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Medical response to Trump requires truth seeking and respect for patients

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j661 (Published 07 February 2017) Cite this as: BMJ 2017;356:j661

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Re: Medical response to Trump requires truth seeking and respect for patients

I would like to express my appreciation to the author of this article as well as to take the opportunity to share my thoughts on the future of vaccine safety communication.

One problem that I have noted with medical journalism as well as with public health authorities regarding vaccines is the near complete avoidance to recognise the progress which has been made in the area of vaccine safety science.

There is an emerging field within vaccinology called adversomics which acknowledges the fact that adverse events following immunisation (AEFI) may be individually determined. This field is based upon the research that has identified that there is inter-individual variation in vaccine responses based upon differences in innate immunity, microbiomes, and immunogenetics.1

There are a number of publications in the literature which describe links between AEFI and individual variation. In the case of narcolepsy and Pandemrix, one of the pandemic influenza vaccines, it was discovered that children with a specific HLA type (DQB1*06:02) elicited a different level of immune response, including autoantibodies which reacted against cells in the CNS responsible for the production of hypocretin.2 Other examples would be the discovery of genetic variants which are associated with an increased risk of febrile convulsions after MMR 3 and local and systemic events after smallpox vaccination 4. Finally, another important publication would be that of Sobolev et al which discovered a unique immunological signature response in subjects experiencing AEFI after Pandemrix compared to those who did not.5

Today’s public is typically underestimated by both medical journalists as well as public health authorities. They are aware of the birth of personalised or ”precision medicine” and are cognizant of growing interest in “patient-centeredness” which strives for an understanding of the patient’s perspective of health conditions and treatment. It is very likely that they have grown to understand that the “one size fits all” argument for vaccines no longer holds, and that their voices are integral to their own health care.

A recent report from the Vaccination Confidence Project out of the London School of Hygiene and Tropical Medicine has noted very concerning low levels of trust in vaccine safety in Europe as well as Japan.6 The current strategies of communication around vaccine safety obviously are not working.

Continued failure to engage with patients and to acknowledge advancements in vaccine safety science that may challenge old paradigms will likely lead to worsening loss of public confidence in both medical journalism as well as public health authorities.

1 Poland GA, Ovsyannikova IG, Jacobson RM. Adversomics: the emerging field of vaccine adverse event immunogenetics. Pediatr Infect Dis J. 2009 May;28(5):431-2. doi: 10.1097/INF.0b013e3181a6a511.
2 Saariaho AH, Vuorela A, Freitag TL, et al. Autoantibodies against ganglioside GM3 are associated with narcolepsy-cataplexy developing after Pandemrix vaccination against 2009 pandemic H1N1 type influenza virus. J Autoimmun. 2015 Sep;63:68-75. doi: 10.1016/j.jaut.2015.07.006.
3 Feenstra B, Pasternak B, Geller F, et al. Common variants associated with general and MMR vaccine–related febrile seizures. Nature Genetics 2014; 46, 1274–1282. doi:10.1038/ng.3129
4 Reif DM, McKinney BA, Motsinger AA, et al. Genetic basis for adverse events after smallpox vaccination. J Infect Dis. 2008 Jul 1;198(1):16-22. doi: 10.1086/588670.
5 Sobolev O, Binda E, O'Farrell S, et al. Adjuvanted influenza-H1N1 vaccination reveals lymphoid signatures of age-dependent early responses and of clinical adverse events. Nat Immunol. 2016 May 19;17(6):740. doi: 10.1038/ni0616-740b.
6 Larson HJ, de Figueiredo A, Xiahong Z et al. The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey. EBioMedicine. 2016 Oct;12:295-301. doi: 10.1016/j.ebiom.2016.08.042.

Competing interests: No competing interests

08 February 2017
Rebecca E Chandler
Physician
Uppsala Monitoring Centre - WHO Collaborating Centre for International Drug Monitoring
Box 1051 Uppsala Sweden 75140