Search results for 'infant mortality'

Childhood mortality and vaccines

2 Oct

One of the ideas that gets presented as fact all too often on the internet is “the United States is the most vaccinated country in the world and has one of the worst childhood mortality rates”. There are variations of this, of course. Unfortunately, this notion gets put forth by autism-parents and even autism-parent organizations.

This sticks in my mind since a rather blatant attempt at misinformation from Generation Rescue in the form of a pseudo-paper “special report”: AUTISM AND VACCINES AROUND THE WORLD: Vaccine Schedules, Autism Rates, and Under 5 Mortality. I wrote about the many failings of that document at the time.

One major failing in the childhood mortality comparisons is that the U.S. measures infant mortality (which is a big piece of under 5 mortality) differently than other countries. As Bernadine Healy (a source highly respected by groups such as Generation Rescue) wrote:

While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that “First, it’s shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless.

But why bring this up again? The reason is simple: I found a very interesting source of data and in reviewing it, I found information on vaccines and on childhood mortality: the Google Public Data Explorer. The Wold Bank dataset includes childhood and infant mortality figures.

What does the childhood mortality rate look like as a function of time for the United States? Not surprising (to most) it has been dropping over the past 30 years. In fact, from 1989 to 2009 the rate dropped from 12.1 per 1,000 to 7.8 per 1,000. (click to enlarge):

Why pick 1989 onward? This is the period when the vaccine schedule in the U.S. increased dramatically. If the idea that vaccines are somehow linked to worse childhood mortality we would expect this trend to be increasing, not decreasing.

Here is a good example of why we can’t say that correlation means causation. Consider childhood mortality for a country. Consider CO2 emissions for a country. Guess what, there is a big trend towards lower childhood mortality with higher CO2 emissions. (click to enlarge)

The “effect” (quotes mean it isn’t real) is huge. Note that the graph is a log-log plot. Countries with high CO2 emissions have 20 times, or more, lower childhood mortality. If we were in the “correlation equals causation” camp, we would decide that CO2 prevents childhood mortality. We could take this another step into the ridiculous and say, “Since CO2 emissions will coincide with higher atmospheric mercury due to coal burning and other sources, mercury must prevent childhood deaths”.

So keep that lesson in humility in mind as we play armchair epidemiologist and look further into the World Bank data. What is correlated with childhood mortality that might make sense? Being from a country in sub-Saharan Africa is correlated with high infant mortality rate. Low income countries have high infant mortality rates. Having a skilled person to attend the birth is correlated with low infant mortality rates.

Vaccines? What about them? They only have data for measles vaccine uptake. Again, not surprisingly, childhood mortality is lower for countries with higher measles vaccine uptake (click to enlarge)

I chose 2003 for the year for this comparison. That year has data as well for the fraction of births attended by skilled health staff. The datapoints are color coded with this to show that this is a big correlate. The more births have a skilled health worker in attendance, the more kids live. Could be a proxy for some hidden variable, but it makes some level of sense that having a health worker would reduce infant mortality. It also makes sense that countries with access to healthcare in general would have lower infant mortality.

But, that brings us back to the measles vaccine and infant/childhood mortality. Does the vaccine reduce infant mortality? Certainly in countries where measles is endemic. But measles vaccination isn’t the reason why childhood mortality figures are higher in, say, Chad than in the United States. And that’s why researchers try to control for other factors, like wealth and access to health care, when trying to correlate factors and diseases.

Otherwise, you end up with “mercury causes autism”. Or, using the World Bank data, “Cell phones cause low fertility rates”. Or other strange ideas.

While I think these data show pretty clearly that childhood mortality is not likely increased by vaccines, they also show the pitfalls of being an armchair epidemiologist. With the internet, data abound. One can find many correlations. Some are just random. Some are due to some unseen variable. Some are an indication of actual causation.

