With the ongoing debate raging between science and the right of parents to make medical decisions for their children, I have thought long and hard about how to approach this issue. Several people have asked me to write about it, but what is there to say that hasn’t already been said? Everyone who has bothered to research this area knows that vaccines are not linked to autism and other childhood diseases and that there are rare instances of allergic reactions and flu-like symptoms in children after getting vaccines. Everyone knows someone who has either gotten a fever from a vaccine or contracted a disease even though they received a preventative vaccine.
Beyond the hype and hyperbole, what do we know so far? Using emotional tactics upfront is an admission that someone can’t defend their opinion, so let’s keep things simple to start with.
Here are seven fairly straightforward points for people on both sides to remember when discussing vaccines.
- Vaccines are not 100% effective. When vaccines work, a very small portion of people will still get the disease. The goal of vaccines is to immunize enough people to prevent the spread of disease. If there are not enough people to infect, a disease fizzles out. If there are enough vulnerable people for a highly contagious disease, it can become an epidemic.
- Vaccines have side-effects. For a vaccine to work, your immune system has to respond to it and build up lasting defenses. This is why many vaccines cause fevers. Many vaccines contain things like compounds from eggs, so some children will have an allergic reaction to their first vaccine (most adults will already be aware of any allergies). An extensive list of side effects can be found here.
- Vaccines have been tested in clinical trials. If you want to know more about the methodology used, look up the “screening method” or read this if you have access to the journal. There are limits to how a compound can be studied that prevents potentially fatal illnesses. Plenty of drug trials are halted midway if it is discovered that people getting a placebo are not given the same life-saving opportunities as patients in the treatment group.
- Tested and established vaccines are safe. Vaccines and drugs go through clinical trials and are then monitored as they go into widespread distribution and use. There is no link between any established vaccines and long-term illness. Some people will have fatigue, soreness or even an allergic reaction, but these all pass. The modern scare over vaccines started with a false report of vaccine-linked autism with financial links to an MMR alternative. Once that study was found to be erroneous, other dangers were proposed without any causal links; publicly funded studies have not found any such links. It is worth noting that one newer H1N1 flu vaccine (Pandemrix) in Europe is under review for links to narcolepsy, although this may be a side-effect common to both the vaccine and that particular strain of flu. Extremely rare side-effects (1 in 1,000,000) are sometimes not discovered until the first few years mass use.
- Correlation does not equal causation. We hear this all of the time, but when something is emotional or sounds too good, we tend to forget this point. When something goes wrong in our lives, we cope by finding someone or something to blame. It is often simplest to look to a recent event as a scapegoat, but without any causal link, it remains just that. You happened to notice some symptoms while carefully monitoring your child for anything amiss after their first round of vaccines, but maybe those symptoms were just more apparent due to the mild postvaccine fever. That tenderness at the site of injection is a bit more likely to be due to the vaccine.
- There are legitimate reasons not to get vaccinated. Some people are too young or too old for a vaccine to be effective. Some people have compromised immune systems and a vaccine won’t work for them. Some people are allergic to things in the vaccines. Some people who are at low risk of a disease may want to wait until a vaccine has been available for a year or two (see point 5). Some people truly do attempt to avoid all things related to modern medicine for religious reasons. Vaccines save lives, but we try to find a balance between being “healthy” as determined by one’s personal beliefs and following the established and tested modern standards. In order to protect these people’s personal views, we have established religious exemptions for things like vaccines. Those religious exemptions were not designed for the “vaccines are scary” exemption. The best reason I have heard to avoid a vaccine is “I don’t feel like it.” I personally don’t think it’s a good reason, but it is honest and does not require the selective dismissal of medical science.
- Not everyone would see things your way if they were in your shoes. We have a habit of assuming “if only they knew what I knew” or “if only they felt what I felt” then “they’d see it my way.” Parents tell scientists “you wouldn’t feel the same way if you had kids” and scientists tell parents “if you only knew the facts, you’d feel differently.” Let’s be realistic, many scientists are parents and many parents have seen the facts. A different pair of shoes is unlikely to change anyone’s mind on this.
Moving away from factual debate, the conversation (firestorm) over vaccines often degenerates into a debate between science and anecdotes, so here are a few anecdotes and claims to remember for each side.
On one hand:
- Almost everyone knows someone who got sick even though they had been vaccinated against the same illness. (FYI, sometimes the strain/serotype of flu you contract is not the same one you just got a vaccine for.)
- Almost everyone knows someone who assumes they or their child got sick as a result of a vaccine.
- Countless children who received a vaccine and became seriously ill or died of anything medically related shortly thereafter is touted as a caused by vaccination.
On the other hand:
- Almost no one remembers what it was like to have smallpox or polio.
- Almost no one remembers what it was like to lose a child to pertussis (whooping cough).
- Countless diseases have been prevented and the best anecdote of all is the lack of epidemics in the news.
