Aug 20 2009

August Is Vaccine Awareness Month – Who Knew?

I applaud the recent attempts by the American Academy of Pediatrics to fight back against the anti-vaccine misinformation scare-mongering machine. As part of that goal August is Vaccine Awareness Month. However, this just brought home for me how much better the PR machine is on the anti-vax side than on the side of science. Here we are half way through August and I am just learning it is Vaccine Awareness Month. This is a topic I track quite closely, and blog about frequently. Where was the media blitz? Where was the rallying of troops?

The Good

OK – it’s not all bad. They did put out an open letter with a fair number of authoritative signature. Here is a brief excerpt:

We, the undersigned, support immunizations as the safest, most effective way to control and eradicate infectious diseases. This August, as another National Immunization Awareness Month comes to a close, we are reminded that diseases such as smallpox and polio were once commonplace in the United States. Thanks to vaccinations, we have not seen or experienced many of the infectious diseases that gripped past generations, but other countries have not been so fortunate and outbreaks continue in the United States.

There is also the Every Child by Two campaign cofounded by Rosalyn Carter and Betty Bumpers (former first lady of Arkansas) and also supported by Amanda Peet. Their website is an excellent source of information on vaccine safety, the benefits of vaccines, and the risks of losing herd immunity through the efforts of anti-vaccinationists.

There is also a significant push-back coming from the scientific arena. On my own site, Science-Based Medicine, as I blogged about yesterday, we are building a resource on many topics, but starting with Vaccines and Autism because of the urgency of this topic. More and more pediatricians and scientists are starting to be vocal in this area. Dr. Joe Albietz, a pediatrician, became involved in SBM because of this issue.

Many scientific and medical organizations have publicly supported the safety of vaccine. The CEO of the American Medical Association, Michael D. Maves, M.D., made the following statement in 2008:

“Scientific data overwhelmingly show that there is no connection between vaccines and autism…We need more research to investigate the actual causes of autism, but it would be a disservice to the health of our children if we let vaccines take the blame for this tragic and complex disease.”

The fight is also international. The Young Australian Skeptics (correction – the campaign was run by a separate group – The Australian Skeptics, but the link I give is a report on the YAS site) have had particular success against the AVN (which stands for Australian Vaccination Network but is really the Anti-Vaccination Network). Sponsored by Dick Smith, they were able to put out an ad campaign against the AVN. Their efforts inspired a formal complaint against the dangerous misinformation put out by the AVN. They had great media coverage over the tragic death of Dana McCaffery from whooping cough, which she contracted largely due to the lack of herd immunity in her area, which in turn was a direct result of the AVN’s campaign.

But also – they exposed the fact that the AVN, in addition to being dangerous anti-vax loons, are also conspiracy theorists endorsing the shadowy world government known as the illuminati.

From my perspective it seems that momentum is growing. But we have an uphill battle.

The Bad

Part of the problem is that until recently those organizations that should be promoting vaccines and fighting back against anti-vaccine propaganda have either been reluctant to do so, or half just been half-hearted or ineffective. The Centers for Disease control has famously made some wishy-washy statements that are easily twisted.

As stated above, from a PR point of view, the efforts to promote vaccines and fight against anti-vaccine propaganda have been lackluster. Vaccine Awareness Month will come and go with barely a whisper.

Part of the problem is that PR campaigns run contrary to the inclinations of scientists. Scientists tend to be guarded and conservative in their statement, they avoid skimming over uncertainty and complexity, and they generally are in the business of persuading through cold hard data. Unfortunately – as a species we are moved not by data but by emotion. It has become conventional wisdom, for example, that intellectuals do not do well in political campaigns. Long explanations don’t play well – emotional manipulation does.

This causes a serious dilemma for scientists and skeptics – how do we hold true to our dedication to good science and intellectual honesty while still being persuasive. I think it can be done, it’s just not easy. Of course, the other side can optimize their message for maximal emotional appeal, sound bites, and manipulation. They are not constrained by science or intellectual honesty – so the playing field is definitely not level.

But there is a lot that can be done without any compromise of message or integrity. We have the data on our side, after all. And the efforts of the anti-vaccine groups are misguided, based entirely on misinformation, and they are very dangerous, and have caused real harm. We have plenty of PR ammunition with the truth – we just have to use it. We need more op-eds by scientists explaining the importance and safety of vaccines. We need to respond quickly to misinformation. We need to grab media attention away from the antics of the anti-vaccinationists. And we need to hold media outlets accountable for propagating dangerous health misinformation

The Dangerous

The recent H1N1 pandemic and efforts to stem the tide of infection through vaccination is a great opportunity to teach the public about the importance and potential of vaccines. Instead I am seeing a wave of anti-vaccine misinformation. Some of it, I think (I can’t really know) is just lazy journalists who haven’t done their research. Two articles in a local online news outlet, the Examiner.com Hartford, seem like lazy journalism (which seems to fit the low standards of this paper, which seems to be mostly a glorified blog collective).

