Immunization

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See also: Vaccination
For financial immunization, see Immunization (finance).

Dr. Schreiber of San Augustine giving a typhoid inoculation at a rural school, San Augustine County,
Texas. Transfer from U.S. Office of War Information, 1944.

Immunization, or immunisation, is the process by which an individual's immune

system becomes fortified against an infectious agent (known as the immunogen).
When this system is exposed to molecules that are foreign to the body, called non-
self, it will orchestrate an immune response, and it will also develop the ability to
quickly respond to a subsequent encounter because of immunological memory. This
is a function of the adaptive immune system. Therefore, by exposing a human, or an
animal, to an immunogen in a controlled way, its body can learn to protect itself: this
is called active immunization.
The most important elements of the immune system that are improved by
immunization are the T cells, B cells, and the antibodies B cells produce. Memory B
cells and memory T cells are responsible for a swift response to a second encounter
with a foreign molecule. Passive immunization is direct introduction of these
elements into the body, instead of production of these elements by the body itself.
Immunization happens in various ways, both in the wild and as done by human
efforts in health care. Natural immunity is gained by those organisms whose immune
systems succeed in fighting off a previous infection, if the relevant pathogen is one
for which immunization is even possible. Natural immunity can have degrees of
effectiveness (partial rather than absolute) and may fade over time (within months,
years, or decades, depending on the pathogen). In health care, the main technique
of artificial induction of immunity is vaccination,[1] which is a major form of prevention
of disease, whether by prevention of infection (pathogen fails to mount sufficient
reproduction in the host), prevention of severe disease (infection still happens but is
not severe), or both. Vaccination against vaccine-preventable diseases is a major
relief of disease burden even though it usually cannot eradicate a disease. Vaccines
against microorganisms that cause diseases can prepare the body's immune
system, thus helping to fight or prevent an infection. The fact that mutations can
cause cancer cells to produce proteins or other molecules that are known to the
body forms the theoretical basis for therapeutic cancer vaccines. Other molecules
can be used for immunization as well, for example in experimental vaccines
against nicotine (NicVAX) or the hormone ghrelin in experiments to create an obesity
vaccine.
Immunizations are often widely stated as less risky and an easier way to become
immune to a particular disease than risking a milder form of the disease itself. They
are important for both adults and children in that they can protect us from the many
diseases out there. Immunization not only protects children against deadly diseases
but also helps in developing children's immune systems. [2] Through the use of
immunizations, some infections and diseases have almost completely been
eradicated throughout the World. One example is polio. Thanks to dedicated health
care professionals and the parents of children who vaccinated on schedule, polio
has been eliminated in the U.S. since 1979. Polio is still found in other parts of the
world so certain people could still be at risk of getting it. This includes those people
who have never had the vaccine, those who didn't receive all doses of the vaccine,
or those traveling to areas of the world where polio is still prevalent.
Active immunization/vaccination has been named one of the "Ten Great Public
Health Achievements in the 20th Century".

Contents

 1History
 2Passive and active immunization
o 2.1Active immunization
o 2.2Passive immunization
 3Economics of immunizations
o 3.1Positive externality
o 3.2Socially optimal outcome
o 3.3Internalizing the externality
 4Race, ethnicity and immunization
 5See also
 6References
 7External links

History[edit]
See also: Inoculation and Vaccination §  History
Before the introduction of vaccines, people could only become immune to an
infectious disease by contracting the disease and surviving it. Smallpox (variola) was
prevented in this way by inoculation, which produced a milder effect than the natural
disease. The first clear reference to smallpox inoculation was made by the Chinese
author Wan Quan (1499–1582) in his Douzhen xinfa (痘疹心法) published in 1549.
[3]
 In China, powdered smallpox scabs were blown up the noses of the healthy. The
patients would then develop a mild case of the disease and from then on were
immune to it. The technique did have a 0.5–2.0% mortality rate, but that was
considerably less than the 20–30% mortality rate of the disease itself. Two reports
on the Chinese practice of inoculation were received by the Royal Society in London
in 1700; one by Dr. Martin Lister who received a report by an employee of the East
India Company stationed in China and another by Clopton Havers.[4] According
to Voltaire (1742), the Turks derived their use of inoculation from
neighbouring Circassia. Voltaire does not speculate on where the Circassians
derived their technique from, though he reports that the Chinese have practiced it
"these hundred years".[5] It was introduced into England from Turkey by Lady Mary
Wortley Montagu in 1721 and used by Zabdiel Boylston in Boston the same year. In
1798 Edward Jenner introduced inoculation with cowpox (smallpox vaccine), a much
safer procedure. This procedure, referred to as vaccination, gradually replaced
smallpox inoculation, now called variolation to distinguish it from vaccination. Until
the 1880s vaccine/vaccination referred only to smallpox, but Louis
Pasteur developed immunization methods for chicken cholera and anthrax in
animals and for human rabies, and suggested that the terms vaccine/vaccination
should be extended to cover the new procedures. This can cause confusion if care is
not taken to specify which vaccine is used e.g. measles vaccine or influenza vaccine.

