By: Erin Stair, MD, MPH
I don’t get the flu shot. It only reduces the risk of infection by 40-60%, and that’s when it’s a good match. I’ve also never gotten the flu and I wash my hands diligently, eat right, prioritize sleep, and don’t work with high risk populations. I’ve also never gotten the flu. But while I don’t get a flu shot, I’m not against vaccines.
If you have anything to do with the “wellness” industry you will encounter people who curse vaccinations. They’ll tell you that vaccines are the devil and the cause of a laundry list of health problems. The most popular accusation is that vaccines cause autism. If you argue against the diehard anti-vaccine people and say that vaccinations are not Satan’s tools, and some vaccinations save a lot of lives, you will be shunned and dubbed a disciple of big Pharma and a traitor to the world of wellness. It makes me ask, “Where is the middle ground? Where is the logic?”
Unfortunately, logic plays seconds to a privileged mindset. The anti-all vaccine enthusiasts mostly live in developed countries that haven’t faced a killer of an epidemic since the early 1900s. That’s a privilege. You’ll find less of the anti-all vaccine people in countries like Niger, Chad, Syria or Papua New Guinea. Those countries are facing formidable killer diseases such as bacterial meningitis and polio. Rich countries don’t have to worry much about those illnesses, because they have gotten them under control with vaccines. When developed nations face a killer epidemic again (and we will), everyone will be banging down the pharmacy’s door and begging to be vaccinated.
Developed countries have faced real killers. There was the Spanish influenza pandemic of 1918 that killed 20 to 40 million people worldwide, including 675,000 Americans. My great grandmother was one of them. My mom tells the story of her going to a wake for a friend who died of the flu, coming home, feeling ill, and then dying 3 days later of the flu. It is estimated that half of the deaths of American soldiers stationed in Europe during WWI were due to influenza. My guess is if you asked any one of the 20 to 40 million people on their deathbeds if they would have liked to receive the flu vaccine, most of them would have said yes. Unfortunately for them, the flu vaccine didn’t materialize till the 1930s and 40s.
The U.S. has not experienced an epidemic like the Spanish Influenza in a very long time. Because many of us haven’t faced the horror of massive amounts of death from an epidemic, we are entitled to bash public health measures, such as vaccines, that have prevented or helped stop these epidemics. This is why the anti-vaccine movement is a privileged one. One could argue that the anti-vaccine movement exists entirely because vaccines were too successful. Poor Countries are not privileged enough to wage an all-out war against all vaccines. This is because they are busy dying from numerous diseases, several of which are preventable with vaccines. Because they are poor, have dismal infrastructure and dismal healthcare, most don’t have access to the vaccines they desperately need.
Take meningitis in Africa, for example. Every 8 to 12 years during the African dry season, outbreaks caused by the bacteria Neisseria meningitidis group A sweep across the continent and kill a lot of people. A lot of kids die, because Meningitis targets young people. In 1996-1997, the outbreak was so huge that 250,000 people were infected and 25,000 of them died. In 2009, 88,000 people became ill from meningitis. If the meningitis doesn’t kill the infected person, he/she will often suffer lifelong consequences, such as mental retardation and deafness. Many people in Africa live long distances from health clinics and hospitals. Often times if a child is struck ill, the parents decide against making the trip to the hospital and instead choose to keep their child at home, as comfortable as possible, until he/she dies. Do you think there is a strong anti-vaccination movement there? Not so much. Luckily, due to private donors like the Gates Foundation, the World Health Organization, PATH and the Serum Institute in India, a vaccine was developed specifically for meningitis in Africa. The Meningitis Vaccine Project ( MVP) was started. In 2011, 1.8 million children and young adults received the vaccine and the incidence of meningitis in 2012 was 2.5 per 100,000 people as compared to 43.6 per 100,000 people in places where people were not vaccinated. That is an amazing difference! Clearly the meningitis vaccine saved a lot of lives. Even more remarkable? No one complained of vaccines.
