anti-vaccination movement (AVM)
http://skepdic.com/antivaccination.html
Fewer youngsters worldwide are dying of childhood diseases now than at any other time in history. About 80% of children today are vaccinated against such deadly illnesses as measles and polio, compared with 20% in the early 1980s.*
There were an estimated 30 to 40 million cases of measles in 2000, causing some 777,000 deaths.*
...immunization can be credited with saving approximately 9 million lives a year worldwide. A further 16 million deaths a year could be prevented if effective vaccines were deployed against all potentially vaccine-preventable diseases.*
"Health officials say aggressive efforts to vaccinate young children against measles have resulted in a 74 percent global decline in the number of deaths due to the illness [between 2000 and 2007]. Experts say the biggest decline, 90 percent, occurred in the Eastern Mediterranean region."*
In England and Wales, measles cases increased 36% in 2008.* Measles cases more than doubled from the year before during the first half of 2008 in the United States.*
"Before smallpox was eradicated with a vaccine, it killed an estimated 500 million people. And just 60 years ago, polio paralyzed 16,000 Americans every year, while rubella caused birth defects and mental retardation in as many as 20,000 newborns. Measles infected 4 million children, killing 3,000 annually, and a bacterium called Haemophilus influenzae type b caused Hib meningitis in more than 15,000 children, leaving many with permanent brain damage. Infant mortality and abbreviated life spans — now regarded as a third world problem — were a first world reality." Amy Wallace
The anti-vaccination movement (AVM) is at least two-pronged: one prong denies a causal connection between vaccines and the eradication or significant reduction of diseases like smallpox, polio, measles, and rubella; the other prong perceives vaccines as causing diseases, e.g., it claims that the MMR (mumps-measles-rubella) vaccine causes autism. Either way, the AVM proponents oppose vaccination against disease.
One might consider a third prong of the AVM to be those who advocate homeopathic "vaccines" or isopathic preparations for such things as meningococcal disease, the "flu", childhood illnesses, malaria, and HIV. Such people offer magic water in place of an actual vaccine developed and properly tested by scientists. They believe the water has been energized and has a selective "memory" of molecules long gone in the homeopathic dilution process. Most homeopathic vaccines are nothing but water or inert substances and cannot protect anyone from anything. They endanger people's lives when they are offered as protection against diseases like malaria. They are sought out by people who do not trust real vaccines and who live according to the principles of vitalism and magical thinking. Thus, we might well say that those who recommend homeopathic vaccines are part of the AVM since, in effect, they oppose real vaccination against disease.
One thing that unites these three prongs of the AVM is that each is selective in its picking of evidence to support its viewpoint and to denigrate one of scientific medicine's major contributions to public health.
are vaccines effective?
Robert Mendelsohn, M.D. is one of the leading opponents of vaccination. He claims that there is "no convincing scientific evidence that mass inoculations can be credited with eliminating any childhood disease." He thinks nobody knows why diseases such as polio have almost been eliminated, though improved living conditions might have something to do with it. Quackwatch calls this misconception #1 about immunization. Mendelsohn reasons that inoculations are ineffective because the diseases diminished not only in the U.S. when vaccinations were widespread but also in Europe even though no mass immunizations took place there. I don't know if this is true, but it should be. In isolated populations with little immunity to a disease, one would expect an infectious disease to either kill people or make them immune to further infection. In any case, whether infectious diseases diminished without inoculation is irrelevant to the causal effectiveness of vaccines. What is relevant, for example, is that the incidence of measles certainly went down due to vaccination programs in the U.S. and the U.K. (Now that a significant number of parents do not have their children vaccinated, measles outbreaks have occurred in both the U.S. and the U.K.)
There is ample and compelling evidence that vaccinations do work, despite what a few contrarians might argue. (See, for example, the Centers for Disease Control's page on vaccines and immunizations.) The evidence, of course, must be understood against the background of immunization theory, going back to Edward Jenner's reasoning about milkmaids and small pox. For example, we know what happened in Japan when the vaccination rate for pertussis (whooping cough) dropped 70% from 1974 to 1976. In 1974 there were 393 cases of pertussis and no deaths. In 1976, there were more than 13,000 cases and 41 deaths.*
Another example that vaccines work is the success of the Hib vaccine for meningitis caused by the bacterium Haemophilus influenzae type b (Hib). When the vaccine was Introduced in the U.S. in 1990 there were about 15,000 cases and 400 to 500 deaths every year from this bacterium and those numbers had been steady for decades. "After the current Hib vaccine was introduced, the incidence of Hib meningitis declined to fewer than fifty cases per year!"* If considered in isolation, these examples might look like post hoc reasoning. But they are not isolated; they are presented within the larger context of our understanding of how the immune system works.
