Skepticblog

Perhaps the weak link in the effectiveness of vaccines is public acceptance. Individual vaccine types vary in terms of their effectiveness, but all are reasonably effective and very safe. Vaccines are, in my opinion, one of the “home runs” of modern medicine – scientists hit upon a way to marshal our own immune systems to make us resistant or even completely immune to certain infectious diseases. The result has been a dramatic decrease in diseases that used to plague humanity, and the complete eradication of one (smallpox).

It is ironic that the greatest barrier to the effectiveness of the vaccine program is public acceptance. Part of the problem is that very high acceptance is needed in order to achieve what is called “herd immunity” – where there is sufficient protection in the population that an infected individual will likely not cause an outbreak.

In the US the numbers are pretty good, and have remained so even through the recent increase in the anti-vaccine movement. About 68% of children complete the full routine vaccination series. Many of the individual vaccines have compliance rates in the 90s (MMR, for example, was 92.1% in 2008). The level required for herd immunity varies, but it is generally around 85-90%.

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There is another major measles outbreak in Europe. The WHO reports:

The World Health Organization said Thursday that France had 4,937 reported cases of measles between January and March – compared with 5,090 cases during all of 2010. In all, more than 6,500 cases have been reported in 33 European nations.

That is four times the rate of 2010. I know – these reports are almost getting boring. The shock has worn off – we have come to accept that previously conquered diseases (at least reduced to minimal cases without outbreaks) have come back. The cause seems clear – outbreaks occur where herd immunity has been lost due to vaccine non-compliance. Fewer people are getting vaccinated, and not much fewer. But the numbers are falling below herd immunity levels in pockets. When vaccination rates fall below a certain level, then infectious organisms are able to spread and cause an outbreak.

The anti-vaccine movement has successfully spread unwarranted fear of vaccines, resulting in the compromise of herd immunity. There is a toll of morbidity and mortality associated with this movement.

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We can add one more study to the pile of evidence showing no association between exposure to thimerosal (a mercury-based vaccine preservative) and autism. The article: Prenatal and Infant Exposure to Thimerosal From Vaccines and Immunoglobulins and Risk of Autism, is published in the latest issue of Pediatrics, and shows no association between prenatal and infant exposure to thimerosal and three forms of autism – autism, autism spectrum disorder, and regressive autism.

No one study can ever be definitive, but now we have a large body of evidence from multiple studies showing a lack of association between thimerosal and autism. This won't stop the dedicated anti-vaccinationists and mercury militia from continuing their anti-vaccine propaganda, but hopefully it will further reassure those who actually care about the science.

Background

This has been a long and complex story, so let me review some of the background. Diagnosis rates of ASD have been climbing for the last 20 years, prompting some to search for an environmental cause. The existing anti-vaccine community, not surprisingly, blamed vaccines. This was given a tremendous boost by the now-discredited study by Andrew Wakefield concerning MMR (which never contained thimerosal) and autism. When the evidence was going against MMR as a cause, attention turned to thimerosal in some vaccines. This notion was popularized by journalist David Kirby in his book, Evidence of Harm.

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I received this from a listener. She noted the following on the website “PreventDisease.com” (quite the ironically named website):

They Just Don’t Learn: CDC Votes To Poison Children Again With Two Doses of Vaccines

Parents of children over 6 months and under 9 years beware. The Centers for Disease Control (CDC) is once again choosing to adopt policies which poison your children with what is now two doses of seasonal flu vaccine this fall.

So she emailed the guy the following: Continue reading…

The anti-vaccine movement, as is probably typical for ideological movements, has natural enemies and allies. Once the notion that mercury in the form of thimerosal in vaccines might be responsible for neurodevelopmental disorders (it’s not) become popular in the anti-vaccine crowd, this made them natural allies with the “mercury-militia” – those who blame environmental mercury for a host of ills. That fact that some anti-vaccinationists seek to provide their children on the autism spectrum with unconventional biological treatments, based on their disproved “toxin” hypothesis, made them natural allies with the alternative medicine community. Both seek freedom from pesky regulation, and rail against the perceived deficiencies of science-based medicine.

Another ideological alliance is brewing – that between the anti-vaccine movement and extreme environmentalists. This post is not a commentary on environmentalism, and please do not take it as such – the purposes and  claims of the two movements are quite distinct. But they share a common thread: distrust of scientific experts and government regulators who reassure the public that environmental exposures are safe.

