Blame Outbreaks on Vaccine Avoidance, Not Refugees

Editor's Note: This piece originally appeared on Medium.

By Layla Katiraee

Measles has been spreading throughout Europe, particularly in Romania. According to this recent article from the World Health Organization, Romania has “reported over 3400 cases and 17 deaths since January 2016”. Unfortunately, these deaths mostly occurred among individuals “who were immunocompromised or had other co-morbidities.”

I recently shared an article about this outbreak on Facebook, and several individuals commented asking whether it was tied to the recent wave of refugees that have entered Europe, particularly as a result of the Syrian war. It led to discussions about the possibility of refugees choosing to waive vaccinations due to religious beliefs, about the vaccination status of undocumented children in the United States, and other topics. As an individual of Middle-Eastern descent and immigrant of the United States, such discussions are challenging and hard not to take personally. I tried to steer the discussion towards the evidence, which I will outline here.

In this post, we’re going to explore how the current outbreak in Europe is spreading across the continent, and whether there’s any evidence to support the idea that refugees or immigrants are more/less involved in disease outbreaks in the United States.

Is the current measles outbreak in Europe associated with refugee populations?

Romania’s measles outbreak began in February 2016, and measles cases in Europe have been linked to individuals who travelled to Romania (see here and here). The World Health Organization (WHO) recommends that the vaccination rate for measles be greater than 95% so that the virus does not continue its transmission. This number is particularly high and is because of how contagious measles can be. The CDC states that “if one person has it, 90% of the people close to that person who are not immune will also become infected.”

Despite the recommendation from WHO, Romania’s vaccination coverage for the first dose of the MMR vaccine was estimated to be 88% in 2015, with a wide range in coverage across the nation. The World Health Organization states that these pockets of suboptimal immunization rate around the country are due to “certain cultural traditions, religious beliefs, fear of adverse effects of the vaccine or lack of confidence in public authorities”. The recent outbreak finds the majority of its cases in regions of Romania “where immunization coverage is especially low”.

Before anyone jumps to the conclusion that the “religious beliefs” exemption referred to above implies Islam, I could find no evidence to support this notion. A 2013 review published in the medical journal Vaccine explored the stance of major religious groups on the topic of vaccines. Although there are Islamic communities around the world that have opposed vaccines, Islamic leaders and thinkers have outlined how vaccinations are acceptable. Islamic medical scholars have examined the components in vaccines and have provided guidance to encourage Muslims to receive vaccinations.

The 1951 Refugee Convention as well as the “European Vaccine Action Plan” outline that refugees and asylum seekers should receive vaccines and/or preventive care, regardless of the individual’s legal status. Catching up on missed vaccines, particularly in children, is of importance as noted by WHO’s regional office in Europe: “Most of the refugees and migrants now arriving in Europe come from Middle Eastern countries where vaccines are widely accepted and coverage has traditionally been high. Those most at risk for vaccine-preventable diseases are young children who have not yet been vaccinated because the vaccination programmes in their home countries have been interrupted by civil unrest and war.”

WHO provides further guidance and recommendations in the document on how vaccinations should be provided to refugees across Europe.

In conclusion, I could find no evidence linking the current measles outbreak in Europe to refugees.
So, why has the vaccination rate in Romania declined? According to this document prepared by UNICEF, anti-vaccine sentiments have grown on social media in Romania, particularly by preying on parents’ fear around the use of chemicals and “toxins”. In other words, regions across Romania are just as susceptible to anti-vaccine arguments as Marin County, California.

Vaccines and Immigrants in the United States
Before we broach this topic, it bears noting that countries around the world include medical check-ups and vaccination records as part of the documents required for residency applications. I’ve lived in four different countries in three different continents. Each residency application required a visit to the doctor, including my green card application in the United States. My green card medical check-up took place while I was pregnant: I received a TdAP vaccine and I had to show my other immunization records.

The immigration process for refugees to the United States also involves medical examinations. Medical and religious exemptions can be granted to all immigrants and reasons for these exemptions are clearly provided. Most involve additional paperwork. In my personal experience, the immigration process is convoluted and long enough that I find it difficult to believe that an individual would seek an exemption unless it were absolutely necessary.