Passive and active immunization[edit]

Medical student participating in a polio vaccine campaign in Mexico

Immunization can be achieved in an active or passive manner: vaccination is an

active form of immunization.
Active immunization[edit]
Main article: Active immunity
A simplified diagram showing the process of immunization through the production of anti-bodies.

Active immunization can occur naturally when a person comes in contact with, for
example, a microbe. The immune system will eventually create antibodies and other
defenses against the microbe. The next time, the immune response against this
microbe can be very efficient; this is the case in many of the childhood infections that
a person only contracts once, but then is immune.
Artificial active immunization is where the microbe, or parts of it, are injected into the
person before they are able to take it in naturally. If whole microbes are used, they
are pre-treated.
The importance of immunization is so great that the American Centers for Disease
Control and Prevention has named it one of the "Ten Great Public Health
Achievements in the 20th Century".[6] Live attenuated vaccines have decreased
pathogenicity. Their effectiveness depends on the immune systems ability to
replicate and elicits a response similar to natural infection. It is usually effective with
a single dose. Examples of live, attenuated vaccines
include measles, mumps, rubella, MMR, yellow fever, varicella, rotavirus,
and influenza (LAIV).
Passive immunization[edit]
Main article: Passive immunity
Passive immunization is where pre-synthesized elements of the immune system are
transferred to a person so that the body does not need to produce these elements
itself. Currently, antibodies can be used for passive immunization. This method of
immunization begins to work very quickly, but it is short lasting, because the
antibodies are naturally broken down, and if there are no B cells to produce more
antibodies, they will disappear.
Passive immunization occurs physiologically, when antibodies are transferred from
mother to fetus during pregnancy, to protect the fetus before and shortly after birth.
Artificial passive immunization is normally administered by injection and is used if
there has been a recent outbreak of a particular disease or as an emergency
treatment for toxicity, as in for tetanus. The antibodies can be produced in animals,
called "serum therapy," although there is a high chance of anaphylactic
shock because of immunity against animal serum itself. Thus, humanized
antibodies produced in vitro by cell culture are used instead if available.

Economics of immunizations[edit]

If individuals make the decision to immunize based on the Private Marginal Benefit we see a quantity of Q1
at the price P1 while the socially optimal point is at quantity Q* and price P*. The distance between the
private and marginal benefit lines is the cost of the marginal benefit to society.

Immunization A does not have a social marginal benefit large enough to shift Q1 to Q(e), instead it lands at
Q*

Positive externality[edit]
Immunizations impose what is known as a positive consumer externality on society.
In addition to providing the individual with protection against certain antigens it adds
greater protection to all other individuals in society through herd immunity. Because
this extra protection is not accounted for in the market transactions for immunizations
we see an undervaluing of the marginal benefit of each immunization. This market
failure is caused by individuals making decisions based on their private marginal
benefit instead of the social marginal benefit. Society's undervaluing of
immunizations means that through normal market transactions we end up at a
quantity that is lower than what is socially optimal. [7]
For example, if individual A values their own immunity to an antigen at $100 but the
immunization costs $150, individual A will decide against receiving immunization.
However, if the added benefit of herd immunity means person B values person A's
immunity at $70 then the total social marginal benefit of their immunization is $170.
Individual A's private marginal benefit being lower than the social marginal benefit
leads to an under-consumption of immunizations.
Socially optimal outcome[edit]
Having private marginal benefits lower than social marginal benefits will always lead
to an under-consumption of any good. The size of the disparity is determined by the
value that society places on each different immunization. Many times, immunizations
do not reach a socially optimum quantity high enough to eradicate the antigen.
Instead, they reach a social quantity that allows for an optimal amount of sick
individuals. Most of the commonly immunized diseases in the United States still see
a small presence with occasional larger outbreaks. Measles is a good example of a
disease whose social optimum leaves enough room for outbreaks in the United
States that often lead to the deaths of a handful of individuals. [8]

Immunization B has a social marginal benefit large enough to bring Q1 to Q(e), the quantity at which
eradication occurs

There are also examples of illnesses so dangerous that the social optimum ended
with the eradication of the virus, such as smallpox. In these cases, the social
marginal benefit is so large that society is willing to pay the cost to reach a level of
immunization that makes the spread and survival of the disease impossible.
Despite the severity of certain illnesses, the cost of immunization versus the social
marginal benefit means that total eradication is not always the end goal of
immunization. Though it is hard to tell exactly where the socially optimal outcome is,
we know that it is not the eradication of all disease for which an immunization exists.
Internalizing the externality[edit]
In order to internalize the positive externality imposed by immunizations payments
equal to the marginal benefit must be made. In countries like the United States these
payment usually come in the form of subsidies from the government. Before 1962
immunization programs in the United States were run on the local and state level of
governments. The inconsistency in subsidies lead to some regions of the United
States reaching the socially optimal quantity while other regions were left without
subsidies and remained at the private marginal benefit level of immunizations. Since
1962 and the Vaccination Assistance Act, the United States as a whole has been
moving towards the socially optimal outcome on a larger scale. [9] Despite government
subsidies it is difficult to tell when social optimum has been achieved. In addition to
hardships determining the true social marginal benefit of immunizations we see
cultural movements shifting private marginal benefit curves. Vaccine
controversies have changed the way some private citizens view the marginal benefit
of being immunized. If Individual A believes that there is a large health risk, possibly
larger than the antigen itself, associated with immunization they will not be willing to
pay for or receive immunization. With fewer willing participants and a widening
marginal benefit reaching a social optimum becomes more difficult for governments
to achieve through subsidies.
Outside of government intervention through subsidies, non profit organizations can
also move a society towards the socially optimal outcome by providing free
immunizations to developing regions. Without the ability to afford the immunizations
to begin with, developing societies will not be able to reach a quantity determined by
private marginal benefits. By running immunization programs organizations are able
to move privately under-immunized communities towards the social optimum.