Within a privileged, free country is a privileged media that has the luxury to make some stories worthy of mass attention and others not, and a privileged media can easily sway public opinion. For example, most anti-vaccine people are especially against the MMR vaccine that kids typically get at age 1 and 4, and most anti-vaccine people are against the MMR vaccine because of the media attention given to a study conducted by Dr. Wakefield, a trained surgeon and researcher in England, that was first published in The Lancet in 1998. It was a study that suggested the MMR combination vaccine, and particularly the measles component, led to an autoimmune reaction in the gut that first created gastrointestinal problems and then created an autoimmune reaction in the brain that led to the neurological and mental symptoms of autism. He came to that conclusion because out of the twelve children in his study population, eight of them started having behavioral difficulties soon after receiving the MMR vaccine. At the completion of his study, he held a big press conference and got his results published in a great journal, The Lancet. His actual conclusion,”We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers,” is rather innocuous and anti-climatic. It still implies that the causes of autism are a mystery and that we should research it more.
Unfortunately, the privileged mainstream media went wild with the result of his study, as did anti-vaccine bloggers, anti-vaccine tweeters and anti-vaccine Facebookers. Soon every parent who had a child with autism blamed vaccines. Then celebrity spokespeople started campaigning against vaccines. The privileged media made lots of people think ALL vaccines are evil. And this happened:
Vaccine rates plummeted, because parents were afraid of giving their kids autism. As a result of dropping vaccination rates, there were several outbreaks of measles and mumps.Then another rumor started that it was actually the thiomersal (ethylmercury used in vaccines to prevent bacterial contamination) that caused autism. It didn’t help that in 1999 the FDA, AAP, and CDC made a statement asking vaccine manufacturers to remove thiomersal from vaccines as soon as possible. This public recommendation was made because the FDA thought the threshold for methymercury would be exceeded due to the increasing number of vaccines given in childhood.
After this chain of events, the traditional medical community panicked, as they should have, and started maniacally researching the vaccine and autism link. If anything positive came from the ridiculous media storm, it is the plethora of research studies aimed at exploring MMR, thiomersal, and autism. Now it is one of the most well-studied areas in medicine.
It should be noted that Wakefield never made the claim that thiomersal led to autism. His study had nothing to do with thiomersal, because thiomersal was never in the MMR vaccine. He was just the MMR guy who made the recommendation that it would be safer to give kids single vaccines as opposed to combination vaccines. That said, he did not fully explain why it would be safer to give kids single vaccines as opposed to combination vaccines, and I’m still very curious to hear his explanation why. In the US, recommended vaccines for kids has only increased. What’s the risk that comes with this? Are we over-vaccinating? Should vaccines be spread out more? These are questions that should be answered.
The CDC has a website full of links to studies on vaccines and autism, all of which do not find any connection. Of course if you are a diehard “wellness” proponent, you won’t trust a government-funded public health organization such as the CDC. That’s okay. Perhaps the more compelling evidence is that the rate of autism has continued to increase in countries that either 1) discontinued the MMR vaccine and 2) discontinued the use of thiomersal in all childhood vaccines. Japan stopped using the MMR vaccine in 1994, yet the rate of autism in Japan continues to increase. ( They discontinued its use after many kids developed meningitis and other complications as a result of using the “wrong” viral strain in the 1993 MMR vaccine.) The United States discontinued the use of thiomersal in childhood vaccines in 2001, but the rate of autism continues to increase.
While all of these later studies on autism and vaccines were happening, Dr. Wakefield’s study was viciously torn apart. Investigators stated that the 12 children in his study were subjected to unethical invasive medical procedures that were not in their best interest. It was discovered that the 12 kids were not randomly selected for Wakefield’s study, but recommended by a law firm that was in the process of preparing a lawsuit against a manufacturer of the MMR vaccine. Then, The Lancet study was formally retracted. Investigators asked Wakefield to reproduce the results of his study, but he never did, and so Wakefield was stripped of his medical license. In short, the study destroyed his career and reputation.
