible diseases such as smallpox
and succeeded in reducing mortality significantaly
due to other diseases such as measles,
whooping cough, polio and many more.
All these diseases are considered
Vaccine-preventable diseases.
What does this mean?
That they are potentially preventable,
but in order to be so, something must be done.
You need to get vaccinated.
I imagine that most, if not all of us here today,
received a vaccine at some point in our life.
Now, I'm not so sure that many of us know
which vaccines or reinforcements we should receive after adolescence.
Have you ever wondered who we are protecting
when we vaccinate?
What do I mean by that?
Is there any other effect beyond protecting ourselves?
Let me show you something.
Imagine for a moment
we are in a city
that has never had a case of a particular disease,
such as measles.
This would mean that in this city no one has ever had contact with the disease.
No one has either the natural defenses nor been vaccinated against measles.
If one day, a person ill with measles appears in this city
the disease won't find much resistance
and will begin spreading from person to person,
and in no time it will disseminate throughout the community.
After a certain time
a big part of the population will be ill.
This happened when there were no vaccines.
Now, imagine the complete opposite case.
We are in a city
where more than 90 percent of the population
has defenses against measles.
It means that they've had the disease, and generated natural defenses.
They either survived, or were immunized against measles.
And one day,
a person sick with measles appears in this city.
The disease will find much more resistance
and won't be transmitted that much from person to person.
The spread will probably remain contained
and a measles outbreak won't happen.
I would like you to pay attention to something.
People who are vaccinated
not only are protecting themselves,
but by blocking the dissemination of the disease
within the community
they are indirectly protecting the people from this community
who are not vaccinated.
They create a kind of protective shield
which prevents from getting in contact with the disease,
so that these people are protected.
This indirect effect of protection
which unvaccinated people have within a community,
simply by being surrounded by vaccinated people,
is called herd immunity.
Many people in the community
depend almost exclusively on this herd immunity
to be protected against disease.
These people displayed in infographics are not just hypothetical.
These people are our nephews, our children,
who may be too young to receive their first shots.
They are our parents, our brothers,
our acquaintances,
who may have a disease,
or receive medication which lowers their defenses.
There are also people allergic to a particular vaccine.
They could even be among us,
any of us who got vaccinated,
but the vaccine didn't produce the expected effect.
Because not all vaccines are always 100 percent effective.
All these people depend almost exclusively
on herd immunity to be protected against diseases.
To achieve this effect of herd immunity,
it is necessary that a large percentage of the population is vaccinated.
This percentage is called threshold.
This threshold depends on many variables.
It depends on the germ's characteristics,
and those of the immune response that the vaccine generates.
But they all have something in common.
If the percentage of the population in a vaccinated community
is below this threshold number,
the disease will begin to spread more freely
and may generate an outbreak
of this disease within the community.
Even diseases
which at some point were controlled may reappear.
This is not just a theory.
This happened and is still happening.
In 1998, a British researcher published an article
in one of the most important medical journals,
saying that the MMR vaccine,
which is given for measles, mumps and rubella,
was associated with autism.
This generated an immediate impact.
People began to stop getting vaccinated, and stop vaccinating their children.
And what happened?
The number of people vaccinated,
in many communities around the world, fell below this threshold.
And there were outbreaks of measles in many cities in the world.
In the U.S., in Europe.
Many people got sick.
People died of measles.
What happened?
This article also generated a huge stir within the medical community.
Dozens of researchers began to assess if this was actually true.
Not only could no one find
a causal association between MMR and autism at the population level,
but it was found that this article had incorrect claims.
Even more, it was fraudulent.
It was fraudulent.
In fact, the journal publicly retracted
from this article in 2010.
One of the main concerns and excuses for not getting vaccinated
are the adverse effects.
Vaccines, like other drugs,
can have potential adverse effects.
Most are mild and temporary.
But the benefits are always greater
than possible complications.
When we are ill,
we want to heal fast.
Many of us who are here
take antibiotics when we have an infection,
We take anti-hypertensives when we have high blood pressure;
we take cardiac medications.
Why? Because we are sick and we want to heal fast.
And we don't question it much.
Why is it so difficult to think of preventing diseases,
by taking care of ourselves when we are healthy?
We take care of ourselves a lot when affected by an illness,
or in situations of imminent danger.
I imagine most of us here,
remember the influenza A pandemic
which broke out in 2009 in Argentina and worldwide.
When the first cases began to come to light,
we, here in Argentina, were entering the winter season.
We knew absolutely nothing.
Everything was a mess.
People wore masks on the street, ran into pharmacies to buy alcohol gel.
People would queue in the pharmacies to receive a vaccine,
without even knowing if it's the right vaccine
that would protect them against this new virus.
We knew absolutely nothing.
At that time, in addition to doing my research scholarship
at the Infant Foundation,
I worked as a home pediatrician for a prepaid medicine company.
I remember that I started my shift at 8 am
and already I had a list of 50 scheduled visits.
It was chaos, people didn't know what to do.
I remember the types of patients that I was examining.
The patients were a little older than what we were used to see in winter,
with longer fevers.
And I remember I told my mentor at the research scholarship,
and he, for his part, had heard the same from a colleague,
about the large number of pregnant women
and young adults
being hospitalized in intensive care,
with clinical profiles difficult to handle.
At that time, we set out to understand
what was happening.
Monday, early morning, we took the car
and we went to a hospital in Buenos Aires province,
that was supposed to be a reference hospital
for cases of the new influenza virus.
We arrived at the hospital, it was crowded.
All health staff was dressed in NASA-like bio-safety suits.
We – with face masks in our pockets.
Just like a hypochondriac, I didn't breathe for two hours.
But we could see what was happening.
Immediately, we started reaching out to pediatricians
from six hospitals in the city and the Buenos Aires province.
Our main goal was to find out,
how this new virus behaves in contact with our children,
in the shortest time possible.
A marathon work.
In less than three months
we could see what effect this new H1N1 virus had
on the 251 children hospitalized by this virus.
We could see which children got more seriously ill:
children under four, especially those less than one year old;
patients with neurological diseases,
And young children with chronic pulmonary diseases.
Identifying these risk groups was important
to include them as priority groups
in the recommendations for getting the influenza vaccine,
not only here in Argentina,
but also in other countries which the pandemic not yet reached.
A year later,
when a vaccine was available against the pandemic H1N1 virus,
we wanted to see what had happened.
After a huge vaccination campaign
aimed at protecting risk groups,
these hospitals,
with 93 percent of the risk groups vaccinated,
had not a single patient
with the pandemic H1N1 virus.
(Applause)
In 2009:
251.
In 2010:
Zero.
Vaccination is an act of individual responsibility,
but it has a huge collective impact.
If I get vaccinated, not only am I protecting myself,
but I am also protecting others.
Sol had whooping cough.
Sol was very young,
and she hadn't yet received her first vaccine against whooping cough.
I still wonder what would have happened
if everyone around Sol
had been vaccinated.
(Applause)