Ed Kellner wrote a piece: Autism worries raise concern about swine flu vaccine, in which he makes some blatantly false and reckless statements, such as the myth that mercury poisoning has been linked to autism. He then gives the standard sciencey statement from the CDC followed by a long list of false claims and misleading statements by the anti-vaccine Autism Research Institute. This wasn’t even false balance – this was grossly slanted toward the cranks. Kellner never mentions that thimerosal was removed from the vaccine schedule in the US by 2002 and yet autism rates continued their rate of increase without any change.

Jennifer Tinch then follows up with Flu Vacciantion Side Effects – Guillian Barre Syndrome. She uses anecdotal accounts to scare her readers about the risks of GBS from the flu vaccine – without ever quoting actual scientific data, such as the fact that the risk of GBS from the flu vaccine is about one in a million. I already dealt with the GBS issue here, so I won’t repeat it. I wonder if the examiner.com is going to become Hartfords answer to the Huffington Post. Let’s hope not.

There is lazy journalism, and then there is giving a voice to a known anti-vax crank. The daily green published an article by Deidre Imus (wife of shock-jock Don Imus, also an anti-vaccine conspiracy theorist). She wrote an article called The 6 Do’s and Don’ts of Childhood Vaccines. This is framed as a friendly health advice column, as if Imus is distilling conventional wisdom from trusted sources. Instead, she is just repeating the talking points of the anti-vaccine movement.

She warns against thimerosal. Tells parents to as if vaccines are really necessary, suggesting that some may not be. She repeats the myth (summarized as “too many too soon”) that vaccines should be spread out more. She also plays the “toxin gambit” by pointing out there are “toxins” in vaccines, like formaldehyde. She fails to mention that we have more formaldehyde naturally in our bodies – this is a chemical that is normally byproduct of certain biochemical reactions. There is also no evidence that it is harmful in the doses present in vaccines. This is pure scare tactics.

But the PR machine of the anti-vax movement is well-funded and effective. They have slick websites, celebrity backers, and good slogans (you gotta give it to them for “green our vaccines.”) It appears they have swindled some of the liberal press into thinking that anti-vaccine propaganda is a liberal issue, while simultaneously playing to the anti-government conspiracy minded on the right (well-played).

Conclusion

Despite having the facts overwhelmingly on our side, we are definitely behind the PR curve and are playing catch-up. But this is an issue we can tackle, because the evidence is so clear.

Vaccines work – they are the most effective public health measure devised by humans.

Vaccines are safe – nothing is without risk, but vaccines are one of the most tried-and-true medical interventions we have. The risks are statistically tiny and overwhelmed by the benefit.

Herd immunity saves lives – getting vaccinated protects others, not just yourself or your children.

Anti-vaccine misinformation kills. Dana McCaffrey is just one example, but a tragic one. We are seeing measles and mumps outbreaks. The flu continues to kill half a million people world wide every year, and we do not yet know how serious the H1N1 pandemic will be. The Jenny McCarthy Body Count website tracks the incidence of vaccine-preventable diseases and deaths.

This is a fight we can win – this time the scientific data and emotion are on our side.

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24 responses so far

24 Responses to “August Is Vaccine Awareness Month – Who Knew?”

  1. papadopcon 20 Aug 2009 at 9:38 am

    Dr Novella,

    I do applaud your campaign against the anti-vax pseudoscience, but I do have a question regarding the whole H1N1 brouhaha.

    I was recently in Greece, where the scare tactics of the media have created a big issue about swine flu and at times it sounds like every single person needs to be vaccinated against it.

    Do you think that would be a good idea?
    My understanding is that although vaccines are a great tool against diseases, they are not 100% risk free either.
    Is it justified then to expose huge numbers of people even to small risks, if the disease we’re trying to fight is also mild (in most cases anyway)?

    Keep up the good work!

    Chris

  2. skellioton 20 Aug 2009 at 10:20 am

    Hi Steve,

    Thanks for the link! Appreciated.

    Correction though, it was the Australian Skeptics who posted the ad I think you are referring to.

    The facebook campaign and petition are a good cause though so please go ahead and sign it and join the facebook page and help stop the AVN!