Anita Petek-Dimmer is another opponent of vaccination. She writes:
Switzerland was affected by a mumps epidemic from Autumn 1999 until Spring 2000. The Swiss Federal Office for Health (BAG) eventually admitted, upon the pressure of the medical profession, that more than 75% of those who contracted Mumps had been fully up to date with their vaccinations. No further comment is necessary here!*
Actually, a comment is in order. Vaccinations are not 100% guaranteed to prevent a disease in everyone who is vaccinated. The Institute of Child Health says:
After one dose of MMR, approximately 90-95% of children are protected against measles, over 95% against rubella, and 85-90% against mumps. After two doses, almost 100% of people will be protected against all three diseases. Because the diseases are so infectious, it is necessary to have very high levels of immunity in the population to control the diseases. It is only possible to do this, if children receive two doses of the vaccine. For this reason, almost all countries, recommend two doses of the vaccine. Those countries that have a high uptake of two doses of MMR vaccine have been most successful at eliminating the diseases.*
If everybody in a population is vaccinated, the chances of contracting the disease is near zero. But the more people in a population who do not get vaccinated, the more the whole population is jeopardized. Imagine a robust individual who is not vaccinated and gets mumps. Before his parents keep him home from school he infects half his classmates, some have been vaccinated and are not affected. Some have not been vaccinated and they get the mumps. Most recover. Maybe one of the non-vaccinated dies. There may also be a child who was vaccinated but who is not very robust and she gets infected by several people, some of whom have been vaccinated and some who have not. Both can be carriers of the virus. The weak but vaccinated girl dies. Does this mean the vaccine doesn't work? No. It means that if some people don't get vaccinated they can jeopardize those who do. On the other hand, if most people have been vaccinated, those in the population who haven't been vaccinated benefit from the actions of the others and get protection against the disease without being vaccinated. If too many people take this free-ride approach, the group suffers.
The previous paragraph indicates why immunizations are not optional in public school districts in the U.S. Because of our peculiar religious history, we make exceptions for those who have religious reasons for not getting their children vaccinated. We also make exceptions for those who have medical reasons for not being vaccinated. As long as the number of parents seeking exemptions for their children is small, school districts can tolerate some non-compliance with vaccination programs. But when the numbers get too large, as they have in some places, the school district will have to take action or the whole point of vaccination will be defeated and the threat of an epidemic becomes very real. For example, two months into the school year, school officials in Prince George's County, Maryland found that more than 2,000 students (out of 132,000) still didn't have their required vaccinations. School officials went to court and Circuit Court Judge C. Philip Nichols ordered parents in a letter to appear at the courthouse and either provide proof of vaccination, get their children vaccinated on the spot, provide an explanation for their failure to have their child vaccinated, or go to jail for up to 10 days.* Even after a deadline had passed, there were still more than 900 students with no record of being vaccinated. A group opposing required immunizations protested the action. Charles Frohman was one of them. He thinks people should have a choice in getting their children immunized. This sounds reasonable but it isn't: those who don't get vaccinated jeopardize those who do and they prevent the eradication of the causal agent of the disease.
Some people seem to think that their children would be better off catching a disease than taking a risk with a vaccine. According to the Institute of Child Health:
If you allow your children to catch the disease, they run the risk of being seriously ill or even dying. On the other hand, the vaccines only rarely cause serious adverse effects. It is true that vaccines do not give long lasting protection 100% of the time but then neither do many diseases. For example, you can catch whooping cough, Hib, meningococcal disease and rubella more than once. However, even if a child does catch the disease after they have had the vaccine, the disease is usually milder. By giving the vaccine most children are spared the effects of the disease. Even if immunity from the vaccine wears off, if enough people are immunized, there will be herd immunity and so this should not be a problem. This will protect people who have lost their immunity.
So, no, the odds are that your child will not be better off if she gets measles, mumps, or rubella. She might end up deaf, paralyzed, or dead.
do vaccines cause diseases?
Most people who don't get vaccinated or don't have their children vaccinated, however, are probably in the camp of the AVM that thinks vaccinations cause diseases. One of the more widespread myths about vaccines is that the MMR vaccine causes autism,* either by itself or by thimerosal or by the combination of the two. (Thimerosal has been used since the 1930s as a preservative to prevent contamination by microbes, but it has never been used in the MMR vaccine, nor has it ever been used in varicella (chickenpox), inactivated polio (IPV), or pneumococcal conjugate vaccines.* In any case, one would think that if thimerosal were so harmful, we might have detected it before now.) This view that vaccines cause autism is growing, despite the fact there is no compelling evidence for it. This prong of the AVM has a strong parent-run lobby and has been aided by questionable medicine, celebrity and media propaganda, as well as by politicians like Robert F. Kennedy Jr.
