Do Vaccines
Cause That?!
A GUIDE FOR EVALUATING
VACCINE SAFETY CONCERNS
Martin G. Myers, M.D.
and Diego Pineda
Do Vaccines Cause That?!
A Guide for Evaluating Vaccine Safety Concerns
Copyright © 2008 by Martin G. Myers and Diego Pineda
www.DoVaccinesCauseThat.com
Immunizations for Public Health
301 University Blvd.
Galveston, TX 77555-0350
nnii@i4ph.org
www.i4ph.org
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without permission in writing from the publisher.
Some sections in this book were first published online at the NNii Web site, www.immunizationinfo.org.
Notice: This book provides information about vaccine safety questions but it is not intended to be an immunization guide for parents. The information contained in this book should not be used as a substitute for the medical care and advice of your health care provider. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.
E-book ISBN-13: 978-0-9769027-2-0
E-book ISBN-10: 0-9769027-2-9
Cover and interior design by Diego Pineda
Contents
7 Foreword
SECTION I : Weighing the Evidence
11 Vaccines—Victims of their Own Success: Why Do
We Give Vaccines for Diseases We Don’t See?!
18 Vaccine Side Effects and Risk Perception: What if
My Child is the One in a Million?!
35 Missing Information and Technical Jargon: Why
Can’t Medical Researchers Talk Normally?!
48 Cause or Coincidence: How Do I Tell Whether or
Not a Vaccine Caused That?!
76
Misinformation and the Return of Infectious
Diseases: Does it Matter if Other Parents Don’t
Immunize
their Child?!
111
Reliable Information: How Do I Find the Right
Information in the First Place?!
SECTION II : BlamingVaccines
121 Do Vaccines Cause Asthma?!
139 Do Vaccines Cause Autism?!
175
Do Vaccines Cause Damage to the Immune
System?!
Immunity; Diabetes; Guillain-Barré Syndrome; multiple sclerosis; low blood patelets; inflammatory bowel disease; arthritis.
201 Other Vaccine Safety Concerns
Febrile seizures;
encephalopathy; SIDS; cancer; AIDS; mad cow
disease; birth defects.
219 Vaccine Safety Terms: A Glossary
229 Thanks
231 Notes
260 Index
268 About the Authors
Foreword
The development and implementation of vaccines over the past five decades have increasingly provided the American population with freedom from nearly all those infectious diseases that caused major morbidity and mortality in years past. It is therefore paradoxical that the need for a publication such as this has become essential. Most parents and physicians are unfamiliar with the serious vaccine-preventable diseases (paralytic polio, diphtheria, measles encephalitis, pneumococcal pneumonia, and Haemophilus influenzae meningitis, among others) that have been eliminated or markedly reduced in the country; and most are unaware that these same diseases are only a jet plane ride away from their infants and children. For example, there have been repeated importations of measles in recent years with resultant spread to unimmunized children in contact with the infected traveler.
The authors of this volume have recognized the absolute need to provide parents with clearly understandable, science-based information about vaccines, immunization, and vaccine safety.
Martin Myers is a pediatrician who has devoted his distinguished career to the prevention of infectious diseases in children. In addition to chairing a university department of pediatrics, he directed the National Vaccine Program Office under the assistant secretary of health from 2000 to 2002 and since then has been director of public health policy and education at the Sealy Center for Vaccine Development of the University of Texas Medical Branch. Since 2003 he has served as executive director and editor for the National Network for Immunization Information (NNii)—an affiliation of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetrics and Gynecology, the American Nurses Association, the American Medical Association, the National Association of Pediatric Nurse Practitioners, and the Society for Adolescent Medicine. The NNii remains independent and accepts no funding from either government or industrial sources in order to assure freedom from any charge of conflict of interest. His collaborator, Diego Pineda, has been a science writer and associate editor at the NNii since 2004. In their roles at NNii, Dr. Myers and Mr. Pineda manage the website www.nnii.org, which publishes up-to-date information about vaccines and vaccine safety. Their decision to write this book expanding on the information from the website was made partially in response to the many parents who asked for such a book to help them understand all the confusing information in the media today about vaccine safety.