Do I believe that there is a reason why childhood mortality is lower in wealthy countries? Yes. Do I believe that there is a reason why childhood mortality is lower in countries with high CO2 emissions? No*. Both show correlations. What about the idea that measured autism rates went up as the exposure to thimerosal increased? Sure, there’s a correlation, just like with CO2 and childhood mortality. And, just like with childhood mortality and CO2, there are other factors at play.

*note–CO2 emissions are linked to countries with greater wealth. In that respect, yes there is a reason for the correlation. But there is no direct correlation of CO2 and childhood mortality.

Children Born to Diabetic Mothers May be More Likely to Have Intellectual Disability

18 Jul

A recent study found possible risk factors for autism in maternal conditions during pregnancy (maternal diabetes, hypertension and obesity). The study: Maternal Metabolic Conditions and Risk for Autism and Other Neurodevelopmental Disorders is online and a discussion can be found here at the Autism Science Foundation blog.

A study (non-autism) has been recently published indicating that diabetes might be a risk factor for intellectual disability. The risk was lower in the new study (1.10) than the previous, autism, study (1.52 risk for ASD, 2.33 odds ratio for developmental disability). Note that the sample size for diabetes in the autism study was small, resulting in large confidence intervals, so the differences may not be significant.

It is not a direct comparison between the studies, so that limits discussion. But it is interesting to see the subject of maternal diabetes and developmental disability again. It has come up before the autism study and will likely come up again.

Here is the abstract from the recent study:

Intellectual disability (ID) is a major public health condition that usually develops in utero and causes lifelong disability. Despite improvements in pregnancy and delivery care that have resulted in dramatic decreases in infant mortality rates, the incidence of ID has remained constant over the past 20 years. There may still be uncharacterized preventable causes of ID such as Diabetes Mellitus (DM). We used statewide individual level de-identified data for maternal and child pairs obtained by linking Medicaid claims, Department of Education, and Department of Disabilities and Special Needs data from 2000 to 2007 for all mother-child pairs with a minimum follow-up of 3-years post birth or until a diagnosis of ID. To ascertain the adjusted relationship between DM and ID, we fit a logistic regression model taking into account individual level clustering on mothers for multiple pregnancies using the population-averaged Generalized Estimating Equations method. Of the 162,611 eligible maternal and child pairs, 5,667 (3.49 %) of the children were diagnosed with ID between birth and 3-years of age. After adjustment for covariates the independent relationship between DM and ID was significant with odds ratio of 1.10 (1.01-1.12). On sub-analysis, patients with pre-pregnancy DM had the highest effect measure with an estimated odds ratio of 1.32 (0.84, 2.09), although this was not statistically significant. In this large cohort of mothers and children in South Carolina, we found a small but statistically significant increased risk for ID among children born to mothers with DM. Additional information about the association between maternal DM and risk of ID in children may lead to the development of effective preventive interventions on the individual and public health levels.

–by Matt Carey

Autism/vaccine activists likened to AIDS denialists

28 May

One of my big worries is that the public will someday turn against the autism community. We, and all segments of the disability community, all rely heavily on the public’s good will. One way we could lose that is if epidemics of infectious disease return and people point the fingers at “autism spokesperson” Jenny McCarthy. We as a group could be in for some real trouble.

One reason to blog and advocate against pseudoscience and dangerous celebrity advice is to make it clear that the autism community as a whole is not behind Jenny McCarthy and her crowd.

So you can imagine the dismay I feel when I search for autism related articles in the Nature journals and I hit upon this one, The dangers of denying HIV.

Why would that article come up using the search word “autism”, I wondered. AIDS denialism is a truly horrible movement in the world. It leads, quite clearly, to disease, suffering and death. Probably no where is AIDS denialism more a problem than in South Africa. The author of this brief note in Nature, Seth Kalichman, notes:

Inadequate health policies in South Africa have reportedly led to some 330,000 unnecessary AIDS deaths and a spike in infant mortality, according to estimates by South African and US researchers. This carnage exceeds the death toll in Darfur, yet it has received far less attention.

