One of the first patients I had to see as a pediatrician was Sol, a beautiful month-old baby who was admitted with signs of a severe respiratory infection. Until then, I had never seen a patient worsen so fast. In just two days she was connected to a respirator and on the third day she died. Sol had whooping cough. After discussing the case in the room and after a quite distressing catharsis, I remember my chief resident said to me, "Okay, take a deep breath. Wash your face. And now comes the hardest part: We have to go talk to her parents." At that time, a thousand questions came to mind, from, "How could a one-month-old baby be so unfortunate?" to, "Could we have done something about it?"
Jedan od prvih pacijenata koje sam imala kao pedijatar bila je Sol, prelepa beba od mesec dana, koja je došla u ordinaciju sa simptomima ozbiljne respiratorne infekcije. Nikada do tad nisam videla pacijenta čije se stanje tako brzo pogoršava. Za samo dva dana priključili smo je na respirator, a trećega dana je preminula. Sol je imala veliki kašalj. Nakon diskusije o slučaju, u ordinaciji i nakon izuzetno tegobne katarze, sećam se da mi je šef sale rekao: "U redu, diši duboko, umij se jer sad nam sledi najteži deo, moramo da razgovaramo s roditeljima." U tom momentu na hiljade pitanja vam prođe kroz glavu. Od pitanja: zašto je jednomesečna beba bila tako loše sreće, do pitanja: da li smo mogli nekako da to izbegnemo.
Before vaccines existed, many infectious diseases killed millions of people per year. During the 1918 flu pandemic 50 million people died. That's greater than Argentina's current population. Perhaps, the older ones among you remember the polio epidemic that occurred in Argentina in 1956. At that time, there was no vaccine available against polio. People didn't know what to do. They were going crazy. They would go painting trees with caustic lime. They'd put little bags of camphor in their children's underwear, as if that could do something. During the polio epidemic, thousands of people died. And thousands of people were left with very significant neurological damage. I know this because I read about it, because thanks to vaccines, my generation was lucky to not live through an epidemic as terrible as this.
Pre vakcina, razne zarazne bolesti su ubijale milione ljudi godišnje. Tokom pandemije gripa 1918. godine umrlo je 50 miliona ljudi. To je više ljudi nego što ih ima današnja Argentina. Možda se malo stariji među vama sećaju epidemije dečje paralize koja je izbila u Argentini 1956. godine. Tada nije bilo dostupnih vakcina za dečju paralizu. Ljudi nisu znali šta da rade. Bili su kao ludi. Izlazili su na ulice i krečili drveće. Stavljali su deci u odeću vrećice s kamforom kao da od toga ima neke koristi. Tokom epidemije dečje paralize umrlo je na hiljade ljudi. I hiljadama ljudi su ostale ozbiljne neurološke posledice. Ja to znam jer sam čitala o tome, jer zahvaljujući vakcinama moja generacija je imala sreće da ne mora da proživljava tako strašnu epidemiju.
Vaccines are one of the great successes of the 20th century's public health. After potable water, they are the interventions that have most reduced mortality, even more than antibiotics. Vaccines eradicated terrible diseases such as smallpox from the planet and succeeded in significantly reducing mortality due to other diseases such as measles, whooping cough, polio and many more.
Vakcine su jedno od najvećih dostignuća javnog zdravlja u XX veku. Odmah nakon pijaće vode, to je intervencija koja je najviše doprinela smanjenju smrtnosti, čak i više od antibiotika. Vakcine su uspešno iskorenile s planete bolest tako strašnu kao što su velike boginje i uspele su da značajno umanje smrtnost od drugih bolesti, poput malih boginja, velikog kašlja, dečje paralize i mnogih drugih.
All these diseases are considered vaccine-preventable diseases. What does this mean? That they are potentially preventable, but in order to be so, something must be done. You need to get vaccinated. I imagine that most, if not all of us here today, received a vaccine at some point in our life. Now, I'm not so sure that many of us know which vaccines or boosters we should receive after adolescence. Have you ever wondered who we are protecting when we vaccinate? What do I mean by that? Is there any other effect beyond protecting ourselves?
