Tuberculosis Ward

 

One side of the vaccine controversy Americans are extremely unlikely to hear about concerns the safest, cheapest and most widely used vaccine in the world – against tuberculosis (TB).Every country in the world, except the US and the Netherlands (where TB is extremely rare), uses or has used the TB vaccine (known as Bacillus Calmette Guerin or BCG) in public vaccination programs. The BCG controversy was my first introduction (in 1971) to the US government propensity to engage in conspiracies and cover-ups. This happened during my second year of medical school, in the TB module taught by University of Wisconsin infectious disease researcher Dr Donald Smith.

Prior to World War II, TB epidemics infected industrialized countries at levels comparable to the current rate of clinical depression. Roughly one out of three families had at least one family member who had died of TB or been sent to a TB sanatorium. Once a leading cause of death in the US, TB is very much a disease of poverty. Healthy subjects can carry the tubercular bacillus for years and only develop active illness if poor nutrition – or stress – lowers their natural immune state (see http://www.annals.org/content/124/7/673.abstract).

With the post World War II boom and vastly improved nutrition and living standards, the incidence of TB declined drastically in industrialized countries. However in the large disadvantaged urban centers that characterize US society, rates of TB infection continue at pre-World War II rates. This is of particular concern with the emergence of “drug resistant” TB, related to an “epidemic” of AIDS and various medical treatments (for example cancer chemotherapy) that compromise immunity.

History of the BCG

Albert Calmette and Camille Guerin first began work on the BCG vaccine at the Pasteur Institute in 1908. They developed their vaccine from the bacillus that produces bovine tuberculosis, based on Edward Jenner’s discovery that vaccinating people with “cowpox” produces immunity against smallpox, a far more virulent disease. The BCG was first used in humans in 1921. In 1928 the Health Committee of the League of Nations (precursor to the WHO) recommended its use in mass immunization campaigns to prevent TB.

There was strong opposition to the vaccine, particularly in the US and Britain, which delayed global acceptance till after World War II. It was first widely used in Eastern Europe between 1945 and 1948. The vaccination of eight million babies with BCG prevented the anticipated TB epidemic, that had always accompanied the widespread dislocation and poverty that occurs when economic and social infrastructure is destroyed by war. The BCG’s success in war torn Eastern Europe led Britain to begin using it in 1953. Between 1956 and 1963, they enrolled 54,239 children in a randomized control study, in which BCG proved to be 84% effective in preventing TB (see http://www.bmj.com/content/2/6082/293).

More recent studies show that BCG is less effective in preventing pulmonary (lung) tuberculosis in the third world, where patients are often too malnourished to develop sufficient antibodies to give them full protection. However the BCG is still widely used in India and other developing countries, owing to its efficacy in preventing fatal complications of TB, when it spreads to the brain, liver, spleen and other vital organs (http://www.ncbi.nlm.nih.gov/pubmed/7744445).

How the US “Prevents” TB

Unlike every other country in the world (except the Netherlands), the US still resists the use of BCG to control the spread of TB in our inner cities. Instead the CDC recommends routine skin testing (known as the Mantoux or PPD) of high risk groups. A patient who has been exposed to the tubercular bacillus (mycobacterium tuberculosis) has a positive reaction. They are then given four to nine months of drug treatment (depending on the medication used – see http://www.cdc.gov/mmwr/preview/mmwrhtml/00041047.htm).

I can personally attest that mycobacterium tuberculosis is alive and well in American ghettos. At age forty, my mother developed a positive skin test within six months of transferring to an inner city school. She subsequent underwent twelve months of treatment with the antituberculosis drug isoniazid.

The Problem with BCG Tice

Sadly the vast majority of Americans – including many doctors – are unaware there is a safe, effective and inexpensive vaccine, BCG, that greatly reduces the rate and severity of new tuberculosis cases. They are far more likely to have come across drug industry hype about one of six new anti-TB vaccines being developed by Big Pharma. African American health providers, especially if they are over fifty, are more likely to have heard of the BCG. Nurses I worked with in a Seattle community clinic in the eighties and nineties used to bootleg BCG from Canada to immunize high risk African American children.

As I mention above, I first learned about BCG at the University of Wisconsin Medical School, from infectious disease researcher, Dr Donald Smith. Smith had grave concerns about the high rates of tuberculosis infection in disadvantaged communities – and in nurses and doctors who worked in them. Owing to massive bureaucratic bungling (combined with an unclear amount of sleaze, graft and cover-up), these health professionals had great difficulty accessing effective BCG vaccines in the US. When I was a medical student, the only effective BCG vaccines were made in Denmark and Prague and had to be imported. Smith was so concerned about our risk of contracting TB from our patients that he ordered BCG from Denmark, offering all 107 of us the opportunity to be inoculated for $2.