Denmark removed thimerosal from its vaccines in 1992. Other countries have followed suit, not because the evidence strongly linked thimerosal to autism or any other disorder. It was removed because of fear generated by anxious parents and the media, and the threat of lawsuits. A study published in Pediatrics magazine (2003) concluded that there is strong evidence from a study in Denmark that thimerosal is an unlikely contributor to the development of autism. The researchers examined data on 956 children diagnosed with autism from 1971 to 2000. The autism incidence rate climbed steadily from less than one child per 10,000 in 1990 to nearly 5 per 10,000 in 1999, seven years after thimerosal was removed from vaccines in Denmark. "Thimerosal has been eliminated from childhood vaccines in most industrialized countries," said lead author Dr. Kreesten Meldgaard Madsen. "If indeed thimerosal was an important cause of autism, (autism rates) should soon begin to decline in these countries."* Unfortunately, there was no sudden drop in autism spectrum disorders after thimerosal was removed from vaccines. (One report makes the claim that there was such a drop but it has been thoroughly refuted.) In 2004, a committee of experts appointed by the Institute of Medicine concluded an examination of scientific studies worldwide and found no convincing evidence that vaccines cause autism. In particular, no link was found between autism and the measles-mumps-rubella vaccine or vaccines that contain thimerosal.*
Thimerosal was pegged as potentially harmful because it is a mercury compound and is metabolized in humans to ethyl mercury. It is possible that some in the AVM mistook ethyl mercury for methyl mercury, which is known to be harmful. Some parents subject their autistic children to chelation therapy to remove heavy metals from their blood. Chelation should not be taken lightly.* There is even one case where it led to the death of an autistic five-year-old.
There are several anti-immunization websites and some of them are posting inaccurate information about the evidence of a causal connection between vaccinations and autism. Many of the websites have been set up by parents of children with autism. Dr. Michael Fitzpatrick, author of MMR and Autism, is concerned that some parents of autistic children believe their personal experience and research—most of which has been guided only by the desire to prove what they already believe, namely, that their children's autism was caused by vaccinations—qualify them as experts on both autism and vaccination.* As the parent of an autistic child, Fitzpatrick sympathizes with the desire to find something to blame for the autism. But, as Dr. Fitzpatrick notes, being a parent of an autistic child does not give him "any special insights into the question of what causes autism, or into any other aspect of the condition."
Fitzpatrick's concern, however, is not just that misinformation is being spread on the Internet but that
Any parent who looks to the anti-immunization campaigns for information will readily find strident condemnations of the government, the medical establishment and the drug companies. Anybody who defends immunization can expect abuse and allegations of corruption or conspiracy. The basic thrust of much of it is that the pro-vaccination party has commercial links with drug companies. Yet, perhaps not surprisingly, these anti-vaccination groups often have their own links with commercial interests.
He notes that a group that goes by the swell name of Jabs (Justice, awareness and basic support) has been in litigation against MMR for more than a decade. The legal firm of Alexander Harris
cleared around £5m out of the total of £15m of legal-aid funding spent before the Legal Services Commission pulled the plug last October. Jabs' encouragement of parents to join this ill-conceived quest for compensation has had a demoralizing effect, not only on the families involved, but on the parents of children with autism, who have been made to feel guilty that by giving their children MMR they may have caused their condition.
Also, Dr. Andrew Wakefield, who sounded the alarm a few years ago about a possible connection between the MMR vaccine and autism and bowel disease in children,* was paid more than £400,000 by lawyers trying to prove that the vaccine was unsafe. The payments were part of £3.4m distributed from the legal aid fund to doctors and scientists who had been recruited to support a now failed lawsuit against vaccine manufacturers.* Thanks in part to Wakefield's false alarm, children in Europe began dying of measles again. Throughout Europe many parents stopped bringing in their children in for the MMR vaccination. Cases of measles in England rose to a 20-year high following the collapse in MMR immunization rates.* In 2007, the National Disease Surveillance Centre in Ireland issued a paper on controlling measles after immunization rates plummeted.* Scotland, where Wakefield operates, also reported troubles with measles. (new A detailed and thorough review of every claim made in Wakefield's book about vaccinations concludes: "I have shown that every major claim Wakefield makes in his book concerning vaccine safety is wrong." See "Wrong About Vaccine Safety: A Review of Andrew Wakefield’s “Callous Disregard”" by Joel A. Harrison, PhD, MPH in The Open Vaccine Journal, Vol 6, 2013, pp 9 – 25. [/new])
According to Fitzpatrick, the anti-immunization websites provide links to private clinics offering alternative vaccines to MMR and to "mercury-free" vaccines. "These clinics have been major beneficiaries of popular anxieties about immunization, making 'substantial' profits by providing inferior vaccines at inflated prices, to parents whose fears have been inflamed by misinformation and scare-mongering journalism." One such beneficiary was Dr. David Pugh, whose clinics in Sheffield and Elstree, Hertfordshire, were closed down after allegations of unsanitary and fraudulent practices. Pugh, who faces trial on criminal charges, has been endorsed by a number of parent groups.