BUT…, even if one chooses to ignore the shortcomings of Wakefield’s study, one should question how a study with zero controls involving ONLY 12 kids creates such a massive public outcry. Wakefield’s study was by no means the gold standard of determining causal relationships ( something he has said since Day 1) and a sample size of 12 is far too tiny to change the ways of conventional medical practice, let alone start an all-out war on vaccines. Wakefield can’t be blamed for that. The privileged media can be.
Wakefield’s study could also be heavily flawed by recall bias, especially when the researcher is asking a parent about the roots of his or her child’s illness. Recall bias, in simple terms, means that a person who has a disease or who is personally affected by a disease is more inclined to find a root cause for such a disease than someone who is not personally affected by it. I am certain that any parent who has an autistic child would love to have an unambiguous answer for what caused the autism.”The MMR vaccine,” is a much more comfortable answer than, “I don’t know.” One’s desire to find a cause for a disease that personally affects him or her would not be limited to the parents recruited to participate in Wakefield’s study. That desire would be burning in any parent who has a child with autism, or any serious illness. So when the media took Wakefield’s study and ran with it, it is easy to understand why parents were enraged, scared, and waging war on vaccines. At the same time, parents of babies and young children are EXTREMELY observant of their children. Almost obsessively so. When you hear a similar story, over and over again, of the likes “My baby received this vaccine, and then only hours later, he/she changed for life,” THAT is a pattern worth researching. I don’t think we help anyone by ignoring them.
The mainstream media also flubbed in the aftermath of Wakefield’s paper, because their coverage on autism was painfully myopic. It only focused on Wakefield’s study and ignored the many other studies that implicate genetics, maternal antibodies, environmental contaminants such as BPA, autoimmune responses, Vitamin D deficiencies, etc., as causal factors for autism. In that sense, the media acted as a huge barricade for progress in autism research. By hyper-focusing on the Wakefield study, the media also kept other studies on vaccines and autism in the dark. When I first started researching the war on vaccines, I thought Wakefield was the only name that would show up. He’s the only guy I ever heard about. Yet as I explored the vaccine-autism link some more, I realized there were other guys in the game. There is Vijendra Singh out at Utah State University who in 2002 conducted a serologic study of measles, mumps and rubella virus on 88 autistic kids and 32 controls. The results of his study show that the antibodies to the Measles virus were significantly higher in autistic kids than in controls. No one really talks about it like they do the Wakefield paper. Why? Because the privileged media chose to ignore it.
A study by Lucija Tomljenovic analyzed whether aluminum vaccine adjuvants contribute to the rising rates of autism. In this case, aluminum is the adjuvant, a molecule that is commonly added to vaccines to stimulate and heighten one’s immune response to a particular pathogen. According to the study, there are 32 childhood vaccines that are recommended prior to school entry and 18 of them contain aluminum. ( For the record, MMR does not contain aluminum.) It is well established that at high enough levels aluminum is a neurotoxin. The authors stress that the side effects of using aluminum as an adjuvant in childhood vaccines are not well studied. The authors also found a significant positive correlation between the use of aluminum vaccine adjuvants and the rising rates of autism.
Singh’s and Tomljenovic’s studies, along with others suggest that children with autism have abnormal immune responses. While I think the MMR vaccine and thiomersal have been safely ruled out as causes of autism, there are other associations about vaccines and autism that would benefit from further research. For instance, perhaps some children have a genetic predisposition for autism that is activated after receiving certain types of vaccines. It can’t hurt to look into it.
And “looking into it” is exactly what a privileged nation should be doing. Instead of waging war on all vaccines and throwing the baby out with the bath water or alternative labeling all anti-vaccine people as “quacks” or idiots, a privileged nation should be conducting more studies on the production and safety of vaccines. In fact, in the plethora of studies conducted after Wakefield’s, many of the authors remarked that there was not a robust body of research on vaccine production and safety. That’s a sad fact for a privileged country that is fully capable of studying vaccines. While it is idiotic to use one’s privilege to blast all vaccines as evil, it’s also idiotic to not utilize one’s privilege to ensure that kids have the safest vaccines and vaccine schedule as possible.