Juan Gérvas, Retired Rural General Practitioner, CESCA Team, Madrid, Spain
jjgervas@gmail.com http://www.equipocesca.org @JuanGrvas
Mercedes Pérez-Fernández, Internal Medicine Specialist, Retired General Practitioner, CESCA Team, Madrid, Spain. mpf1945@gmail.com

Summary
Pertussis vaccine is a necessary one, but it needs urgent improvement. In the face of pertussis outbreaks, and pertussis deaths, it is important to realise that the problem is not the anti-vaccine movement but the vaccine. The pertussis vaccine is of low effectiveness. We need a better vaccine (one that generates lasting immunity and prevents infection and transmission).

Introduction
The scandal in many countries over the whooping cough death of a baby whose mother had not been vaccinated at the end of her pregnancy it is a common fact. See for example: “Jerusalem baby dies of whooping cough, mother not vaccinated”
The headline is biased and copied in all the media (print and online press, radio, television, etc.), as it incites the blame on the pregnant woman, and has managed to create a real popular lynch mob, including the accusation of murder. No one has asked why pregnant women should be vaccinated, nor why a public health problem has become a personal problem.
It is convenient to bring out the news now because there is a whooping cough epidemic, so that the population revolts against the «anti-vaccine» and not against those who maintain and promote an inefficient vaccine: the health authorities (the Ministry of Health and others), the industries and the «scientific» societies (public health, epidemiology, health economics, family/general medicine,
paediatrics, etc.).
It should also be noted that the pertussis vaccine does not exist as such, but is part of a triple bacterial vaccine (pertussis, tetanus and diphtheria)

Whooping cough vaccine is highly ineffective The pertussis vaccine was first used successfully in 1929. Given its significant local reactogenitic capacity and other frequent adverse effects (in addition to the usual local inflammatory effects and fever associated with many vaccines, whole-cell pertussis vaccines sometimes trigger prolonged crying and febrile convulsions and, very rarely, hypotonic–hyporesponsive episodes), which led to rejection, a «light» version was prepared (acellular, with less antigenic capacity and less capacity to stop contagion but fewer adverse effects) which was introduced into practice from the end of the 1980/90s (first in Japan, 1981, later in many countries, for example in 1998 in Spain, full implementation in 2005).
We currently use a combined vaccine, diphtheria, tetanus, acellular pertussis, DTaP, with a high load (in childhood), and dTpa, also Tdap, diphtheria-tetanus-acellular pertussis vaccines with a low load, with a lower amount of diphtheria and pertussis (in adolescents and adults).
Pertussis vaccine is a necessary vaccine but needs urgent and profound improvement. It fails with incomplete vaccination but even with correct vaccination.
For example, one study in California (the USA) found that protection against pertussis waned during the 5 years after the fifth dose of DtaP. In Alberta, Canada, of the 81.6% (n = 1,348) pertussis cases with immunization records, 48.3% were up-to-date with immunization. The pertussis cases that were up-to-date with their immunization were older (median age 12.9 years) as compared to those with incomplete (median age 9.7 years) or no pertussis immunization (median age 3.8 years).
In one study of an outbreak in Alicante (Spain) with 104 reported cases of pertussis confirmed by PCR, 85 cases (82%) had correctly complied with the 5-dose vaccine schedule. The protection time was 2.1 years with Tdpa and 5.1 years with DTaP. In other words, most cases occur in correctly vaccinated patients, and protection lasts at most 5 years: In Ontario, Canada, the conclusion was: “We identified good early vaccine effectiveness, which rapidly declined when time since last vaccination surpassed 4 years, in a population with relatively stable disease incidence”
In Spain, all vaccinations are free of charge, and are widely accepted by the population. But sometimes vaccines fail. For example, revaccination of pregnant women is not enough to prevent deaths from whooping cough: «A baby dies in Castellón from whooping cough (the mother was vaccinated)». «A baby dies of whooping cough in Jaén despite the fact that her mother had been vaccinated during pregnancy».

Whooping cough outbreaks after the «honeymoon».
If immunity wanes at five years, and acellular vaccination was completed in 2005 in Spain, a resurgence of the disease is to be expected in Spain from 2010 onwards. And so it is, according to data recorded by the Institute of Health Carlos III (page 8, table 1) which show that the incidence increased more than 7-fold between 2011-19 compared to 2005-10.