    Elliot Birch
    Young Australian Skeptics

  3. son 20 Aug 2009 at 10:20 am

    Vaccines are a boon, but they are not totally without risk. Certain individuals are more prone to immune overreaction due to the use of adjuvants like aluminum hydroxide and squalene. It is important to identify the mechanisms (genetical, lifestyle and health at vaccination) to minimise onset of chronic autoimmune disease and other possible complications. See e.g. (note that article is in french) Gherardi RK. [Lessons from macrophagic myofasciitis: towards definition of a vaccine adjuvant-related syndrome], Rev Neurol (Paris). 2003 Feb;159(2):162-4.

    To quote from the abstract:
    “Even in the absence of overt autoimmune disease they commonly show subtle signs of chronic immune stimulation, and most of them are of the HLADRB1*01 group, a phenotype at risk to develop polymyalgia rheumatica and rheumatoid arthritis. Macrophagic myofasciitis is characterized by a stereotyped and immunologically active lesion at deltoid muscle biopsy. Electron microscopy, microanalytical studies, experimental procedures, and an epidemiological study recently demonstrated that the lesion is due to persistence for years at site of injection of an aluminum adjuvant used in vaccines against hepatitis B virus, hepatitis A virus, and tetanus toxoid.”

    and;
    Kuroda Y et al Distinctive Patterns of Autoimmune Response Induced by Different Types of Mineral Oil, Toxicological Sciences 78, 222-228 (2004)

  4. skellioton 20 Aug 2009 at 10:23 am

    Also, it is worrying that she believes in Illuminati conspiracy theories. There was a post on their mailing list which I wrote about on the Young Australian Skeptics website too. This is what is considered evidence to the Australian Vaccination Network.

  5. superdaveon 20 Aug 2009 at 10:29 am

    Number 5, “Vaccines are a boon, but they are not totally without risk. ” seems to be the most relevant sentence in that post. It is nice to know people are doing research to try to fully understand why these reactions happen, they will pave the way to make vaccines even safer.

  6. son 20 Aug 2009 at 11:00 am

    The best solution would of course be to dispense of “adjuvants” altogether and/or individually adapt immunizations (based on the interaction between the genetic basis of individual immune reactions and environment) and also preferentially inoculate in the same way a pathogen normally enters the body to elicit a more appropriate immune response. I.e. by e.g nasal spray for influenzas (“LAIV”). By ingestion for other pathogens and so on. But that is still in the future.

  7. rc_mooreon 20 Aug 2009 at 11:55 am

    In celebration of Vaccine Awareness Month, the Journal of American Medical Association has decided to give the anti-vax movement the best present possible:

    http://jama.ama-assn.org/cgi/content/full/302/7/795?home

    They have now validated and given authority to the techniques of the anti-vax movement. “Vaccines are unsafe, slip through our testing system (which is corrupt) and don’t believe me, believe JAMA.”

    This is a disaster.

  8. Calli Arcaleon 20 Aug 2009 at 12:01 pm

    You can’t dispense with adjuvants; since the vaccine is designed to not make the person sick (i.e. the antigen isn’t pissing off your immune system), you need to add something else to call your immune system to arms. Otherwise, it won’t realize that it should form an antibody to the stuff that just got injected.

    As far as avoiding vaccines for those prone to “immune overreaction”, be careful there as well. If you are prone to life-threatening immune reactions, vaccination may be even more important. Seriously. Think of it this way — if you’re immune system reacts like this to the vaccine, imagine what it’ll do if it encounters the real thing! You’ll have to look at each available vaccine and decide whether or not the risk of contracting the real disease outweighs the risk of GBS or another adverse effect — and decide whether or not you need to take special measures to avoid infection with the real disease if you could not receive the vaccine. For instance, if your child reacts violently to certain vaccinations, the best approach might be to vaccinate the hell out of everybody else in the family.

  9. Steven Novellaon 20 Aug 2009 at 12:03 pm

    s – you make some factual claims – that the “best solution” is to dispense with adjuvants (when in fact they are there to improve the effectiveness of the vaccines) and that other methods of immunization provide an “appropriate” immune response.

    These claims require evidence and more precise definition.

  10. rc_mooreon 20 Aug 2009 at 12:13 pm

    In response to “Vaccines are a boon, but they are not totally without risk.”

    I live in a very polluted area of the U.S. It is quite easily demonstrated that for me “Breathing air is a boon, but not totally without risk”.

    Ok, I see the fallacy in that comparison — air is required to live, vaccines are not. But still, the risk of deadly epidemics is so great, does it make any sense to worry about vaccination risks?

    I am recovering from pertussis, it has taken over a year, and it almost killed me. We eliminated pertussis several decades ago, and now it is back, and the anti-vax movement is stymieing efforts that would have been a given in the 1960′s.

    As a nation, as a world, we are losing something — the willingness to move forward, even when risk is involved.

