Don’t be an anti-vaccine activist

The South Dakota State Medical Association put out this collection of essays and reports (PDF) on the history of vaccines. It makes for good reading. If you don’t have enough time to read it all, read the afterword, especially this part:

“Public health has faced resistance to vaccination for as long as it has been used to protect the public’s health, but today the scope of the challenge facing public health to address these challenges has grown, including the increasing dependence of consumers on obtaining health information online. For decades, public health has accomplished its mission using its most valuable currency – trust and credibility. The public’s trust in public health and our credibility in using the best scientific and outcome-based evidence to drive our policies have enabled the dramatic successes in vaccination. Maintaining that trust and credibility is key to the success of future public health activities. If, to counter resistance to vaccines, public health overstates vaccine efficacy and effectiveness, the risk of being infected, and experiencing serious illness as the result of a vaccinepreventable disease, or the safety of vaccines, we will ultimately lose public trust and credibility. Our ability to promote vaccines will then be seriously challenged.”

I’ll be the first one to confess that I have, at times, used some of the tactics that anti-vaccine activists have used. I’ve been a troll on their comments section. (This one being my latest, greatest coup.) At times, I have called people names, and I have been very short-tempered when others were exhibiting their stupidity. In short, I’ve been antagonistic, and I blame the anti-vaccine and anti-science forces for making me come off that way.

No more.
How will I go about doing this? Through some simple rules:

1. Don’t exaggerate. Anti-vaccine people will use exaggeration to try and prove their points, sometimes claiming that events that happen once in a thousand years occur often enough to be feared. They do this a lot with Guillain-Barre Syndrome (GBS). This syndrome happens between 3,000 and 6,000 times each year to people regardless of whether or not they received any vaccine. Yes, GBS is known to be one of the things that could happen with vaccines, but it is very rare, and you have equal odds of getting it whether or not you’re vaccinated. But that’s not true to the anti-vaccine activist. To them, there is a clear and present danger of developing GBS with any and all vaccines, and this danger is so high (to them) that you should not get vaccinated.

Likewise, there have been a handful of cases of polio vaccine-derived poliomyelitis. A handful! But the anti-vaccine activists make it sound like any polio vaccine will undoubtedly lead to full-blown polio. They will tell you that the polio vaccine in places like India has caused a huge number of cases of “acute flaccid paralysis”, and they will recommend to you — with a straight face — that you are better off just washing your hands and drinking bottled water if you go to India and are not vaccinated.

On the other hand, I’ve seen some vaccine advocates use exaggeration as well. For example, subacute sclerosing panencephalitis (SSPE) is a known complication from having measles. It happens to people, particularly children, who get measles and don’t quite clear the virus. (No, it doesn’t happen from the measles vaccine, despite the vaccine virus being live, attenuated.) This type of encephalitis is incredibly rare, but it debilitating and awful for a child to go through. In an attempt to get people to vaccinate, I have used it as an example of something that could happen if you did not vaccinate. Others have done the same thing. And I’ve noticed that we don’t quite do the due diligence of clarifying the risk. Henceforth, I promise to say something like this, “Listen, the chances of SSPE are incredibly small, but they are larger than the chances of adverse effects from the MMR vaccine. The MMR vaccine reduces your chance of measles to almost nothing, and the chance of encephalitis and other nasty things from measles to even less than that.”

I’ll try not to exaggerate.

2. Don’t smear. One of the favorite things that anti-vaccine people do is to try and smear their opponents or people they disagree with. To some, a certain vaccine researcher and quite awesome pediatrician working in Philadelphia is a “vaccine industrialist” because he spent decades of his life trying to develop a life-saving vaccine and got compensated for it. A journalist who wrote an excellent book on the anti-vaccine forces is a “Pharma mouthpiece”, and so on and so forth. Anyone who comments online in an attempt to set the fact straight is labeled a “Pharma shill” or a “paid commenter.” Very seldom will the anti-vaccine activist address the facts being laid before them.