Robert F. Kennedy Jr. has been the most prominent environmentalist to take up the anti-vaccine cause, in several articles and speeches. While he appears to be only a part-time anti-vaccinationist, his celebrity and street cred among evnironmentalists led a great deal of weight to his paranoid musings about scientific fraud and government coverups. It seems he wants to recapitulate the moral clarity that his uncles displayed in the 1960s, defending the little guy against abuses by the powerful and privileged. He is ready to see a conspiracy, and he wants to be the crusader for environmental justice – and if kids are the alleged victims, all the better. His article in the Huffington Post – “Attack on Mothers,” says it all.

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We are still in the midst of the libel suit brought by the British Chiropractic Association against Simon Singh, and now another defender of science has been targeted by such a suit. Paul Offit, Amy Wallace, and Wired Magazine have been sued for libel by Barbara Loe Fisher, the head of the National Vaccine Information Center (NVIC).

Here is a pdf of the complaint.

The subject of the suit is the excellent article by Amy Wallace criticizing the anti-vaccine movement. Wallace was attacked for this piece by anti-vaccinationists – essentially because she got the story correct. Wallace pointed out that the science strongly favors vaccine effectiveness and safety, and that the anti-vaccine movement is dangerously wrong – hurting the public health with their misinformation. The anti-vaccinationists were apparently very upset over be called out by a mainstream journalist. They got a lot of bad press this year, the Chicago Tribune also did a series of articles detailing the dangerous pseudoscience of the anti-vaccine movement. Wallace’s article earned her a place in the infamous baby-eating photo (along side Offit and yours truly) that only served to further embarrass the anti-vaccine movement via the blog, Age of Autism.

The law suit, in this context, seems like just the next step in the campaign against Offit and Wallace.

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If you peruse skeptical blogs you are probably familiar with the recent controversy over giving the Richard Dawkins award to Bill Maher by the Atheist Alliance International (AAI). To summarize, the AAI decided to recognize Bill Maher with their award named after Dr. Dawkins. The award is for:

The Richard Dawkins Award will be given every year to honor an outstanding atheist whose contributions raise public awareness of the nontheist life stance; who through writings, media, the arts, film, and/or the stage advocates increased scientific knowledge; who through work or by example teaches acceptance of the nontheist philosophy; and whose public posture mirrors the uncompromising nontheist life stance of Dr. Richard Dawkins.

The part that caused controversy was the bit about “advocates increased scientific knowledge.” A number of skeptics (Orac, I think, was most verbose)  had a problem with this because Bill Maher is an advocate for medical pseudoscience. He does not believe in vaccines, he denigrates “western medicine” as a scam, and he has a problem with germ theory.

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This Sunday before game-time you might want to set your Tivos to record Dateline. This week, supposedly, Matt Lauer interviews Dr. Andrew Wakefield and several other affiliates of the Thoughtful House Center for Children, along with Dr. Paul Offit and journalist Brian Deer.

The Thoughtful House agreed to the interviews because they figured they would get fair treatment from the likes of Matt. I’m interested to see what kind of a program NBC has put together on this very sensitive subject.

Depending on how this major media outlet writes the script, it could either be a major affirmation of what many within the science community already know, or it could increase the divide between anti-vax’ers and science.

Please, Matt… don’t go Jenny McCarthy on us. Don’t do the usual journalistic job of being “fair-and-balanced”. This is not a “he said, she said” issue. This is science. Do tell the world what the science supports.

The UK-based Sunday Times has a potential bombshell on their site; they claim Dr. Andrew Wakefield, who started the whole "vaccines cause autism" garbage, faked his data to make that claim.

About 10 years ago, Wakefield published a study dealing with children who were autistic, developing symptoms shortly after getting their shots, and linked this with irritated intestinal tracts. This study came under a lot of fire, and eventually most of the authors retracted the conclusion that autism was associated with "environmental factors", that is, vaccinations. By then, though, it was too late, and the modern antivaccination movement was born.

The Sunday Times investigated Wakefield’s original research, and alleges that the symptoms Wakefield reports in his research do not match hospital records of the 12 children studied at the time. In only one case were there symptoms that arose after the injection; in many of the other cases symptoms started before the children had been vaccinated (in fact, there have been allegations for some time that neurological issues occurred in the children before they had actually been vaccinated, casting doubt on Wakefield’s work). Also, hospital pathologists reported that the bowels of many of the children were normal, but Wakefield reported them as having inflammatory disease in his journal paper.

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This story is so sad, and what makes it worse is that it was preventable.

The Centers for Disease Control has put out an alert: in Minnesota in 2008, there were five confirmed cases of Haemophilus influenzae type b (or Hib) among children younger than five years old. Of these five cases, three of the children were unvaccinated, one had started the series of vaccines but did not complete the series due to shortages, and the fifth — who had been fully vaccinated — had an immune deficiency.

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