In the era of the Internet, and the widespread coverage of medical events by the media, it is difficult, if not impossible, for parents without a sophisticated scientific background to distinguish between information and misinformation. The initial chapters of the book offer careful, articulate explanations to the reader as to how best to weigh and evaluate what they read or hear about vaccine safety and immunization. How a scientist distinguishes temporal from causal events and relationships is critical to these explanations. With this background, the reader is then prepared to proceed through additional chapters that deal specifically with concerns relating to possible vaccine-related adverse events. Exhaustively and convincingly, they discuss specific vaccine safety concerns that have been paramount in recent years. The processes that are described in the initial chapters are then used to assist in evaluation of these concerns and to enable the reader to assess what is published in the media. The overall theme is to arrive at conclusions based on science. Where scientific evidence is not available or is inconclusive, the authors frankly admit this and encourage the acquisition of further knowledge.
One hopes—anticipates—that besides a broad lay audience, health care personnel at every level will take advantage of this book to augment their own perspectives so they can discuss vaccines more comfortably and convincingly with the families for whom they are responsible.
Samuel L. Katz, M.D. Louis W. Sullivan, M.D.
W.C. Davison Professor President Emeritus
Chairman Emeritus of Pediatrics Morehouse School of Medicine
Duke University
SECTION
I
Weighing
the
Evidence
Chapter
One
Vaccines—Victims
of their Own Success: Why Do We Give Vaccines for Diseases We Don’t
See?!
In
1736 I lost one of my sons, a fine boy of 4 years old, by the Small
Pox... I long regretted bitterly and I still regret that I had not
given it to him by inoculation; This I mention for the sake of
parents, who omit that operation on the supposition that they should
never forgive themselves if a child died under it; my example showing
that the regret may be the same either way, and that therefore the
safer should be chosen.
Benjamin Franklin, Autobiography,
1791
Our children are our most precious assets. As parents, we want to protect them in the best ways possible. Indeed, most parents agree that vaccinations are the best way to protect children against disease—even though they may be unfamiliar with the diseases that vaccines prevent and are troubled that the immunizations are painful.1 But some wonder if vaccinations are really necessary and are concerned because some parents believe that their children have been harmed by vaccines. Perhaps you are confused about contradictory information about vaccine safety.
Because modern biomedical technology has made—and continues to make—new vaccines available, it is only natural for parents to also worry about whether all those vaccines “are really needed” (yes, they are, as we describe later in this chapter), and whether a child’s immune system can “handle so many vaccines” (yes, it can, as we discuss in Chapter 9).
New parents have lots of questions—about feeding, sleeping, rashes, diaper frequency, and the child’s development, as well as about the need for shots and the safety of vaccines. Most parents get information about all these issues from a trusted doctor or nurse, but they may still have more questions. Often parents will also obtain health information from TV, radio, newspapers, and the Internet. As we will discuss later in this section, the news media often present contrasting view points, which creates interesting stories, but stories that might not reflect the best available science. Information found on the Internet can be reliable—or it can be cleverly packaged misinformation. It is important to know how to distinguish reliable information about vaccine safety from misleading materials that could lead to poor decisions for our children’s health.
Since 2004, we have managed an evidence-based Web site about vaccines and vaccine safety (www.immunizationinfo.org). Every article on this Web site is reviewed for accuracy by other experts and for clarity by nonscientists. Not surprisingly, we get many questions from parents, students, journalists, nurses, physicians, and others about the benefits and risks of vaccines. We have tried to incorporate answers to many of those questions in this book.
The Incredible Impact of 100 Years of Vaccines
During the 20th century, infectious diseases began to be better controlled thanks to the availability of clean water and pest control. But it was not until vaccines became widely used in the 1950s that the rate of the vaccine-preventable diseases dropped dramatically in the United States.2
For example, before the measles vaccine was licensed in 1963, there were about 500,000 reported cases and 500 deaths from measles each year. In 2005, only 66 cases were reported. Also, since the Haemophilus influenzae type b (Hib) vaccine was introduced in 1985, serious Hib disease among children younger than 5 years of age—an important cause of brain damage, deafness, and other long-term problems—has declined from about 20,000 cases per year to 9 cases in 2005.