  11. daedalus2uon 20 Aug 2009 at 12:23 pm

    A great many compounds act as adjuvants and will cause adjuvant arthritis; essentially anything hydrophobic including mineral oil (straight chain hydrocarbons greater than C12), vegetable oil (olive, corn and safflower), esters, silicone oil, vitamin E, vitamin E acetate.

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=4214125

    Squalene is a normal product of metabolism, is an intermediate in cholesterol synthesis and is the most abundant lipophilic constituent of sebum after lipid (triglycerides) at 12%. The primary reason to use adjuvants is that it takes less antigen and a better immune response is generated. Adjuvant induced arthritis is more difficult to induce with Squalene than with mineral oil.

    If supplies of antigen to make vaccines is in limited supply, then adjuvants are essential to cover more individuals.

  12. son 20 Aug 2009 at 3:41 pm

    “s – you make some factual claims”
    There should have been a “Maybe” at the beginning (Maybe the best…). My error. I am not making claims. I am just musing aloud, which was not apparent due to the missing ‘maybe’.

    Yes I am aware of why adjuvants are used, but thanks Calli and Daedalus for clarifying my muddled musings.

    What I muse about is if vaccinations, from an evolutionary viewpoint, should be done differently. Evolution is often dismissed as irrelevant to solving acute disease. But understanding the co-evolution of e.g. pathogens and the human host is often very useful (may I mention allergies…).

    E.g. we could ask ourselves and test if immune response differs in any significant way between different modes of administration (mucosal, transcutaneous, intramuscular, intravenous, enteral) of the same vaccine. How adjuvants affect these diverse routes. And how individual genetic etc differences affect these routes.

    Research indicate that this is the case, but I have not been able to find any comprehensive review.

    Maybe, and I muse again, it would then be possible to dispense with adjuvants and elicit a response more similar to a “natural” response.

  13. daedalus2uon 20 Aug 2009 at 6:24 pm

    Adjuvants are completely natural. Why does the skin have so much squalene in it? Could it be so that when there is disruption of the skin by an infectious organism, be that animal, vegetable or mineral, the natural skin lipids prime the immune system to mount a stronger attack on things now coated with skin lipids?

    The ultimate fate of antigens is much the same regardless of their mode of entry, they are engulfed by cells that digest and present the antigens on their surface primed with other molecules that are recognized by cells that generate antibodies to those antigens. This happens in lymph nodes which are throughout the body. The cells that it occurs in are pretty much the same. There may be differences, but those differences are hard to measure, they are likely idiosyncratic and will change from day to day and depending on the state of the individual.

    Social stress acts as an adjuvant too.

    A lot more could be known about vaccines, but that is basic research which is very hard to do. The immune system is very complex and not well understood. It has complex genetics and those genetics are not well understood. There is no genetic test that could be used to tell how a vaccine would or would not work.

  14. halincohon 20 Aug 2009 at 8:07 pm

    Years ago I listened to Imus because I thought his show an interesting venue to listen to politicians speak a little more candidly than usual.

    Then came the anti vaccine nonsense and I stopped listening because I couldn’t tolerate my own screaming at the radio as I drove to work each day.

    As you suggested during a conversation we had ( don’t worry , I don’t pretend one bit that you remember our specific conversation ) at Rebecca’s party, it will require a diverse counter-attack to minimize their PR machine.

    It will take old media and new media personalities and messages, old media and new media writers, serious journalism and down and dirty comedy. It will also take those of us who work in the trenches.

    Though those of us who administer vaccines, (we pediatricians , FPs , PAs or NPs ) , must manage our time aggressively, we must spend whatever time it takes in our office to inform those parents who are misinformed. We must do so in our offices and we should consider doing so in our communities at large. If we don’t DIRECTLY combat this LOUDLY, it will only make the task at hand that much more difficult. I think most of us do take the time to take apart the anti vaccinationist’s arguements, but I can only assume, as most things in life, it isn’t 100%.

  15. son 21 Aug 2009 at 6:11 am

    Did finally find some relevant papers on differences between vaccination elicited immunity and natural infection elicited immunity. In the Mayo Clinical Proceedings article “Flu Myths: Dispelling the Myths Associated With Live Attenuated Influenza Vaccine” the authors sum it up: “The immune protection conferred by natural infection is thought to result in a broader immunologic response, including induction of local IgA nasal mucosal antibodies, cell-mediated cytotoxicity, and serum antibodies.37-47″

    http://www.mayoclinicproceedings.com/content/83/1/77.long

  16. Steven Novellaon 21 Aug 2009 at 7:04 am

    s – irrelevant. Getting the flu or getting the flu vaccine only partially protects from next season’s flu as the flu viruses constantly mutate to new strains.