This is, he argues, due in large part to AIDS denialism–promoting the idea that HIV does not cause AIDS and encouraging people to forgo treatement.

The tragic events in South Africa have been exacerbated by AIDS ‘denialists’ who, Kalichman alleges, assert that HIV is harmless and that antiretroviral drugs are toxic. The author discusses the psychology of denialism, which he says is “the outright rejection of science and medicine”.

Dr. Kalichman makes it very clear that denialists are acting outside of the boundaries of decency:

Kalichman dismisses denialists’ attempts to portray themselves as intellectually honourable dissidents who question accepted wisdom. He draws clear distinctions between dissidence and denialism; the latter, he says, is merely a destructive attempt to undermine the science.

What does this have to do with autism? Dr. Kalichman groups vaccine-autism groups in with AIDS denialists in their tactics:

Groups that support intelligent design, doubt global warming, claim that vaccines cause autism, argue that cigarettes are safe, believe that the terrorist attacks of 11 September 2001 were an intelligence-agency plot or deny the Holocaust all use similar tactics.

That is an “ouch” moment. To see that the outside world is starting to group autism activists with so many denialst groups is troubling, to say the least. If there are more outbreaks of disease that can be tracked back to vaccine rejectionism sparked by autism groups (for example, recent outbreaks of whooping cough), we are in for a public relations nightmare.

If you don’t think the analogy to AIDS denialists is well earned, consider this passage:

Kalichman describes how quacks, like some of the academics involved, misrepresent their qualifications to create an illusion of authority. One, he claims, treats AIDS with hyperthermia, massage, oxygen, music, colour, gem, aroma, hypnosis, light and magnetic fields, each word followed by “therapy”.

We have certainly seen inflated qualifications and the list of therapies could easily be attached to autism.

It isn’t as though Dr. Kalichman hasn’t read up on autism, either. He concludes his piece with:

Action might have widespread benefits: Paul Offit’s tour de force, Autism’s False Prophets, claims that pseudoscientists and quacks have used similar tactics to parasitize the suffering of desperate parents by persuading them that vaccines cause autism. As Kalichman says, denialism “will not break until the public is educated to differentiate science from pseudoscience, facts from fraud”.

“denialism will not break until the public is educated to differentiate science from pseudoscience, facts from fraud”

I wonder if that time will ever come?

Generation Rescue: a dishonest autism charity?

6 May

Generation Rescue has a long history of promoting bad science. They even have tried their hand at it themselves before, with a phone survey that was so bad it would have earned a college freshman in epidemiology a failing grade.

So when they came out with their own “study” of vaccination rates around the world, you can imagine I didn’t expect it to be good. In fact, I just avoided it altogether until they sent me an email telling me how good it was.

So I looked.

It was worse than I expected. Far worse.

The “study” is here. Generation Rescue (GR) looks at the vaccine schedules for multiple countries and compares this with the infant mortality rate and autism rates in those countries.

I read it and, Oh…my…god… I expected bad science and poorly/biased interpretations. Instead, what I found was pretty clear evidence that Generation Rescue is knowingly distributing misleading information.

Before you get worried that this post is way long and question whether you really want to read the details, here’s the short version:

1) They compare infant mortality rates between the US and other countries–even though it is clear (according to their own expert no less!) that the US uses different criteria for infant mortality and it isn’t accurate to compare the US infant mortality to that in other countries.

2) They compare autism rates amongst countries to show the US has the highest rate, suggesting that the higher the number of vaccines the higher the autism rate. They just “forget” to tell you that the prevalences for the other countries are from old studies. We can debate why the reported autism prevalence is going up with time, but no one debates that the older studies report lower prevalences than we see now. So, why does Generation Rescue compare prevalence in the US using 2002 data for kids born in 1994 with, say, a Finnish study using 1997 data on kids born as early as 1979? I consider them very biased, but not incompetent enough to miss those fatal mistakes in their study.