There was a large epidemic of rubella in 1964 and 1965, 4 years before the rubella vaccine was licensed. This epidemic affected 12.5 million people. Of the 20,000 infants born with congenital rubella syndrome, infection caused 11,600 to be born deaf, 3,580 to be born blind, and 1,800 to be born mentally retarded. In modern times, with widespread use of rubella vaccine, there have been only four cases of congenital rubella from 2003 through 2006.
In 1952, polio paralyzed more than 21,000 people in the United States, mostly children. Polio left a body part such as a leg unusable because of nerve damage. In modern times, with widespread use of polio vaccine, there have been no cases of natural polio in this country in almost 30 years.
If the Diseases are Gone, Why Does My Child Still Need the Vaccine?
Decades ago, when thousands of children and adults in the United States contracted smallpox, diphtheria, poliomyelitis, or measles each year,2 parents feared these diseases. Because of the success of vaccines, the situation is very different today: the diseases aren’t seen and some people have developed a false sense of security.
High immunization rates have lowered the number of cases of these illnesses to nearly zero in the United States. Most parents have never seen a child paralyzed by polio, or choking to death from diphtheria, or brain damaged by measles, congenital rubella, or Hib. As a result, fear of these diseases does not—but should—haunt parents just as it did historically. These diseases seem to be gone. But they are not!
Except for smallpox, the diseases that vaccines can prevent are still here. For example, tetanus—which does not spread from person-to-person—is still in the soil. Cases of mumps and rubella (and congenital rubella) continue to occur.
And measles—the most contagious disease—is active in many places in the world, repeatedly arriving in our midst by airplane.
Although it is reasonable to worry about vaccine side effects, we must carefully examine each claim about safety and consider it in light of the known benefits of vaccination.
First, we need to compare safety concerns to the risk of the disease prevented by the vaccine. We need to recognize that almost all vaccine-preventable diseases are still “out there” and are capable of infecting our children and their friends. With global air travel, for example, measles, mumps, rubella, diphtheria, and polio are just a plane ride away.
Second, we need to understand the science of vaccine safety, and use available tools—like the ones offered in this book—to evaluate the information presented in the media and by those who voice vaccine safety concerns.
This book will help you sort through the conflicting information about vaccines. We hope to provide the facts you need to make informed decisions about vaccines. Our goal is to give parents who have questions a means to understand the merits and limitations of vaccines, based on the available evidence.
The Bottom Line: Why Do We Still Need to Give Vaccines for Diseases We Don’t See?!
Vaccines prevent disease and death. They have been so effective that the absence of disease in our communities has made us feel safe. However, the infecting germs are still lurking and can come back to our communities. When parents stop vaccinating their children, the unseen diseases can return. That is why we need to continue giving vaccines, even if we don’t see the diseases they prevent. To not immunize a child can have tragic consequences for the child, the child’s family, and for the child’s classmates and friends.
If you want to read more:
Centers for Disease Control and Prevention. 1999. Achievements in public health, 1900–1999. Morbidity & Mortality Weekly Report 48:621-8. Available online at www.cdc.gov/mmwr/PDF/wk/mm4829.pdf.
Offit PA, Bell LM. 2003. Vaccines: What You Should Know (3rd ed). Hoboken, NJ: Wiley & Sons, Inc.
Chapter
Two
Vaccine
Side
Effects and Risk Perception: What if My Child is the One in a
Million?!
Aunt
Josephine was giving them a tour of their new home and so far
appeared to be afraid of everything in it, from the welcome
mat—which, Aunt Josephine explained, could cause someone to trip
and break their neck—to the sofa in the living room, which she said
could fall over at any time and crush them flat.
Lemony Snicket,
A
Series of Unfortunate Events,
Book 3
During one of her child’s pediatric visits, Diane was reading the doctor’s handout about the DTaP (diphtheria-tetanus-acellular pertussis) vaccine. It had a section about serious but rare adverse reactions to the vaccine. One bullet read, “Serious allergic reaction (less than 1 out of a million doses).”
She knew that immunization was “the right thing to do,” but the handout was pretty scary. As she watched her son play in the waiting room, she couldn’t help but wonder, “What if he is the one in a million?”
