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The Truth about Vaccines: It’s Nuanced

The Truth About Vaccines
By: Erin Stair, MD, MPH

If this read is complicated, good. The truth about vaccines is a nuanced story.

If you have anything to do with the “wellness” industry, you will encounter people who curse vaccines. They’ll tell you that vaccines are the devil and the cause of a laundry list of health problems. The most popular accusation is that vaccines cause autism. If you argue against the diehard anti-vaccine people and state that vaccines are not Satan’s tools, and some vaccines save a lot of lives, you will be shunned and dubbed a disciple of Big Pharma and a traitor to the world of wellness. It makes me ask, “Where is the middle ground? Where is the logic?” 

Unfortunately, logic plays second to a privileged mindset. The anti-vaccine enthusiasts mostly live in developed countries that haven’t faced a killer of an epidemic since the mid-1900s. That’s a privilege. You’ll find less of the anti-vaccine people in countries like Niger, Chad, Syria or Papua New Guinea. Those countries regularly face formidable killer diseases such as bacterial meningitis and polio. Rich countries don’t have to worry about those illnesses, because they have gotten them under control with vaccines. When developed nations face a killer epidemic again ( We will, and it will have a higher case fatality rate than COVID-19),  I think mostly everyone will be banging on the pharmacy’s door and begging to be vaccinated.

But…do people who question the safety of vaccines have any legitimate concerns? Yes, I believe they do. The truth about vaccines is nuanced, and I will address those concerns after I make some important points about vaccines that often get taken for granted.

The US has faced significant killers in the form of viruses. There was the Spanish influenza pandemic of 1918 that killed 20 to 40 million people worldwide, including 675,000 Americans. My great grandmother was one of them. My mom tells the story of her going to a wake for a friend who died of the flu, coming home, feeling ill, and then dying 3 days later of the flu. It is estimated that half of the deaths of American soldiers stationed in Europe during WWI were due to influenza. My guess is if you asked any one of the 20 to 40 million people on their deathbeds if they would have liked to receive the flu vaccine, most of them would have said yes. Unfortunately for them, the flu vaccine didn’t materialize till the 1930s and 40s.

Sadly, the AIDS epidemic of the 1980s stands out as a case of gross ignorance on the side of the US. AIDS research was delayed because of homophobia. It’s that simple. In the beginning, AIDS mostly impacted and killed gay men, and because of that, it was ignored by the government, media and public health officials. When we finally addressed it, AIDS was widespread, global and affected men, women and children. In 2019 there were 1.7 million new HIV infections and 690,000 AIDS-related deaths. In sub-sahara Africa, women and girls account for 59% of new HIV infections. We’ve made tremendous progress in terms of medication and treatments, but we still don’t have a vaccine for HIV or AIDS. But, we’re working on it. Given the enormous mortality rate of AIDS, I can’t imagine anyone being against an AIDS vaccine.

While we are currently battling COVID-19, it doesn’t seem to scare people as much as historical epidemics. But imagine if COVID-19 was more like Smallpox. Folks would probably react differently. Because many of us haven’t faced the horror of massive amounts of death from a viral epidemic, we feel entitled to bash public health measures, such as vaccines, that have prevented or helped stop these epidemics. This is why the anti-vaccine movement is a privileged one. The truth about vaccines is that the anti-vaccine movement exists because vaccines were too successful. (Mind you, I am not talking about folks who have legitimate concerns about vaccines. I am talking about people who are against vaccines, period.) Poor Countries are not privileged enough to wage an all-out war against vaccines, because they are busy dying from numerous diseases, several of which are preventable with vaccines. Because they are poor, have dismal infrastructure and dismal healthcare, most don’t have access to the vaccines they desperately need. 

Take meningitis in Africa. Every 8 to 12 years during the African dry season, outbreaks caused by the bacteria Neisseria meningitidis group A sweep across the continent and kill a lot of people. A lot of kids die, because Meningitis targets young people. In 1996-1997, the outbreak was so huge that 250,000 people were infected and 25,000 of them died. In 2009, 88,000 people became ill from meningitis. If the meningitis doesn’t kill the infected person, he/she will often suffer lifelong consequences, such as mental retardation and deafness. Many people in Africa live long distances from health clinics and hospitals. Often times if a child is struck ill, the parents decide against making the trip to the hospital and instead choose to keep their child at home, as comfortable as possible, until he/she dies. Do you think there is a strong anti-vaccination movement there? Not so much. Luckily, due to private donors like the Gates Foundation, the World Health Organization, PATH and the Serum Institute in India, a vaccine was developed specifically for meningitis in Africa. The Meningitis Vaccine Project (MVP) was started. In 2011, 1.8 million children and young adults received the vaccine and the incidence of meningitis in 2012 was 2.5 per 100,000 people as compared to 43.6 per 100,000 people in places where people were not vaccinated. That is an amazing difference! Clearly the meningitis vaccine saved a lot of lives. Even more remarkable? No one complained of vaccines.