3) They claim that the US has the highest vaccination rates and the highest autism rates. They conveniently ignore prevalence from Canada and the UK, which have comparable prevalences to the US and much much lower numbers of vaccines. Yes, you read that right, they left out the well known studies that would show that their conclusions are nonsense.

The worst part is that it is almost certain that Generation Rescue didn’t make an honest mistake. These are so obvious that whoever wrote that “study” had to know he/she was producing what amounts to the lowest form of junk pseudoscience.

For those who want the gory details, here they are:

Infant Mortality Rates

Generation Rescue points out that the reported infant mortality rate is highest in the United States, which also has the most childhood vaccines. All well and good, but can we really compare the infant mortality rates from country to country?

When I type infant mortality rate into a google search, the first hit is a Wikipedia page which, as it turns out, addresses exactly this question.The answer is a resounding “NO”, we can’t compare the US infant mortality rate with that of other countries.

While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that “First, it’s shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless.

So, who wrote that 2006 article in US News & World Report?

Bernadine Healy.

Yep, the same Bernadine Healy that is Generation Rescue’s favorite “mainstream” doctor.

One has to believe that GR saw that article in Wikipedia and the US News article. They are, after all, Google Ph.D.’s. Given the author was Bernadine Healy, they have to have considered it accurate, don’t you think? And, yet, GR conveniently forgets to mention the differences in how the US and other countries count infant mortality in their vaccines cause autism “study”.

Autism Rates 1: Autism Prevalence by country

Start with the conclusion of the Generation Rescue “study”:

This study appears to lend credibility to the theory that the U.S. vaccine schedule is linked to the U.S. epidemic of autism, particularly when compared to the published autism rates of other countries.

Given this bold claim, it is critical that they use good data for the autism rates. By “good” I mean that they need data that they can accurately compare to the CDC reported prevalence of 1 in 150. That data was taken in 2002 on 8 year old children. I.e. kids born in 1994. Since reported prevalence numbers are going up with time, it would be very misleading if they were to use, say, prevalence numbers from the early 1990’s, wouldn’t it?

Any prevalence that they use would have to use prevalence numbers from about the same time, on kids of about the same age.

Here’s their table comparing the autism rates.


Let’s take a look at the studies they cited for their numbers, shall we?

Iceland: Prevalence of Autism in Iceland. This 2001 study uses kids from birth years 1984-1993. I.e. most (if not all) of the kids are from the time before the big upsurge in autism diagnoses. Hardly a good comparison to the 2002 CDC study, eh?

For Sweden, they use a paper called, “Is autism more common now than 10 years ago?” from The British Journal of Psychiatry. Published in… 1991. That’s pre DSM-IV. Amongst other problems, they won’t be including the other PDD’s in the autism spectrum, like the CDC study does. Besises, the kids from the CDC study weren’t even born yet, it was so old! Is there any wonder that the Swedish study shows a lower prevalence?

For Japan, they use a paper titled Cumulative incidence and prevalence of childhood autism in children in Japan. The study uses data from 1994 on kids who were born in 1988.

Are you starting to see the pattern here? Time after time, GR is comparing US 2002 prevalence data to much older data from other countries. Let’s go on:

For Norway, they use the paper Autism and related disorders: epidemiological findings in a Norwegian study using ICD-10 diagnostic criteria. The paper was published in 1998 on children 3-14 years of age. Simple math suggests they had kids with birth years going back to at least 1984 in that study. Hardly a good comparison to kids born in 1994.

For Finland, they use Autism in Northern Finland. Here is an updated version from 2005. The study uses data from 1996-97, on kids up to 18 years old. I.e. they are using kids that were born as early as 1979. Also, they are using data on patients from hospital records who used “communal health services”. Sounds a lot like “inpatient”–one of the critiques that GR uses against studies from Denmark. Also, the Finland study didn’t include Aspeger syndrome, as that was a new diagnosis at the time. Hardly a good comparison to the CDC study.