I have as well failed to address the lies laid before me by anti-vaccine activists and just attacked their intelligence. I have done this for several reasons. First, you can only explain things to people so much before it gets old and exhausting. Second, the very act of using lies to prove a point makes people worthy of one’s questioning of their mental abilities. It’s easier to write, “Listen, you moron. You painfully, obviously did not study biology because of this idiotic statement you’re making.” On the contrary, I plan to have some “canned comments” to just paste to people that make a claim. Usually, “Wakefield committed fraud and none of his claims have been duplicated nor validated” should suffice.

I’ll try to keep my composure and not smear, and not call names.

3. Easy with the anecdotes. I’ll be the first to tell you that there is some use to anecdotes because they can give us a worst case scenario for things. If one of my friends goes to a restaurant and gets gnarly food poisoning 12 to 24 hours later, I’ll probably avoid that restaurant. If another friend goes down a dark alley at night in downtown Managua, Nicaragua, getting stabbed and killed in the process, I’ll probably not go down a dark alley at night in downtown Managua, Nicaragua. Know what I mean?

The problem is when we use anecdotes to say that they represent the majority of cases, or the average experience of every person around you. For example, I told you about the man who is convinced that his daughter has type one diabetes because she got the hepatitis B shot as a newborn. There is no other evidence out there that the hepatitis B vaccine causes type one diabetes, but he continues to claim that his anecdote represents the whole of human experience. That makes him sound even more nutty unreasonable.

So I’ll keep anecdotes to a minimum and try to put them in perspective.

4. Be honest. There will be times when the evidence doesn’t back up what you deeply believe in, and you’ll be very tempted to lie or twist the truth a little bit. Don’t do it. That’s what the anti-science crowd does. They’ll look at the number of cases of a vaccine-preventable disease and how they plummeted after the introduction a vaccine and lie to you, telling you that it was hygiene, soap, or homeopathy that did it, not the vaccines.

You are going to see things that will shake your foundations on something that you believe to be true. I went through it just recently with the flu vaccine. As it turns out, the vaccine is not all that it can be. The injectable vaccine in the US doesn’t have adjuvants, so older people or people with malfunctioning immune systems will not react to the vaccine. Likewise, the intranasal vaccine doesn’t be very good at protecting adults. It does a good job with kids, though.

I had to present these findings to you and to my colleagues, and I didn’t back down because it is important to gain something from the truth, even if it’s a truth we don’t want to hear. It is necessary for science to grow that we correct our way and go on the path of knowledge, not the path of emotion.

I’ll continue to be honest, no matter where that takes me.

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17 thoughts on “Don’t be an anti-vaccine activist

  1. "You have all the time to hate yourself for being dishonest."The only way I'd hate myself is if I were an anti-vax troll.But let's look at the paper you cited: http://www.scielosp.org/pdf/bwho/v80n3/v80n3a07.pdf1) Do they mention using an alternative case definition to hide polio? No, they don't. That accusation is yours.2) In the findings section, you can see that the risk of VAPP actually — pay attention now — goes down with the administration of vaccine, from 1 in 4.6 million overall to 1 in 13.9 million after two doses.3) But what about the increased risk from 1 in 4.6 million to 1 per 2.8 million after the first dose? Glad you asked, my little troll. The risk of VACCINE ASSOCIATED paralytic polio if you go from no vaccine to vaccine, but then the second dose brings you back to a better than ever risk.4) You tell me, you'd rather risk 1 in 4.6 million or 1 in 13.9 million?5) "On the basis of data from a highly sensitive surveillance system the estimated VAPP risk in India is evidently lower than that in other countries, notwithstanding the administration of multiple OPV doses to children in mass immunization campaigns."Yeah, totally increasing the risk and hiding polio and whatnot.