    The bottom line is this – if you get the flu one year, you can still get it again. If you get vaccinated one year, you can still get the flu that year and following seasons. You will have some immunity, but not enough to prevent getting the flu again. (i.e. getting the flu to prevent the flu makes no sense.)

    Without the vaccine, you are susceptible to getting the flu every year. With it, your chances of getting the flu are much less. And your chance of infecting other people are less – just as if other people get vaccinated they decrease your chance of getting the flu.

    The only real comparison that matters is risk vs benefit, which favors getting the vaccine.

  17. daedalus2uon 21 Aug 2009 at 9:25 am

    s, I agree with Dr N, you are using the “perfect is the enemy of good” argument. Because vaccines don’t provide perfect immunity they are harmful because there are side effects. What ever the imperfection of the immunity that vaccines provide, it is demonstrably better (via numerous clinical trials) than nothing (which is what the absence of vaccination provides).

    I suspect that any vaccination that did sufficiently stimulate the immune system to provide the same level of protection as a natural infection would have essentially the same side effect profile as that natural infection. If you gave vaccines with antigen doses that stimulated the immune system enough that you killed the same fraction that the natural infection kills, I think the survivors would have a better and more robust immune response, just that there would be fewer of them because of the fatalities.

  18. son 22 Aug 2009 at 9:31 am

    OK guys,

    next argument:

    Check this page: http://www.vaclib.org/intro/present/index2.htm . This shows why anti-vax movement (probably) will not go away (soon) despite lots of argumentation otherwise. Unless a good medical, societal and evolutionary explanation can be given as to why (*assuming their graph represent correct stats*) a decline can be observed before the introduction of immunization programs.

    One simple explanation is of course better hygiene and cleaner water surces leading to a better helath in the general population. Are there other explanations?

    The data seems correct btw as a check of the following articles indicate: http://jama.ama-assn.org/cgi/content/abstract/281/1/61, http://www.ajph.org/cgi/content/abstract/89/12/1883 and the “Annual Summary of Vital Statistics” published in Pediatrics.

  19. daedalus2uon 22 Aug 2009 at 10:55 am

    The decline observed was in death rates and in severity, not in the number of cases. People still got the diseases, they just didn’t die from them. They died from other things. Antibiotics and prevention of secondary infections likely played a role.

    One explanation that I have is that the decline in NO levels following the increased sanitation skewed the immune system to greater basal activation and increased systemic inflammation (NO inhibits NFkB and is the normal “off” signal for inflammation and the immune system). This increased immune system activity increased resistance to infectious diseases, but caused adverse effects such as autoimmune disorders, heart disease, and cancer (chronic inflammation is a carcinogen).

    Low NO does increase the sensitivity of mast cells to degranulation. Immune cell activation causes a “respiratory burst” which generates superoxide which lowers NO levels local to the activation.

    I suspect that reducing the threshold for triggering the immune system is the mechanism behind the use of mercury as a therapeutic since antiquity. Mercury does induce a state of oxidative stress, which is a low NO state, and that could reduce the threshold for triggering the immune system. Mercury can induce autoimmune disorders. Children were given gigantic quantities of mercury in teething powder (~55,000 micrograms per dose) during the first half of the 20th century. Deaths due to pink disease (aka mercury poisoning) were not small. Pink disease in the years 1947 plus 1948 killed 174 children. All other causes killed 585. In other words, 23% of child deaths during that time were from mercury poisoning.

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=14821416

    Maybe going back to giving infants teething powder containing mercury would reduce the death rate due to measles if those infants were not vaccinated and measles became endemic again. Vaccinating them instead would be a lot better.

  20. son 23 Aug 2009 at 2:35 pm

    “I do applaud your campaign against the anti-vax pseudoscience,”
    Is it?

    The following is long and not a discussion about thiomersal and adjuvants in vaccines, but about actual demographic facts.

    Mortality figures show that childhood survival increased drastically with the introduction of clean water, better health care, better living conditions and a general increase in income leading to better general health. The only (global) mass vaccination prior to the 1950ies was smallpox vaccine.

    So I believe it correct to say that in developing countries of the western world vaccination played a minor role in the drastic diminuition in deaths and disablity caused by common childhood diseases prior to 1960. When antivaxers refute the effect of vaccination they may base themselves on that fact, which is correct. On the other hand pro-vaccination advocates may base their argument on effects in underdeveloped countries and on “residual” cases in developed countries. So both parties may present correct arguments.

    Has thus vaccination had any effect on mortality in developed countries from about 1960 and on. Most likely. Research indicate that even in the western world vaccination benefits are greater than the sum of adverse effects *if* proper substance testing is performed. If not, as, e.g., in the case with early polio or the 1976 H1N1 vaccine in the US, vaccination will cause an increase in mortality.

