Tuesday, 20 January 2015

7 Things That Pro Vaccine Campaigners Need To Understand

I read a lot of really aggressive pro vaccination pieces via my Facebook contacts, and I can't help but cringe. Most seem to have no clue who the "anti vaccination" bunch are they're addressing, beyond some media caricature of the dirty unvaccinated spreading disease; as such most written is really quite pointless.

So I thought pointing out some basics might help.

1.  There is no "anti vax campaign"
I know, weird right given what the media tell us - but this article explains quite clearly why it's simply not true. What's more, this piece in which author Rachel Hills realises this made me chuckle:
"Not all of the parents Reich spoke with were “anti-vaxxers” in the sense that we typically think of the term; only a small minority identified as activists in the Jenny McCarthy mold, campaigning other parents not to vaccinate or advocating for policy change. Nor did they necessarily abstain from vaccination completely."
Guess what Rachel, not all gay men are into fashion, have uber trendy apartments and adore Madonna either.  That's the problem with stereotypes, they often don't reflect reality.

The further problem with the belief in an "anti vaccine movement" is that often people without a particular stance are lumped into "pro" or "against", potentially forcing their hand.

For example, someone shares a scientific study showing a measles outbreak came from a fully vaccinated person.  In response people quickly state whoever posted it clearly has an "anti vaccination agenda".  They claim it's irresponsible to share it at all, as it doesn't help the pro vaccination cause any" (which apparently all responsible people should do).

Whereas the poster may previously have felt aligned with vaccination and merely found the study interesting, now they might wonder why they aren't allowed to talk about it and whether that's because there's something to hide.  They might feel offended by those who have attacked them, and instead the responses that resonate are from those who also want to explore vaccine failure rates or wonder how long they actually last.  This leads them to do more questioning.

The problem is any questioning or initiation of discussion exploring vaccines, is similarly considered "anti vaccine" (and yes I speak from experience) - it seems one has to be wholly 100% behind each and every vaccine, without question, and trying to convince others of this to qualify as "pro" - otherwise you are "anti", and someone can quickly find themselves in this position in just a few mouse clicks.

Seems to me incorrect stereotypes and belief in an anti-vaccine agenda don't do either side any favours.

Let's then explore who actually make up these "anti vaxers"?

In my experience they include people who:
  • Selectively vaccinate based on disease - for example they may give meningitis but not tetanus.
  • Believe in selective vaccination based on age/demographic/availability of healthcare - for example they may be pro giving a Malaria vaccine in the slums of India, but not the Varicella (chicken pox) vaccine in the UK.
  • Really aren't sure and so are delaying whilst they decide
  • Have some concerns over certain aspects of vaccines ie perhaps they believe in the concept, but have safety concerns over how or where they are produced.  For example they may be concerned about contamination issues at foreign manufacturing plants.
  • Have had an experience following vaccination that has worried them or has led them to believe their child was injured by it.  Or have friends/relatives that have had a negative vaccination experience.
  • Recognise vaccination is absolutely cost effective from the perspective of a healthcare system focussing on £/$/€, but don't feel this is the same as stating there are of benefit of to each and every individual.
  • Believe vaccines may indeed prevent the disease, but this may carry other unforeseen consequences like virus mutation, increase in other illnesses or changing the target age range of the condition ie making the very young or elderly at risk.  For example they may believe the suggestion vaccinating everyone against flu, results in an increase in respiratory infections needs to be considered, or that maintaining acceptable vaccine compliance for an "eradicated disease" is notoriously difficult, leaving room for a more virulent strain to be re-introduced intead.
  • Have spend months or years gathering and debating evidence from journals and feel they have made an informed choice; or they feel the right studies have not been done, or that funding influences research, or that data presented is inaccurate.  For example it's standard to combine figures for both pneumonia and influenza to establish the death rate from flu.  This is done because flu can lead to pneumonia, and if this results in death, it's pneumonia that's recorded on the death certificate.  This quite rightly presents an artificially low picture of deaths from flu.  However similarly, adding all pneumonia deaths and calling them flu is likely to give an artificially high picture, because there are many causes of pneumonia.  What's more because many people never visit the doctor with mild to moderate flu, national figures are "estimates" that some feel are inaccurate.
  • Believe scientists don't fully understand the immune system, which is why auto-immune conditions prove so challenging to the medical world today.  They argue if it's not fully understood, how can anyone be confident vaccines don't impact?
  • Don't believe the diseases warrant vaccination and that a healthy immune system is key.
  • Don't believe vaccination prevents disease.
  • Believe vaccinations are linked to autism/ADHD/encephalitis because of what they have heard or read.
This list obviously isn't exhaustive, it's based on my experience of discussing vaccination - and I've listed those I hear most often near the top.  If we then consider most pro vaccination material typically focusses on the last three points and that in reality this isn't really why most people aren't vaccinating - you kinda have to wonder why waste the keyboard clicks?  Sure you might get lots of hits from others already on the same team, but this surely defeats the object somewhat.