For France, they use Autism and associated medical disorders in a French epidemiological survey. This uses “French children born between 1976 and 1985”.

For Israel, they use Autism in the Haifa area–an epidemiological perspective. This paper looks only at autistic disorder (no PDD-NOS, no Aspergers, no Rett’s no Childhood Degerative Disorder). Right off the bat that reduces the prevalence and makes it impossible to compare the the CDC 2002 study. The Israell study also is, you guessed it, based on kids older than the CDC study: children born between 1989 and 1993.

Last, Denmark. If you’ve been following the thimerosal debate, you know this is going to be ironic. They use Madsen’s paper, Thimerosal and the Occurrence of Autism: Negative Ecological Evidence From Danish Population-Based Data. Generation Rescue refers to this study (incorrectly, I might add) as “This one goes beyond useless”. I guess “useless” is only when it is used to refute the thimerosal hypothesis? Come on, GR, this level of hypocrisy is just painful.

Missing Studies

There are some very well known studies that Generation Rescue somehow forgot to include in their “study”. Could this be due to the fact that they are very good counterexamples to the vaccine-hypothesis ? Let’s look at some and see, shall we?

United Kingdom: Pervasive Developmental Disorders in Preschool Children: Confirmation of High Prevalence ( study performed in 2002 with a prevalence of 1 in 170), and Pervasive developmental disorders in preschool children (study performed in 1998/9 with a prevalence of 1 in 160).

Canada: Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links With Immunizations (birth years 1987 to 1998. Prevalence 1 in 154).

Wow, the United Kingdom and Canada have prevalence numbers comparable to those in the US!

So, let’s complete the comparison, shall we? What is the vaccine schedule like for the UK and Canada? Using the Generation Rescue “study” we get 20 vaccines for Canada and 21 for the UK.

Wow, that’s way less than the US (with 36), and they have the same autism prevalence as the US? How could that be? Is it, perhaps, that the autism is NOT related to the number of vaccines in a given country’s schedule?

Anyone doubt why GR left the UK and Canada off their table of Autism Prevalences Around the Globe? No, I am not giving them a pass that this could be an honest mistake.

To quote Generation Rescue’s top funny guy (Jim Carrey), “How stupid do you think we are?”

Why the next CDC autism rates spells bad news for the mercury hypothesis

22 Mar

A recent article on Disability Scoop discussed an upcoming CDC autism report. The MMWR’s(Morbidity and Mortality Weekly Reports) from the CDC have been one of the standards for autism prevalence for years. Each CDC prevalence estimate is calculated for a group of 8 year olds born in a certain year. For example, the last estimate was “Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities Monitoring Network, United States, 2006” for children born in 1998.

Every time a new CDC autism MMWR has come out, the prevalence estimates are higher. Every timer there are groups that point to the rising number of vaccines and mercury exposure from those vaccines. People point out that there is a correlation between mercury exposure (thimerosal) and the autism rates. The MMWR’s so far have been all for children born in the 1990’s, a period when the number of vaccines and the thimerosal exposure from those vaccines was increasing.

Here are the autism prevalence estimates from recent CDC reports:

2006 (birth year 1998) 9 per 1000
2004 (birth year 1996) 8 per 1000
2002 (birth year 1994) 6.6 per 1000
2000 (birth year 1992) 6.7 per 1000

Following this trend, the next report will be for children born in 2000, age 8 in 2008. From the perspective of testing the vaccine hypothesis, in particular the mercury/thimerosal hypothesis, this is the start of a new era. In 1999 the AAP recommended that thimerosal be removed from vaccines. By 2001, all infant vaccines with the exception of influenza were produced only in thimerosal-free versions. This means that children born in 2000, the cohort the CDC will likely report upon, received, on average, a lower exposure to thimersal than the previous groups.