    N.B. that the 1976 swine flu was contained to Fort Dix and that *no* epidemic outbreak was seen in the US, nor any pandemic.

    Thus (“demographic”) anti-vaxers are again sort of correct, despite maybe ignoring that, at least as far as we currently know, the overall effect of vaccination *has decreased the even low rates of childhood mortality* that are occuring in developed western countries. So when anti- and pro-vaxers quarrel they essentially are both correct. But why are the arguments for vaccination ignored by some anti-vaxers? Why do some parents prefer not to vaccinate? Barring religious fundamentalists and plain “pig-headed” people, some of the cheering and jeering on these pages are one cause. When authoritharian argument is slammed on your head under the guise of sound skepticism, some people will react by closing their ears and just ignore any further argument.

    I personally believe that a more generous attitude and a discourse both accepting that *vaccines were not the major player* in mortality decrease under “western conditions” and explaining the differences between societal development and vaccination impact would benefit the debate. A more open, i.e. better explanations for the layman, of vaccine adverse effects and trade-offs, that are easily found described in PubMed or the NIH VAERS registry (yes I know that VAERS may contain non-vaccine related cases).

    Real world proof?
    Is there the proof, not from anti-vax sources, for the argument that vaccines were not a major player for western countries?

    Yes, there is. The best statistics are probably those of Sweden and Finland. The first census was made in 1749. And “modern” statistics began in the mid 19th century published in BISOS and its followers.

    As shown by elaborations of the statistics decadal epidemic mortality rates (rounded figures taken from diagrams in ref (3)) where about 1300/100000 in 1749-1757, approximately 400/100000 (under 0-10y approc 240/100000) around 1840 (before the beginning of variola vaccination) and about 2/100000 (0-10 approx 30/100000) by 1950. That is, before the beginning of mass vaccinations other than variola. (The spanish flu caused an increase.) The same trend can be seen regardless of age group although no spanish flu bump is noticed for 0-19 years old.

    The swedish smallpox (variola) experience
    Did smallpox inoculation cause most of the mortality decrease? No! but since its beginning around 1801 (compulsory from 1816) death rates fell from 50/100000 to almost zero by 1875. It is of interest to note that smallpox mortality decreased rapidly from 450/100000 in 1750 to 50 (as mentioned above). So even smallpox inoculation did not cause a major decrease in mortality, and it likely had no part (indirect or not) in the decrease in all cause mortality from 1870 to about 1960.

    So regardless of vaccinations Swedish all cause mortality diminished rapidly from about 1300/100000 in 1750 to almost zero in 1950. Thus the anti-vaxers are correct: vaccinations are worthless, or?

    Well not quite, but almost, if the statistics are broken down per age group “residual” mortality for the 0-10y age group is still about 30/100000 in 1950. So when pro-vaxers talk about the advantage of vaccinations they obviously (?) refer to these residual numbers.

    The swedish whopping cough (pertussis) experience
    In Sweden no pertussis vaccinations were performed between (and including) 1979-1996. Did the unvaccinated children get infected? Yes, 60% had had clinical pertussis before age 10 and 90% had anti-bodies. Did lots of kids die? No! only six previously very ill and/or premature children died. Ok how many children died after vaccination began anew in 1997? Seven children (also weak and premature). So during the 17 years with no vaccination 6 died. During the 12 with vaccination seven died.

    I.e. more died with vaccination in place than without…

    And you wonder why anti-vaxer belive vaccination is bullshit? How is this easily explained? N.B. I talk about mortality here not incidence rates. Those obviously declined.

    So, yes, the vaccine proved its effectiveness by lowering the incidence, and also the opposite by not decreasing infant deaths. Why the very similar death rate? Maybe because most of these children are under 3 months of age (when the first vaccine shot is given). If that is the case what is the point of the vaccine anyway? (I have not managed to find any figures of incidence of severe CNS complications and survival).

    Effective vaccination–busted?
    Not quite, but let’s face it: for western countries, good sanitation, proper care and feeding and good physical health of the children is far more important than the (common childhood disease) vaccines per se. I may venture to assume that ultimately most deaths prior to the inception of vaccination were mostly caused by bad health and injuries, not by the proximate infectious disease. When sanitation etc improved, health improved and most individuals immune system was able to fight off any infection. As the swedish pertussis experience show it is still mostly immune weakened individuals that die.

    Questions remaining to be answered
    To be properly skeptic you also do need to be skeptic by assertions by authority and plain tradition. Vaccinations are pretty obviously much less important than sanitation etc. But do vaccines decrease child and infant mortality in underdeveloped countries with bad/absent sanitation? Well I do currently not know. Stats would be interesting indeed.

