The controversy behind vaccine safety.

My kids and I are currently going through the Harry Potter books for our bedtime reading. However, we decided to pick up The BFG by Roald Dahl for a change of pace last night .

Despite being a fan of Roald Dahl, this is the first time I am reading this book.

I notice the dedication on the first page ‘For Olivia. 20 April 1955 – 17 November 1962’. Whoever Olivia was, she only lived for a short while. Intrigued, I looked her up and learned that Olivia was Roald Dahl’s eldest daughter.

She contracted measles from an outbreak at school. The measles eventually caused inflammation in her brain (encephalitis), which caused her to go into a coma. She died within twelve hours after.

Over 20 years after his daughter’s death, Dahl wrote a short essay ‘Measles, a Dangerous Illness’.

He noted that in 1962, there was nothing doctors could do to save Olivia from measles encephalitis, and they still could not save a child who developed the same deadly reaction from measles as Olivia did in 1986.

Today, 34 years later, there is still no specific treatment for measles.

There is still limited knowledge about how measles causes encephalitis, or how to save someone who develops this condition.

Today, even previously healthy children who are not immune may need hospitalisation from measles and one in 20 of infected kids develop pneumonia while one in 1000 of them have brain inflammation, causing permanent brain damage or death.

We are fortunate today that despite being a potentially deadly disease and the most contagious disease known to humankind, measles was practically eliminated in most places - including Malaysia - thanks to a high majority of children (~98%) being protected through national vaccination programs. Vaccines help save the lives of

many children who often face the highest danger from infectious diseases, because otherwise their immune system are less prepared to fight off invading germs.

Before vaccines were available, millions of children all over the world died from infectious diseases like measles before reaching their fifth birthday.

Unfortunately, the measles vaccine, usually given in a combination of live weakened measles-mumps-rubella virus (MMR) vaccines, is one of the vaccines that continues to be embroiled in one of the most misguided controversies in medical history.

Loss of confidence in this vaccine means many children are unvaccinated and remain vulnerable to measles.

Malaysia recorded 195 people with measles in 2013. In 2018, this number rose to 1,934 people-- six of them died, of which none were vaccinated.

Often, people who are sceptical or refuse vaccines are concerned about safety.

Vaccines are produced with the highest safety standards – even when their production is expedited, like the Covid-19 vaccines.

But out of the billions of people given many vaccines over many years, there will be rare instances when side effects more severe than the common temporary soreness at the injection site occur.

The MMR vaccine, given in two doses to babies at 9 – 18 months of age is known to cause seizure in 3.2 out of 10,000 children.

A fever and rash are more rare adverse reactions to the vaccine, and s eizures happen in some babies who develop fevers.

Scientists continue to find ways to reduce the risks of adverse reactions following immunizations (AEFI), and they continuously monitor AEFI for all vaccines. However, fevers, rash and even seizures, as uncomfortable and frightening it may be for parents to experience with their children after vaccination, are not dangerous in and of themselves, and they do not mean vaccines are not safe.

We need to reconsider what our idea of safety is.

Safety does not mean absence of pain or discomfort—it means being protected from danger, risk or injury.

Similarly, we need to reconsider our idea of protection. Vaccines protect us from getting sick from infectious diseases, but they are not shields that stop people from catching germs.

Instead, vaccination is a martial arts training course for the immune system to be more prepared to fight germs.

In the process of training, there may be some bruises from fighting a pretend opponent— these are like some of the ‘side effects’ from vaccination that mimic symptoms from natural infection.

But because the fighting is more controlled, any damage to the body is limited and temporary.

After the training is complete, a trained person should be able to fight and have higher chances of winning an actual opponent or a bad guy who might really harm them.

There will be differences in how good someone gets after the training, and some differences in how much can be learned training with different versions of pretend opponents.

Yet, the same person would do much better fighting an opponent or offender after being trained rather than coming in entirely unprepared.

But a vaccine can’t shield a person from being exposed or infected with a germ anymore than martial arts can prevent someone running into a thug picking a fight on the street.

However, in both instances, having been trained makes you more prepared, stronger, and less like to get hurt from the encounter.

Discomfort from vaccination is common.

Serious side effects are very rare, but they do occur.

There have been extremely rare tragedies in areas with limited resources and less robust healthcare systems, where contamination and human error in administering vaccines have caused illness and death. Indeed, vaccines and va ccination are not perfect.

But their value in reducing human suffering from the clutches of dangerous diseases cannot be understated. As Voltaire suggested, we cannot let demands for perfect be the enemy of the good.

From a public health perspective, vaccines are sufficiently safe and effective to give to everyone except those for which clear contraindications to the vaccines are known.

Preparedness and transparency in communicating about vaccine shortcomings is important, especially before vaccination by healthcare providers.

Most parents only want to make the best decisions for their children. We all need to be empowered with understanding that sometimes we should choose the best option we have based on the best evidence we know. Even if it is not perfect, the alternative is far deadlier.

Upon finishing the first chapters of The BFG, I turned to my eldest son who was still awake, and asked him to read the dedication. He asked, Who is Olivia?

I told him that she was the author’s daughter and that she had died from measles when she was seven years old. He mulls over this then says, I’m seven years old.

I explained to him that he was vaccinated when he was baby, and nowadays most children are vaccinated so they do not get sick from measles anymore.

I only hope this remains true for years to come.

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Dr Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah

Dr Khayriyyah Mohd Hanafiah is senior lecturer in Medical Microbiology at Universiti Sains Malaysia, and an affiliate of Young Scientists Network-Academy of Sciences Malaysia. She is active in science communication and infectious disease biomedical research. She was the first female Asian champion of FameLab, the world’s longest running science communication competition, in 2018. The writer’s views are her own.


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