by Santorini Dave • Updated: January 30, 2011
Vaccinations have been one of the greatest public health achievements of modern times. Yet, vaccination rates are declining as parents fear the risks of vaccination more than the illnesses that vaccines prevent.
Dr. Paul Offit holds the position of Chief of the Division of Infectious Diseases and Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and the Maurice R. Hilleman Professor of Vaccinology at the University of Pennsylvania School of Medicine.
He has also written a new publication concerning vaccines, the anti-vaccination movement, and the fear guiding many choices involving vaccinations.
I spoke with Dr. Offit by phone from his home near Philadelphia.
David: At times when perusing Deadly Choices, I felt there were two differing accounts being shared. In the initial, vaccination rates are reducing and society is at an increased risk of an epidemic. In the second, several new vaccines have been developed over the last 20 or 30 years, and we’ve seen another round of illnesses step away from everyday risk. How do you make sense of these two contrasting narratives?
Dr. Offit: I believe that we expect a substantial amount from the general public of America, more so than any other country. When you`re requesting that the common people of America vaccinate their children with vaccines to prevent 14 different illnesses by age five, 16 different illnesses by adolescence, which can mean as many as 26 shots in the initial years of life and five shots at one time, that is a great deal to expect particularly when you don`t see most of these diseases. Therefore, vaccination is an issue of trust.
In general, looking at the broader picture of the United States, immunization rates are quite high, typically in the upper 80s or low 90 percent range, and accordingly there has been a significant reduction in the incidence of these diseases. However, what has occurred is that certain locales or areas have begun witnessing a decline in vaccine rates. This has led to outbreaks, such as measles in Southern California, mumps in New York and New Jersey, or mumps in the Midwest, whooping cough in California at levels not seen since 1947. When observing this, it does present at least some fraying at the edges and concern that this fraying could worsen considerably.
When you hear Jenny McCarthy say, “I’ll take the freaking measles every time,” she has no idea what measles is — which tells you in some ways how remarkably successful the vaccine programs have been.
David: Do you see any silver lining to the anti-vaccine movement? The possibility that this has led to ultra-vigilant safety measures, that when considered in the long term may prove beneficial to public health and public confidence in vaccines?
Dr. Offit: I certainly think consumers have a role regarding vaccines. An example would be John Salamone. His child experienced permanent paralysis from the oral polio vaccine. He formed a group called Informed Parents Against Vaccine-Associated Paralytic Polio, IPAV. He would attend CDC meetings and American Academy of Pediatrics meetings to advocate the fact that this vaccine had a really uncommon but still valid side effect which impacted his child.
He greatly influenced our shift in 1998 from a vaccine schedule that contained the oral polio vaccine to one without it. Consequently, we now utilize the inactivated polio vaccine because a safer option existed. Do I believe consumer views have a role regarding vaccines? Unquestionably, but the views must constantly be supported by scientific facts. When examining the current anti-vaccine movement – the claims mention vaccines causing autism, diabetes, multiple sclerosis, autoimmune diseases, or illnesses clearly not induced by vaccines and demonstrated to have no link, yet that movement persists in advocating yes they do and we won`t trust the evidence, I don`t feel anything positive stems from that.
I believe that presently, the system in place to monitor, test vaccines before approval, and to monitor vaccines after approval is excellent. I think that the sort of unrest by the anti-vaccine people that vaccines are causing autism when they are not has done no good.
David: It is one of the hardest things to communicate to individuals why singular stories and individual experiences do not carry much significance in matters relating to science and medicine. Yes, such evidence can raise some intriguing queries. Yes, it can serve as a starting point for investigation and research, but by itself it cannot – and does not – determine what works and what does not, what is harmful and what is not. Do you have any useful comparisons for clarifying why clinical studies hold more value than a single story or personal experience? How do you personally explain this concept to someone without a scientific background?
Dr. Offit: I simply hope that it were accurate that scientific research outweighs anecdotal evidence. It’s quite difficult for scientific studies, at minimum in the perspectives of numerous parents, to outweigh anecdotal evidence because stories hold so much power, emotion, and individuality. It’s very difficult to outweigh that with statistics.