In the U.S., over 4,900 autism claims are pending. They've been piling up for about eight years (Novella 2007). In June 2007, nine cases were heard by three "special masters" of the Autism Omnibus, a U.S. Court of Federal Claims. The Court issues updates from time to time. The latest, as of this writing, was July 8, 2008. The plaintiffs are covering all bases, arguing three different lines of causation: MMR vaccines and thimerosal cause autism, thimerosal alone causes autism, MMR alone causes autism. How the court rules in the nine test cases will affect the outcome of the other 4,900 claims. Of course, if the Court rules that the evidence is not compelling for a vaccine-autism causal link, many of the plaintiffs will see "conspiracy" once again. The Court is in the pockets of Big Pharma. Or something like that. The fact is, there is no telling how a court will rule, no matter what the science actually says.
vaccines and harm
There is evidence, however, that some vaccines do cause harm. In northern Nigeria, there was a polio outbreak in the summer of 2003 that was triggered by a vaccine designed to eliminate it.*
Muslim clerics and disgruntled northern politicians banned polio vaccinations in the area, claiming that the drugs were a Western ploy to spread HIV and sterilize Muslim girls. The year-long mass boycott of the vaccine sparked a rash of new infections, and the virus jumped to about a dozen other countries — a devastating rollback for a polio eradication campaign that seemed finally on the verge of success....
...the World Health Organization and the Centers for Disease Control revealed in early October [2007] that 69 Nigerian children had been paralyzed by polio virus since 2005 — and had contracted the illness through exposure to the live virus found in the oral vaccine ....(Time)
Even so, vaccine coverage has doubled countrywide in Nigeria from 35% in 2005 to a high of about 76% in 2007. Rates of new infections have dropped dramatically. Nigeria no longer has the highest number of polio cases worldwide. In 2006, Nigeria accounted for 1,125 of the 2,000 polio cases worldwide. In 2007, there were only 198 cases through October. In 2008, however, there were 788 cases, prompting a vigorous campaign to encourage vaccination.* (For comparison, in 1988 there were 350,000 new cases of polio in 125 countries, most of them in the developing world.*)
"The campaign to eradicate the polio virus must be intensified," says Sheikh Ahmed Gumbi, the powerful chief imam of the Sultan Bello mosque in Kaduna [Nigeria's second largest northern city]. "The good job must be completed. The vaccine is safe and healthy, despite a few cases of vaccine-induced infections. The immunization should continue until Nigeria is polio free." (Time)
AVM proponents note that only 1 in 200 cases of polio causes paralysis. Fever, flu-like symptoms, or no symptoms are typical in those carrying the virus.* We should remember, though, that only a very small percentage of those vaccinated with the polio virus will contract polio and that percentage will be much smaller than the percentage who will contract polio if there is no vaccination program. "The outbreak was caused by the live polio virus that is used in vaccines given orally — the preferred method in developing countries because it is cheaper and doesn’t require medical training to dispense."* The Nigerian outbreak was not the first. In 2001, 22 children were paralyzed from polio in the Dominican Republic and Haiti. "The oral polio vaccine contains a weakened version of polio virus. Children who have been vaccinated excrete the virus, and in unsanitary conditions it can end up in the water supply, spreading to unvaccinated children."*
No vaccination is completely without risk. Public health officials require certain vaccinations in order to prevent outbreaks of contagious diseases, whose costs would be far greater than the costs incurred by vaccinating.
do vaccines weaken the immune system?
Finally, some people think that the immune systems of children are being weakened by vaccines, making them vulnerable to illnesses later on in life. Quackwatch calls this misconception #7. For example, some think that their child's asthma or respiratory problems may be due to "vaccine overload" on their immature immune systems.
In fact babies have an ability, right from birth, to cope with lots of different germs. The body is constantly surrounded by germs and has to react to them in different ways. The advantage of being immunized rather than catching the disease is that the vaccine uses only part of the germ, or, if the whole germ, it is either killed or toned down (“attenuated”). In this way, the challenge to the immune system is less than that from the disease, but it is enough to produce protection.
In 2002, the Immunization Safety Review Committee of the American Institute of Medicine made a detailed examination of all the evidence about the effects of multiple immunizations on a baby’s immune system. They concluded that there was no evidence to support the suggestion that multiple immunizations overwhelm the immune system. They strongly supported the continuing use of vaccines against multiple diseases....
If immunizations are delayed, a baby will remain unprotected for longer than necessary. This could be particularly dangerous for whooping cough and Hib. Very young babies, if they catch whooping cough, are likely to be much more seriously ill than older children and are more likely to need hospital care. Babies under a year old are more likely to catch Hib than older children Studies have shown that when the vaccines are given at the younger age, babies have fewer reactions such as fever, sore injection sites etc, while at the same time they are still protected.*
There have been many well-designed studies that have examined claims that vaccines cause chronic diseases such as asthma, multiple sclerosis, chronic arthritis, sudden infant death syndrome, and diabetes. The studies have not found compelling evidence for any such links.* That has not stopped some anti-vaccinationists from speculating that some children are "especially sensitive" to vaccines and that scientific control studies can't be refined enough to validate this claim.