According to Smith, the American vaccine, known as BCG-Tice was notoriously ineffective in preventing TB in both animals and humans (see Why Not Vaccinate, Three Different BCGs, Differences in Biological Activity, and Efficacy and Applicability). It was a story I was to hear often about researchers and drug company CEOs with powerful friends in Washington. Rather than acknowledging the Tice vaccine was useless and importing Danish or Prague BCG, the Centers for Disease Control gave their blessing to the use of Tice in the two largest American BCG trials (in Georgia and Alabama), accepting the abysmal results as “proof” that BCG is useless in preventing tuberculosis.

The Influence of Big Pharma

In The People’s Health: Public Health in Australia, 1950 to the Present, Milton James Lewis (The Peoples’ Health) also sees the rising influence of pharmaceutical companies in the fifties and sixties as a factor in American resistance to BCG. Thanks to Big Pharma’s aggressive marketing efforts, the US saw a major shift in the mid-1950s away from public health and preventive medicine to “curative” medicine based on drug treatment. As a long time health care reform advocate, I also see a more sinister racial and class bias underlying this shift. In the US, which has consistently opposed publicly funded medical care, curative medicine is only and option for patients with the ability to pay for doctor visits and prescription medication. Public (i.e. government-funded) health measures, in contrast, are mainly aimed at the poor and disadvantaged. In allowing public health and preventive medicine to be systematically eroded (over the last three decades), American political leaders decided, at some level, that the poor are expendable.

A Set-Up to Create Drug Resistant TB

In my view, the American medical establishment has made a big mistake in opting to “control” TB via testing and drug treatment, rather than prevention. There is no doubt the emergence of drug resistant TB directly relates to this approach. Compliance with long anti-TB drug regimens (lasting 4-9 months) is notoriously spotting in low income, poorly educated populations with limited access to medical follow-up. It’s exactly this partial/inadequate treatment scenario that promotes the development of drug resistance. Infectious organisms exposed to any medication without being killed by it typically develop resistance. This means the infection is passed to new victims in a drug resistant form.

The Vaccine Controversy

I am of two minds regarding the current vaccine controversy. There is no question the US government has totally destroyed public confidence in vaccination, by handing vaccine manufacture over to for-profit pharmaceutical companies with inadequate and/or corrupt regulatory oversight. In my view, their knowing use of polio vaccine contaminated with cancer-causing monkey viruses in the fifties and sixties (see SV-40 and the Cancer Epidemic) was a crime against humanity. Likewise their decision to permit the exposure of millions of developing brains to the potent neurotoxin mercury (used as a vaccine preservative prior to 2001 – see http://www.naturalnews.com/011764.html). That being said, I would hate to see industrialized societies return to the pre-vaccination era, where poor families routinely lost half or more of their children to deadly childhood illnesses, such as whooping cough (pertussis) and diphtheria.

With the exception of the polio vaccine, the vaccines most baby boomers received in early childhood (against pertussis, diphtheria and tetanus) have been in use more than half a century with an excellent safety record. Obviously I would add BCG to this group. I have to question the motives of Internet pundits and bloggers promoting the urban legend that all vaccines are harmful to peoples’ health. From a social control perspective, wiping out fifty percent of low income kids under five, is a perfect (but brutal and immoral) method of population control (see * below).

A Perfect Storm

Epidemiologists predict a big upsurge in infectious epidemics in the industrialized world, as more and more families fall into poverty and as governments cut funding for both public health and direct treatment. While I agree parental skepticism is warranted about vaccinating children vaccinating against relatively minor illnesses, such as mumps, German measles and chicken pox., I can’t think of a worse time to make parents paranoid about vaccinating their kids against the high mortality illnesses such as diphtheria, pertussis, tetanus and measles. Other vaccines, for example against hepatitis B and papilloma virus (which causes cancer of the cervix), fall into a gray area. I find it alarming that both are marketed so heavily to parents without full disclosure of the health risks. The line parents are given is that teenagers can’t be taught to use condoms to protect themselves against sexually transmitted diseases. This has not been my experience in the thirty plus years I have spent instructing adolescents in the safe use of condoms.

*I have personally witnessed the tragic effect of parental paranoia over vaccines, owing to a recent whooping cough epidemic here in New Plymouth. The disease is heart breakingly brutal, as is measles. Auckland is currently experiencing a measles epidemic, with 401 cases in 2011. Ninety-one children have been hospitalized, many of whom will experience permanent brain changes.