If the mercury hypothesis were correct (and there already a great deal of evidence to say that it is *not* correct) the autism rate should go down. At the very least, it should stay the same as the group before–about 0.9%.

Of course we will hear claims like “but not all the thimerosal containing vaccines were gone for this group” and “but what about the influenza vaccine?” and more obvious excuses in case (at it seems likely) the prevalence goes up again.

All of these avoid the fact that the average thimerosal exposure will be much lower for this group than the previous (1998 birth year) group. The excuses amount to…well…how about a visual?

With thanks to Reuters for the image I am using.

Yes, goal posts will move. Nice idea putting them on wheels. Could save a lot of effort, but those promoting the mercury idea are already used to moving goalposts.

And what if the CDC also reports on birth year 2002 (they have reported two birth cohorts at the same time in the past)? Those goalposts might to have to move quite a bit.

Now consider a different perspective. Consider that each CDC report has been an undercount. They don’t do a “whole population” survey like was done in Korea recently. They don’t test all children, they rely upon records already in existance. The last CDC report found that about 23% of the children identified as autistic in the study did not have a diagnosis before the study. Clearly the United States has not been identifying all the autistics in the population. Given this, the rising autism prevalence estimates (and, yes, they are *estimates*) could be seen as an accomplishment. This is a position put forth by Prof. Richard Grinker. The rising prevalence estimates reflect a the U.S. getting better at identifying the autistic students in our schools.

Too many falsehoods, too often

11 Oct

ResearchBlogging.orgThere are a number of falsehoods used in the vaccine-rejectionist arsenal. One, which we’ve discussed recently, is the idea that vaccine preventable diseases are in reality “not that bad.” Another is that deaths from vaccine preventable diseases were decreasing before vaccines were introduced, implying that the vaccines are getting credit for something that was already happening. Another is that somehow we are “overvaccinating” and that we can go back to an earlier schedule and be just fine. Another is that we vaccinate children too young.

We all know the current catch phrases. And that’s what they are, slogans, catch phrases…the efforts of marketing rather than science.

But, let’s take a look at a paper that covers a number of these falsehoods at once. This is an older paper, from 1994. The paper is National Trends in Haemophilus influenzae Meningitis Mortality and Hospitalization Among Children, 1980 through 1991.

As you can imagine, they were looking at the reduction in deaths and hospitalizations from meningitis caused by Haemophilus influenzae. This is what the Hib vaccine protects against. The first Hib vaccine licensed in the U.S. came out in 1985. However, it didn’t work for children >18 months of age, and had only moderate effectiveness for older children. A more effective vaccine was licensed in 1987 for children >18 months, and in 1990 for children >2 months.

Bottom line, good protection against Hib meningitis came to the U.S. in 1987.

So, if this actually worked, we should see trends changing about that time. Take a look at Figure 1 from the paper. (click to enlarge)

U.S. Hib deaths by year 1980 to 1991

The top trend is for Hib induced meningitis. The other two datasets are for Streptococcus pneumoniae and Neisseria meningitidis induced meningitis.

Note that the mortality was dropping with time before the introduction of the vaccine. Deaths declined by 40% from 1980 to 1987 (a span of 8 years) for Hib meningitis (with similar big drops in the other types). Dang. Good job, docs! But, that’s only part of the story. Take a look at what happens after 1988. Hib meningitis deaths drop at a much faster rate. After the introduction of the vaccine, Hib meningitis deaths dropped 90% in only 4 years.

But, you don’t have to geek out like me on the numbers, just look at that trend–in 4 years, Hib meningitis went from the highest cause of meningitis deaths, to tied with the lowest in this comparison.