Fewer youngsters worldwide are dying of childhood diseases now than at any other time in history. About 80% of children today are vaccinated against such deadly illnesses as measles and polio, compared with 20% in the early 1980s.*
There were an estimated 30 to 40 million cases of measles in 2000, causing some 777,000 deaths.*
...immunization can be credited with saving approximately 9 million lives a year worldwide. A further 16 million deaths a year could be prevented if effective vaccines were deployed against all potentially vaccine-preventable diseases.*
"Health officials say aggressive efforts to vaccinate young children against measles have resulted in a 74 percent global decline in the number of deaths due to the illness [between 2000 and 2007]. Experts say the biggest decline, 90 percent, occurred in the Eastern Mediterranean region."*
In England and Wales, measles cases increased 36% in 2008.* Measles cases more than doubled from the year before during the first half of 2008 in the United States.*
"Before smallpox was eradicated with a vaccine, it killed an estimated 500 million people. And just 60 years ago, polio paralyzed 16,000 Americans every year, while rubella caused birth defects and mental retardation in as many as 20,000 newborns. Measles infected 4 million children, killing 3,000 annually, and a bacterium called Haemophilus influenzae type b caused Hib meningitis in more than 15,000 children, leaving many with permanent brain damage. Infant mortality and abbreviated life spans — now regarded as a third world problem — were a first world reality." Amy Wallace
The anti-vaccination movement (AVM) is at least two-pronged: one prong denies a causal connection between vaccines and the eradication or significant reduction of diseases like smallpox, polio, measles, and rubella; the other prong perceives vaccines as causing diseases, e.g., it claims that the MMR (mumps-measles-rubella) vaccine causes autism. Either way, the AVM proponents oppose vaccination against disease.
One might consider a third prong of the AVM to be those who advocate homeopathic "vaccines" or isopathic preparations for such things as meningococcal disease, the "flu", childhood illnesses, malaria, and HIV. Such people offer magic water in place of an actual vaccine developed and properly tested by scientists. They believe the water has been energized and has a selective "memory" of molecules long gone in the homeopathic dilution process. Most homeopathic vaccines are nothing but water or inert substances and cannot protect anyone from anything. They endanger people's lives when they are offered as protection against diseases like malaria. They are sought out by people who do not trust real vaccines and who live according to the principles of vitalism and magical thinking. Thus, we might well say that those who recommend homeopathic vaccines are part of the AVM since, in effect, they oppose real vaccination against disease.
One thing that unites these three prongs of the AVM is that each is selective in its picking of evidence to support its viewpoint and to denigrate one of scientific medicine's major contributions to public health.
are vaccines effective?
Robert Mendelsohn, M.D. is one of the leading opponents of vaccination. He claims that there is "no convincing scientific evidence that mass inoculations can be credited with eliminating any childhood disease." He thinks nobody knows why diseases such as polio have almost been eliminated, though improved living conditions might have something to do with it. Quackwatch calls this misconception #1 about immunization. Mendelsohn reasons that inoculations are ineffective because the diseases diminished not only in the U.S. when vaccinations were widespread but also in Europe even though no mass immunizations took place there. I don't know if this is true, but it should be. In isolated populations with little immunity to a disease, one would expect an infectious disease to either kill people or make them immune to further infection. In any case, whether infectious diseases diminished without inoculation is irrelevant to the causal effectiveness of vaccines. What is relevant, for example, is that the incidence of measles certainly went down due to vaccination programs in the U.S. and the U.K. (Now that a significant number of parents do not have their children vaccinated, measles outbreaks have occurred in both the U.S. and the U.K.)
There is ample and compelling evidence that vaccinations do work, despite what a few contrarians might argue. (See, for example, the Centers for Disease Control's page on vaccines and immunizations.) The evidence, of course, must be understood against the background of immunization theory, going back to Edward Jenner's reasoning about milkmaids and small pox. For example, we know what happened in Japan when the vaccination rate for pertussis (whooping cough) dropped 70% from 1974 to 1976. In 1974 there were 393 cases of pertussis and no deaths. In 1976, there were more than 13,000 cases and 41 deaths.*
Another example that vaccines work is the success of the Hib vaccine for meningitis caused by the bacterium Haemophilus influenzae type b (Hib). When the vaccine was Introduced in the U.S. in 1990 there were about 15,000 cases and 400 to 500 deaths every year from this bacterium and those numbers had been steady for decades. "After the current Hib vaccine was introduced, the incidence of Hib meningitis declined to fewer than fifty cases per year!"* If considered in isolation, these examples might look like post hoc reasoning. But they are not isolated; they are presented within the larger context of our understanding of how the immune system works.