    Speculative
    Another interesting question is the Spanish flu mortality of young adults. Were these immune weakened individuals that would have died anyway, or do they represent “overmortality”. An initial and cursory look and english stats show no permanent “overmortality” as with the WW1 and WW2 age groups, So the 1918 flu may just have hastened the death of individuals that had health issues.

    Is there proof? Maybe. The 1971 UK population pyramid shows a clear WW2 notch for 50-60 y old (born 1909-1919). No corresponding notch for those born around 1895-1900 (20-25 during the spanish flu). Also the Swedish pyramid shows a WW2 flattening, but no outright notch as no Swedish soldiers fought in the war, and also no overt flu effects. Is this because, as I mentioned, only individuals with impaired health were struck down? Yes this is extremely over-simplified, but never the less…

    And maybe not. Flu and WW1 may also be superimposed as norwegian research indicates. See (10) for an in depth analysis not quite agreeing with my above musings on 1918 ;-)

    Why vaccinate?
    So. Is it so that it is a monetary question? Is it so that neither society nor parents can afford to stay at home and care for a child for up to 10 weeks? Is that the real cause for gov’t and employer wishes for vaccinations? Or is it because of un-selfish wishes? The discussion surrounding the current swine flu debate may makes me wonder.

    Well I am for sure less convinced of the need of vaccinations (for normal healthy people that can afford to stay at home) after this weeklong tour of the literature after Steven slammed me for not giving sources after my initial musing with its forgotten ‘maybe’.

    Select sources
    (1) Population development in Sweden in a 250-year perspective (http://www.scb.se/Grupp/Hitta_statistik/Historisk_statistik/_Dokument/Befolkningsutvecklingen_under_250_ar_Historisk_statistik_1700talet_1800talet_1900talet.pdf)
    (2) Mass vaccination: global aspects – progress and obstacles, Stanley A. Plotkin (ed.)
    (3) The two faces of smallpox – a disease and its prevention in eighteenth- and nineteenth-century Sweden. P Sköld. (summary here http://asclepio.revistas.csic.es/index.php/asclepio/article/viewFile/136/133)
    (4) Ten Year Report – Pertussis surveillance in Sweden Progress Report October 1, 1997 – December 31, 2007 with an executive summary (4:2008) (http://www.smittskyddsinstitutet.se/upload/SMI-rapport nr 4-2008.pdf)
    (5) Brit population pyramid http://www.statistics.gov.uk/populationestimates/svg_pyramid/uk/index.html
    (6) Swedish ditto http://www.h.scb.se/kommunfakta/pyramider/index.asp
    (7) Mamelund SE. A socially neutral disease? Individual social class, household wealth and mortality from Spanish influenza in two socially contrasting parishes in Kristiania 1918-19, Social Science & Medicine 62(4), 2006, 923-940
    (8) Mamelund SE. Spanish Influenza and Beyond: The Case of Norway, Ph.D.-thesis, Department of Economics, University of Oslo, 2004.
    (9) Mamelund SE. Can the Spanish Influenza Pandemic of 1918 Explain the Baby Boom of 1920 in Neutral Norway?, Population 59(2), 2004, 229-260.
    (10) Mamelund SE. Effects of the Spanish Influenza Pandemic of 1918-19 on Later Life Mortality of Norwegian Cohorts Born About 1900, Memorandum 29, Department of Economics, University of Oslo, 2003.
    (11) Reflections on the 1976 Swine Flu Vaccination Program (http://www.cdc.gov/ncidod/eid/vol12no01/05-1007.htm)

  21. Steven Novellaon 23 Aug 2009 at 2:59 pm

    s – The argument we are contradicting by some anti-vaxers is that vaccines do not work. Vaccines clearly work. The data also supports that the benefits outweigh the risks (even in developed nations) and that they are cost effective. How much benefit they have compared to other interventions is not really relevant. (This would only be relevant if we were trying to decide to pay for vaccines or something else because we could not afford both.)

    Further, while I think we can always do a better job of public education, most official efforts to educate the public about vaccines are completely open and accessible, discussing risks and side effects openly. Have you taken a look at the CDC vaccine page – quite a lot of info there for the public. http://www.cdc.gov/vaccines/

  22. son 24 Aug 2009 at 6:14 am

    Hi Steven,
    the CDC page sucks: most normal people will react with schock and dismay at the clutter of information and never bother to go there again.

    Anyhow, you avoid my main argument that: “for western countries, good sanitation, proper care and feeding and good physical health of the children is far more important than the (common childhood disease) vaccines per se”.