Although Diane’s concern about her son being “the one in a million” who experiences a serious reaction to the vaccine is understandable, she misses the point that the probability is extremely low: 999,999 children who receive the vaccine do not have the reaction. A risk of one in a million is equivalent to 30 seconds in a year, 1 inch in 16 miles, or 1 drop in 16 gallons. If one million people were lined up one foot apart the line would be 189 miles long! A one in a million risk means that of the 4.1 million children born in the United States every year, four of those children across the country could be affected.
You can also put the probability into perspective with other risks: A child has 1 chance in 6,666 of dying in a car crash (in any given year); 1–4 chances in 1,000 of dying of measles if infected; and 1 chance in 2 of dying of tetanus if contracted.
Many well-educated and intelligent people are innumerate,1 which means they have difficulty with mathematical concepts and methods. They have no problem identifying with the language of poets and philosophers who write about life’s tragedies. But the language of scientists, who call such tragedies “adverse events,” leaves most parents cold.
This book is an attempt to translate the language of scientists for today’s parents.
Assessing Risks of Vaccine Safety
The expression “less than one in a million will experience the side effect” is a statement of risk. It is calculated by dividing the number of reported cases of a side effect by the total number of doses of vaccine given.
The risk of “less than one in a million” is actually so low that scientists may not be able to tell whether the event was in fact caused by the vaccine or not.
For example, scientists argue whether Guillain-Barré (GHEE-yawn BAR-ay) syndrome—a polio-like form of paralysis—occurs after influenza immunization by coincidence or is caused by the vaccine. This syndrome occurred after the swine influenza vaccine program in 1976 at a rate of about 1 per 100,000, but it isn’t clear whether annual influenza vaccine causes Guillain-Barré at a rate of about one in a million or occurs by coincidence.2 (See page 188.)
Most serious complications that occur after influenza vaccination occur even less frequently than that. The experts agree that there are some real complications of the vaccine, but they are so rare that it is not possible to calculate the true rate of the risk—such as the risk of developing encephalitis after measles vaccination.3 (See page 202.)
Pain when the shot is given and then local reactions—such as pain, swelling, redness—with or without fever, and generally feeling crummy, concern all parents. Depending on the vaccine and which dose the child just got, these types of reactions can occur fairly often (fever 5–15% of the time after measles vaccine, for example). In some cases they even occur most of the time (for example, local reactions after the first dose of influenza vaccine occur as often as 65% of the time). These reactions pass in a day or two, but no one likes to have their child not feeling well. This is why doctors and nurses often recommend something for fever and discomfort when they give the vaccines.
In some children, fever can sometimes cause a “febrile seizure”—for example, 3 per 10,000 after the measles, mumps, and rubella combination vaccine (MMR). Although a febrile seizure can be the first seizure that a child with a seizure problem has, most of the time the seizures go away as the child gets older. Although it took many years to collect the data to prove it, none of the routine childhood vaccines cause ongoing seizure problems (see page 201).
Perceptions of Risks about Vaccine Safety
While risk can be measured, risk perception—what we think about risks—often cannot be. Despite the fact that many health risks are at their lowest levels ever, perceived health risks are the center of attention for the media—especially in regard to vaccines.
Media reports about the alleged vaccines–autism link, for example, are published almost every week. Scientists say they have been disproved, but some parents insist they have been proven.
These media reports often cite both sides of the story with equal emphasis. Although one conclusion may be based on scientific evidence, the other may not. These contradictory reports generate uncertainty among parents considering immunizations for their children—thus possibly affecting their perceptions of risk and their decision to vaccinate their child.4
Research shows that people respond better to some types of risk than others.5 For example, natural risks (such as infectious diseases) are better tolerated than manmade risks (such as vaccine side effects) and risks that affect adults are better tolerated than risks affecting our children. Risks that are perceived to have unclear benefits are less tolerated than risks where the benefits are clearly understood. Take, for example, measles and the MMR vaccine. Because measles is no longer epidemic in the United States, some parents incorrectly believe that the risk of contracting the disease is lower than the risk of their child experiencing a serious side effect from MMR. If they think that there is little benefit from immunizing their child, they may conclude that there is no reason to take the risk of experiencing an adverse event.