2.  Forget Andrew Wakefield, forget autism.
Really it's a teeny, tiny, make that microscopic, number of people who choose not to vaccinate based on one study by Andrew Wakefield.  In fact I've never met a single person who has stated this as their reason for not vaccinating, yet every last blooming article bangs on about it.  People who aren't vaccinating tend to find it quite insulting, the assumption they make big decisions like vaccinations based on one man. Really, let it go..

3.  Vaccine debate has always existed
I know it's nice to pretend there used to be a time people were so ill and without hope they gratefully all lined up for vaccinations, but it's not true.  As another example when discussing introduction of the measles vaccine to the UK, it wasn't considered a "no-brainer", in fact there was a lot of disagreement between experts.

To be fair even now the CDC and the NHS can't seem to agree on the severity of Varicella and thus the need for a vaccination.  As a result one country routinely offers it, the other doesn't.  Ditto giving Hepatitis B vaccination at birth, the US/CDC recommends all children receive it, whilst the UK/NHS recommends it only for those at risk.

If health authorities can't agree, why expect anyone else to?  Writing articles that state or imply people are stupid for daring to engage in discussion or holding a different point of view, rather than "leaving it to the experts" are unlikely to provoke a change of heart.

4.  Herd Immunity
Another massive feature of pro vaccination articles is protecting others.  Selfish non vaccinators don't care about immune compromised children or newborns who can't protect themselves, not like those vaccinating who are carrying around their giant shields of protection, carrying the burden for society #romantic view.

Think this through for a minute though.  If you plan on giving a vaccine anyway because you believe they are the bees knees, the additional selfless act of "protecting others" is a by-product.

However if someone believes a vaccine is harmful and could injure their child, how likely are they to give one on the theoretical basis of protecting a stranger?  What are the ethics of asking someone to, even if they don't believe it works?  Put it this way I've never met a single person ever, who said they believed vaccinations were a bad idea, but gave them anyway to protect someone else who was vulnerable.

What's more, whether herd immunity is a feasible concept when vaccine driven (rather than via wild disease, which is where the concept of herd immunity is derived from), seems to also still be hotly debated. Recent events with pertussis certainly raise a brow; either way hinging an argument on herd immunity and emotional blackmail is unlikely to win over your target audience.

5.  Accuracy.
This is my pet hate, an example from late last year:
"Pertussis (whooping cough) cases are on the rise due to an increasing number of parents choosing not to vaccinate.  This means a disease that was virtually wiped out is now BACK and babies are dying as a result!"
Whilst this might trigger a good reaction and read rate (that's the job of the media done then), it's wrong, wrong, wrong, wrong wrong.

Pertussis levels have increased despite ever increasing vaccination rates.  Researchers have established its entirely possible to catch and pass on pertussis when fully vaccinated, all without showing any symptoms.

The CDC have updated their page stating that "vaccinated children and adults can become infected with and transmit pertussis; however, disease is less likely to be severe" (no research reference is given for claims regarding severity."

In addition to this they're currently exploring mutation and how this may be part of the picture.