  2. I always refer to the Worldwide Polio Eradication Initiative for weekly reports about the eradication of polio. Now, about those comments from "Anonymous", which have no links to reliable sources…how about this web page?http://www.polioeradication.org/Polioandprevention/Thevirus/Vaccinederivedpolioviruses.aspx"Vaccine-derived polioviruses (VDPVs) are rare strains of poliovirus that have genetically mutated from the strain contained in the oral polio vaccine.The oral polio vaccine contains a live, attenuated (weakened) vaccine-virus. When a child is vaccinated, the weakened vaccine-virus replicates in the intestine and enters into the bloodstream, triggering a protective immune response in the child. Like wild poliovirus, the child excretes the vaccine-virus for a period of six to eight weeks. Importantly, as it is excreted, some of the vaccine-virus may no longer be the same as the original vaccine-virus as it has genetically altered during replication. This is called a vaccine-derived poliovirus.Very rarely, vaccine-derived poliovirus can cause paralysis. Vaccine-associated paralytic poliomyelitis (VAPP) occurs in an estimated 1 in 2.7 million children receiving their first dose of oral polio vaccine.Types of vaccine-derived poliovirusThere are three types of vaccine-derived poliovirus: 1. circulating vaccine-derived poliovirus (cVDPV) 2. immunodeficiency-related vaccine-derived poliovirus (iVDPV) 3. ambiguous vaccine-derived poliovirus (aVDPV).1. Circulating vaccine-derived poliovirus (cVDPV)On very rare occasions, if a population is seriously under-immunized, there are enough susceptible children for the excreted vaccine-derived polioviruses to begin circulating in the community. These viruses are called circulating vaccine-derived polioviruses (cVDPV).The lower the population immunity, the longer these viruses survive. The longer they survive, the more they replicate, change, and exchange genetic material with other enteroviruses as they spread through a community.If a population is fully immunized against polio, it will be protected against the spread of both wild and vaccine strains of poliovirus.Episodes of circulating vaccine-derived poliovirus are rare. Between 2000 and 2011 – a period in which more than 10 billion doses of oral polio vaccine were given worldwide – 20 cVDPV outbreaks occurred, resulting in 580 polio cases. In the same period, wild poliovirus paralysed over 15 500 children."(Epidemiology 101: Learn some "Anonymous")

  3. "Of course, expand the case definition, and you get a "surge" in cases, like it happened with autism in the 1990's."Also a means to hide polio, isn't it?"Note how these cases of AFP are not from polio, or the polio vaccine, but from other enteroviruses. Some anonymous commenters can't see the forest for the trees."Did you even bother reading the bulletin? "Number of AFP cases with ITD result as…1. Wild poliovirus 2. Vaccine poliovirus 3. VDPV 4. NPEV by PCR5.Non enterovirus6. NegativeNow tell me which of these accounts the most cases of AFP?

  4. Here is one credible source:"Case definitionAFP cases in which wild poliovirus was isolated from any stoolsample were classified as confirmed polio cases and wereexcluded from the VAPP case definition. VAPP was defined asoccurring in AFP cases if there was residual weakness 60 daysafter the onset of paralysis, if vaccine-related poliovirus wasisolated from any stool sample, and if no wild poliovirus wasisolated from any stool sample."http://www.scielosp.org/pdf/bwho/v80n3/v80n3a07.pdfYou have all the time to hate yourself for being dishonest.

  5. That's funny. Then why didn't you cite VAPP and instead you only mentioned a handful cases of VDPV? That's a red flag and you know that. Be honest.

  6. No, that's not how "citing" works. You don't send the reader to the sources, you bring the sources to the reader. Cite your sources, and then we'll talk.As for my medical background there's an about page right here: http://thepoxesblog.blogspot.com/p/about.htmlI'm an infectious disease epidemiologist. Period.Now, go grab us some sources, credible ones not media reports or conspiracy blogs, and bring us some links to them, maybe some tables with numbers where it is definitely proven that the polio vaccine is causing all these cases of paralysis (which is funny that it would be only in India and not anywhere else where the OPV is given).(Hilarious that an anonymous commenter demands credentials.)

  7. How come you're confusing VDPV from VAPP? Is it because there's just "a handful" of VDPV compared to VAPP? Credible sources? They are everywhere i.e npsindia.org, WHO, CDC. Why don't we talk about your medical background on how you understand the essence of AFP surveillance in diagnosing polio, huh?

