The recent anti vaccination campaigns, conspiracy theories and possible links to conditions like autism have caused us to rethink the use of mass vaccination. The questions on everyone minds are: should we continue mass vaccination? Is vaccination a safe public health measure? These questions, in recent times, have become socio political, medical, religious and even ethical. The socio political basis of the argument is due to the fact that some political groups like the liberalists are against forced vaccination due to liberality. Also, there are some conspiracy theories about their use in regional subjugation through the spread of infectious agents. The medical argument of course comes from the potential adverse effects and concerns over potentially harmful agents like thimerosal (a mercury containing compound)that have been phased out in many countries including Canada.

The concerns about the public health safety of vaccination exist because of the potential harm that vaccines can cause. Let us briefly discuss vaccines to understand why this potential harm exists. Vaccination is the administration of vaccines (which contain a microorganisms in a weakened or killed state, or proteins or toxins from the organism) in order to stimulate the immune system to defend against an infectious agent. Generally, the closer the organism or virus resembles the original organism, the more the immune response that would be generated but the more likely it would reverse to the original organism, that is, the more the potency the less safe it is. This risk of reversion is why vaccines are contraindicated in high risk groups such as:

• Children
• Elderly
• Pregnant women
• Immune-compromised individuals e.g. AIDS patients
• Individuals under immunosuppressive therapy

Despite these risks, vaccination is recommended for some group of people because they are more likely to be exposed to an infectious agent. These groups include:

• Health workers and Vetenarians
• Travellers moving to areas of high endemicity
• Explorers and researchers moving to wild regions
• Children going to public schools

Amidst the debate, the answer to the question “should we continue mass vaccination?” remains a RESOUNDING YES! Why? Let us look at these facts

• Immunization currently prevents 2-3 million deaths every year
• Over 1.5 million children die annually from diseases that can be prevented by vaccination
• Since 2000, 2.5 billion children have been vaccinated and the number of polio cases has fallen by more than 99%, dropping to just 22 cases in 2017
• Measles vaccinations averted an estimated 21.1 million deaths between 2000 and 2017

And regarding vaccine safety? Vaccination is safe. Even with the ethical argument about one person in a million being at risk of serious adverse reaction or toxicity, this is not surprising as no procedure is 100% safe. Consider this…

• The risk for colonoscopy complications, a routine screening procedure is about 0.35%
• In Canada, the risk of severe pregnancy complications is about 1.5% and 1.6%(700 to 900 deaths) each year in the US
• For venepuncture, serious complications are seen in 3.4% of these procedures

Food Safety is a public health issue that involves the handling, preparation and storage of foods in ways that prevent or reduce the risk of contamination from external sources. Consumption of contaminated foods results in individuals becoming sick from the food, referred to as food borne illnesses. Food safety is a global and public health concern that encompasses a variety of different areas of everyday life. Food contamination is a part of food safety; there is a lot more to food safety than handling, preparing and storing foods properly decrease the chances of contamination. The choice of what and how to eat is perhaps the most important aspect of food safety. We all have to choose between healthy diets (diets high in fibre, low in saturated and trans-fat) and unhealthy diets (diets high in saturated and trans-fat but low in fibre). Unhealthy diet is associated with chronic diseases like cancers particularly colorectal cancer, diabetes and heart disease. Beyond these health benefits/risks, it is also important to stay away from unsafe sea foods such as the puffer fish delicacy. These types of foods are very common in Asia and cause quite a number of deaths; first timers and people not used to these foods should make sure they are properly cooked. Not every food must be eaten!! I mean, you don’t just pick any mushroom in Scandinavia and eat because you want to eat mushroom. You must check if it has white gills like most poisonous ones or you run the risk of eating the death cap.

On a daily basis, avoiding spoilt foods, unlabelled or improperly labelled foods and disfigured canned foods are good food choices. Due to the nature of the 21st century society, people are switching more to produced and processed food which are often stored in containers like cans, sachets etc. This has led to addition of substances to food which act as preservatives, flavours, sweeteners, stabilizers. These food additives, even though they are added for beneficial reasons, some of them like nitrates used in meat preservation are dangerous to health in this case with a known risk of colon cancer. This is why they are tested and guaranteed by the Joint FAO/WHO Expert Committee on Food Additives (JECFA); then clearly written on the food label. This helps people to make better choices if they want to limit the intake of any substance for any reason.

The case is quite different for food adulteration which involves addition of inferior and harmful substances that mimic the desired substance but with reduced quality. It is important to note that food adulteration is a criminal offence as individuals have the right to expect a certain quality of food they purchase; and food adulteration tramples on this right with impunity. It is mostly due to profit drive but can also be due to increased demand and lack of strong regulatory food laws. Some adulterants and food involved with ways to detect the adulterant are

• Mustard oil(adulterant is argemone oil): Shake and heat mustard oil with drops of nitric acid for 2 minutes, argemone oil is present if it turns red
• Salt/sugar (chalk powder): Stir in a spoonful of the salt in a glass of water. If the solution turns white and a residue settles at the bottom, it indicates the presence of chalk.
• Turmeric powder (adulterant-metanil yellow, chalk powder, lead chromate): Add a teaspoon of turmeric to a glass of warm water. Do not stir it and leave it still for a while. Check after about 20 minutes. If the powder settles down at the bottom of the glass with clear water above, the turmeric is pure.
• Chilli powder(brick powder): Adulterant settles on addition of water

These imitations pose serious health risk to consumers and must be taken seriously. As many persons are ignorant of them and the fact that people will not usually carry out these tests, it left for the government to enact strong regulatory laws and policies along with strong surveillance systems to stop this menace. Finally, the fuss about genetically modified foods (or bioengineered foods if you like)  deserves mention. Whether GMOs have future harmful effects is unproven but the general consensus is that they are at least safe for now.