Sve ove bolesti spadaju u grupu bolesti koje se zovu bolestima koje se mogu sprečiti vakcinama. Šta to znači? Da se potencijalno mogu sprečiti, ali da bismo u tome uspeli, nešto moramo da preduzmemo. Moramo da se vakcinišemo. Pretpostavljam da je velika većina, ako ne i svi mi ovde, primila bar jednom u životu neku vakcinu. E sad, ne bih bila tako ubeđena da mnogi među nama znaju koje su to vakcine, iliti imunizatori koje moramo da primimo nakon adolescencije. Jeste li se nekada zapitali koga štitimo kada se vakcinišemo? Šta hoću da kažem? Da li su efekti vakcinacije veći od zaštite nas samih?
Let me show you something. Imagine for a moment that we are in a city that has never had a case of a particular disease, such as the measles. This would mean that no one in the city has ever had contact with the disease. No one has natural defenses against, nor been vaccinated against measles. If one day, a person sick with the measles appears in this city the disease won't find much resistance and will begin spreading from person to person, and in no time it will disseminate throughout the community. After a certain time a big part of the population will be ill. This happened when there were no vaccines.
Dozvolite da vam nešto pokažem. Zamislite na trenutak da se nalazimo u gradu koji nikada nije imao iskustva s određenom bolešću, poput, na primer, malih boginja. Šta želim da kažem? U tom gradu niko nikada nije dolazio u dodir s tom bolešću, to jest ne postoji prirodni imunitet, niti je iko vakcinisan protiv malih boginja. Ako bi se jednoga dana, u tom gradu pojavila osoba koja boluje od malih boginja, bolest ne bi naišla na dovoljan otpor i počela bi da se prenosi sa osobe na osobu, i za kratko vreme zarazila bi celokupnu zajednicu. Za određeno vreme velika većina stanovništva bila bi bolesna. To se dešavalo kada nije bilo vakcina.
Now, imagine the complete opposite case. We are in a city where more than 90 percent of the population has defenses against the measles, which means that they either had the disease, survived, and developed natural defenses; or that they had been immunized against measles. If one day, a person sick with the measles appears in this city, the disease will find much more resistance and won't be transmitted that much from person to person. The spread will probably remain contained and a measles outbreak won't happen.
A sada, zamislite potpuno suprotan slučaj. Nalazimo se u gradu gde više od 90% stanovništva ima izgrađen imunitet protiv malih boginja. Što će reći da su preležali tu bolest i da su stekli prirodni imunitet. Preživeli su. Ili su primili vakcinu protiv malih boginja. I jednoga dana, u tom gradu se pojavi osoba bolesna od malih boginja. Bolest će da naiđe na mnogo veći otpor i neće moći toliko da se prenosi sa osobe na osobu. Širenje će, najverovatnije, da bude obuzdano i neće doći do epidemije malih boginja.
I would like you to pay attention to something. People who are vaccinated are not only protecting themselves, but by blocking the dissemination of the disease within the community, they are indirectly protecting the people in this community who are not vaccinated. They create a kind of protective shield which prevents them from coming in contact with the disease, so that these people are protected. This indirect protection that the unvaccinated people within a community receive simply by being surrounded by vaccinated people, is called herd immunity.
Želim da vam skrenem pažnju na nešto. Vakcinisane osobe, ne samo da štite same sebe, već i sprečavaju širenje bolesti unutar zajednice, oni, indirektno, štite osobe iz zajednice koje nisu vakcinisane. Oni formiraju svojevrstan štit koji nevakcinisane čuva od kontakta s bolešću, te oni ostaju zaštićeni. Taj efekat indirektne zaštite nevakcinisanih osoba unutar zajednice, samo zbog toga što su okruženi vakcinisanim pojedincima, se zove kolektivni imunitet.