Perception of risk depends on people’s experiences and knowledge. A person who experienced an adverse event after vaccination—or thinks that someone else did—would likely think that vaccines are riskier than a person who has not. Conversely, someone who has survived a vaccine-preventable disease—or a physician who has treated that disease—will likely be an advocate for vaccines.
Antivaccine activists and immunization advocates are both responding to risk perceptions. For instance, in the 1980s a mother reported that she believed that her child’s “minimal brain damage, learning disabilities, and attention deficit disorder” were caused by whole-cell pertussis (whooping cough) vaccine. As a consequence, she did not give the vaccine to her next two children, both of whom developed whooping cough—one of them severe, according to her account—because she incorrectly thought the risk to be lower from the illness than the vaccine.
On the other hand, the mother of a teenage boy who died suddenly of meningococcal meningitis in 1998 is an equally outspoken advocate for the meningococcal vaccine, urging other families to vaccinate their teenagers, because she wants to help others avoid what she went through with the loss of her son.
In the same way, many older pediatricians are assertive advocates for vaccine use because they vividly recall caring for children with vaccine-preventable diseases. They watched these children die or become permanently damaged and they don’t want to see today’s children suffer those dreaded diseases.
Taking extreme positions after dramatic life experiences is understandable, but it may not be the wisest choice. We must define a middle ground where risks and benefits are objectively evaluated and properly balanced.
The media is always eager to report differences in opinion. Reporters call it “balance” when they quote contrasting thoughts. What parent would not sympathize more with a distraught mother convinced that her child was harmed by a vaccine than with a scientist who dismisses that concern? While the mother’s words sound warm and compassionate, the scientist’s words often seem cold and technical.
Emotional arguments versus facts may make good two-sided stories, but may not be accurate—they may even be misleading.
This sympathy for the subjects of emotional stories may be reinforced by the medical community. Some physicians may not take time to address parents’ concerns adequately, dismissing them too quickly. A few may even become annoyed when parents question their recommendation to immunize their child. Such experiences may strengthen the hesitant parents’ concerns, predisposing them to believe new claims about vaccine side effects.
Vaccine Side Effects and Adverse Events
Soon after being diagnosed with a common type of childhood leukemia (cancer of the blood), 5-year-old Ronald began treatment with the drug doxorubicin. Within an hour of receiving the first injection, Ronald felt nauseous and vomited. This was the first of a series of well-known side effects of doxorubicin, which not only kills cancer cells but normal cells as well.
After a week, Ronald had sores in his mouth and lips, gastrointestinal ulcers, and a low blood cell count—all because of the drug, which later would also cause him to lose his hair.
Despite these very unpleasant side effects, Ronald’s parents knew there was no other option. Without the treatment, Ronald would die. On the other hand, leukemia is cured, on average, 80% of the time following chemotherapy.
Like doxorubicin, most available drugs cause side effects—ranging from mild through life-threatening. Nevertheless, people will tolerate those side effects if they can expect a benefit.
As with any drug, there are risks and side effects with vaccines, although serious side effects—those that involve hospitalization, severe illness, or death—are mostly rare. For instance, the oral polio vaccine can cause paralysis in a small number of recipients. And smallpox vaccine can cause a rare side effect that leads to serious illness and death. When polio and smallpox were common in the United States, people tolerated these side effects because the risk of being paralyzed or killed was much greater from the disease than the vaccine. Things changed when polio and smallpox were eliminated from the country—cases of paralysis after the oral polio vaccine and deaths from smallpox vaccine became more common than natural smallpox and polio. Killed polio vaccine (IPV)—without the side effect of paralytic disease—was substituted for oral polio vaccine (instead of stopping immunization altogether because children could still be exposed to polioviruses imported from other areas of the world). Use of smallpox vaccine was stopped because the disease had been eradicated.
