“A cousin of my mom’s survived Polio and lived the rest of his life with its effects. He was not expected to live past his teens but made it to his 40s. I am grateful that modern science can protect us from Polio and other diseases and I choose to take advantage of modern science to give my kid better odds of not dying from a preventable disease. I had heard a lot of noise from people claiming vaccines caused Autism, but never saw any clear evidence. It just seemed to me like people really wanted to point to something as the cause and they latched onto vaccines.”–Jennifer
I have been getting into a lot of discussions about whether vaccines are safe in the last few days. I’m not sure if it’s because of a post going viral about a (terrible) Italian court ruling last year (In contrast, American courts side with doctors and scientists on vaccine safety) or Jenny McCarthy’s recent hiring as co-host on “The View”, or simply (as a friend suggested to me today) the fact that a new school year is starting soon and parents are having to provide vaccination records to schools.
“(I got my children vaccinated) because the science supports it and I don’t want my kids to die. And civic reasons. It’s so straightforward.”–Britta
Whatever the reason, this week I’ve been in many conversations with individuals staunchly against vaccinations, parents who are very upset at the idea of unvaccinated children putting their own kids at risk, and parents who are confused and worried and want to know how to make the best decision possible for their children’s safety. I’m writing this for the third group of parents.
What’s going on?
There has been a very steep decrease in the rate of vaccinations recently, particularly (but I want to stress not only) within communities of affluent, well-educated parents. [UPDATE: Keep in mind that there's considerable diversity among anti-vaccine proponents. A conservative religious community here in Texas, opposed to vaccines because "faith should be enough", is currently experiencing an outbreak of measles].
“It’s that whole natural, BPA-free, hybrid car community that says ‘we’re not going to put chemicals in our children,’” Shapiro told Salon. “It’s that same idea: ‘I’m going to be pure and I want to keep my child pure.’”
California law mandates that all students get vaccinated, but it also makes it easy to get exemptions for personal beliefs. And parents in tony places like Marin County are taking advantage of it in seemingly growing numbers. One public elementary school in Malibu, an affluent beach town just north of Los Angeles, reported that only 58 percent of their students are immunized — well below the recommended 90-plus percent level — according to Shapiro.
And it’s even worse in some of L.A.’s private schools, where as few as 20 percent of kids are vaccinated in some schools. “Yes, that’s right: Parents are willingly paying up to $25,000 a year to schools at which fewer than 1 in 5 kindergartners has been immunized against the pathogens causing such life-threatening illnesses as measles, polio, meningitis and pertussis (more commonly known as whooping cough),” she wrote. –from http://www.salon.com/2013/08/14/whats_with_rich_people_hating_vaccines/ (Emphasis mine)
This is particularly frustrating when there is overwhelming evidence that vaccinations DO NOT cause autism. As the wonderful blog Science Based Medicine puts it:
“At this point, the evidence is so utterly overwhelming that there is not a whiff of a hint of a whisper of a correlation between vaccines and autism that it has become irritating that antivaccine activists keep pressuring scientists to do the same study over and over again, coming up with the same results over and over again, and then seeing antivaccinationists fail to believe those same results over and over again. Apparently, antivaccine activists think that if the same sorts of studies are done enough times, there will be a positive result implicating vaccines as a risk factor for or contributing cause to autism.”
Why are parents choosing not to vaccinate their children?
I think there are several reasons, but they all may have some connection to misunderstanding of what the scientific evidence on this issue is, or resistance to perceived authority. In Western cultures, we’re accustomed to framing every public issue as two-sided. People who refuse to acknowledge that there’s legitimacy to the other side are “unfair.” I think this viewpoint is really muddling the vaccine safety conversation. When the media presents scientists on one side, and Natural News on the other, it’s creating a false equivalency. The anti-vaxxers have no credible scientific evidence supporting their position, but placing them opposite a scientist makes it seem like there are two legitimate sides to this debate. There aren’t. The simple fact is that there’s overwhelming scientific consensus that the MMR vaccine doesn’t cause autism.
