Non-epidemiologist tries to do epidemiology, feeds anti-vaccine activists

One of the rules of this blog has been to not name any names, but it’s going to be broken for this post because it’s hard not to break it in this case. The person I’m going to write about is putting himself out there, sometimes vociferously, to say some things that, as an epidemiologist, I find frustrating. First, a little background. A few months ago, a friend of this blog wrote this post about influenza vaccines. In that post’s comments, the name of one Peter Doshi, PhD, came up. Dr. Doshi wrote this article in the British Medical Journal and delivered this presentation (PDF) at the “Selling Sickness 2013” conference in Washington, DC. In his article and his presentation, Dr. Doshi, who is not an epidemiologist, makes some clear mistakes about the nature of the yearly flu epidemics that we see, the deaths from influenza, and the benefits/risks of the influenza vaccine.

“Immunize vs. Vaccinate” from two perspectives

If you’ve read some of the mind-numbing comment posts about vaccination, you’ll will undoubtedly come across the following argument:

“Vaccination is not the same as immunization!”

That statement means different things to different people. To us scientists, it’s a “truism.” Vaccination is a way to immunize, so is a natural infectious process. Both may not immunize if the person getting the vaccine or the disease doesn’t react to the vaccine or the disease in a way that creates immunity. For example, there are plenty of people who are “non-responders” to the hepatitis B vaccine. That is, they don’t make detectable antibodies against hepatitis B when they go through the vaccination series. They’re not considered immune, but they are also not excluded from working in healthcare and other “risky” professions. Why? Because the jury is out as to whether or not non-responders are really not immune. That is, we don’t really know if they’ll be protected or not. But, by taking the vaccine series, they did the best they could to be protected, short of using personal protective equipment and universal precautions.

Vaccine apologetics?

I don’t usually associate apologetics with scientific concepts. I associate them with religious things. Often, you have people on the radio or on television, defending their faith. I don’t blame them nor find any fault with this. For things that are untestable, apologetics is a good way to defend beliefs. For science, we have evidence. You either believe the evidence or you don’t. If you don’t believe in something that is tangible, testable, and objective, then you’re a denialist.

Denialists are scarier to me than apologists because these are people who are presented with actual, verifiable evidence of scientific claims, and they still find it in themselves to deny the evidence and continue to live in their own world. One such denialist showed up on “The Poxes” and commented on the “Measles” chapter. Here is what the denialist wrote:

Click to enlarge, of course.

The denialist was responding to this passage in that chapter:

“It wouldn’t be until the 1960s that a highly effective vaccine was developed and launched all over the world. The number of cases dropped precipitously to almost nothing in many parts of the world. While deaths had been avoided through better medical care once someone was infected, outbreaks still occurred in great numbers right up until the time when the vaccination level reached 90%, then outbreaks were halted because of herd immunity.”

That part of that chapter was not fiction. It is true that the advent of the measles vaccine in the 1960’s brought about the decline of measles cases and measles outbreaks in the United States. There were no huge leaps in food preparation, food hygiene, sewer systems, or hand washing in the 1960’s. Those things were well in place before the 1960’s, and they did squat to stop the spread of measles. Here’s the number of cases per year of measles:

Here is a graph with more information:

Can you see when measles cases dropped precipitously? When did we start having sewers or washing our hands in the United States? Sometime around the 1960’s? Nope.

The reason why improvements in hygiene and food preparation don’t do anything against infections like measles, rubella (German measles), or chickenpox, is that these infections are transmitted through droplets suspended in the air. You can scrub down a room until you can eat off the floor and still have measles suspended in the air if a person infectious with measles had been there a few hours earlier. You can hermetically seal all food, water, and waste, and these viruses would still linger in the air.

The best infection prevention against measles is to cycle the air in a room through a filter or let the room stand unoccupied for several hours and then scrub it down once the droplets settle onto surfaces. The thing is, you wouldn’t know that these droplets were there because they’re microscopic. Furthermore, someone with measles is infectious a few days before they get any symptoms. So you could very well have a healthy person walk into a room and contaminate the hell out of it.

I’m willing to give the denialist the benefit of the doubt and say that they have not “done their research” on measles, hence the misunderstanding. But this is another comment this person left for me on a blog post about the flu vaccine:

Click to enlarge, won’t you?