That’s the sort of data that the mercury-causes-autism crowd were expecting to see in the autism rates starting a couple of years ago. (but, I digress…)

Note that there isn’t a change in the trends for the non Hib versions of meningitis graphed. It’s about as clear as data can get–introduce the vaccines, fewer people die. Note that the hospitalization rate is about 15x higher than the death rate. So, a lot of kids ended up in the hospital. I have to admit, I didn’t realize how really nasty this disease is. If about 1 in 15 of the people who go to the hospital die…well, dang, thank god there’s a vaccine.

I can already hear the response–but, why do we have to be so “aggressive” in giving these vaccines to such young children? Take a look at figure 3 from the paper.

Hib meningitis deaths for infants and young children 1980-1991

They broke the data down to infants (younger than 1 year old) and children 1-4 years old. Notice that the trend is the same for both age groups. More importantly, notice that the death rate is about 5x larger for the youngest children.

Yes, five times higher. But, protecting these young children is “aggressive”. If that’s aggressive, thank god for aggressive.

You may be wondering what prompted this little excursion to a paper from the 1990’s. Well, take another look at the citation:

Kenneth C. Schoendorf, John L. Kiely, William G. Adams and Jay D. Wenger (1994). National Trends in Haemophilus influenzae Meningitis Mortality and Hospitalization Among Children, 1980 through 1991 Pediatrics, 93 (4), 663-668

Note that one author, John L. Kiely? He recently wrote an Op-Ed for the Atlanta Journal Constitution on the importance of the MMR vaccine. Or, you may know him as EpiWonk.

But, to summarize:

Go back to the 1980 vaccine schedule? Had they not added Hib, thousands of kids would have died in the last 20 years. Many more would have suffered permanent injury.

We give too many vaccines? Based on what? Can we just do without the Hib?

Vaccines given too young? A 5x higher mortality rate for the youngest. Where’s the sense in delaying protection?

Vaccine preventable disease were becoming more manageable, so vaccines weren’t really doing anything. I guess if you believe in levitating dolphins, that argument works. For everyone else, the data are clear: vaccines work. They work well.

Protecting Public Trust in Immunization

28 Jul

That’s the title of a special article in Pediatrics:

Public trust in the safety and efficacy of vaccines is one key to the remarkable success of immunization programs within the United States and globally. Allegations of harm from vaccination have raised parental, political, and clinical anxiety to a level that now threatens the ability of children to receive timely, full immunization. Multiple factors have contributed to current concerns, including the interdependent issues of an evolving communications environment and shortfalls in structure and resources that constrain research on immunization safety (immunization-safety science). Prompt attention by public health leadership to spreading concern about the safety of immunization is essential for protecting deserved public trust in immunization.

It is quite bizarre that something that is overwhelmingly good for society and good for individuals should become the scapegoat for just about every ailment the modern world has. I’ve seen vaccines blamed for (aside from autism) asthma, AIDS, heart disease, obesity amongst other things and portrayed as part of a global Illuminati agenda to control the world population. I’ve seen people tie it in (or try anyway) to the events of 11th September 2001 and threaten scientists associated with their manufacture with death for them and their children. How the hell did we get here?

The paper from which I’ve included the Abstract above is an attempt to try and recognise how these things have happened and how the medical/science establishment can regain public trust in vaccination.

The paper opens with a little bit of self-chastisement:

Every time a mother holds her healthy infant to be immunized, she is demonstrating great faith in the potential benefit and safety of the vaccine and trust in the clinician who recommended it. Over past years, clinicians and public health leaders have taken for granted the magnitude of that act of trust. We also have basked in the praise that comes with being a participant in the success of immunization in dramatically reducing morbidity and mortality in childhood and changing the practice of

For doctors, who are by and large subscribers to the scientific mentality, the benefits of vaccination are obvious. Their error has been to not notice that 99.99% of their case load are not subscribers to the scientific mentality and therefore they will not look at things with the same lack of emotion. It is in fact very difficult to do so. Particularly for something like vaccination when we are essentially treating our kids for things they haven’t got. Also difficult to see for emotional rather than scientific people are things like keeping up herd immunity:

“Vaccines are victims of their own success” is the shorthand now used to reflect the reality that, in the absence of vaccine-preventable disease, many parents fear vaccines more than the diseases known to them only vaguely.