Anita Petek-Dimmer is another opponent of vaccination. She writes:
Switzerland was affected by a mumps epidemic from Autumn 1999 until Spring 2000. The Swiss Federal Office for Health (BAG) eventually admitted, upon the pressure of the medical profession, that more than 75% of those who contracted Mumps had been fully up to date with their vaccinations. No further comment is necessary here!*
Actually, a comment is in order. Vaccinations are not 100% guaranteed to prevent a disease in everyone who is vaccinated. The Institute of Child Health says:
After one dose of MMR, approximately 90-95% of children are protected against measles, over 95% against rubella, and 85-90% against mumps. After two doses, almost 100% of people will be protected against all three diseases. Because the diseases are so infectious, it is necessary to have very high levels of immunity in the population to control the diseases. It is only possible to do this, if children receive two doses of the vaccine. For this reason, almost all countries, recommend two doses of the vaccine. Those countries that have a high uptake of two doses of MMR vaccine have been most successful at eliminating the diseases.*
If everybody in a population is vaccinated, the chances of contracting the disease is near zero. But the more people in a population who do not get vaccinated, the more the whole population is jeopardized. Imagine a robust individual who is not vaccinated and gets mumps. Before his parents keep him home from school he infects half his classmates, some have been vaccinated and are not affected. Some have not been vaccinated and they get the mumps. Most recover. Maybe one of the non-vaccinated dies. There may also be a child who was vaccinated but who is not very robust and she gets infected by several people, some of whom have been vaccinated and some who have not. Both can be carriers of the virus. The weak but vaccinated girl dies. Does this mean the vaccine doesn't work? No. It means that if some people don't get vaccinated they can jeopardize those who do. On the other hand, if most people have been vaccinated, those in the population who haven't been vaccinated benefit from the actions of the others and get protection against the disease without being vaccinated. If too many people take this free-ride approach, the group suffers.
The previous paragraph indicates why immunizations are not optional in public school districts in the U.S. Because of our peculiar religious history, we make exceptions for those who have religious reasons for not getting their children vaccinated. We also make exceptions for those who have medical reasons for not being vaccinated. As long as the number of parents seeking exemptions for their children is small, school districts can tolerate some non-compliance with vaccination programs. But when the numbers get too large, as they have in some places, the school district will have to take action or the whole point of vaccination will be defeated and the threat of an epidemic becomes very real. For example, two months into the school year, school officials in Prince George's County, Maryland found that more than 2,000 students (out of 132,000) still didn't have their required vaccinations. School officials went to court and Circuit Court Judge C. Philip Nichols ordered parents in a letter to appear at the courthouse and either provide proof of vaccination, get their children vaccinated on the spot, provide an explanation for their failure to have their child vaccinated, or go to jail for up to 10 days.* Even after a deadline had passed, there were still more than 900 students with no record of being vaccinated. A group opposing required immunizations protested the action. Charles Frohman was one of them. He thinks people should have a choice in getting their children immunized. This sounds reasonable but it isn't: those who don't get vaccinated jeopardize those who do and they prevent the eradication of the causal agent of the disease.
Some people seem to think that their children would be better off catching a disease than taking a risk with a vaccine. According to the Institute of Child Health:
If you allow your children to catch the disease, they run the risk of being seriously ill or even dying. On the other hand, the vaccines only rarely cause serious adverse effects. It is true that vaccines do not give long lasting protection 100% of the time but then neither do many diseases. For example, you can catch whooping cough, Hib, meningococcal disease and rubella more than once. However, even if a child does catch the disease after they have had the vaccine, the disease is usually milder. By giving the vaccine most children are spared the effects of the disease. Even if immunity from the vaccine wears off, if enough people are immunized, there will be herd immunity and so this should not be a problem. This will protect people who have lost their immunity.
So, no, the odds are that your child will not be better off if she gets measles, mumps, or rubella. She might end up deaf, paralyzed, or dead.
do vaccines cause diseases?
Most people who don't get vaccinated or don't have their children vaccinated, however, are probably in the camp of the AVM that thinks vaccinations cause diseases. One of the more widespread myths about vaccines is that the MMR vaccine causes autism,* either by itself or by thimerosal or by the combination of the two. (Thimerosal has been used since the 1930s as a preservative to prevent contamination by microbes, but it has never been used in the MMR vaccine, nor has it ever been used in varicella (chickenpox), inactivated polio (IPV), or pneumococcal conjugate vaccines.* In any case, one would think that if thimerosal were so harmful, we might have detected it before now.) This view that vaccines cause autism is growing, despite the fact there is no compelling evidence for it. This prong of the AVM has a strong parent-run lobby and has been aided by questionable medicine, celebrity and media propaganda, as well as by politicians like Robert F. Kennedy Jr.