Since people tend to revert to analogies when trying to explain something to someone that just doesn’t “get it” and analogies flow like water during a spring thaw…
- Vaccines are like speed limits. Some people assume that they are not beholden to such things. They will go about their business and rarely suffer any consequences. They are more likely to be injured as a result and they may harm others around them in the process. Just because someone did follow the guidelines does not guarantee that they will be safe.
- Vaccines are like building regulations. You can build it however you want, but who wants to walk into a building that jostles anytime you lean on the wall? If only you’d followed those pesky guidelines, you could sleep at night without thinking the roof might cave in.
- Vaccines are like going to a dentist. Your teeth might be just fine without it, but if you run into any problems, it’s going to be far worse than if you had been getting those regular cleanings and checkups.
Getting more to the point of actions and consequences…
What happens when people stop getting vaccinated?
Polio has been eradicated from nearly every region of the planet, but there are a few pockets of wild polio where medicine and vaccination programs are forbidden under threats of violence. When people from one of these regions travelled to Syria, they brought polio to a place where polio no longer existed and vaccines had been halted during the current civil war. Now, polio is spreading in Syria among the unvaccinated younger population. Read more here.
A Texas megachurch had a recent measles outbreak among their antivaccine congregation. Again, someone had travelled to an area of the world where this disease was more common, then they brought it to an area where too few people were protected to prevent its spread.
In California, whooping cough (pertussis) has made a resurgence in communities lacking sufficient levels of vaccinations.
The necessary vaccination levels to prevent such outbreaks and maintain herd immunity can be found here.
What happens when people do get vaccinated?
Some people get fevers, soreness and fatigue. In severe cases, people have allergic reactions to the vaccine or the adjuvant used to stimulate the immune response. There’s not really much to say here since vaccines largely prevent things from happening.
What is more important is what does not happen when people get vaccinated. Contagious diseases require a large enough susceptible population to spread. Reducing the size of this population prevents outbreaks and prevents the spread of these diseases beyond those unprotected areas. Polio slips into neighboring regions and fizzles out. That measles outbreak in Texas didn’t create an epidemic in other overlapping communities. Pertussis doesn’t flow out of those communities in California and spread like wildfire through the areas that still receive vaccines.
Does any of this really matter to the debate that has been created surrounding vaccines? Probably not. If you came here thinking that vaccines are a dangerous ruse by the pharmaceutical companies, it is unlikely that I will convince you otherwise. If you came here looking for something to enlighten your anti-vaccine friend with, you’re probably wasting your time. It’s science v. anecdote, data v. emotion. Whichever opinion you hold, there is a chasm where you’re hoping to find middle ground.
If you want to have a real discussion, you must be able to speak in the same terms as the other person. If you want to counter anecdotes, you’re better off using stories of people who skipped their vaccines and got sick. For every kid who got sick and had a vaccine, there is a kid who got a preventable illness.
If you want to counter the science, then use science. Learn how science works and use data to support your claims. Avoid redacted studies and be able to interpret the data yourself. Don’t use disproven data and don’t use someone’s faulty conclusions, otherwise your credibility with facts will be forever brought into question.
I’ve tried to keep the personal opinion to a minimum until the end, but as a scientist and a parent who seldom takes data and conclusions at face value without looking into the details myself, you can guess where I stand. I vaccinate myself against things that I don’t want my child to suffer from until they can be vaccinated themselves. Until they can be vaccinated, I’d rather not associate with people who voluntarily run the risk of transmitting those diseases to others. When it comes to highly contagious and highly preventable diseases, I like to know that I’ve done what I can to protect myself and that I’m in a community where the spread of such things has been hampered by other people making responsible choices as well.
In the end, vaccinations are a choice, but be aware of whether you are basing your decisions on input from scientists and medical professionals or celebrities and politicians.
- A simple video explaining vaccines and how those less fortunate are protected by everyone else being vaccinated (herd immunity): http://www.youtube.com/watch?v=s_6QW9sNPEY
- An article explaining the necessary vaccination rates to maintain herd immunity with vaccination rates in various states : http://commonhealth.wbur.org/2013/08/low-state-vaccine-rates
- Some common vaccine misconceptions explained in detail: http://www.cdc.gov/vaccines/vac-gen/6mishome.htm
- A list of side-effects from the most common vaccines: http://www.cdc.gov/vaccines/vac-gen/side-effects.htm
- A chiropractor’s opinions on vaccine conspiracies. Things like this are why the CDC had to systematically refute those misconceptions. (Note: he states upfront that he doesn’t know anything about antibodies in infants. Also, the data he chooses to show all stop several decades ago.): http://www.drkurtperkins.com/2012/05/my-crystal-clear-stance-on-vaccines.html
- An anecdotal about one person who did not get vaccines as a child: http://www.voicesforvaccines.org/growing-up-unvaccinated/
- There are many articles in the last year regarding the flu vaccine mentioned in point 5 (Pandemrix): http://www.reuters.com/article/2013/12/18/health-narcolepsy-vaccine-idUSL6N0JX4DN20131218
- Any published scientific study that you want to look into should also be available via PubMed: http://www.ncbi.nlm.nih.gov/pubmed