If you have ever developed abdominal pain and discomfort with frequent stooling, chances are that you are just part of the 1 in 10 people who have suffered from diarrhoeal diseases, the most common result of food contamination. Diarrhoea is implicated in, and has been reported as a cause of over 200,000 deaths worldwide. About 600 million people fall ill due to food contamination leading to economic losses of over $950 billion. With the involvement of larger group of people- international and intercontinental outbreaks of food poisoning like the fipronil egg contamination case in Eurasia and many other cases, it has become clear that this problem is worldwide public health priority essential to achieve food safety, better nutrition and food security. Although anyone can get affected, vulnerable populations such as the elderly, sick and children especially those under 5 years of age, are more likely to be affected and even die from food borne diseases which result from contaminated food. Also, people living in developing parts of the world like Africa and Asia (especially South East Asia) are more likely to get food borne diseases due to poor food handling, sanitation, waste management and weak food regulatory laws.

Even though these features are risk factors for contamination, they are not direct causes. The major causes of food contamination include:

• Biological contaminants: These are microorganisms including bacteria, parasites, viruses, fungi and even the novel infectious agents, prions. Notable agents are salmonella (the cause of typhoid fever), E. coli (the cause of diarrhoea), vibrio (the cause of cholera), rota and noro viruses, the prion protein that caused the disastrous disease, kuru.
• Chemical contaminants: Chemical substances like pesticides, herbicides, food additives and adulterants added throughout the process of food production and processing can result in contamination. Also, contaminants may find their way into food due to other reasons like poor waste management, water and land pollution.
• Physical contaminants: These are foreign objects like metal, glass, hair, plastic etc that could be found in food due to poor food production, handling and cooking practices.

It is important to stress the importance of food safety which is the absence of hazards in food. Food safety actually involves everyone from producer to consumer, from farm to fork. That is why the WHO in the quest for better food safety education have provided 5 ways of proper food hygiene which include keeping food clean, separating raw and cooked food, cooking thoroughly, keeping food at safe temperatures and using safe water and raw materials. Food safety education should also involve teaching the public to make better food choices and other good food handling practices like proper spacing when storing foods in the refrigerator and following producer directions on containers that should not be put in a microwave. Those involved in food production and processing must be regulated by strong regulatory laws from the government who should be influenced by WHO/FAO codex alimentarius.

Hunger is an unpleasant feeling reflected by abdominal pain, discomfort, irritability or headaches. These feelings tell our brain that we’re hungry so we can find something to eat. In the case of food insecurity, there is the unavailability or lack of access to food in the face of hunger. Food insecurity is fear of hunger because there is nothing to, something that is more common than we think. Food insecurity is a global problem and needs to be addressed as public health emergency. Although the statistics in the developing nations of Africa, Asia and South America is alarming, the problem of food insecurity is far from being restricted to these regions; there is a lot of food insecurity in North America including US, Canada and other developed nations. About 1 in 7 people have food insecurity in the US; some regions like Milwaukee are even worse with 1 in 4 people living with food insecurity (Nunavut and other parts of northern Canada have more than 40% of people living in food insecurity). There is a direct correlation between food insecurity and protein energy malnutrition with resulting effects like psychosocial problems (depression and anxiety), stunting growth and other developmental problems predominantly seen in children. In addition, food insecurity is a risk factor that sits at the heart of many public health problems such as marginalization, food safety, political Instability and mass migrations, etc.

It is necessary to know the components of food insecurity to understand how it is caused. The four components of food insecurity are:

• Availability: Sufficient quantities of appropriate food are unavailable from domestic production, commercial imports or food assistance.
• Access: Adequate income or other resources are unavailable to access appropriate food through home production, buying, exchange, gifts, borrowing or food aid.
• Utilization: Food eaten is unsafe from contaminants and nutritionally inadequate to meet the needs of the individual
• Stability: Adequate food is lacking at all times so that access and availability of food is curtailed by acute or recurring emergencies

The most common cause of serious food insecurity is political instability due to conflicts and wars. It is almost impossible to see any war where hunger is not used as a war strategy; Yemen, South Sudan, Syria…These disrupt food availability to as much as 30-50% of the population. Aside conflict, government policies like reduced budget allocation to agriculture, reduced incentives and loans to farmers could increase the likelihood of food insecurity. Also, Poverty which is related to unemployment and low income leads to food insecurity by reducing access to available food. It is more common in developing countries, rural areas and marginalized groups. More so, extreme climate events like global warming and natural disasters such as droughts and floods are also important causes of increasing food crisis and insecurity. One of the oldest examples come from the biblical Egyptian famine story where Joseph saved the Egyptians by storing food in the good times.

With that said, we would expect to address food insecurity by working on the above causes but it’s not that simple. First, natural disasters and conflicts are out of control most times, plus poverty which remains a persistent problem. One of the most important things is to address the stigma around food stamps which leads to low self-esteem, anxiety, depression and shame. Food supports should be available and accessible to people in need; not by increasing production as, sadly, one-third of the world food is wasted. This is why there should be food policies that would facilitate proper food distribution. There are lots of stereotypes about people living in food insecurity; that hunger should have a certain appearance (ragged clothes) but there are well dressed people who do not know where their next meal would come from. Public health programs, education and awareness are needed to correct these unfounded beliefs.