The Practitioners - Shelley Steuart
Who are they? Doctors, governments, disease experts, public health officials.
When we talk about the practitioners in relation to vaccinations, we could firstly look to a category that would be most widely recognized: a qualified or trained medical expert. Medical practitioners are authorized and responsible for the administration of vaccinations to the general public, or more broadly as 'a person actively engaged in an art, discipline, or profession, especially medicine'. So who authorizes these medical professionals to administer vaccines? In countries such as Australia, there are National Immunization Program Schedules (Australian Government Department of Health, 2015). This means that ultimately, the responsibility lies further ahead than the general medical practitioners who actually administer the vaccinations. Most general practitioners receive an incentive from the government to administer certain vaccinations. In this case the government could be the practitioner, as they are giving the authorization. This can been seen on an even larger scale when we look at the World health Organization (WHO), who approves the administration of vaccinations and coordinates international health.
The practitioners responsible:
The practitioners responsible could trace back as far as the biomedical scientist, immunologists and disease prevention experts. All contribute to the final product that is administered by your doctor or nurse. In countries where access to vaccination is limited, the practitioners responsible for administering these vaccinations may be international health workers, or non-government organizations. Essentially in this scenario, it is the policy makers and international partners who are responsible for what vaccines to roll out, and the logistics of administering them.
How do the practitioners know what they know?
The practitioners knowledge of these vaccinations can come from a biomedical perspective and medical training. We can also look to history, observation and scientific research. Biomedical advances have been seen throughout history, with large-scale programs targeting the elimination of immunizable diseases globally. These programs were mandated by international policy makers (Casiday 2005). Programs such as these are implemented based on research and expert advice from health practitioners.
What is the source of their authority?
The authority that medical professionals hold over the general population stems from a power/knowledge framework. When looking at it from a place of trust and risk analysis, the majority appear to trust and are confident with the medical advice they are given, because they believe the medical training, and professional code of practice that doctors and nurses follow (Casiday 2005).
In many countries such as Africa, the majority will accept a vaccination if it is available, without having much knowledge of it, indicating that the organization administering the vaccinations are trusted within that community.
The Healing Ritual - Natasha Smith
How does it work?
From a biomedical standpoint, vaccinations exploit the already-present mechanisms of the immune system that are responsible for fighting off diseases in the body. What causes us to experience ill health from a pathogen is the low number of antibodies that can recognize it upon invasion. It normally takes time to increase antibody numbers in order to overwhelm the pathogen. By introducing a modified or inactive form of the pathogen, vaccines safely trigger this antibody-producing mechanism without subjecting the person to the active disease. Upon an attempted re-invasion by the same organism, the body would recognize the surface antigens of the pathogen, preventing illness (Goering et al 2015, p. 491).
Where does it occur?
Vaccine proponents ideally want immunization to be distributed worldwide, particularly in parts of the world where vaccine-preventable infectious diseases are still prevalent and responsible for high death rates (Streefland 2000, p. 160). Where they are available, they are distributed to the community, delivered into the bloodstream via injection.
Who is involved?
There are a few different groups involved with the production, distribution and use of vaccinations. Many biological scientists undertake specific training to understand disease and immunization processes and develop the vaccines. Statistical knowledge bases such as the CDC and WHO are responsible for providing information about vaccinations. Finally, vaccination services travel around the world to communities and provide a vaccine injection to the population.
Areas of difficulty, misunderstanding or ignorance regarding vaccine integration:
Despite over a century of clinical use and a well-documented record of its safety and effectiveness, vaccinations are not always accepted by communities across the globe (Reading 6 p. 1). There are three general modes of non-acceptance; the first two are particularly relevant to parents, especially mothers, in poor rural countries such as Bangladesh, Malawi and Ethiopia (Streefland et al 1999, p. 1710).
The first mode of vaccine non-acceptance is where mothers are willing to go to vaccinate their children but are unable to (Streefland et al 1999, p. 1710). This is due to the long distances mothers need to travel to reach a local health service, as well as the extensive duties mothers engage in daily. Another significant obstacle is political instability, preventing vaccine distribution services from reaching the people (reading 2 p. 160). The second mode is where the mothers refuse to go. This is often a consequence of inadequate vaccination services, in which the mothers eventually lose patience (Streefland et al 1999, p. 1710). The third mode is questioning the need for vaccinations. This can stem beyond individual refusals to an organized resistance (Streefland et al 1999, p. 1710). This has negative consequences for public health, with the resurgence of vaccine-preventable diseases in first-world countries (Constable et al 2014, p. 1793).
Anti-vaccination groups in Western countries adopt a particularly privileged position of health due to good sanitation and vaccination rates, yet they take this status for granted and shift their trust away from the biomedical model of health. Their principal objections to vaccinations, vocalized primarily on the Internet, are:
* The contents of the vaccination, including the concentration of ingredients and their "excessive" distribution to children. That they are ultimately dangerous and unethical in their makeup, and this causes adverse reactions in children.
* The fact that they apparently don't work, or we don't need them. 'Natural' immunity is sufficient.
* Parental 'rights' over their children, and general mistrust of both the State and the biomedical institution, who are 'only in it for the money' (Behrmann 2010, p. 5).
The Subject or “Patient” - Kitty Romanowska
Who becomes sick? Why?
Throughout history, epidemic diseases have had drastic effects on the population. More recently, we have been able to pre-empt the disease through quarantine procedures and vaccines in more wealthy countries. In an ideal world, the development of a corresponding vaccine should prevent the spread and recurrence of any given disease fairly quickly and efficiently. However, the real world presents a number of practical and social complications which have seen diseases continue to spread, especially in poorer countries, or even recur in places they had previously been eliminated (Katz 2006).
Who is not in a position to seek treatment?
A large percentage of the world's population simply do not have access to treatments, either because they are not available in their area, or due to financial obstacles or travel distances that conflict necessary paid work. There are many technical and organisational difficulties to making improved vaccines cheap and easy to access, especially in resource - poor countries (Heggenhougen & Clements 1990, p. 20). One example is that vaccines need to be kept cold between manufacture and delivery, or run the risk of being rendered useless.
Who actively avoids treatment? Why?
As mentioned above, vaccines can be damaged by poor manufacture or transport practices. This can lead to previously pro-vaccine parents losing faith in a system that is clearly failing to keep their children healthy. Additionally, carelessly manufactured and tested vaccines can cause the very disease which they are intended to prevent, and the horror stories that this give rise to often outweigh the less immediately obvious effects of a properly prepared and successful vaccine (Kitta 2012, p. 59). In wealthier countries, long term use of vaccines mean that the current generation of parents know of the risks of disease from education and anecdote, but have no firsthand experience. As such, some regard the "unnatural" injection of chemicals, or rumours that vaccines can cause autism or allergies in their children as a more immediate risk than diseases such as polio which they are less likely to be exposed to (Kitta 2012, p. 111). Finally, past or current persecution of religious or cultural groups can lead to distrust of the motives of governmental or charitable organisations in providing vaccines freely or cheaply. At the end of 2003, Northern Nigeria's polio vaccine program had to shut down after accusations that the vaccines were being used to target their Muslim population with HIV and/or anovulatory agents (Katz 2006).
What effects does vaccine non-acceptance have?
Non-acceptance of vaccines, especially on a large scale, can have disastrous and far-reaching effects. In the Northern Nigerian example above, there was a resurgence of polio that spread to at least fourteen other countries within the next eleven months. Some of them had been completely free from polio for up to ten years before this resurgence. Later, it spread all the way to Indonesia (Katz 2006).
So there you have it - vaccination ftw!
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