Its true. Getting the message through that just because the vaccine-preventable disease is not right here right now doesn’t mean its gone for ever is difficult. And here is another place in which the scientific community have fallen down: they have not got the message through. Until very recently, they have not even tried.

Over the past 10 years the Internet, particularly the web, has grown to every corner of the globe and over the years, those who used to be anti-vaccine cranks have now become trusted gurus to the parents who think that looking on is the same as doing research. The scientific community has failed to keep up with this. Their solutions (the NHS website for example) whilst very informative are stilted, formal and do not speak to the emotional side/needs of parents.

The Pediatrics paper lists a number of ways for science to regain the trust of parents.

One area that needs increased investment is immunization-safety science;


What is immunization-safety science? Or, more accurately, what are the sciences necessary for protecting public trust in the safety of vaccines? Most of the biological, social, and communication sciences have roles.

Some of these sciences are more central and obvious than others, such as allergy/immunology, epidemiology, and infectious diseases, but anthropology, ethics and political science also have important roles given the multiplicity of questions. Research on the short- and longer term risks and benefits of combinations and timing of multiple vaccines requires a different profile of disciplines than does the question of “what is the value of mandates in public immunization programs?”

Yes. Definitely. These are science based questions that need addressing.

Invest more in public awareness and genuine public engagement around immunization issues. Recognize the number and heterogeneity of publics to be served and the diversity and legitimacy of their questions and concerns.

? Educate the public on the elaborate, already existing US system for research and testing of vaccines, including the responsibilities of the vaccine industry and, particularly, the independent and interdependent functions of industry, the US Food and Drug Administration (FDA), the CDC, the Health Resources and Services Administration, and all their advisory bodies for prelicensure and postlicensure evaluation.
? Educate the public on the function, membership, and selection process for members of key advisory bodies.
? Increase the number and diversity of citizen members on advisory bodies without reducing scientific expertise.
? Give the public sufficient information and adequate time to understand the rationale for any new vaccines before embarking on immunization campaigns, which can be done without delaying protection.
? Engage local communities and parent groups as advocates of new vaccines.
? Avoid the hyperbolic marketing practices of overselling.
? Improve the communication skills of public and private health leaders to present information in perspective, including benefits, risks, and gaps in knowledge. Avoid obfuscation, admit gaps in knowledge, and be available and candid in answering the questions asked, building comfort even when the circumstances are uncomfortable. Take the time to explain changes in recommendations/policy. Such explanations are essential for reducing charges of waffling, indecision, and hidden agendas.
? Invest in research on what is truly driving parents’ questions and concerns and what may be needed to earn/keep their trust in vaccines.
? Decrease reliance on state mandates and in no case push for mandates before evaluating the results of voluntary immunization programs.

Yes, again, good points. However, to me, the key question is not being addressed. How do you intend to do this? What needs to change is how you get these things over to the general public. For example, parents of autistic people generally trust other parents of autistic people. I’m sure that there are some Paediatricians who are also parents of autistic people. Maybe they are even AAP members! Or work for the CDC. Give these people a voice.

Lets see some voxpop ‘interviews’ on YouTube. Nothing stilted, nothing formal, just people doing their job, speaking their minds. If there’s fault, let them admit it.

And you’re going to have to accept I think that there is a generation of parents here who are never going to see it your way. They’re lost. Concentrate on the new parents. If they’re having vaccinations, hold a Q&A but be ready for the hardcore anti-vaxxers. If they’re in for an autism assessment for their kids (or themselves) talk to them, don’t just diagnose and dismiss, let them express their fears. Yeah, it’ll take more time but it’ll be worth it in the long run.

Said the Brit, daring to comment on US health policy 😉