This person is not dumb. They’ve done “research”. They just refuse to see the evidence. (Of course, that Cochrane Collaboration did not find anything like that. The denialist is reading into it what the denialist wants to see.)

So, no, I’m not apologizing for vaccines. I don’t need to. The evidence is there. It is clear. It is testable. It is objective. Let whoever has ears (and eyes and intelligence) to understand the evidence listen and learn and help us move forward as a species.

Eight nurses with one neuron between them

If you haven’t heard it by now, here’s the scoop. Eight nurses at a hospital at the IU Health Goshen Hospital in Goshen, Indiana, refused to comply with hospital policy on influenza immunization and were fired. You know where this is going, right? Yeah, you do. The words “Nazi”, “Marxist”, “Forced”, and “Vaccination” are forthcoming.

First, some case law. The US Supreme Court, in Jacobson v. Massachusetts, ruled that the states have the authority to impose compulsory vaccination laws. This decision was upheld in Zucht v. King and even expanded to local town ordinances. Yes, in this Great Republic, filled with Democracy and Equality Under The Law, you must comply with immunization orders from your elected officials and their designated health officers or suffer the consequences. No, no one will hold you down and forcibly immunize you, but you may be put under quarantine, kept away from the vulnerable public, or fined/incarcerated. But, again, no one will hold you down and jab a needle in your arm.

We’re not Nazis.

Second, a word on “discrimination”. Discrimination has to do with selective reprisals or impositions on individuals based on a trait that they can’t help, like their race, ethnicity, place of birth, sexual orientation, color of their skin, etc. If someone says that you, you there in front of your computer or other digital device, cannot enter a building because of any of those traits and those traits alone, you’re being discriminated against. If you are fired because you are Hispanic, then you have a good case for discrimination.

Now, onto the nurses. These eight nurses were told that influenza vaccines were going to be required as a condition of their employment at the hospital. They were not going to be held down and vaccinated. None of their families were going to be dragged away to an internment camp. They were just going to be let go, free to find another job as nurses. (I hear there is quite the demand.) So what did the nurses do? They refused to get the flu vaccine.

They didn’t refuse because of an allergy or a medical condition that prevented them from being immunized. No. They refused because of their religion. This is what one of the nurses had to say about her dismissal:

““We all have different faith walks,” said Gingerich, who describes herself as a nondenominational Christian. “I feel like in my personal faith walk, I have felt instructed not to get a flu vaccination, but it’s also the whole matter of the right to choose what I put in my body and what I feel God wants me to put in versus someone mandating what I put in. It is a very big issue for me.” Gingerich was horrified that she was forced to choose between her beliefs and her job, but ultimately she said she knew what the right path was for her. “I feel like our religious freedoms are being challenged and not honored in a country that supposedly has these freedoms,” she said.”

Was she being told not to practice her religion? No. Was she not able to go to the church of her choice whenever she wanted to? No. Was she being forced to worship a different deity than the one she worships now? No. She was just asked to get a flu vaccine. A [expletive deleted] flu vaccine!

If you’re not familiar with the work of nurses, they play a critical role in the care of patients. They take orders from a healthcare provider and administer care, often in the form of medication. That is, they inject sick patients with medicine to make them feel better. So what did another vaccine-refusing nurse have to say about her situation? This:

“Your body has its natural responses to fight off certain viruses and infections, and if you continually inoculate your body with something that’s not even guaranteed from preventing you from getting it, why would you do it?”

The same can be said of any medicine; none of them are guaranteed to work. Why would you do it? Because the flu vaccine reduces the chances of you getting the flu, something that can be deadly for many people, especially hospitalized patients. What does this nurse have to add? This:

“As a nurse, my passion was to be the best advocate I could be for my patients. They knew I could be there for them even if sometimes it caused a rippling of the waters, but as a nurse there was no advocate for me except for several physicians who attempted to go to bat for our cause, but they were denied. So, what message is this sending to the public if this institution shoots down their own patient advocates?”

The message that this hospital is sending is that it cannot pussyfoot around when it comes to protecting its patients from influenza. If that takes firing nurses that will not comply — for whatever reason — then so be it.

And there is the hospice nurse, someone who works with incredibly frail people:

“Schrock believes that there are other steps people can take to stay healthy rather than getting a flu shot, like taking natural vitamins, eating well and exercising. The last time she had a flu shot was about 30 years ago.
“I just learned more and more about natural healing,” she said. “We’ve been using natural products for a good 20 years, and that’s the way we believe healing takes place.”
Schrock said her decision to decline the vaccination was, in part, “God-led.”
“I’m a pretty quiet, spiritual person, and for me, it was a big decision, but it was something that was very meaningful for me not to have in my body,” she said.”