Denmark removed thimerosal from its vaccines in 1992. Other countries have followed suit, not because the evidence strongly linked thimerosal to autism or any other disorder. It was removed because of fear generated by anxious parents and the media, and the threat of lawsuits. A study published in Pediatrics magazine (2003) concluded that there is strong evidence from a study in Denmark that thimerosal is an unlikely contributor to the development of autism. The researchers examined data on 956 children diagnosed with autism from 1971 to 2000. The autism incidence rate climbed steadily from less than one child per 10,000 in 1990 to nearly 5 per 10,000 in 1999, seven years after thimerosal was removed from vaccines in Denmark. "Thimerosal has been eliminated from childhood vaccines in most industrialized countries," said lead author Dr. Kreesten Meldgaard Madsen. "If indeed thimerosal was an important cause of autism, (autism rates) should soon begin to decline in these countries."* Unfortunately, there was no sudden drop in autism spectrum disorders after thimerosal was removed from vaccines. (One report makes the claim that there was such a drop but it has been thoroughly refuted.) In 2004, a committee of experts appointed by the Institute of Medicine concluded an examination of scientific studies worldwide and found no convincing evidence that vaccines cause autism. In particular, no link was found between autism and the measles-mumps-rubella vaccine or vaccines that contain thimerosal.*
Thimerosal was pegged as potentially harmful because it is a mercury compound and is metabolized in humans to ethyl mercury. It is possible that some in the AVM mistook ethyl mercury for methyl mercury, which is known to be harmful. Some parents subject their autistic children to chelation therapy to remove heavy metals from their blood. Chelation should not be taken lightly.* There is even one case where it led to the death of an autistic five-year-old.
There are several anti-immunization websites and some of them are posting inaccurate information about the evidence of a causal connection between vaccinations and autism. Many of the websites have been set up by parents of children with autism. Dr. Michael Fitzpatrick, author of MMR and Autism, is concerned that some parents of autistic children believe their personal experience and research—most of which has been guided only by the desire to prove what they already believe, namely, that their children's autism was caused by vaccinations—qualify them as experts on both autism and vaccination.* As the parent of an autistic child, Fitzpatrick sympathizes with the desire to find something to blame for the autism. But, as Dr. Fitzpatrick notes, being a parent of an autistic child does not give him "any special insights into the question of what causes autism, or into any other aspect of the condition."
Fitzpatrick's concern, however, is not just that misinformation is being spread on the Internet but that
Any parent who looks to the anti-immunization campaigns for information will readily find strident condemnations of the government, the medical establishment and the drug companies. Anybody who defends immunization can expect abuse and allegations of corruption or conspiracy. The basic thrust of much of it is that the pro-vaccination party has commercial links with drug companies. Yet, perhaps not surprisingly, these anti-vaccination groups often have their own links with commercial interests.
He notes that a group that goes by the swell name of Jabs (Justice, awareness and basic support) has been in litigation against MMR for more than a decade. The legal firm of Alexander Harris
cleared around £5m out of the total of £15m of legal-aid funding spent before the Legal Services Commission pulled the plug last October. Jabs' encouragement of parents to join this ill-conceived quest for compensation has had a demoralizing effect, not only on the families involved, but on the parents of children with autism, who have been made to feel guilty that by giving their children MMR they may have caused their condition.
Also, Dr. Andrew Wakefield, who sounded the alarm a few years ago about a possible connection between the MMR vaccine and autism and bowel disease in children,* was paid more than £400,000 by lawyers trying to prove that the vaccine was unsafe. The payments were part of £3.4m distributed from the legal aid fund to doctors and scientists who had been recruited to support a now failed lawsuit against vaccine manufacturers.* Thanks in part to Wakefield's false alarm, children in Europe began dying of measles again. Throughout Europe many parents stopped bringing in their children in for the MMR vaccination. Cases of measles in England rose to a 20-year high following the collapse in MMR immunization rates.* In 2007, the National Disease Surveillance Centre in Ireland issued a paper on controlling measles after immunization rates plummeted.* Scotland, where Wakefield operates, also reported troubles with measles. (new A detailed and thorough review of every claim made in Wakefield's book about vaccinations concludes: "I have shown that every major claim Wakefield makes in his book concerning vaccine safety is wrong." See "Wrong About Vaccine Safety: A Review of Andrew Wakefield’s “Callous Disregard”" by Joel A. Harrison, PhD, MPH in The Open Vaccine Journal, Vol 6, 2013, pp 9 – 25. [/new])
According to Fitzpatrick, the anti-immunization websites provide links to private clinics offering alternative vaccines to MMR and to "mercury-free" vaccines. "These clinics have been major beneficiaries of popular anxieties about immunization, making 'substantial' profits by providing inferior vaccines at inflated prices, to parents whose fears have been inflamed by misinformation and scare-mongering journalism." One such beneficiary was Dr. David Pugh, whose clinics in Sheffield and Elstree, Hertfordshire, were closed down after allegations of unsanitary and fraudulent practices. Pugh, who faces trial on criminal charges, has been endorsed by a number of parent groups.