Many people in the community depend almost exclusively on this herd immunity to be protected against disease. The unvaccinated people you see in infographics are not just hypothetical. Those people are our nieces and nephews, our children, who may be too young to receive their first shots. They are our parents, our siblings, our acquaintances, who may have a disease, or take medication that lowers their defenses. There are also people who are allergic to a particular vaccine. They could even be among us, any of us who got vaccinated, but the vaccine didn't produce the expected effect, because not all vaccines are always 100 percent effective. All these people depend almost exclusively on herd immunity to be protected against diseases.
Mnogi unutar zajednice zavise, gotovo isključivo, od kolektivnog imuniteta da bi se zaštitili od bolesti. Ti ljudi nisu prosto hipoteze u nekoj animaciji. Ti ljudi su naša rodbina, naša deca, koja su možda isuviše mala da bi primila svoje prve vakcine. To su naši roditelji, naši bližnji, naši poznanici, koji možda imaju neku bolest ili primaju neki lek koji im narušava imunitet. Takođe postoje ljudi koji su alergični na određenu vakcinu. Takođe, među nama se nađu i oni koji se vakcinišu, ali kod kojih vakcina ne postigne željeni efekat. Jer nisu sve vakcine uvek 100% efikasne. Svi ti ljudi zavise, gotovo isključivo, od kolektivnog imuniteta da bi se zaštitili od boesti.
To achieve this effect of herd immunity, it is necessary that a large percentage of the population be vaccinated. This percentage is called the threshold. The threshold depends on many variables: It depends on the germ's characteristics, and those of the immune response that the vaccine generates. But they all have something in common. If the percentage of the population in a vaccinated community is below this threshold number, the disease will begin to spread more freely and may generate an outbreak of this disease within the community. Even diseases which were at some point controlled may reappear.
Da bi se postigao efekat kolektivnog imuniteta potrebno je da značajan procenat stanovništva bude vakcinisan. Taj procenat se zove prag. Prag zavisi od mnogo varijabli. Zavisi od karakteristika klice, od karakteristika imunološke reakcije koju prouzrokuje vakcina. Ali svi imaju nešto zajednčko: ako je procenat vakcinisanog stanovništva u jednoj zajednici ispod vrednosti praga, bolest počinje da se širi slobodnije i može da pređe u epidemiju u toj zajednici. Takođe i bolesti koje su u ovom trenutku pod kontrolom mogu ponovo da se vrate.
This is not just a theory. This has happened, and is still happening. In 1998, a British researcher published an article in one of the most important medical journals, saying that the MMR vaccine, which is given for measles, mumps and rubella, was associated with autism. This generated an immediate impact. People began to stop getting vaccinated, and stopped vaccinating their children. And what happened? The number of people vaccinated, in many communities around the world, fell below this threshold. And there were outbreaks of measles in many cities in the world -- in the U.S., in Europe. Many people got sick. People died of measles. What happened?
Ovo nije puka teorija. Ovo se dešavalo i dešava se i dalje. Godine 1998, jedan britanski istraživač je objavio članak u jednom od najuticajnijih časopisa iz medicine u kome je tvrdio da MMR vakcina, koja se daje protiv malih boginja, zauški i rubeole, uzrokuje autizam. Ovo je imalo trenutni učinak. Ljudi su odustajali od vakcinacije, prestali su da vakcinišu svoju decu. I šta se desilo? Broj vakcinisanih u mnogim zajednicama u svetu je pao ispod vrednosti praga. Imali smo epidemiju malih boginja u mnogim gradovima u svetu. U SAD-u, u Evropi. Mnogi ljudi su oboleli, a neki su i umrli od malih boginja. Šta se desilo?
This article also generated a huge stir within the medical community. Dozens of researchers began to assess if this was actually true. Not only could no one find a causal association between MMR and autism at the population level, but it was also found that this article had incorrect claims. Even more, it was fraudulent. It was fraudulent. In fact, the journal publicly retracted the article in 2010. One of the main concerns and excuses for not getting vaccinated are the adverse effects.