“I unapolagetically vaccinate my kid, and it’s not just because that’s what you do, it’s because I really looked at what the science said and made a decision based on facts, evidence, and rational weighing of risk-benefit. I think the problem is that it’s easier to feel off the hook for risking your kids via inaction rather than action. But realistically, the risks of vaccination are so much less than the risks of what could happen if your child does get a vaccine-preventable disease, and you are also protecting those who *can’t* be vaccinated. That’s why I get a flu shot. Not because I am going to die of the flu, but to protect the elderly, infants, and immunocompromised folks I might come into contact with.” –Melissa (emphasis mine)
Do vaccines work?
Yes. Here are some of the diseases prevented with vaccinations:
Do vaccines cause autism?
No. As a starting point for you, here’s a roundup of trustworthy scientific resources for you to read on your own (everything is peer-reviewed, or contains links to peer-reviewed articles):
Immunization Safety Review: Vaccines and Autism http://www.ncbi.nlm.nih.gov/books/NBK25349/
Vaccine Safety studies (a bunch of studies, with notes about what they mean): http://www2.aap.org/immunization/families/faq/vaccinestudies.pdf
Concerns about vaccine safety (this is really great, and written in layman’s language) http://www.immunizationinfo.org/issues/vaccine-safety/concerns-about-vaccine-safety
How do we know that scientists and doctors are right?
I’ve been asked about this quite a bit lately. One person asked me “why aren’t we getting peered reviewed research from other points of view?” The reason is quite simple: there isn’t any.
Scientific research works like this:
You start with the specific questions “Does the MMR vaccine cause autism?”, “Does the MMR vaccine increase the risk of inflammatory bowel disease?” and so forth. You then design a study to test that question. It’s not starting from one “side” or the other, trying to seek proof for it. That’s the way politics works, not science. When you get an answer, it’s either “yes” or “no” (actually it tends to be “there is a statistically significant association between this drug and this disease” or “there is NOT a statistically significant association between this drug and this disease.”) Your results are submitted to experts for peer review. These experts then go over your results and methods with a fine-toothed comb, trying to find weaknesses in your approach, or over-interpretation of the results. They evaluate your statistics to make sure that they’re correct. If they decide that it’s acceptable (and this is usually a very hard test to pass), your paper gets published and is considered “peer-reviewed.” But that’s not the end.
Studies are then done by other research groups to both test and build upon your results. While the initial screen by peer reviewers is very stringent, it doesn’t always catch mistakes, and can miss identifying faked data (for example, Andrew Wakefield’s paper got past peer review because the reviewers didn’t catch that his data were fraudulent). However, all scientific research is iterative–that is, it builds upon a foundation created by other research. So if your results are wrong, or faked, it will quickly become obvious to other researchers who try to replicate or use them. Scientific consensus is VERY hard to achieve. So when it happens, pay attention.
Why do I (and others) keep harping on “peer-reviewed” studies? Why do I (and others) refuse to acknowledge the truth of what X blogger says?
Science operates based on the philosophy that the truth is knowable if we design experiments correctly, and we do enough of them to rigorously test our hypotheses. And I hope that you know by now that anyone with a keyboard can make stuff up. Peer review is how we test that someone isn’t making things up. Experts in your field have to agree with your conclusions.
But what about Andrew Wakefield’s research?
“I got my son vaccinated after doing research about it. I had been going through birthing classes that were against it, but the scientist in me questioned what they were saying. I found the info about the falsified info about autism. I still couldn’t believe (and still can’t) that parents would hold chicken pox parties. I’d had chicken pox as a kid, and I know about shingles. It just made sense to me.”–Charity
Andrew Wakefield faked his data for profit. His medical license has been revoked as a consequence. It’s important that people know that the the link between vaccines/autism is based on an outright lie–most of the other authors on the paper have removed their names from it. You can read more about this story here:
What are the consequences of not vaccinating your children?
“We chose to vaccinate Vera on a regular schedule, and to be honest I did not do extensive research. I read enough to know that the studies showing an autism link were bad science and I found a pediatrician I really trusted and talked to her about it. I also really do believe that those of us with healthy kids should vaccinate to protect children who have compromised immune systems.”–Faye
Harm to your child:
Penn and Teller illustrate this beautifully (if profanely: language NSFW)
To put it simply, your child is at risk of contracting a preventable disease.