The situation I reference is one that happened to my wife. She came into the office on a weekend day. She was assisting the nurse administer vaccines. She entered a room. A mother was sitting with her four month old child waiting alongside the wall. While my wife was drawing the vaccine through the syringe, the infant experienced a seizure and went on to have the permanent seizure disorder, epilepsy. If my wife had administered that vaccine five minutes earlier, I believe no amount of statistical data worldwide would have convinced that mother of anything other than the vaccine caused it. What else could it have been, right? I mean, the child was fine, they received this vaccine, and then they had epilepsy. What else could it have been? Even though, in that particular case, my wife hadn’t administered the vaccine yet.
So statistically analyzing that question is rather challenging. But statistics are what we have to work with. If a parent inquires about their otherwise healthy child receiving the measles-mumps-rubella vaccine and then exhibiting signs of autism, that seems a fair concern to raise. Thankfully, it`s a question that can be addressed. Multiple investigations involving hundreds of thousands of individuals have now looked at whether that vaccine poses any increased risk of autism compared to not getting the vaccine. The data clearly shows no difference in risk between those who did or didn`t receive it. I think the key is endeavoring to explain this evidence to concerned parties. It`s not a simple task.
When I was resident at a hospital in Pittsburgh, there was a five year old child who had leukemia. The mother was convinced that in the previous month he had for the initial time started to consume peanut butter sandwiches, and she wondered whether those peanut butter sandwiches could have induced his leukemia. I mean, it’s a reasonable question. You could envision something. You could say the aflatoxin, which is a toxin contained in trace amounts of peanuts and therefore likely in peanut butter, we know can harm the liver. Perhaps you could argue that it could also harm bone marrow and cause leukemia. I don’t think there has ever been a study examining the relationship between peanut butter sandwiches and leukemia, but that’s feasible. You can conduct that study. So I guess you just have to try and clarify what the scientific method is, how it works, how it can answer questions parents have. And then hopefully, when the answers come, they’ll be believed.
David: I think one factor contributing to the strength of the anti-vaccine movement is that it brings together different sociopolitical groups typically divided. You see anti-government conservatives mixed with new age liberals. The blunt and decidedly lowbrow Jenny McCarthy sharing ideas with Bill Maher, who usually appeals to a fairly educated audience. Does this make them harder to discredit?
Dr. Offit: It is remarkable, isn`t it? I remember watching a Larry King episode and this really gets to the heart of the issue. Larry King had on — not that anyone should look to Larry King for healthcare advice — but in this particular episode he had Jenny McCarthy, he had Holly Robinson-Peete, both mothers of children with autism. Then he had a non-celebrity mother of a child with autism. His show aims to examine autism, its causes, its treatments. He seriously considered each of those three parents and said, “What do you think causes autism?”
This television program features the discussed topic yet does not include an expert who has committed their career to comprehending the disorder through published investigations, answering queries concerning autism. Certainly, there are beginning to be some findings concerning autism that are intriguing. Why does one think that if a parent has a child with a specific condition, that automatically makes them specialized in that condition, when they have not studied it? They are only specialized in their own child. So this thought process is illogical and surprising.
You make a fair point. Typically, those who question vaccines tend to be well-educated, higher socioeconomic groups. Yet one might assume that if listening carefully to Jenny McCarthy and how she structures her arguments and builds her logic, it would be difficult to not be impressed by her approach. Still, people are influenced. I`m unsure why. Perhaps it`s because she`s seen widely in movies and shows. I haven`t watched her much on the big screen myself, but being in a film like “John Tucker Must Die” may be enough for some to feel they know her better than scientists scheduled to appear. It`s unfortunate, really.
David: Some of the data provided in the book are genuinely startling: around 7,000 deaths annually from whooping cough in the 1940s; hundreds of casualties from measles; roughly 70 yearly deaths from chicken pox. Numerous of these sicknesses are considered rites of passage for youthful youngsters, however in truth they utilized to cost numerous youngsters their lives. These aren`t little infections that can be disregarded, wouldn`t you say?
Dr. Offit stated that there are no rites of passage associated with many vaccine-preventable diseases unless referring to heavenly journeys. Measles alone used to claim the lives of thousands of children annually, between three thousand and five thousand. Mumps was a common source of deafness. Rubella or German measles brought about twenty thousand cases per year of permanent birth defects. My parents who witnessed these sicknesses viewed immunizations as an easy decision according to Dr. Offit, since they saw the harms firsthand. Dr. Offit was a child of the 1950s for whom vaccines were readily approved as he did not directly experience the diseases. However, Dr. Offit mentioned that some people today do not accept the severity of these conditions, demonstrating both how hugely successful vaccine drives have been yet also how little the savings are cherished. This is apparent in the perspective expressed by Jenny McCarthy that she would rather contract measles over immunization, even though she lacks an understanding of what that sickness truly entails.