The question that remains is: are vaccine-preventable outbreaks associated with undocumented immigrants, particularly children, in the United States?

Such claims have been made by many individuals, including politicians, in the United States. However, there is no evidence to support the claim. The CDC has found that unaccompanied children that arrive at the US border pose little risk: “Countries in Central America, where most of the unaccompanied children are from (Guatemala, El Salvador, and Honduras), have childhood vaccination programs, and most children have received some childhood vaccines. However, they may not have received a few vaccines, such as chickenpox, influenza, and pneumococcal vaccines. As a precaution, ORR [Office of Refugee Resettlement] is providing vaccinations to all children who do not have documentation of previous valid doses of vaccine.”

However, to ensure that all children across the country receive the required vaccinations, laws such as California’s SB277 are needed, which ensure that children enrolling in the public school system are up-to-date on their immunizations.

It is my biased opinion that immigrants and refugees would be more likely to receive vaccinations. Individuals leave their home country in search of safer and better opportunities, and that includes better healthcare for their families. Vaccines have been a victim of their own success: many North Americans have not experienced the harms of forgotten diseases and have not experienced a dangerous disease outbreak. Yet many South Americans know and fear diseases: as a child living in Venezuela I remember a cholera epidemic, as a teenager my entire family got dengue fever, and we got our yellow fever vaccinations before moving to South America. It is my perspective that South American immigrants would have an immunization rate equivalent or greater than that of US-born Americans, and there’s some evidence to support this.

Finally, a paper published in 2016 examined the risk of importing measles from undocumented immigrants versus US travellers. The paper concluded (emphasis has been added):
“Overall, there are 10 times more annual US visitors to high measles incidence countries than there are unauthorized immigrants in the US from high measles incidence countries.

Efforts to prevent reestablishment of indigenous measles transmission in the US should focus on evidence-based risk assessments, highlighting a greater potential measles importation risk of from US residents travelling internationally than unauthorized immigrants coming to the US.”

Conclusion

It bears noting that there have been instances where vaccine-preventable illnesses have had outbreaks in refugee camps. These were associated with the living conditions in some camps and provided much learning to the organizations involved. However, vaccine-preventable illnesses have also had outbreaks in Disneyland and Manhattan. That we should assume that refugees or immigrants are more likely to “carry disease” points to our own prejudices about segments of our society that should be embraced rather than shunned and assimilated rather than outcast. We should be mindful of the agenda behind websites, like Breitbart, that promote such myths, and turn to health organizations such as WHO or CDC for information on disease outbreaks.

Layla Katiraee is a NGS production development scientist in California who blogs about GMOs. She is mother to a four-year-old.

Big Alterna and the Ties That Bind

By Karen Ernst

Editor's Note: Voices for Vaccines does not and never has accepted any government or pharmaceutical funding. The organization is supported 100% by individual member donations.

Recently, an anti-vaccine blog put together 11 Facts about Voices for Vaccines claiming to show that we are a “front group” for Big Pharma/the CDC. The blogger drew up charts showing the connection between various people (the charts were wrong) and included a map to show how close our fiscal agent was to the CDC (2.6 miles!). Yet, I work in my little (messy) rambler 1,120 miles away from this supposed vortex of evil, busily not being directed or controlled by the Task Force for Global Health, the CDC, Emory, or Big Pharma (or the reptillian overlords).

All the conspiracy theories and convoluted logic about supposed and unproven influence by the CDC and pharmaceutical companies on a parent-led vaccine advocacy group makes it that much more interesting that the National Vaccine Information Center is indelibly tied to the hugely influential Big Alterna figurehead Joseph Mercola. Unlike any fiscal connection alleged between Voices for Vaccines and the CDC or Pfizer or any pharmaceutical company, the fiscal ties between NVIC and Mercola are factual, and I want to explore them with you here.