A lot of people will argue that vaccines are only necessary in underdeveloped countries because they have poor infrastructure, especially when it comes to water supply, wastewater cleanup and healthcare. That is somewhat true for some viruses. It’s fair to say that if they didn’t live so close to one another or had cleaner water, a healthier diet and a better sewage system, people would get less viruses that spread via close contact or the fecal-oral route. It’s also true that more advanced medical care can better treat viruses and help prevent death. But you don’t even have to compare a developed nation, like the USA, with an underdeveloped one. You can make a similar analogy right here in the US. Take COVID-19, the current pandemic: While it can infect and kill anyone, the death rate is higher for underserved minorities. These are people who live in crowded neighborhoods or crowded homes and have to take mass transit to and from work. Many are obese ( a significant risk factor for severe COVID-19 infections) due to living in areas with an abundance of fast, unhealthy food and a lack of healthy options. These folks often have poor health insurance and reduced access to quality care. Whatever their situation may be, I think we can make the generalization that they would benefit from a vaccine more than folks with good jobs and good health insurance, who live in richer, cleaner, less crowded, less dense homes and neighborhoods, with an abundance of healthy food and green space.

The other thing to remember is that some killer viruses don’t target “poor” people more than rich people. Take polio for example. Polio is a virus that enters via the mouth, travels into the small intestine and is excreted in the stool. It can infect the CNS via the bloodstream, and when it does, it can lead to severe muscle weakness and paralysis. Bulbar polio, its worst version, causes paralysis of the breathing muscles, which often leads to a horrible death. Between 1910-1914, polio outbreaks often occurred in middle class, rural areas of the US, not in the impoverished, crowded areas of cities. People often blamed “immigrants,” crowded, dirty areas, poor sewer systems, stray cats, and other mangy critters for viral illnesses, but Polio didn’t work like that. Around this time, the germ theory also came to light and America, having never been known for its cleanliness, began an all-out war on invisible microbes, rodents and house flies. Everyone felt like they were constantly at risk of being infected, and obsessive cleanliness became a massive trend. All of a sudden, soap was a huge hit, and folks sprayed anything and everything with that month’s “hottest” antiseptic cleaner. In relation to Polio, folks sprayed DDT everywhere, because they wanted to kill flies, those horrid creatures known for sitting on piles of crap and then buzzing around, spreading germs everywhere. Unfortunately, DDT had its own horrific consequences, serving as a good reminder that the “cure” might be just as bad as the cause.

 

Within a privileged country is a privileged media that has the luxury to make some stories worthy of mass attention and others not, and a privileged media can easily sway public opinion. For example, many anti-vaccine people don’t trust the MMR vaccine that kids typically get at age 1 and 4. They don’t trust it because of the media attention given to a study conducted by Dr. Wakefield, a trained surgeon and researcher in England, that was first published in The Lancet in 1998. The study suggested that the MMR combination vaccine, and particularly the measles component, led to an autoimmune reaction in the gut that first created gastrointestinal problems and then created an autoimmune reaction in the brain that led to the neurological and mental symptoms of autism. He came to that conclusion because out of the 12 children in his study population, eight of them started having behavioral difficulties soon after receiving the MMR vaccine. At the completion of his study, he held a big press conference and got his results published in a great journal, The Lancet. His actual conclusion,”We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers,” is rather innocuous and anti-climatic. It still implies that the causes of autism are a mystery and that we should research it more.

Unfortunately, the privileged mainstream media went wild with the result of his study, as did anti-vaccine bloggers, anti-vaccine tweeters and anti-vaccine Facebookers. Soon every parent who had a child with autism blamed vaccines. Then celebrity spokespeople started campaigning against vaccines. The privileged media made lots of people think ALL vaccines are evil. And this happened:

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Vaccine rates plummeted, because parents were afraid of giving their kids autism. Then another rumor started that it was actually the thiomersal (ethylmercury used in vaccines to prevent bacterial contamination) that caused autism. It didn’t help that in 1999, the FDA, AAP, and CDC made a statement asking vaccine manufacturers to remove thiomersal from vaccines as soon as possible. This public recommendation was made because the FDA thought the threshold for methymercury would be exceeded due to the increasing number of vaccines given in childhood.

