Bianca de Loryn
College of Public Health, Medical and Veterinary Sciences
3 December 2021
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Public health means saving millions of lives
People need accurate information so they are able to make informed decisions about vaccinations, says JCU's Associate Professor Lars Henning from the Australian Institute of Tropical Health & Medicine.
“I always wanted to do, perhaps, vaccine development or work in the life science sector in general,” Lars says. But after studying biochemistry and working for three months in Tanzania, where he assisted in a malaria project, Lars realised that being a biochemist was not enough to achieve his goals. “So, I went to medical school and became a doctor, even though my intention was never to become a GP.”
Instead, Lars specialised in Tropical and Travel Medicine and became a Global Public Health physician. “In public health, it’s not so much about personalised medicine or the best treatment for you personally,” Lars says. “Instead, we are looking for what’s the best approach for 90 to 95 per cent of the people. Overall, this is where most lives are saved, especially in resource-limited settings.”
Public health seen from the ‘One Health’ perspective
The Swiss Tropical Public Health Institute had a big impact on Lars as a researcher, especially in regard to their ‘One Health’ perspective on public health. “When it comes to the ‘One Health’ approach, human health, animal health and the environmental aspects, they're all interlinked,” Lars says. “People used to speak about the ‘first world,’ the ‘second world’ and the ‘third world’. Then they started talking about ‘the North’ and ‘the South’. But, as my former boss used to say: there is only one world.”
Lars thinks that it is important to see diseases from the One Health perspective. “The philosophy behind this is that the problems in ‘the South’ sooner or later will also become our problems,” he says. “Just think about Ebola in West Africa or about COVID-19. We are all interconnected.”
What would the world be like if we didn't have any vaccinations today?
Humans were first vaccinated more than two hundred years ago, and public health has come a long way since then. “People often don’t appreciate the benefits, because they don't remember how it was, for example, when polio was still a huge public health problem,” Lars says.
“Before the Polio vaccines were rolled out there were a lot of polio cases worldwide. Some people were paralysed, and they couldn’t even breathe. They would have to lie in what is called an ‘iron lung’, a machine that would take over the breathing for you,” Lars says. “Some of them survived in these machines for 10, 20 years. Maybe they could move their head, depending on how high up the paralysis went. But they had to live for years in these ‘iron lung’ machines.” Today, polio has been eradicated in all countries except for Pakistan and Afghanistan and there is a lot of surveillance going on to keep this that way.
When people don’t take contagious diseases seriously
The measles have also been on the decline for many years, but with more people being critical towards vaccination, outbreaks still happen, such as in Samoa. In late 2019 and early 2020, 5,707 people in Samoa were infected with measles, 83 people died, and 72 of them were children under 5, according to a study in the medical journal the Lancet.
“When this happens, and when children die, there is always a big uproar. Why did it happen? Because the child wasn't vaccinated,” Lars says. “The discussion is the same as having a fire department: As long as there're no fires, you're arguing about the need for a fire department.”
Vaccines have also contributed to the long life expectancy that we are enjoying now. “The mortality in under five-year-old children was very high before vaccinations started, like for example polio, diphtheria and tetanus,” Lars says. As an example, one hundred years ago, children under 5 represented over 25 per cent of all deaths. Today, the number has gone down to under 1 per cent, according to the Australian Institute of Health and Welfare.
Making decisions based on evidence
A focus of Lars’ work is to advise people in regard to vaccinations when they travel to tropical countries. “There're a lot of myths and misinformation about vaccines,” he says.
When people are looking for information in terms of vaccines, it’s important not to take sides. “First of all you need to explain. I always tell people, ‘look, I'm here to give you the best evidence I have’, Lars says. “'I'm going to tell you what are the pros and the cons, but in the end, it’s your decision.’”
Lars states that he can’t make a decision for the people who come to him. Instead, he says, “it is about empowering the client to understand the issue, and then he or she makes the decision. Very often people come to me, and they have no concerns with vaccines. They say, ‘yes, I want that vaccine’,” Lars says. “If people are hesitant, I don’t try to convince them. I just give them evidence which is out there.”
Difficult decisions about rare diseases
Lars says that sometimes people have to make difficult decisions, especially when it comes to rare diseases like rabies. Rabies is mostly transmitted by infected dogs in travellers, for example in Africa or South East Asia. “If you get bitten by a rabid dog, and if you didn't get a vaccine and you don't see a doctor, then you're going to die,” Lars says.
The power of vaccines
In the end, if we get vaccinated or not, depends on us: we need to find reliable information so we can make informed decisions that are based on facts and not emotions. “Vaccines are one of the most powerful public health interventions we have, and vaccines have saved millions of lives in the past decades,” Lars says. “Let’s keep it this way.”
Lars Henning is a Tropical Medicine and Travel Medicine specialist and holds a PhD in Virology. Before he joined the JCU College of Public Health, Medical and Veterinary Science, he worked for several years in Bangladesh, Uganda and Tanzania. Lars’ research focus has been on infectious diseases and neglected tropical diseases and translational research.
Currently he is involved in a project building capacity to detect and respond to infectious disease outbreak through community-based surveillance in the Asia-Pacific region using the One Health approach. In addition, he has provided clinical care and supervision in different settings. Lars uses his personal experiences in his tropical medicine, travel medicine and communicable disease teaching.