INFORME EPIDEMIOLÓGICO SOBRE LA SITUACIÓN DE LA TOSFERINA EN ESPAÑA, 2023

As noted above, these outbreaks mainly affect patients who have been correctly vaccinated.
The public health response is to maintain such a useless pertussis vaccine (not to improve it), to increase the number of revaccinations and to use women as a womb (vaccinating them with a triple vaccine that adds two unnecessary re-vaccinations).
Problems with the pertussis vaccine
The pertussis vaccine has several problems, such as a) its short duration of immunity (between 1 and 5 years), b) its impact on the bacterium itself (bordetella), forcing its evolution into more aggressive strains that evade vaccine immunity, and c) its ineffectiveness on mucous membranes, so prevents neither contagion nor transmission of the bacterium (and therefore does not create herd immunity).
Within years of childhood vaccination, pertussis emerges in adolescents and young adults, who pass it on to their mothers and infants.
We have been studying the pertussis bacterium, the disease and the vaccine for over a hundred years, yet:

1/ the mechanisms of human immunity to pertussis are not fully understood

2/ there is no satisfactory vaccine

3/ there is no sensible and useful explanation for the outbreaks that occur in well-vaccinated populations in developed countries.

«Toward a new vaccine for pertussis».
«Coping Strategies for Pertussis Resurgence».

Questions and answers
1.- Was pertussis vaccine not ineffective before and is it ineffective now?
The pertussis vaccine has always been of low effectiveness, but even more so when switching to «acellular» (to avoid the rejection of parents and infants due to the intense local reactions of the cellular, «complete» vaccine). The pertussis vaccine is a necessary vaccine, but it has always been in need of profound and urgent improvement.
2.- If it was not before, what has changed?
It has changed because the «honeymoon» period has ended and immunity has faded, which means that a large part of the population is now «infectable» by the bacterium. This honeymoon is not maintained because the vaccine does not prevent the disease but hinders the usual spontaneous re-immunisation of the population (passing the disease does not create lasting immunity, but successive infections maintain it throughout life).
3.- Does whooping cough kill?
Whooping cough is a mild disease (very annoying because of persistent cough) in affluent countries where adequate clinical care is provided, but whooping cough is serious and causes death when it is associated with inequity, poverty, hunger and poor living conditions and where there is a lack of a public health system with universal coverage.
«The World Health Organization estimates that in 2018 there were about 16 million cases and 195,000 deaths from whooping cough worldwide, but more than 95 per cent were in developing countries«.
It is worth bearing in mind that pertussis can kill especially young children under the age of one year and especially those under two months, who have no antibodies left from their mother, have not yet been vaccinated and have an immature immune system to defend themselves against infection.
4.- If this has always been the case, what is the point of repeated administration in childhood and pregnancy?
In Spain, vaccination of pregnant women is recommended «from the 27th week of pregnancy, but preferably in week 27 or 28′′. Subsequently, the baby receives two doses, at 2 and 4 months of life, a first booster dose at 11 months and another at 6 years of age. In some Autonomous Communities, a fifth dose is added in adolescence.
As a lesser evil, so much revaccination does make sense (we have a lousy vaccine, it must be acknowledged, we have to revaccinate and revaccinate to remedy it, even if it means big business for the industry).

But it is a shame to give up on demanding vaccine improvement after decades of empirical proof of its inefficiency. Even more shameful is the easy solution, and forever, of vaccinating pregnant women (and with triple presentation!).
It is a disgrace that feminism tolerates this transformation of the pregnant female in a woman’s womb.
And it is a disgrace that public health is run by industry and never demands better vaccines against whooping cough.
Moreover, there is no separate commercial presentation of the vaccine, so that the pregnant woman has to be revaccinated at the same time against whooping cough, tetanus and diphtheria. Again and again two unnecessary «added» vaccines. Moreover, the vaccine is forcing the bacteria to evolve into more aggressive forms.
Medical ethics and deontology are in free fall.

Summary
The cause of the cause of the current pertussis epidemic, with its deaths, is the responsibility of the health authorities (led by the Ministry of Health), the industries and the «scientific» societies (public health, epidemiology, health economics, family/general medicine, paediatrics, etc.).

“Tosferina. Brotes y muertes. No son los antivacunas, es la vacuna. spanish version
“Tosferina. Epidemias sin antivacunas y la mujer como vientre”