  8. One ponders one vaccine. One that did have horrendous consequences for those it not only didn't work on, but were infected by it.Indeed, for them, it was 100% fatal, overall. For partially successible, only wounded/scarred on a variable basis.The disease in question, smallpox. One of the primary POXES.Even today, the risk is considered acceptable, even if it costs millions to save the life of the occasional successible victim of the virus.The really funny thing is, today, vaccinia would not be accepted at all. It'd be rejected, smallpox would still reign.Or, as then, some sacrifices would be, regrettably, accepted and the disease would die.Smallpox is extinct in the world, save for a sparse few vaults where it still exists, in a super frozen state.I know of this from science and my own reality, one who experienced a limited progressive vaccinia infection. In later life, I was revaccinated without ill effect.SOME would accept smallpox or today's epidemic virus.I won't.I've personally witnessed the horrors of polio on villages that refused inoculation, overall, because of purely political reasons.To be brutally honest, any people who accept politics over the lives of their babies should be euthanized.But then, my wife and I have a singular perspective.One where we wished for three children, got two live births.Out of 16 pregnancies and one abortion, due to an ectopic pregnancy.I also have the perspective of witnessing polio and more progressing upon a populace, courtesy of my military duties to help them with their epidemic.Want to know the bottom line of experiencing such an event?It sucks on steroids.

  9. I have to say, don't be a germ denialist, polio promoter.In India, where it is saturated with OPV, an AFP case is considered VAPP unless proven otherwise. Almost all OPV recipients will excrete the vaccine-type virus which is also called OPV-like or VRPV (vaccine-related poliovirus) with more than 99% sequence identity to the OPV. Since people like you tend to skew the numbers of polio cases, AFP due to VRPV are automatically discarded as non-polio AFP, hence the nadir of "polio" cases but not the actual paralysis. If the isolate is found to have less than 99% sequence identity to the OPV, then it is VDPV (vaccine-derived poliovirus). So which of these is an exaggeration? Finally some words of wisdom,[…]you don't even let them comment. How detached from reality are you?[…]

  10. I have been perusing the reader comments at Amazon, and decided to revisit those for Deadly Choices.I found one person who is retired from public health who provides a model on how to deal with anti-vaxers: Joel A. Harrison. A sample of his comments can be found here.

  11. Hi Reuben: So sorry you are under the weather. There's an excellent blog "out there", which I follow, which provides some great information to counteract the nonsense about vaccines. Go there to see the dreadful consequences of the anti-vaccine movement; click on the "link" to the coroner's report about the circumstances surrounding the death of a 33-day-old baby from Hemorrhagic Disease of Newborns:http://momswhovax.blogspot.com/2013/01/consequences-in-language-of-courts.htmlAlso see the commentary about which medical doctor, who sells supplements, vitamins and $ 4,000 "tanning beds", has to say about vaccines and autism.P.S. A lady never reveals her age. (hint) I have a roll of steel pennies, given to me on my birthday…eons ago. 🙂

  12. @lilady, during the initial stage of prenatal care, an educational packet for new parents is valuable and the addition to factual information on vaccines would be more than invaluable. I'm nauseous already with this virus (grandson sneezed into my open mouth and shared his and his sister's misery with me), so I'd rather not search out what the antivax crowd are claiming about vitamin K. Can you give a quick note on their nonsense claims?Frankly, I suspect they'd object to that "artificial" NS injectable, were they to see the package insert…Can't recall the pre-measles vaccine days, as it became available when I was two, way back in 1963.However, I've personally witnessed polio sweep through villages over the years, all because their local religious leaders simply wanted our vaccination campaign to fail and that was more important than the health of the villagers and their children.

  13. Spammer Alert above.Great post Reuben and I do love your post on that notorious anti-vaccine website…which remarkably got past "moderation".I've often opined that education about childhood vaccines should begin before a couple has a child…such as providing the VISs (Vaccine Information Statements) in a folder to expectant mothers who are receiving obstetric care. Included in that "folder" could be some reliable information about breast feeding and Vitamin K injections at birth to prevent HDN (Hemorrhagic Disease of Newborns). (Newborn Vitamin K injections being "the latest target" of those crank anti-vaccine internet sites).IMO, this is the way we could provide reliable information about vaccines, and the program of prenatal vaccine education could be easily accomplished for parents who are members of HMOs, where there is a continuum of obstetric and pediatric care.Yes, I will continue to remind people that us "oldsters" actually remember when polio and measles vaccines were not developed. My childhood chum died from polio and my older cousin contracted measles and was left with lifelong permanent neurological sequelae due to measles encephalitis.

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