Excuse me? There are other steps… Like vitamins and eating well? I’m not even going to touch the religiosity of her statements. I’ll touch the stupidity. There is no evidence that eating well and exercising prevents you from getting the flu. Washing your hands thoroughly, wearing a mask when working with people who are sick, those are evidence-based ways to prevent the flu. But a nurse recommending vitamins and exercise instead of the flu vaccine? Really?

The nurses continued to display their lack of science knowledge in the comments section of the article:

Name that vaxlie!

Can’t even spell “Guillain-Barre“, a 1 in 1,000,000 reaction. Shameful.

Also telling were the comments to the news article.

I don’t like to mention names, but, in this instance, I’m all for naming names. Thank God Almighty, Maker of Heaven and Earth, that Sue Schrock, Joyce Gingerich, and Ethel Hoover are no longer nurses at that hospital. Their inability to think critically and in an evidence-based way put a lot of people in danger, in my opinion. I mean, the all-or-nothing fallacy about the vaccine, really?

And the commenters? They said these things in public.

Others covering this:
Skewed Distribution
Harpocrates Speaks

Flu Vaccine Not As Effective As We Thought: Ring The Alarm?

Science is a funny thing. Just when you think you have it all figured out, something comes along that challenges the status quo, and we scientists end up going back to the drawing board. It happened to Einstein, believe it or not. When Edwin Hubble came along with observations that stated that the universe was expanding, Einstein didn’t quite want to believe it. When those observations were shown to be true, Einstein didn’t hold fast to his own views. He analyzed the evidence and judged it for what it was. Then he changed his mind.

Likewise, when we are talking about vaccines with an anti-vax person — and most discussions are not really about “talking” — the accusation comes up that we, the people who support and encourage the use of vaccines to prevent some horrible epidemics, somehow belong to a “cult” or a “religion” that worships vaccines. Nothing could be further from the truth. What we do is take in the evidence that has shown that vaccines — the licensed ones — are safe and effective against some nasty diseases. We weigh that evidence against what we know, and then we render judgment on that evidence.

Once in a while, like it happened with Einstein, something will come along to change our view about vaccines, or a vaccine, and we do change our view. Again, we weigh the evidence. (Can you see a recurring theme here?)

The National Association of County and City Health Officials (NACCHO) did an extensive study of the influenza vaccine in the United States. Guess what? It’s not as good as we thought it was.

Let that sink in for a minute or two.

Did you catch your breath? Well, you shouldn’t be out of breath to begin with because this is not earth-shattering news. It’s not to us epidemiologists, anyway. We’ve been noticing that, despite some pretty good vaccine coverages in different populations, we were still seeing some gnarly flu outbreaks each year. We were lacking the evidence on why this was occurring, but now we have it.

Here is the full report.

The long and short of it is that the flu vaccine is not as effective as public relations campaigns will have you believe. Were they lying? No. They were making those statements based on sub-par scientific evidence. (That’s why we weigh evidence before we render judgment, though it doesn’t always happen that way.) Also, the Advisory Committee on Immunization Practices (ACIP) has been making some of the flu vaccine recommendations based on expert opinion and not hard data. So the NACCHO report suggests that better vaccines be developed, that current vaccine recommendations be based on hard data, and that we don’t stop vaccinating in light of this evidence.

Why not? Because the flu vaccine is still the best thing we have against a disease that kills thousands of Americans each year and millions worldwide. So, while we work on the next best thing — and we must — we must also continue to use what we have.

It’s kind of hard to think about this from a scientific point of view, so it will not surprise me at all if the anti-vax crowd twists and bends what is in the report to fit their views. I’ll bet you $5 that they will.

Nevertheless, this report tells us that there are dedicated public health officials looking at these things and not being afraid to criticize them. If Edwin had been afraid to tell Albert that his general theory of relativity was a bit off, our GPS systems would be off. (They really would.) So, while the anti-vax crowd will raise this report as a failure of vaccine policy in this country, I raise it here as a success.

Now that we know what is going on with the flu vaccine, we can make a better, more efficacious one. And that is not a bad thing at all.