In 1977, after a cluster of cases in a small town of New England, clinicians identified what would become an emerging disease for surrounding states, today infecting tens of thousands annually. And the township in question, its name now carrying a measure of infamy, was Lyme, Connecticut.
Dr Todd Hatchette is a microbiologist and infectious disease physician with the Nova Scotia Health Authority, possessing a professional interest in the disease’s progress since the 1970s. Lyme disease is what we call a zoonotic infection, as he explained over the phone in early June, the sort of ailment which originated in animals and has since leapt to human beings. It spreads by way of the blacklegged tick, known also as the deer or Ixodes tick, once restricted climatically to the northeastern United States.
In 2002 alone, 23,763 cases were reported to the Centers for Disease Control and Prevention in the U.S, even though the pharmaceutical community rose to this challenge a decade earlier. In fact two vaccines made their way to the forefront in the early 1990s, their stories chronicled in a 2006 paper entitled The Lyme Vaccine: A Cautionary Tale, supplied to me by Dr Hatchette.
Of these vaccines – LYMErix and ImuLyme – only the former made its way to market on Dec 21, 1998, shown by exhaustive clinical trials to be 76 per cent effective against the growing threat of Lyme disease. By 2001, over 1.4 million doses had been administered to the public.
Vaccines are a modern miracle in my estimation, standing among our most powerful tools in the prevention and even eradication of diseases mild or deadly, and while LYMErix wasn’t perfect, extensive study demonstrated its safety and effectiveness. But for as long as we’ve used vaccines in defence of public health, portions of that public have greeted them with distrust. LYMErix, sadly, was no exception.
Within a year of its release, people began claiming adverse effects from this vaccine, the 59 cases of arthritis standing out, all culminating in a 1999 lawsuit against the vaccine’s manufacturer, SmithKlineBeecham. I won’t go into the post-market studies undertaken by this company as well as the Food and Drug Administration (FDA) in response to these concerns; it’s enough to say that rates of arthritis among vaccinated individuals were the same as those who weren’t vaccinated at all, nor was there a spike in arthritis diagnoses following the vaccine’s release. With a great deal of effort and after an FDA advisory panel meeting in early 2001, the vaccine’s safety was reaffirmed by both government and industry.
Us humans are passionate creatures, more easily swayed by personal stories than by cold, hard data. We’re also excellent at recognizing patterns, even where none exist. That some people would develop arthritis around the time of vaccination is a matter of probability, inevitable given the sample size, but to claim their arthritis was caused by the vaccine requires that cold hard data we talked about, which, in this instance, didn’t support these claims at all.
But unfortunately the damage was done. It’s easy to distrust pharmaceutical companies and government, even easier to side with perceived victims on the front page. In spite of all the evidence, public opinion turned against LYMErix and many people stopped vaccinating, so in the face of poor demand and an impending lawsuit, the manufacturer discontinued their vaccine on Feb 26, 2002.
Another Quirk of a Changing Climate
It’s ironic the withdrawal of our first and only vaccine against Lyme disease would coincide with the ailment’s arrival in Nova Scotia. According to our own branch of Communicable Disease Prevention and Control, there have been 701 cases across the province from 2002 – 2015 and that number continues to climb.
Dr Hatchette told me that, originally, Nova Scotia was too cold for the blacklegged tick, but with the unwelcome progress of climate change they’ve been able to expand their range northward, conveying this disease from their guts to our shores.
Already our counties have been divided into categories of high risk (Yarmouth, Shelburne, Queens, Lunenburg, Halifax and Pictou), moderate risk (Digby, Hants, Colchester, Cumberland, Guysborough and Antigonish), and low risk (Annapolis, Kings, Richmond, Inverness, Cape Breton and Victoria) for encountering infected ticks.
While she wasn’t speaking directly to the demise of LYMErix, I did sit down with infectious disease specialist Dr Shelly McNeil to discuss this long standing assault on vaccines in April.
“It’s unfortunate there are these vaccine myths out there, but there’s more evidence, by far, for their safety than for everything else people are given in hospitals,” she told me, working, among other things, as an investigator with the Canadian Centre for Vaccinology.
She and Dr Hatchette both explained that vaccines go through three phases of study before ever reaching market, the first on animals, the second on humans and the third on control groups numbering in the thousands, all three to determine safety and effectiveness, typically over years. Even after market release, when sample sizes reach millions, studies continue. Few of our medicines are examined with this sort of rigour.
“Overwhelmingly our followup studies show, time and time and time again, that vaccines are safe,” Dr McNeil told me. “There’s no question in my mind that vaccinations are safe.”
And yet, the doubts among many of us have spread more widely than the diseases we’re trying to prevent. So while LYMErix would likely be recommended to citizens of our high risk counties right now, we instead go without, the unfounded crusade down south leaving us regrettably disarmed.
Prevention and Common Sense
“I don’t think people need to panic about this,” said Dr Hatchette of our local Lyme. “I think it’s important people get out, exercise and enjoy themselves.”
While infectious diseases rarely inspire peace of mind, Dr Hatchette said Lyme disease is only fatal in the rarest of cases and is very treatable with antibiotics. He recommends wearing light clothing in high risk areas so ticks can be easily spotted; wearing DEET containing bug repellents; and, perhaps most importantly, have yourself checked thoroughly for ticks after outings.
A blacklegged tick must be attached for 24 hours before Lyme disease can be contracted, so their prompt removal all but guarantees your good health. If you spot one attached that’s already swollen with blood and you’re unsure, a preventative dose of antibiotics from your family physician is easy to arrange.
Dr Hatchette said Lyme disease can be told apart from more common, harmless reactions to a tick bite by way of the rash its typically inspires at the infection site, which will expand over a 48 hour period, creating what’s often called a bullseye rash. This is exactly the time to seek treatment. Some cases, however, won’t present this rash and other signs of infection should be watched for, such as flu-like symptoms.
If untreated after those 48 hours this disease can disseminate to the rest of the body, affecting the heart to cause blockages; the nervous system to cause bell’s palsy or meningitis; and finally it can impact the joints. If you go a month without treatment more serious consequences can set in, resulting in neurological symptoms or arthritis.
In Defence of Needles
Of all the diseases with defunct vaccines, Lyme disease is a milder example. It’s easily prevented and with treatment, there’s no replicable data to suggest it causes anything chronic. We should count ourselves lucky, but there are diseases considerably more serious whose vaccines are under attack, avoided by citizens lost in the controversy. Dangerous diseases once eradicated from Canada, such as measles, are now making a comeback, and with a little diligence on our part, we can throw them out again. It’s time we stand up in defence of needles.
Zack Metcalfe is a freelance conservation journalist, author, and writer based in the Maritimes. This article was originally published with the Chronicle Herald.