In the U.S., over 4,900 autism claims are pending. They've been piling up for about eight years (Novella 2007). In June 2007, nine cases were heard by three "special masters" of the Autism Omnibus, a U.S. Court of Federal Claims. The Court issues updates from time to time. The latest, as of this writing, was July 8, 2008. The plaintiffs are covering all bases, arguing three different lines of causation: MMR vaccines and thimerosal cause autism, thimerosal alone causes autism, MMR alone causes autism. How the court rules in the nine test cases will affect the outcome of the other 4,900 claims. Of course, if the Court rules that the evidence is not compelling for a vaccine-autism causal link, many of the plaintiffs will see "conspiracy" once again. The Court is in the pockets of Big Pharma. Or something like that. The fact is, there is no telling how a court will rule, no matter what the science actually says.
vaccines and harm
There is evidence, however, that some vaccines do cause harm. In northern Nigeria, there was a polio outbreak in the summer of 2003 that was triggered by a vaccine designed to eliminate it.*
Muslim clerics and disgruntled northern politicians banned polio vaccinations in the area, claiming that the drugs were a Western ploy to spread HIV and sterilize Muslim girls. The year-long mass boycott of the vaccine sparked a rash of new infections, and the virus jumped to about a dozen other countries — a devastating rollback for a polio eradication campaign that seemed finally on the verge of success....
...the World Health Organization and the Centers for Disease Control revealed in early October [2007] that 69 Nigerian children had been paralyzed by polio virus since 2005 — and had contracted the illness through exposure to the live virus found in the oral vaccine ....(Time)
Even so, vaccine coverage has doubled countrywide in Nigeria from 35% in 2005 to a high of about 76% in 2007. Rates of new infections have dropped dramatically. Nigeria no longer has the highest number of polio cases worldwide. In 2006, Nigeria accounted for 1,125 of the 2,000 polio cases worldwide. In 2007, there were only 198 cases through October. In 2008, however, there were 788 cases, prompting a vigorous campaign to encourage vaccination.* (For comparison, in 1988 there were 350,000 new cases of polio in 125 countries, most of them in the developing world.*)
"The campaign to eradicate the polio virus must be intensified," says Sheikh Ahmed Gumbi, the powerful chief imam of the Sultan Bello mosque in Kaduna [Nigeria's second largest northern city]. "The good job must be completed. The vaccine is safe and healthy, despite a few cases of vaccine-induced infections. The immunization should continue until Nigeria is polio free." (Time)
AVM proponents note that only 1 in 200 cases of polio causes paralysis. Fever, flu-like symptoms, or no symptoms are typical in those carrying the virus.* We should remember, though, that only a very small percentage of those vaccinated with the polio virus will contract polio and that percentage will be much smaller than the percentage who will contract polio if there is no vaccination program. "The outbreak was caused by the live polio virus that is used in vaccines given orally — the preferred method in developing countries because it is cheaper and doesn’t require medical training to dispense."* The Nigerian outbreak was not the first. In 2001, 22 children were paralyzed from polio in the Dominican Republic and Haiti. "The oral polio vaccine contains a weakened version of polio virus. Children who have been vaccinated excrete the virus, and in unsanitary conditions it can end up in the water supply, spreading to unvaccinated children."*
No vaccination is completely without risk. Public health officials require certain vaccinations in order to prevent outbreaks of contagious diseases, whose costs would be far greater than the costs incurred by vaccinating.
do vaccines weaken the immune system?
Finally, some people think that the immune systems of children are being weakened by vaccines, making them vulnerable to illnesses later on in life. Quackwatch calls this misconception #7. For example, some think that their child's asthma or respiratory problems may be due to "vaccine overload" on their immature immune systems.
In fact babies have an ability, right from birth, to cope with lots of different germs. The body is constantly surrounded by germs and has to react to them in different ways. The advantage of being immunized rather than catching the disease is that the vaccine uses only part of the germ, or, if the whole germ, it is either killed or toned down (“attenuated”). In this way, the challenge to the immune system is less than that from the disease, but it is enough to produce protection.
In 2002, the Immunization Safety Review Committee of the American Institute of Medicine made a detailed examination of all the evidence about the effects of multiple immunizations on a baby’s immune system. They concluded that there was no evidence to support the suggestion that multiple immunizations overwhelm the immune system. They strongly supported the continuing use of vaccines against multiple diseases....
If immunizations are delayed, a baby will remain unprotected for longer than necessary. This could be particularly dangerous for whooping cough and Hib. Very young babies, if they catch whooping cough, are likely to be much more seriously ill than older children and are more likely to need hospital care. Babies under a year old are more likely to catch Hib than older children Studies have shown that when the vaccines are given at the younger age, babies have fewer reactions such as fever, sore injection sites etc, while at the same time they are still protected.*
There have been many well-designed studies that have examined claims that vaccines cause chronic diseases such as asthma, multiple sclerosis, chronic arthritis, sudden infant death syndrome, and diabetes. The studies have not found compelling evidence for any such links.* That has not stopped some anti-vaccinationists from speculating that some children are "especially sensitive" to vaccines and that scientific control studies can't be refined enough to validate this claim.