The reality as things stand is that even 100% vaccination rate could not establish herd immunity against pertussis, because we know vaccines can fail. According to the CDC:
"Pertussis vaccines are effective, but not perfect. They typically offer high levels of protection within the first 2 years of getting vaccinated, but then protection decreases over time. This is known as waning immunity. Similarly, natural infection may also only protect you for a few years. 
In general, DTaP (Kerfuffle note - this is the initial vaccine) vaccines are 80-90% effective. Among kids who get all 5 doses of DTaP on schedule, effectiveness is very high within the year following the 5th dose – at least 9 out of 10 kids are fully protected. There is a modest decrease in effectiveness in each following year.
Our current estimate is that Tdap (Kerfuffle note - this is the booster) vaccination protects 7 out of 10 people who receive it. Since Tdap vaccines were only licensed in 2005, we don't yet have results on long-term vaccine protection. We're still working to understand how that protection declines over time or might differ based on which vaccine was received during early childhood (i.e., DTaP or DTP). CDC will be conducting an evaluation in collaboration with health departments in Washington and California to better understand how long Tdap vaccines protect from pertussis. The data from these evaluations will help guide discussions on how best to use vaccines to control pertussis.
Add to this that the entire population would need boosters, and that we don't yet know how long they last - and herd immunity against pertussis seems more fantasy than reality at the moment.  People often seem to conveniently forget that adults are perfectly capable of catching pertussis and passing it around too.  Adults can also not be aware they have pertussis, but put it down to a cough - because the symptoms are often milder than in children, reducing likelihood they will isolate themselves.

The US seems to highlight this more often, stating that if you have a baby - ask all your relatives to get a pertussis vaccine. However if we are really concerned about the vulnerable and immune compromised as per herd immunity claims, surely vaccination should not only occur when your own baby is born but at regular intervals regardless?  Otherwise how do we know who is passing it round the supermarket?

Of course with travel this means anyone entering the country (legally or otherwise) also needs vaccinating - and none of this considers that the vaccine is only against the current most significant strain....

Which rather begs the question as to why so many articles exist claiming it's the fault of those who don't vaccinate?  To induce hate towards another group?  To improve compliance for vaccinations via whatever means necessary?

6.  Discrediting due to vaccine stance.
Take one highly respected doctor with a glorious academic history, top of all his studies, referenced by many - and watch what happens if he questions or utters a single negative thing about vaccines.  Suddenly the label firmly shifts to "quack" in pro vaccine material, and he is accused of having an "anti vaccine agenda".

Now I get that in the academic world, the key is to go with the general body of research.  If scientists accept something as true, stating you disagree with this is likely to get you discredited with your peers PDQ.

However this doesn't mean that parents do or should feel the same - because rightly or wrongly as the old adage goes:
"First they ignore you. Then they ridicule you. And then they attack you and want to burn you. And then they build monuments to you." (Nicholas Klein 1918).
It's pretty well recognised that when we have our "belief system" challenged, the knee jerk reaction is denial - whether this particular person is correct or not.

Parents discuss what motive a reputed doctor would have for risking his career, being mocked by his peers and discredited - if he didn't really believe what he was saying.   What's more, because someone has  "pro vaccine" or "anti vaccine" stance, does this make what they have to say any less important? Simply stating an article is worthless because the author is a known "anti vaxer" doesn't make much sense to many - particularly when they themselves are now considered "anti vaccine".

7.  A duty to society.
Apparently due to costs of treating illnesses, protecting the vulnerable etc we often hear that parents should vaccinate for the greater good of society.  I have to be honest this annoys me because it seems to only apply to vaccines, yet it's in some ways it's rather comparable to breastfeeding.

There are recognised risks to not breastfeeding.  We know modest interests in breastfeeding would prevent so many hospital admissions in the UK it would save the NHS around £40 million.   Research suggests increasing breastfeeding rates in neonatal units from 35% to 75% could save £6 million per year by reducing the incidence of necrotising enterocolitis (NEC), according to the study.

Forget the money, what about the lives of those who die from NEC, who suffer long lasting complications as a result?  If we are really all about protecting the vulnerable, why aren't the papers highlighting the "selfish formula feeding mothers who don't attempt breastfeeding and as a result their babies die!".

Ouch harsh isn't it, and certainly not something I would like to read - so why do people feel it's OK to make similar comments to those who don't vaccinate, and then feel they might be receptive to considering another perspective?

