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Vaccine hesitancy-mediated Secondary Immunodeficiency

By guest contributors Carlos E. Medina-De la Garza and María de los Ángeles Castro-Corona

Health conditions causing secondary immunodeficiency (SID) range from HIV infection and measles to malnutrition and diabetes. SID is an impairment of the immune response resulting from conditions or factors extrinsic to the immune system. Humans develop and mature their protective immune responses through exposition to antigens. Thus, children and adults must be exposed to relevant antigens to develop immune competence and preserve homeostasis. Vaccination also provides such antigens. Despite ever-increasing information in health sciences and biotechnological know-how, vaccine hesitancy and rejection are paradoxically widespread in society and even among healthcare professionals. An individual susceptible to an infection for which there is a safe, available vaccine is exposed to an unacceptable risk of infection if not vaccinated, bearing an immune handicap similar to a SID: a healthy immune system is intentionally not exposed to a beneficial antigen and put at high risk of infection, the hallmark of all immunodeficiencies. We propose that the adverse anti-vaccine scenario be recognized as a social cause of SID and point out an additional perspective on addressing vaccine hesitancy. The concept of vaccine rejection as causing SID may help the public, and some health professionals acknowledge that unvaccinated children/adults acquire a real and present immunological disadvantage towards a specific disease. The potential risk is evident: figures from UNICEF’s 2023 Report show that between 2019 and 2021, 67 million children missed out entirely or partially on routine immunization because of Covid19 pandemic.  This added to decreased confidence in vaccination, social conflict, and scarce resources, indicating that the confluence of adverse factors may increase the threat of vaccination hesitancy. We can find a similar situation in elderly populations: aging adults hampered from receiving the vaccination against Influenza, S. pneumoniae, or Herpes-zoster could sustain an additional severe infection risk by secondary immunodeficiency added to immunosenescence and comorbidities.

Vaccine hesitancy-mediated SID will further remind us of the short and medium-term consequences vaccination-related adverse scenarios may bring to the regular care of our patients. Disinformation by social media, outdated concepts, fear, and misunderstanding of what vaccination realistically is all fuel the distrust of vaccination. Our task at all healthcare levels is to build confidence and conviction in vaccination.   Vaccine hesitancy is a complex issue, but the public view of vaccination may improve if we also stress that avoiding a socially mediated SID in children and susceptible adults through timely vaccination is in our hands.

Carlos E. Medina-De la Garza (DTMP, Hamburg) is a Doctor of Medicine and Professor of Immunology at the University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León (UANL) in Monterrey, Mexico. In addition to teaching at the Faculty of Medicine of UANL and University Hospital, his interests include immunomodulation, vaccination, primary and secondary immunodeficiencies, HIV infection, and parasitic and tropical diseases.  ORCID 0000-0002-9491-2670

María de los Ángeles Castro-Corona is an Immunologist with a medical and pediatrics background. She provides diagnosis and specialized counseling for children with recurrent infections for diagnosis of Primary and Secondary immunodeficiencies, including HIV infection, at the Immunology Service of University Hospital, UANL.  As a professor of immunology, she teaches medical students, residents, and masters/doctoral candidates and supports them in developing their thesis. ORCID 0000-0001-5612-4342

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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