David: Where would you place vaccines in the order of advances that most increased life expectancy in the 20th century?
Dr. Offit: Undoubtedly in 1900, the average lifespan in the early 20th century was noticeably shorter than today`s life expectancy, having expanded by approximately 30 years. Among the key factors contributing to this, perhaps the primary aspect is the purification of drinking water, meaning achieving an adequate separation of sewage from potable water supplies. I would place vaccines second in importance. Indeed, looking at when immunizations are introduced into certain developing nations shows dramatic increases in lifespan as well as notable decreases in child mortality rates. Therefore, vaccines could be considered the second most impactful factor.
David: For several years, the work of Dr. John Ioannidis has brought into question how firmly based medicine is on solid scientific evidence, contrary to what many doctors believe – as he has consistently made the case that medicine isn`t nearly as grounded in quality research as we tend to think. More recently, a study conducted by two physicians from Johns Hopkins found that preceding investigations into similar topics are rarely referenced in later rounds of inquiry, challenging the very foundation on which biomedical science rests. What makes you confident that immunizations fall outside of these issues, allowing us to have such strong faith in their safety and efficacy?
Dr. Offit: I argue that vaccines have perhaps the strongest evidential basis of any medical practice. In order to be approved, thousands and now tens of thousands of children must participate in prospective, controlled studies with a placebo. No other medical product, particularly drugs, undergo such extensive assessment. Furthermore, approved vaccines are continuously tracked through databases like the Vaccine Safety Datalink, which has no comparison in drug monitoring. Should an issue emerge, the vaccine is swiftly pulled from the market, as proved by the withdrawal of RotaShield in 1998.
Vaccines sit on a very solid foundation and have withstood scrutiny for over two centuries since Edward Jenner developed the smallpox inoculation in the late 1700s. Smallpox was likely humanity`s deadliest infectious pathogen, and through vaccination, we may never encounter it again. No other medical intervention has such a robust evidentiary basis as immunization. The historical record powerfully illustrates vaccines` lifesaving capabilities.
David: Perhaps one of the most troubling aspects of the anti-vaccine movement is their disregard of all the genuine risks and limitations associated with vaccinations. For example, the oral polio vaccine that was unnecessarily transmitting the disease to approximately 15 children each year in the early 1980s – this issue did not appear to concern the anti-vaccine demonstrators.
Dr. Offit: There are issues with vaccines, as with any medical product, where they can have positive effects but also potential negative effects. However, constantly focusing on problems that studies have not linked to vaccines, like autism, diabetes, and multiple sclerosis, does not seem helpful. I do not think that good comes from centering on matters that lack a scientific basis. It is unfortunate.
The thing that amazes me. Andrew Wakefield, for example, released a publication in the Lancet medical journal. Now, to say that research was flawed is an understatement. It truly wasn`t a research study at all, but rather a case report. And now we know there were multiple fraudulent behaviors and inaccurate statements tied to that case report.
Those opposing immunizations still prize Andrew Wakefield highly. What does this imply, it`s almost as if he has become a counter-cultural champion. Because he is essentially viewed as revealing truth to authority. Unveiling truth to the system. When all he has done is prevented individuals from obtaining a vaccination that could have saved their lives. 3 people deceased in Ireland. 1 person in England, because the guardian was more frightened of the vaccine than the ailment their child perished from.
David: As a society we dedicate substantial funds towards healthcare. And a sizable portion of that covers treatments, supplements and procedures that offer little real assistance in helping individuals live longer or healthier lives. Can you identify any investment we`ve made as a community that yields a higher return on the investment than vaccinations?
Dr. Offit states that a significant portion of health spending goes towards what was formerly called unconventional or fringe medicine but is now more softly termed alternative or complementary medicine. However, where is the evidence that taking more vitamins, minerals, supplements or natural herb products provide value? There is none. Furthermore, what gains have been realized from the $80 billion pharmaceutical industry promoting such products? Likely, the money spent aiming to enhance health could have been utilized more beneficially.
More information and further reading:
- Dangerous Choices: How the Anti-Vaccine Movement Endangers Us All
- A critical examination of flawed scientific methods, risky medical practices, and the search for a solution to autism described in the referenced publication..
- Michael Specter on The danger of science refusal (TED Talk)
- Watch the PBS special The Vaccine War
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