The Science Is Not Settled

As a practicing primary care physician for the last 43 years, and as a parent since 1981, I have followed the evolution of vaccination policy and science with interest, and not a little dismay.

The number of vaccines given to children has increased significantly over the last 70 years, from four antigens in about five or six injections in 1949 to as many as 71 vaccine antigens in 53 injections by age 18 today (the number varies slightly from state to state). This includes four vaccines given in two shots to pregnant women (and thus the developing fetus) and 48 vaccine antigens given in 34 injections from birth to age six.

Each vaccine preparation, in addition to the antigen or live virus, contains many other substances, including preservatives (mercury, formaldehyde), adjuvants to hyperstimulate the immune response (aluminum), gelatin, aborted fetal DNA, viral DNA, genetically modified DNA, antibiotics, and so on. We know that the young child's nervous and immune systems are actively developing and uniquely vulnerable, but I wonder how many thinking adults would themselves voluntarily submit to such an invasive drug regimen?

In 1986 the National Vaccine Injury Act was passed, prohibiting individuals who feel they have been harmed by a vaccine from taking vaccine manufacturers, health agencies, or health care workers to court. At the time, vaccine producers were threatening to curtail or discontinue production because of the mounting number of lawsuits claiming injury to children, mostly relating to immunization against diphtheria. Once relieved of all liability, pharmaceutical corporations began rapidly increasing the number of vaccinations brought to market.

Pharmaceutical companies are now actively targeting both adolescents and adults for cradle-to-grave vaccination against shingles, pneumonia, human papilloma virus, influenza, whooping cough, and meningitis. There are many more vaccines in the pipeline. Who wouldn't love a business model with a captive market, no liability concerns, free advertising and promotion by government agencies, and a free enforcement mechanism from local schools? It is, truly, a drug company's dream come true.

Judging from what one reads and hears in the popular media, it is easy to conclude that the science is settled, that the benefits of each vaccine clearly outweigh the risks, and that vaccinations have played the critical role in the decline of deaths due to infectious diseases such as measles, whooping cough, and diphtheria, all of which claimed many lives in the past.

However even a cursory look at the available data quickly reveals that the mortality from almost all infectious disease was in steep decline well before the introduction of vaccination or antibiotics. Diphtheria mortality had fallen 60 percent by the time vaccination was introduced in the 1920s, deaths from pertussis/whooping cough had declined by 98 percent before vaccination was introduced in the late 1940s, measles mortality had dropped 98 percent from its peak in the U.S. by the time measles inoculation was introduced in 1963-and by an impressive 99.96 percent in England when measles vaccination was introduced in 1968. In 1960 there were 380 deaths from measles among a U.S. population of 180,671,000, a rate of 0.24 deaths per 100,000.

The takeaway here is that vaccination played a very minor role in the steep decline in mortality due to infectious disease during the late 19th century and early to mid- 20th century. Improved living standards, better nutrition, sanitary sewage disposal, clean water, and less crowded living conditions all played crucial roles.

Current immunization policy relies on the oft-repeated assertion that vaccines are safe and effective. Yet the Centers for Disease Control and Prevention, the Institute of Medicine, and even the American Academy of Pediatrics have acknowledged that serious reactions, including seizures, progressive encephalopathy, and death, can and do occur. The federal vaccine injury court, which was established at the same time that vaccine manufacturers were exempted from liability, has to date paid $2.6 billion dollars in compensation for vaccine injuries. And there is ample reason to believe that the incidence of vaccine injury is strongly underreported.

Ronald Bailey has made the colorful assertion that an individual choosing not to vaccinate themself or their child is akin to a person walking down the street swinging their fists/microbes at others. Rather than indulging in broad generalizations about immunization, a close examination of data regarding the recent pertussis outbreaks may help illustrate the complexity inherent in immune function, individual susceptibility, and the spread of infectious illness.

In 2011, there were numerous outbreaks of pertussis around the United States, notably in California, Washington, and Vermont. The majority of whooping cough infections in each state were reported among well-vaccinated adolescents and young teens. There was also a slight increase in cases among infants younger than 1 year old.

In Vermont, 74 percent of individuals diagnosed with whooping cough had been "fully and appropriately vaccinated" against pertussis. Vermont Deputy Commissioner of Health Tracy Dolan stated: "We do not have any official explanation for the outbreak and have not linked it to the philosophical exemption." In a July 2012 interview, Ann Schuchat of the Centers for Disease Control's National Center for Immunization and Respiratory Disease stated that: "We know there are places around the country where large numbers of people are not vaccinated [against pertussis]. However, we do not think those exemptors are driving this current wave. We think it is a bad thing that people aren't getting vaccinated or exempting, but we cannot blame this wave on that phenomenon."

It's clear that the pertussis vaccine is not very protective against a disease that already has a very low mortality, likely because the pertussis bacterium has developed resistance, much like bacteria become resistant to antibiotics over time. In a September 2012 article, The New England Journal of Medicine concluded that "protection against pertussis waned during the 5 years after the 5th dose of DTaP [a type of combination vaccine]."

Recent studies suggest that immunized persons, once exposed to wild Bordetella pertussis bacteria, take longer to clear the pertussis bacterium from their respiratory tract than individuals who have had natural pertussis and thus gain natural immunity. These vaccinated individuals can then become asymptomatic carriers of the bacteria and vectors for transmission. So those who choose to opt in can also, as Bailey puts it, "swing their microbes."

Vaccine-induced immunity is not the same as naturally acquired immunity, and the much touted "herd immunity" resulting from mass vaccination is a far cry from natural herd immunity, the latter being much more protective, long-lasting, and transferrable to nursing infants who are then protected during their most vulnerable stage of development.

Understanding vaccine effects is complicated. The "fence" or "firewall" as Bailey puts it, is in fact a two-way street. Much has been said about all the "junk science" cited by anyone questioning vaccines (Jenny McCarthy, anyone?), but even a cursory peek over that fence will reveal some very good information and science-Mary Holland's Vaccine Epidemic and Suzanne Humphries' Dissolving Illusions, for example.

Lumping skeptical parents with the crazies is a way to avoid legitimate questions. Such as: Should tetanus vaccination be required for entrance to school, given that tetanus is not a communicable disease? Why should hepatitis B immunization be required for school entrance, when the disease is found primarily among adult drug users and sex workers? Do we need to keep immunizing against diseases, such as chickenpox, that are almost always mild?

There is a considerable difference between giving a seriously ill child a proven life-saving medicine versus subjecting a completely healthy child to a drug that is known to cause severe, or even potentially fatal, adverse effects, however small the chance. This is an ethical issue that goes to the heart of our basic human right to informed consent to any drug treatment or medical intervention.

Given the sheer volume of vaccine promotion and propaganda, coupled with the cozy relationship between government, industry, and media, there are sufficient grounds for a healthy skepticism. Individual parents have become the last line of defense (not offense, not a swinging fist), and their choices should be respected and preserved.