After this chain of events, the traditional medical community panicked and started maniacally researching the vaccine and autism link. If anything positive came from the media storm, it is the plethora of research studies aimed at exploring MMR, thiomersal, and autism. Now it is one of the most well-studied areas in medicine.

It should be noted that Wakefield never made the claim that thiomersal led to autism. His study had nothing to do with thiomersal, because thiomersal was never in the MMR vaccine. He was just the MMR guy who made the recommendation that it would be safer to give kids single vaccines as opposed to combination vaccines. That said, he did not get the chance to explain why it would be safer to give kids single vaccines as opposed to combination vaccines, and that’s a shame. He was “cancelled” before cancelling was cool. I’d still love to hear his explanation. For kids in the US, the number of recommended vaccines in a given time interval has increased. What are the risks that come with this? Are we over-vaccinating? Should we make changes to the vaccination schedule and allow parents to spread them out? These are fair questions that should be researched and answered. In fact, some doctors, like board-certified pediatrician Brian Thornburg, believe in “vaccine choice” when it comes to our current vaccine schedule. He discussed his reasons why on my Causes or Cures podcast, as well as his approach to vaccination when it came to his own 8 kids. Some veterinarians, like the brilliant Jean Dodds, caution about vaccinosis in dogs. She came on my podcast to discuss her approach to vaccination. She’s a veterinarian, yes, but concern over vaccinosis in animals should naturally lead to concern about it in humans.

Now, the CDC has a website full of links to studies on vaccines and autism, all of which do not find any connection. Of course if you are a diehard “wellness” proponent, you won’t trust a government-funded public health organization such as the CDC. That’s okay. Perhaps the more compelling evidence is that the rate of autism has continued to increase in countries that either 1) discontinued the MMR vaccine or 2) discontinued the use of thiomersal in all childhood vaccines. Japan stopped using the MMR vaccine in 1994, yet the rate of autism in Japan continues to increase. The United States discontinued the use of thiomersal in childhood vaccines in 2001, but the rate of autism continues to increase. The case of Japan is interesting for other reasons too. The MMR vaccine was discontinued after many kids developed meningitis and other complications as a result of using the “wrong” viral strain in the 1993 MMR vaccine. Could something like that happen again? Yes, it’s fair to say that it could. There are other historical examples of similar vaccine mishaps happening, which leads me to ask: Is it right for governments to mandate vaccines? Should people have a choice when it comes to vaccines, particularly if they recognize a risk before the government does? Where is the equilibrium between public health mandates and personal liberties?  I lean towards a person always having a choice.

While all of these studies on autism and vaccines were happening, Dr. Wakefield’s study was viciously torn apart. Investigators stated that the 12 children in his study were subjected to unethical invasive medical procedures that were not in their best interest. It was discovered that the 12 kids were not randomly selected, but recommended by a law firm that was in the process of preparing a lawsuit against a manufacturer of the MMR vaccine. Then The Lancet study was formally retracted. Investigators asked Wakefield to reproduce the results of his study, but he never did, and so Wakefield was stripped of his medical license. In short, the study destroyed his career and reputation. He now makes films about vaccines and health risks.

Even if one chooses to ignore the shortcomings of Wakefield’s study, one should first ask how a study with zero controls and only 12 kids created a massive public outcry. Wakefield’s study wasn’t the gold standard for determining causal relationships, something he has said since Day 1, and a sample size of 12 is too small to change the ways of conventional medical practice, let alone start an all-out war on vaccines. Wakefield can’t be blamed for that, but the privileged media can be.

Wakefield’s study may also be flawed by recall bias, especially when a researcher asks parents about their child’s illness. Recall bias means that a person who has a disease or who is personally affected by a disease is more inclined to find a root cause for such a disease than someone who is not personally affected by it. Any parent who has a child with autism would love to have an unambiguous answer for what caused the autism. “The MMR vaccine,” is a much more comfortable answer than, “I don’t know.” The desire to find a cause for a disease that personally affects your child would not be limited to the parents in Wakefield’s study. That desire is burning in any parent who has a child with autism or any serious illness. So when the media took Wakefield’s study and ran with it, it is easy to understand why parents were enraged, scared, and started a war on vaccines. I don’t blame them. That said, parents of babies and young children are extremely observant of their children. Obsessively so. When you hear a similar story, over and over and over again, a story that sounds like this, “My baby received this vaccine, and then several hours later, my baby was never the same,”  well, that is a pattern worth researching. We don’t help anyone by ignoring or ridiculing those parents, nor do we do anything for the advancement of science or getting ourselves closer to the truth about vaccines.