Race, ethnicity and immunization[edit]

In the United States, race and ethnicity are strong determinants of utilization of
preventive and therapeutic health services as well as health outcomes. [10] Rates of
infant mortality and most of the leading causes of overall mortality have been higher
in African Americans than in European Americans. A recent analysis of mortality
from influenza and pneumonia revealed that African Americans died of these causes
at higher rates than European Americans in 1999–2018. [11] Contributing to these
racial disparities are lower rates of immunization against influenza and
pneumococcal pneumonia.[10] During the COVID-19 pandemic, death rates have been
higher in African Americans than European Americans and vaccination rates have
lagged in African Americans during the roll-out. [12] Among Hispanics immunization
rates are lower than those in non-Hispanic whites. [13]

See also[edit]
 Immunization registry
 Influenza vaccine
 Network theory
 Pandemic
 Targeted immunization strategies
 Vaccination
 Correlates of immunity
 Vaccine-preventable diseases
 World Immunization Week

References[edit]
1. ^ "Vaccines".
2. ^ "Top Vaccination For Your Child". Vaxins. Archived from the
original on 15 August 2016. Retrieved  29 July 2016.
3. ^ Needham, J. (1999). "Part 6, Medicine".  Science and Civilization
in China: Volume 6, Biology and Biological Technology.
Cambridge: Cambridge University Press. p.  134.
4. ^ Silverstein, Arthur M. (2009). A History of
Immunology (2nd  ed.). Academic Press.
p. 293.  ISBN  9780080919461.
5. ^ Voltaire (1742). "Letter XI".  Letters on the English.
6. ^ "Ten Great Public Health Achievements in the 20th
Century". Archived 2016-03-13 at the Wayback Machine CDC
 7. ^ Hinman, A. R.; Orenstein, W. A.; Rodewald, L. (2004-05-
15).  "Financing Immunizations in the United States".  Clinical
Infectious Diseases.  38  (10): 1440–
1446.  doi:10.1086/420748. ISSN 1058-4838.  PMID  15156483.
8. ^ Cook, Joseph; Jeuland, Marc; Maskery, Brian; Lauria, Donald;
Sur, Dipika; Clemens, John; Whittington, Dale (2009). "Using
private demand studies to calculate socially optimal vaccine
subsidies in developing countries". Journal of Policy Analysis and
Management.  28  (1): 6–28. doi:10.1002/pam.20401. ISSN 0276-
8739.  PMID  19090047.
9. ^ "Vaccine-Preventable Diseases, Immunizations, and MMWR –
1961–2011".  www.cdc.gov. Retrieved 2018-03-07.
10. ^ Jump up to:a b Health United States 2017 With special feature on
mortality. Hyattsville, MD: National Center for Health Statistics.
2018.
11. ^ Donaldson, Sahai V.; Thomas, Alicia N.; Gillum, Richard F.;
Mehari, Alem (January 2021). "Geographic Variation in Racial
Disparities in Mortality From Influenza and Pneumonia in the
United States in the Pre-Coronavirus Disease 2019
Era".  Chest.  159  (6): 2183–
2190.  doi:10.1016/j.chest.2020.12.029. PMID 33400931.
12. ^ Bassett, Mary T.; Chen, Jarvis T.; Krieger, Nancy (20 October
2020). "Variation in racial/ethnic disparities in COVID-19 mortality
by age in the United States: A cross-sectional study".  PLOS
Medicine. 17 (10):
e1003402.  doi:10.1371/journal.pmed.1003402.  PMC 7575091. P
MID  33079941.
13. ^ Gorina, Y; Kelly, T; Lubitz, J; Hines, Z (2008). Trends in
Influenza and Pneumonia Among Older Persons in the United
States. Hyattsville, MD: National Center for Health Statistics.

External links[edit]

Wikimedia Commons has media related to Immunology.

 National Network for Immunization Information (NNii)

 Centers for Disease Control National Immunization
Program
 Immunisation, BBC Radio 4 discussion with Nadja
Durbach, Chris Dye & Sanjoy Bhattacharya (In Our
Time, Apr. 20, 2006)
show

Infants and their care

show
 Artificial induction of immunity / Immunization: Vaccines, Vaccination, Infection, Inoculation (J07)

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