What happens in the absence of our vaccination program? Read about it here: http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm
Harm to other children:
“Unvaccinated children are concentrated in particular states, increasing the risk of transmitting vaccine-preventable diseases to other unvaccinated children, undervaccinated children and fully vaccinated children.” http://www.immunizationinfo.org/science/demographics-unvaccinated-children
One person with whom I was discussing this issue (he has not vaccinated his kids, but does homeschool them) put forth a hypothesis:
“but if you are correct, i guess in the near future the progressive states will have noticeable outbreaks (and not just the ones you read about), ones that touch somebody you know, as more and more hippy parents stop vaccinating their kids. stay clear of the pacific northwest or perish. ahaha. nah, we are growing super strong natural kids for the future here, and not ones reliant on medicines from a lab. we are sprouting wings and soon we shall fly to furthest regions of the universe and beyond”
I agree with that hypothesis. Unlike the rest of his comment, it’s quite scientific. IF vaccines are protective, and IF parents are choosing not to vaccinate, we should be seeing outbreaks of those diseases in states where the rate of non-vaccination is highest.
This is indeed the case. Here are two examples:
Incidents of whooping cough (pertussis) are significantly higher in states that easily allow parents exceptions from the vaccination. In Washington state alone, there was a 1,300% increase in cases.
Have you ever taken care of a child with pertussis? I have. This is what it’s like (warning: video of children in pain):
And cases of measles infection in the United States have already doubled since last year.
That’s just the beginning. This post is already too long, but I urge you to go to the CDC’s website and read about recent outbreaks. They are tied to regions where vaccine rates are low.
Googling and listening to what people tell you over on parenting message boards, “Natural News”, and similar sites is not the same thing as advice from a trained physician. I really believe that the vast majority of parents who are leery of vaccinating their kids are simply confused because they’ve been given bad information.
“We live in a society, and our actions have consequences for others. It’s our responsibility to protect our children and our neighbors’ children. Plus our ancestors could only have dreamed of something that would protect their children from these horrible diseases.”–Mary
Vaccination is not just to protect your own child. It’s also a moral and civic issue. Remember that we are incredibly privileged in our society to have access to vaccines. In many places around the world, people don’t have easy access to them, and there are even some places where aid workers are killed for trying to administer vaccines. Our privilege confers responsibility as well. By vaccinating your children, you are also protecting other children (and adults) who can’t be vaccinated. Here is a really great explanation of this, and the concept of herd immunity.
“I chose to have my first child vaccinated because I paid some attention in science classes and it works. I paid better attention in history classes and have a sense of the suffering various preventable diseases have caused in the past and I didn’t want that for my child. After my first born spent a week in the hospital with an infection, I feel much more strongly about having my second child vaccinated. In that case, it wasn’t something that could have been vaccinated against, but there is no reason and no excuse for subjecting your child to the risk of that kind of suffering over a preventable disease. It’s irresponsible and cruel.”–Eric
Wakefield, McCarthy, Kennedy and other leaders of the movement are deceiving you. They bear responsibility for the deaths of children. That’s why I keep speaking out on this issue.
I hope that I’ve provided you with a starting point from which to do your own research. If you have any questions, please don’t hesitate to ask me here, or on twitter, or by email (firstname.lastname@example.org), or–even better–ask your physician!
UPDATE: I wrote a tutorial/example of how to critically read a vaccine safety study here. If you wish to do your own research, I suggest that reading the primary, peer-reviewed literature is a vastly better approach than relying on books/Facebook memes/discussion forums. Hopefully the tools you’ll find in that post (and this one) will be helpful.
What actually causes autism? That’s a really important question, and it’s been the subject of intense research. I’ll write a post summarizing the latest results soon.
Edited to remove Lyme disease from list of vaccine preventable illnesses. There’s a vaccine currently in clinical trials, but it’s not fully tested or available yet. Thanks to “justreadingyourblog” for pointing that out to me.
Also edited for grammatical errors.