Ovaj članak je izazvao ogromnu pometnju unutar zdravstva. Desetine naučnika odlučili su da provere da li je ovo uistinu tačno. Ne samo da niko nije mogao da pronađe uzročno-posledičnu vezu između MMR vakcine i autizma na nivou populacije, već su i otkrili da sam članak sadrži brojne neistine. I ne samo to, već i da je u pitanju obmanjivanje. Obmanjivao je javnost. Kao posledica toga, časopis se javno ogradio od tog članka 2010. godine. Jedan od glavnih razloga i izgovora za nevakcinisanje, u ovom trenutku su negativna dejstva.
Vaccines, like other drugs, can have potential adverse effects. Most are mild and temporary. But the benefits are always greater than possible complications. When we are ill, we want to heal fast. Many of us who are here take antibiotics when we have an infection, we take anti-hypertensives when we have high blood pressure, we take cardiac medications. Why? Because we are sick and we want to heal fast. And we don't question it much. Why is it so difficult to think of preventing diseases, by taking care of ourselves when we are healthy? We take care of ourselves a lot when affected by an illness, or in situations of imminent danger.
Vakcine, kao i lekovi, mogu da imaju negativna dejstva. Većinom se radi o blagim i privremenim dejstvima. Ali korist je uvek veća od potencijalnih komplikacija. Kada smo bolesni, želimo što pre da se izlečimo. Većina nas ovde, kada imamo neku infekciju, uzmemo antibiotike. Ako imamo povišen pritisak, uzimamo antihipertenzive. Uzimamo lekove za srce. Zašto? Zato što smo bolesni i želimo da brzo ozdravimo. I ne razmišljamo previše. Zašto nam je toliko teško da suzbijamo bolesti, tako što ćemo da brinemo o sebi dok smo zdravi? Brinemo se o sebi mnogo kada smo bolesni ili se pazimo neposredno pred trenutnom opasnošću.
I imagine most of us here, remember the influenza-A pandemic which broke out in 2009 in Argentina and worldwide. When the first cases began to come to light, we, here in Argentina, were entering the winter season. We knew absolutely nothing. Everything was a mess. People wore masks on the street, ran into pharmacies to buy alcohol gel. People would line up in pharmacies to get a vaccine, without even knowing if it was the right vaccine that would protect them against this new virus. We knew absolutely nothing. At that time, in addition to doing my fellowship at the Infant Foundation, I worked as a home pediatrician for a prepaid medicine company. I remember that I started my shift at 8 a.m., and by 8, I already had a list of 50 scheduled visits. It was chaos; people didn't know what to do. I remember the types of patients that I was examining. The patients were a little older than what we were used to seeing in winter, with longer fevers.
Pretpostvaljam da se većina vas ovde seća pandemije gripa koja se desila ovde u Argentini, i u celom svetu, 2009. godine. Kada su prvi slučajevi obelodanjeni, kod nas u Argentini je počinjala zima. Ništa se nije znalo. Sve je bilo haotično. Ljudi su s maskama izlazili na ulice, hrlili smo u apoteke da bismo kupili alkohol u gelu. Ljudi su formirali redove u apotekama da bi primili vakcinu, a da nisu ni znali da li ih ta vakcina štiti od ovog novog virusa. Apsolutno ništa se nije znalo. Ja sam tada, pored toga što sam stažirala na Institutu za novorođenčad, radila kao kućni pedijatar za jednu privatnu medicinsku kompaniju. Sećam se da bih započela dežurstvo u osam ujutru i već u osam sati sam dobijala listu od pedeset zakazanih poseta. Bilo je haotično, ljudi nisu znali šta da rade. Sećam se da su mi privukle pažnju odlike pacijenata koje sam gledala. To su bili pacijenti nešto stariji od onih koje smo navikli da gledamo tokom zime, s groznicom koja je duže trajala.