The mainstream media also flubbed in the aftermath of Wakefield’s paper, because their coverage on autism was painfully myopic. It only focused on Wakefield’s study and ignored the many other studies that implicated genetics, maternal antibodies, environmental contaminants such as BPA, autoimmune responses, Vitamin D deficiencies…as causal factors for autism. In that sense, the media acted as a huge barricade for progress in autism research. By hyper-focusing on the Wakefield study, the media also kept other studies on vaccines and autism in the dark. When I first started researching the war on vaccines, I thought Wakefield was the only name that would show up. He’s the only guy I ever heard about. Yet as I explored the vaccine-autism link some more, I realized there were other guys in the game. There is Vijendra Singh out at Utah State University who in 2002 conducted a serologic study of measles, mumps and rubella virus on 88 kids with autism and 32 controls. The results of his study show that the antibodies to the Measles virus were significantly higher in kids with autism than in controls. No one really talks about it like they do the Wakefield paper. Why? Because the privileged media chose to ignore it. Once again, ignoring stuff doesn’t get us closer to the truth about vaccines.

A study by Lucija Tomljenovic analyzed whether aluminum vaccine adjuvants contribute to the rising rates of autism. Aluminum is an adjuvant, a molecule that is commonly added to vaccines to stimulate and heighten one’s immune response to a particular pathogen. According to the study, there are 32 childhood vaccines that are recommended prior to school entry, and 18 of them contain aluminum. ( MMR does not contain aluminum.) It is well established that at high enough levels, aluminum is a neurotoxin. The authors stressed that the side effects of using aluminum as an adjuvant in childhood vaccines are not well known. The authors also found a significant positive correlation between the use of aluminum vaccine adjuvants and the rising rates of autism. Something worth exploring? Yes.

An interesting pilot study that caught my eye compared the rates of neurodevelopmental disorders (NDDS) and allergies in vaccinated, homeschooled children compared to unvaccinated, homeschooled children in Mississippi, Florida, Oregon and Louisiana. Surveys were completed by the mothers of the kids. Results showed a significantly higher rate of allergies and NDDs in the vaccinated group. They also found a strong association between preterm birth, vaccination and NDDS. This was a very small study that used surveys from parents, which is a super-biased way of collecting data. The study shouldn’t be used to change or dictate policies on vaccines. However, why not conduct a bigger study with the same research question and a more rigorous method of collecting and analyzing data? We have the data to do the study, and it’d be interesting to see if any significant associations arise. Why not look into it? Wouldn’t such studies help us learn more about vaccines?

Singh’s and Tomljenovic’s studies, along with others, suggest that children with autism have abnormal immune responses. While the MMR vaccine and thiomersal have been safely ruled out as causes of autism, there are other associations about vaccines and autism that would benefit from further research. For instance, perhaps some children have a genetic predisposition for autism that is activated after receiving certain types of vaccines. It can’t hurt to look into it, right? In the spirit fo getting closer to the truth about vaccines?

And “looking into it” is exactly what a privileged nation should always be doing. We should always ask questions! Instead of waging wars on vaccines or  labeling people with legitimate concerns as quacks or idiots, a privileged nation should continually study the safety of vaccines and how that relates to scheduling vaccines. In fact, in the plethora of studies conducted after Wakefield’s, many of the authors remarked that there was not a robust body of research on vaccine production and safety. That’s a sad fact for a privileged country that is fully capable of studying every inch of a vaccine. While it’s superbly ignorant for someone to blast vaccines as evil, it’s also ignorant to not use our privilege to ensure that kids have the safest vaccines and vaccine schedule as possible.

 

If you got through all that, thanks for reading. I’m happy to hear your comments. Vaccines are a hot topic (again), because we are in the throes of COVID-19 and vaccine hesitancy is incredibly high. It doesn’t help that the pandemic has been politicized and public health messages have been inconsistent. And it doesn’t help that Big Pharma has an insanly strong influence on the practice of medicine, drugs and standards of care. Nor does it help that drug companies are the largest lobby group in D.C. It’s almost like we made our own mess. When people act shocked or disgusted by the growing anti-vaccine movement and the growing distrust in public health advisors, I often think of the boy who shoots his parents, then cries that he’s an orphan.

 

Best,

Erin

 

If you’re interested, read my parody on wellness: Yours in Wellness, Krystal Heeling! 

For a darker read & a true story, check out: Manic Kingdom 

 

 

 

 

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