People often respond that not breastfeeding only affects your own child and not other peoples - which I find confusing.  Does that mean it's OK for your own vulnerable young to suffer as long as this doesn't impact on anyone else?  Or that it doesn't matter to the economy if someone is off sick more caring for their child as the NHS state?

In an age where people can globally discuss issues, I suggest that instead of insulting those who don't agree - we try listening and perhaps re-examining our own beliefs.  In her piece above, Rachel sums it up well if we continue and read the rest of her quote:
"Rather, what united them was a sense that vaccines were up for negotiation: to be administered or rejected depending on the convictions of the parent and the needs of the child. Reich’s interviewees saw themselves as critical consumers of information. They engaged with doctors not as authorities to be obeyed, but as another data point to be evaluated, embraced, or discarded. They continually assessed risk: How likely was it that their child would be exposed to Disease A? What would be the consequences if they contracted Disease B?
This is absolutely the reality of today, whether the CDC et al like it or not.  Gone are the days when people did things simply because their doctor told them to.  And like a dominant parent, angry their child does not blindly comply without question - more aggression and force is unlikely to be the answer.


  1. I got insulted really badly on the guardian page for saying that we shouldn't be afraid of measles. I was polite and didn't retaliate (too much!!) but the abuse and name calling was so bad. I was called a murder, worse than a person with aids knowingly having sex with people to give them the HIV virus and more. It's scary to stand up publicly for what one believes. I am so happy to have pages like this.

    1. Yeah its hard. I'm kind of slow too. I understand, so I usually wont post in any place someone in the field might see and comment. They can be so rude. Thanks for posting.

  2. Brilliant article! What parents need is real, dissected, debated information, not knee-jerk emotional diatribes from people insistent that everyone has some evil agenda if they ask questions!

  3. Briefly re: Pertussis and severity in the vaccinated vs non-vaccinated: these may be of interest. http://cid.oxfordjournals.org/content/37/6/772.long http://www.ncbi.nlm.nih.gov/pubmed/14595048 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1177947/

    1. Thanks! I've been looking for that data. The only confounding factor is that according to your first link, the researchers administered both whole-cell and acellular pertussis vaccines. Parsing out the data according to which subject was vaccinated with which vaccine is essential to our understanding of how the acellular vaccine, the only one in use in the U.S. and Britain, is affecting pertussis severity.

    2. Ah! I just read your second link and found the same thing: DTP vaccination instead of DTaP. Your first link is from 2003, so I hope that one of the authors didn't have the same conflicts of interests then that she does more currently. http://projects.propublica.org/docdollars/search?utf8=%E2%9C%93&term=halloran&state%5Bid%5D=&company%5Bid%5D=&period%5B%5D=&services%5B%5D=

  4. Measles! Measles! Measles! :')
    If the link doesn't work, go on Facebook to Erin at Health Nut News January 17 at 1:21am (Central time)

  5. It's ironic that the adults who shout about all kids should be vaccinated are more than likely not upto date with vaccines themselves. So by their own logic they are a danger to society themselves.

  6. I will not vaccine because there is no product liability. I have children damaged by vaccines, and I can not sue them, I have to go to some court, setup by the government, that even if I win, if will not be paid out by the vaccine makers. So they can put any crap they want to and be free of liability. I do not trust them, so til I can sue them I will not vaccinate.

  7. I reserve the label "anti-vaccine" for individuals who come to conclusions based on false and erroneous information. For example, if someone thinks the amount of formaldehyde found in some vaccines is "toxic", that's a red flag. Also, there are many websites that are proud to call themselves anti-vaccine. If someone quotes from these sites I can safely conclude that person is also anti-vaccine.

    1. "If someone quotes from these sites I can safely conclude that person is also anti-vaccine." Can you? They might not have just stumbled across it when Googling and not know why it's inaccurate yet (or not)?

  8. Yes that would be a red flag for me also - The EPA say that formaldehyde is a possible carcinogen .. the question is the levels.. http://www.cancer.gov/cancertopics/factsheet/Risk/formaldehyde