Side effects (or side reactions) are symptoms and signs that occur either locally—such as pain or redness at the injection site—or in other parts of the body—such as headache or fever—because of a particular immunization or dose of a drug. A mild measles-like rash after measles vaccine is fairly common, for example. Serious, life-threatening allergic reactions can be side effects of vaccines, but occur very rarely. The symptoms of a serious allergic reaction include:
Difficulty breathing
Hoarseness or wheezing
Hives
Paleness
Weakness
Fast heart beat
Dizziness
Swelling of the throat
An adverse event is something quite different from a side effect. A side effect is “caused by” the vaccine, whereas an adverse event is something that occurred at about the time a vaccine was given, but which could have been caused by the vaccine or could have just occurred at that time by coincidence. Although fever is a side effect of many vaccines, not all occurrences of fever after vaccines are caused by the vaccine. This book discusses how scientists determine whether an adverse event is actually a side effect—that is, caused by the vaccine. Thus, when an adverse event occurs after vaccination, it needs to be determined whether the adverse event was caused by the vaccine or whether it was just coincidental—that is, it was going to happen anyway.
Although no drug—including vaccines—is 100% safe, there is a much higher standard of safety expected of preventive vaccines than for drugs because
Vaccines are generally given to many people, most of whom are healthy.
Most children born in the United States begin receiving vaccinations shortly after birth and continue to receive vaccines during their first 2 years of life—with additional immunizations and booster doses years later.
Many vaccines are given to children at the ages when developmental and other problems are being recognized for the first time (birth to 36 months of age). Stories about bad things happening to children after a vaccination circulate widely on the Internet, are discussed on radio and TV, and are described in magazines and newspapers. Scientists take these reports of adverse events very seriously, but they recognize that just because something happened at about the same time that a vaccine was given does not mean that the vaccine caused the problem.
These facts—the time when vaccines are given and their widespread use—make them perfect “suspects” to be blamed for causing diseases of unknown or poorly understood causes (such as the diseases in Section II of this book).
Community Immunity
Public health officials know that vaccines are most effective when almost everyone has been immunized: the infectious agent cannot spread in a community with a lot of immune people and those who are not immune will be protected by the immune people around them. This is called community (or herd) immunity.
With community immunity, vaccinated people help those who don’t or can’t receive a vaccine.
Who needs to be protected by community immunity?
Persons too young for vaccination
children under 6 months are not given influenza vaccine, because they have a poor immune response to this vaccine
children under 12 months do not respond well to measles vaccine, but can be vulnerable to severe disease
Persons with compromised immune systems—children being treated for certain other diseases cannot usually receive live virus vaccines, such as measles or chickenpox vaccines. For example, children being treated
for certain forms of cancer
for immune deficiency diseases
with certain medicines, such as steroids
Persons with other medical reasons
pregnant women are not given rubella vaccine
Persons who did not become immune when they were immunized but who cannot be easily identified
such as occurs about 5% of the time after measles vaccine
Persons who intentionally did not get vaccinated
A child who has never had measles or the MMR vaccine is susceptible to measles. In other words, if exposed to measles virus, the child could become infected and develop the measles along with its potential complications. However, if everyone in proximity to the susceptible child (like in a classroom) is immune to measles, the susceptible child can be protected—unless the child is in contact with the case of measles elsewhere. Because everyone else is immune, measles cannot spread through the classroom.
However, measles vaccine only makes 95% of vaccinees immune—which is the threshold for measles virus to spread in classrooms—so a second dose of a measles-containing vaccine is recommended. Because 95% were immune after the first measles vaccine, after the second dose almost all the children will be immune, blocking the transmission of the infection to the susceptible classmates.
Imagine, for example, a community of 100 people where 98% were immunized once against measles:
Two people are susceptible because they are not immunized
Five others are susceptible because the vaccine fails (it is estimated that the measles vaccine does not work 5% of the time)
Thus, 93 people (95% of 98) in that community are immune against measles—but 7 are still susceptible. If measles were introduced into the community, these seven people might develop measles. People who don’t understand these numbers might say that the vaccine didn’t work—because most of those who got measles got the vaccine (5 of the 7). Of course, they neglect to point out that 93 did not!
With a second dose of measles vaccine, those in whom the first dose failed have a better chance of becoming immune. After the two doses, only the two unimmunized, and perhaps one of the others, might develop measles if they were exposed—and most of these would be protected by community immunity because measles doesn’t spread well in communities where more than 95% of people are immune.