    Sensible public info through TV and printed media is better. And acknowledging that vaccines cover the “residual” mortality not covered by “sanitation” would sure help.

    When you quote that “…Thanks to vaccinations, we have not seen or experienced many of the infectious diseases that gripped past generations…” you support, from a demographic viewpoint, an erroneous conclusion, which anti-vaxers pretty correctly can construe as a plain lie.

    If we ignore the anti-vax loons and focus on the “demographic” argument I am willing to concede their point, no question about it they are correct. But I would then also to proceed to discuss the pros and cons of helping the “residual” cases survive. And I do believe that even a sensible anti-vaxer would be hard pressed to deny the benefit for those.

    And finally:
    Re “herd immunity” it would from an evolutionary standpoint be better if weak individuals died. So that argument is just pointless. Better to acknowledge that our modern society has as a goal to minimize deaths from disease (for those able to pay for health care).

  23. carykohon 25 Aug 2009 at 11:59 am

    @s
    The CDC page may be difficult to navigate, probably the easiest thing to do is check out the CDC Pink Book, it has very easy to interpret graphs that clearly show how vaccines have had a profound effect on diseases. You clearly are at least somewhat internet literate since you were able to pull so many links in your previous post, so the idea that you couldn’t navigate the CDC site seems somewhat ingenious, but again, just check out the Pink Book if it is that troublesome, I can provide a link if necessary. I also would like to note that antivaxxers like yourself never seem to mention H.flu in discussions of hygiene and nutrition. This vaccine was introduced in the early 90′s, I doubt much has changed in hygiene and nutrition since then, yet the number of cases of invasive H.flu, i.e. epiglottitis, periorbital cellullitis, meningitis, has dropped to nearly zero since the vaccine was introduced. A great article on herd immunity is written by Mark Crislip on SBM if you actually want to know more about it. Your last statement is just plain odd, of course our modern society has a goal to minimize death from disease, and vaccines are incredibly cost effective in this respect, not sure your problem with that.

  24. son 29 Aug 2009 at 10:05 am

    carykoh,
    you make many false assumptions. I am not an anti-vaxxer, I am just a skeptic.

    So let me begin by making the false assumption that you are a skeptic too, and thus present this lesson in skepticism for your enjoyment: “Relation of study quality, concordance, take home message, funding, and impact in studies of influenza vaccines: systematic review” BMJ 2009;338 by the Cochrane vaccine coordinator T Jefferson et al.

    To quote: “Higher quality studies were significantly more likely to show concordance between data presented and conclusions (odds ratio 16.35, 95% confidence interval 4.24 to 63.04) and less likely to favour effectiveness of vaccines (0.04, 0.02 to 0.09). Government funded studies were less likely to have conclusions favouring the vaccines (0.45, 0.26 to 0.90). A higher mean journal impact factor was associated with complete or partial industry funding compared with government or private funding and no funding (differences between means 5.04). Study size was not associated with concordance, content of take home message, funding, and study quality. Higher citation index factor was associated with partial or complete industry funding.”

    Re the CDC Vaccine Pink book I notice that you went out of your way *not* to mention all diagrams showing that incidence and/or mortality was close to zero long before vaccination of e.g. common childhood diseases began (hmm selective choice of data presented… are you anti-something). Read my ’23 Aug 2009 at 2:35 pm’ post on residual mortality and historical mortality to understand what I am talking about. That good sanitation and health is the great victory, (but do also see my quote at the end) not the eradication of residual mortality — which of course is good too. (And it would be even better to know what environmental or genetic causes are behind this residual mortality…)

    And to counter your ad hominem slur on “internet literacy” I may just note that if you had understood the meaning of the english words in “the CDC page sucks: most … never bother to go there again.” it would had been pretty obvious that I expressed a sentiment about the obvious absence of any usabilty testing done by the CDC on the public usability of said page. E.g. the first link eminently shown for those interested in an overview of the vaccination from 1960 and on, should have been a link to the “Pink Book”.

    Re your comment about my comment on herd immunity I assume you missed my reference to evolution. From an evolutionary standpoint it is irrelevant how herd immunity in any population is aquired, but it will improve if individuals less well adapted to the disease are removed from the gene pool, i.e. die, as that selects for resistant individuals.

    To end with some food for thought from S Gupta (Infection, Genetics and Evolution 4 (2004) 69–75): “A more obvious consequence relates to the challenge of emerging disease in a context where exposure to natural related pathogens is much reduced. … They are those diseases whose threat has been greatly reduced without any obvious intervention that pose the greatest problem here. While improved “living conditions” might have lowered our exposure to a range of pathogens, they may concommitently have increased our susceptibility as a population to their more pernicious cousins.”

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