If you are a person who lives a normal life and only thinks about immunization when you bring your child in for his well-child check, the National Vaccine Information Center might sound like a good thing. It might sound positive to have information about vaccines in one convenient “center” for the whole nation.  The problem is that NVIC is definitely anti-vaccine. They have even gone as far as promoting a conspiracy theory about high school kids who created a film about immunization in an after school program. (Shockingly, like football and yearbook, this program was advised by adults, thus prompting the conspiracy theory.)

In addition to the billboards NVIC buys across the United States asking motorists to “Know the Risks and the Failures” of immunization, NVIC also spends a great deal of time and energy opposing a great deal of vaccine-related legislation. They are even opposing proposed legislation that would provide information about vaccines and record students’ vaccination status.

For an organization that claims it is not anti-vaccine but is rather “pro-informed consent,” opposing information seems odd.

Except that they are anti-vaccine and pro-misinformed consent.

I had assumed for a long time that this was the entire story, until the day (two days actually) the NVIC website went down and in its place:

It turns out, the NVIC website is provided as an in-kind donation from Mercola.com.

If the VFV website went down, I do not know what would appear there, but to be clear, VFV pays for its website from its own funds which comes from individual donors. The Task Force for Global Health is listed as the owner of our domain name because, as our fiscal agent (we are not yet our own 501(c)3 so do not have ready access to our bank account), they actually issued the check using the funds we raised for Voices for Vaccines.

So, which websites does Mercola provide funding for? (A hat tip to the Skeptical Raptor for this next part.)

Click here for a larger image

Most interesting in this list of domains owned by Mercola.com is the number of them selling something. Bath products! Tanning beds! Water filters! Why would someone selling such an odd mish mash of home products care about helping an anti-vaccine organization promote their misinformation?

Perhaps because there is money to be made off of parents who eschew immunizations out of fear of what they see as “unnatural.” Make no mistake, parents seeking natural health alternatives make big bucks for Big Alterna. And Joseph Mercola, the doctor behind Mercola.com, is near the top of those cashing in.

Let’s review: the National Vaccine Information Center claims not to be anti-vaccine, but in favor of informed choice about vaccine, but as an organization they have made documented efforts to make it more difficult for parents to receive information about vaccines. They do not want schools to know who among their students is vaccinated (even in the case of outbreaks), and they do not want high school students to pursue documentary filmmaking about topics that interest them.

I believe Theresa Wrangham or even Barbara Loe Fisher, the women heading NVIC, believe the misinformation they promote, but if they believe they are not anti-vaccine, they are seriously delusional. And if they believe that Joseph Mercola is providing them with a website because he has a heart of gold, they should know that he probably bought that gold.

For a couple years now, I have sat on my slightly-too-tall IKEA chairs at my old computer fielding accusations about my connections to Big Pharma and the CDC, who apparently want to force parents to immunize their children because there’s money in it, and because the’re evil. (Note: you cannot buy tanning beds or supplements from VFV, the CDC, Emory University, or the Task Force for Global Health.) This strange theory is promoted enthusiastically by NVIC.

And I’m not even sure what that is. Hypocrisy? Willing ignorance? Arrogance? I’m genuinely curious about what drives NVIC’s willingness to schlep out the Pharma Shill gambit while simultaneously being a Big Alterna Shill.

But the public should not be fooled. This isn’t a story of the little guy who is desperately seeking alternative health options in a world of cruel public health bullies trying to take away the little guy’s freedoms. This is a story about a well-oiled, well-funded machine. A machine that wants to keep you scared--that demands that you look at their information but no one else’s. A machine that would harass children and their teachers in order to obscure the truth about immunization and to sell you a tanning bed.

Informed Consent and Vaccines

By Dorit Reiss

The process of informed consent is more regulated for vaccines than for most medical treatments or drugs. Still, anti-vaccine activists often use “informed consent” as part of their general attack on vaccines. Parents, they say, are not given appropriate information about vaccines and their risks, so they cannot make an informed decision about them. That claim is incorrect.

When I teach my students about informed consent and vaccines, I use the Vaccine Information Sheet (VIS) - the basis of informed consent in this area – as a model, because it is a reasonably good form. To understand why, you need to first understand what informed consent means, and how it works in the context of vaccines.