Community immunity is achieved when the vast majority of the population is immune. In other words, a population needs high immunization rates to reap the benefits of community immunity. Thus, a city or town with many unimmunized children and young adults is at higher risk for the introduction and the sustained spread of vaccine-preventable diseases. The same is true at the neighborhood, church, or day care level, too. Whenever and wherever a community has many unimmunized people, the entire community is at risk.
Mandatory Immunizations for School Attendance
Some vaccines are required by state law so that the number of children who are immunized is big enough to achieve community immunity. This helps protect the health of the public. The goal of these laws and policies is to increase immunization rates.
However, some people think that vaccine requirements violate their civil rights because they object to vaccines for religious or philosophical reasons.
Many states permit exemptions for these people despite the fact that avoiding vaccination puts others in the community at risk.
Different states require different vaccines and have different exemptions. For listings of requirements by state, see www.immunizationinfo.org.
In 2001, 63% of U.S. children 19 to 35 months of age were fully immunized with all the vaccines recommended at that time. It was estimated that of the remaining 37% of these children, 3 children per 1,000 had never received any vaccines, while the others were incompletely immunized.8
States that allow philosophical exemptions to immunization laws have many more unvaccinated children than states that do not have philosophical exemptions. Indeed, unvaccinated children tend to cluster in certain states and communities, increasing the risk of transmitting vaccine-preventable diseases to others in those communities—to the incompletely vaccinated children as well as to the small number whom vaccination did not protect.
Children who had received exemptions are 35 times more likely to contract measles and, of course, are more likely to spread measles to others.9
Although the number of unvaccinated children in the United States is small, it has been increasing. Unvaccinated children tend to cluster in certain states—California, Illinois, New York, Washington, Pennsylvania, Texas, Oklahoma, Colorado, Utah, and Michigan—and their parents tend not to consider the advice of physicians or other health professionals.
In summary, vaccines have greatly reduced the risks from many serious infectious diseases, rendering them unknown to the public. Fear about vaccine side effects has replaced fear of the diseases. Meanwhile, vaccine safety concerns have negatively affected immunization rates, opening a door for infectious diseases to return and harm our children.
This scenario brings up some important questions: Are parents who do not vaccinate their children making informed decisions? Are they able to distinguish misinformation about vaccines from reliable information? Or are they missing some information—such as the risks of the diseases and the importance of community immunity? Do physicians and nurses understand the concerns of parents about vaccine safety?
The next chapter deals with the problem both parents and scientists face when little or no information is available to answer whether or not a vaccine is causing a serious side effect.
If you want to read more:
Ropeik D, Gray G. 2002. Risk: A practical guide for deciding what’s really safe and what’s really dangerous in the world around you. New York: Houghton Mifflin.
Centers for Disease Control and Prevention. 2007. Parents’ guide to childhood immunizations. Available online at www.cdc.gov/vaccines/pubs/parents-guide/.
Chapter
Three
Missing
Information and Technical Jargon: Why Can’t Medical Researchers
Talk Normally?!
Whatever
you have been told, science is not about certainty. And this creates
problems for those health professionals who are charged with
interpreting and relating data to the general public. We are expected
to refute wholesale misunderstandings, in a popular forum, to people
who may well be intelligent but who know nothing of evidence-based
medicine, in soundbite format.
Ben Goldacre, The
Guardian,
Nov. 2, 2005
Asthma, autism, and type 1 diabetes rates seem to have increased dramatically since the 1980s. Some media reports are even talking about asthma and autism “epidemics.”
What are the reasons behind these boosts? Are there changes in the inheritance of genes in our population? Does living in the city or suburbs make a difference? Are there environmental contaminants in our air, water, food, or vaccines? Are we recognizing illnesses differently?
Some people believe that the parallel increase in the number of vaccine doses given to children in the past two decades is to blame for these “epidemics.” In the early 1980s, children in the United States received 5 shots and 3 oral doses of vaccines in their first 2 years of life; in the 2000s, they could receive more than 20 shots.
Is there a cause-and-effect relationship between more vaccines and the increasing numbers of cases of asthma, autism, or diabetes? Or is it just coincidence? How do you decide?
What about other things that have also increased in the past 20 years such as cell phones, personal computers, microwave ovens, fast food restaurants, and soft drink consumption? Do they have something to do with the increase in many childhood diseases or is it merely coincidental?