On this episode of Kentucky Health, host Dr. Wayne Tuckson speaks with Dr. Michael Kuduk, assistant professor of pediatrics at the University of Kentucky Children’s Hospital, about the effectiveness of vaccinations for children and adults.
The History and Value of a Life-Saving Medical Invention
According to the Centers for Disease Control and Prevention, childhood vaccinations prevent 4 million deaths each year. Dr. Kuduk says the practice of giving vaccines to immunize populations for certain diseases has a long history. It originated in China and sub-Saharan Africa during the 15th century, Kuduk says, when physicians devised the idea of dosing people with a less virulent strain of smallpox to protect them from catching a strain with a 30- to 40-percent fatality rate.
In the late 1700s, English Dr. Edward Jenner noticed that during smallpox outbreaks, milkmaids did not get the disease. He found that they had previously been infected with cowpox, a genetically related but milder infectious disease. That led him to eventually vaccinate the larger population with cowpox to prevent smallpox.
“With vaccines the idea is to give your body a little bit of an infection and allow your body to develop an immunity to it, so when the real infection comes through, you’re able to fight it off,” Kuduk says.
For example, Kuduk says the initial COVID-19 vaccines released in early 2021 as well as the subsequent boosters were not designed to prevent infection. Rather, he says they introduced a small amount of the virus into the body in order to generate a minimal immune response that will then ward off a massive reaction if and when a person comes in contact with the circulating virus. “Because it’s really your body’s response to COVID that’s making you sick, not necessarily the virus itself,” he explains.
During the 1800s and even into the 1900s, vaccinations carried risk of complications caused by injecting a new virus into the body in a less-than-sterile manner. But Kuduk says modern vaccines are incredibly safe and have been developed to eliminate impurities. Nevertheless, he acknowledges that during the past several years – and especially during and since the COVID-19 pandemic – public hesitance to getting vaccinated has increased, often fueled by misinformation.
Vaccine Hesitancy: Why It Exists and How to Reduce It
Kuduk reasons that part of the hesitancy arises from how effective prior vaccines have been. He notes that in early 2023 many beds at the UK Children’s Hospital are filled with infants suffering from Respiratory Syncytial Virus (RSV), and he says most of the parents of these patients are eager for a vaccine that will prevent the disease. (A vaccine for RSV was introduced earlier this year.) On the other hand, unwillingness to receive vaccines for nearly eradicated diseases such as measles and polio is growing.
“Sometimes vaccines are so successful that they’re kind of victims of their own success,” he says. “I always teach my students that in the 1950s, America was afraid of two things: Russia and polio... But once that vaccination program was successful, and you don’t see that disease anymore, (now) people have forgotten what polio looks like.”
A U.S. Supreme Court decision in 1905 decided that state governments could enact mandatory vaccinations, Kuduk says, and he regards that ruling as the birth of the public health system in this country. Still, he recognizes how embedded the principle of individual rights is in our society and says that the best way to approach vaccine-hesitant individuals is with persuasion rather than authority.
“I’m not a fan of compulsory anything,” he says. “I think forcing somebody to get vaccinated is a bad idea. I still think it should be somebody’s choice – but it should be an informed choice.”
During the COVID-19 pandemic, persons who resisted getting the COVID vaccine often cited herd immunity as their reason. Kuduk explains that those folks believe that once a certain number of people within a population are infected with a disease and develop natural immunity, the risk for the entire population dwindles.
Unfortunately, Kuduk says the COVID virus continued to mutate at a rate that made herd immunity impossible, thus requiring multiple vaccinations as new strains arose. Even now the virus is not completely eradicated three years later.
“Herd immunity for something like smallpox or measles is more reasonable,” he explains. “Because unlike COVID, which can keep switching its proteins, smallpox and measles just come in one serotype, so there’s just one set of proteins. And once you develop an antibody to that, you’re good – you should be protected.”
Despite a growing resistance to vaccines sparked by COVID mandates, Kuduk says getting immunized is necessary for adults and critical for children.
“A lot of people question why we give vaccines so early,” he says. “The reason we give them so early is those particular diseases pose a threat to young children. If a 2-year-old gets bacterial meningitis, that is really life altering.”
The standard vaccine schedule for infants starts at two months, followed by four months and then six months, Kuduk says, and then spaces out after that. Infants and young children have immune systems that have not developed enough memory, he explains, which means that multiple rounds of boosters must be given in stages.
In the late 1990s, a paper published by a British doctor claimed to find a link between vaccines and autism. The paper was eventually discredited due to faulty research, and Kuduk notes that numerous scientific studies tried to replicate its methods and failed to get similar findings.
Even so, the idea that vaccines cause autism spread through nascent social media channels and still has adherents today. But Kuduk explains that research into the autism spectrum indicates the neurological condition is complex and results from genetic and environmental factors.
“There’s a lot of fear,” he concedes. “And if we had an explanation for what causes autism, that probably would help. But right now there isn’t one.”
Kuduk says he treats people who come to him with an illness that could have been prevented by vaccination the same as those who have their immunizations current. He says he explains to vaccine-hesitant patients how their health issue could have been avoided.
Overall, Kuduk is committed to using persuasion rather than commands to combat vaccine misinformation and hesitancy. He believes that once people learn about how effective and safe vaccines are, they will be eager to get themselves and their family members vaccinated.
“Some of the residents in my training program have buttons that say, ‘Vaccines cause adults,’” he says. “And I really like that, because it’s true.”