And I mentioned that to my fellowship mentor, and he, for his part, had heard the same from a colleague, about the large number of pregnant women and young adults being hospitalized in intensive care, with hard-to-manage clinical profiles. At that time, we set out to understand what was happening. First thing Monday morning, we took the car and went to a hospital in Buenos Aires Province, that served as a referral hospital for cases of the new influenza virus. We arrived at the hospital; it was crowded. All health staff were dressed in NASA-like bio-safety suits. We all had face masks in our pockets. I, being a hypochondriac, didn't breathe for two hours. But we could see what was happening. Immediately, we started reaching out to pediatricians from six hospitals in the city and in Buenos Aires Province. Our main goal was to find out how this new virus behaved in contact with our children, in the shortest time possible. A marathon work. In less than three months, we could see what effect this new H1N1 virus had on the 251 children hospitalized by this virus. We could see which children got more seriously ill: children under four, especially those less than one year old; patients with neurological diseases; and young children with chronic pulmonary diseases. Identifying these at-risk groups was important to include them as priority groups in the recommendations for getting the influenza vaccine, not only here in Argentina, but also in other countries which the pandemic not yet reached.
I sećam se da sam to pomenula mom mentoru kod kog sam stažirala, a on je čuo, od jednog kolege, da je veliki broj trudnica i mladih ljudi poslato na intenzivnu negu s ne baš tako dobrim izgledima. Tada smo odlučili da pokušamo da dokučimo šta se to dešava. U ponedeljak, čim je svanulo, ušli smo u auto i odvezli se do bolnice u predgrađu Buenos Ajresa u koju su upućivani slučajevi novog virusa gripa. Stigli smo u bolnicu, koja je vrvela od ljudi. Svi medicinski radnici su bili obučeni u zaštitna odela, poput NASA-inih. A mi smo imali po maskicu u džepu. Ja, hipohondar, nisam disala dva sata. Ali bilo nam je jasno šta se dešavalo. Istog trena smo stupili u kontakt s pedijatrima iz šest bolnica u Buenos Ajresu i iz predgrađa. I predložili smo da, u najkraćem roku, otkrijemo kako se manifestuje ovaj novi virus kod naše dece. U jednom maratonskom poduhvatu, za manje od tri meseca, mogli smo da vidimo kakve su odlike ovog novog virusa H1N1 kod 251 deteta, hospitalizovanog zbog ovog virusa. Mogli smo da vidimo koja deca su najozbiljnije obolela, a to su bili mlađi od četiri godine, naročito oni mlađi od godinu dana, pacijenti s neurološkim oboljenjima, mališani s hroničnim plućnim bolestima. Identifikovati te rizične grupe, bilo je izuzetno važno kako bismo mogli da ih obeležimo kao prioritetne grupe za primanje vakcine protiv gripa, ne samo ovde u Argentini, već i drugde gde još uvek nije stigla pandemija.
A year later, when a vaccine against the pandemic H1N1 virus became available, we wanted to see what happened. After a huge vaccination campaign aimed at protecting at-risk groups, these hospitals, with 93 percent of the at-risk groups vaccinated, had not hospitalized a single patient for the pandemic H1N1 virus. (Applause) In 2009: 251. In 2010: zero.
Godinu dana kasnije, kada je vakcina protiv gripa H1N1 već bila dostupna, želeli smo da vidimo šta se dešava. Nakon obuhvatne kampanje za vakcinaciju, usmerene na zaštitu rizičnih grupa, u ovim bolnicama, gde je 93% vakcinisanih iz rizičnih grupa, nismo imali ni jedan slučaj hospitalizacije zbog pandemije virusa H1N1. (Aplauz) Godine 2009: 251 slučaj. Godine 2010: nula.
Vaccination is an act of individual responsibility, but it has a huge collective impact. If I get vaccinated, not only am I protecting myself, but I am also protecting others. Sol had whooping cough. Sol was very young, and she hadn't yet received her first vaccine against whooping cough. I still wonder what would have happened if everyone around Sol had been vaccinated. (Applause)
Vakcinacija je čin lične odgovornosti, koji ima ogroman uticaj na društvo. Ako se vakcinišem, ne štitim samo sebe, takođe štitim druge. Sol je imala veliki kašalj. Sol je bila isuviše mala i još uvek nije bila primila svoju prvu vakcinu protiv velikog kašlja. Ja se i danas pitam, šta bi se desilo da su sve osobe u Solinom okruženju bile vakcinisane. (Aplauz)