The Basics of Informed Consent

Informed consent has two parts: the patient has to consent, or agree, to a treatment, and the consent has to be made after the patient has been given sufficient relevant information. Our system values patient autonomy very, very highly. With a few narrow exceptions (court order, emergency, lack of capacity to consent), a doctor may not provide treatment to a non-consenting patient. Even if the lack of treatment will kill that patient. An adult in sound mind has the right to choose death over treatment. A doctor providing treatment without consent may be liable for a battery (see Schloendorff v. Society of New York Hospital, 211 N.Y. 125, 105 N.E. 92 (1914).) However well-intentioned the doctor, she may not give treatment without consent.

For a child, the consent of the child’s legal guardian  - usually the parent – substitutes for the child’s consent. There are some exceptions to that – doctors may treat children in an emergency when no parent is around; a state may mandate treatment over a parent’s opposition, through legislation or court order, in some circumstances; and most states allow adolescents to consent to certain treatment without parental permission.

Informed consent cases are different. In those cases, the patient actually consented to the procedure. The claim, however, is that that consent was flawed, because the patient did not have complete information. It is a claim that the doctor was negligent in providing the information necessary for the patient to fully understand the situation and make an informed decision (Natanson v. Kline, 350 P.2d 1093 (1960)). To evaluate informed consent, courts use one of two approaches. Some courts compare the information provided to the patient to the information a doctor in good standing would provide—what is customary in the profession to give. This is referred to as the professional standard, or the physician standard. It requires expert testimony on the standard in the profession.

Other courts ask the jury to compare the information given to the patient to what a reasonable patient in the plaintiff’s shoes would consider important. This is referred to as the patient standard or the material risk standard.

If a patient underwent a treatment without informed consent, a doctor may be liable for harms arising from that treatment – even if the treatment was performed properly, even if there was no medical malpractice.

Informed Consent and Vaccines

What would a person need to know to give informed consent to a vaccine under this rubric (or what would a parent need to know to give informed consent to vaccinate a child, which is the more common situation)? A parent would need to know “the nature of the treatment” – that the child is getting a vaccine, whether it’s injected or oral; the “risks and benefits” of the treatment – the benefits of the vaccine, in other words, the risks from the disease we vaccinate against; the risks of the vaccine – potential side effects; and alternatives, which do not really exist for vaccines.

In 1986 Congress passed the National Childhood Vaccine Injury Act. The act did a number of things, but the important part for our purposes is that it required the Secretary of the Department of Health and Human Services to

“develop and disseminate vaccine information materials for distribution by health care providers to the legal representatives of any child or to any other individual receiving a vaccine set forth in the Vaccine Injury Table. Such materials shall be published in the Federal Register and may be revised.” (§300aa-26).

The materials developed require – for their initial preparation and any revision – a 60-day notice and comment process with the public, and consultation with “the Advisory Commission on Childhood Vaccines, appropriate health care providers and parent organizations, the Centers for Disease Control and Prevention, and the Food and Drug Administration.”(id – see http://www.law.cornell.edu/uscode/text/42/300aa-26).

Today, any health care provider administering a vaccine is legally required to provide these materials to the individual – or a guardian, in the case of a child – before giving the vaccine.

These materials – referred to as the Vaccine Information Sheets – can also be found on the CDC’s website. 

Examining one selected at random – the DTaP Vaccine Information Sheet - the VIS opens with “Why get Vaccinated” - including a description of the diseases, who should or should not get the vaccine, and the potential risks from the vaccine. It also provides instructions of what to do if, after the vaccine is administered, a reaction develops,which include calling your doctor or going to an emergency room, reporting the reaction to the Vaccine Adverse Event Reporting System, and information about the compensation mechanism.

In short, a parent reading through the Vaccine Information Sheet should get a good sense of why the vaccine is given, what are its benefits and risks, and additional information, such as what to do if there’s a problem. This seems to cover the requirements of informed consent. The hope is that the recipient of the VIS will read it before the vaccination. Of course, all doctors can do is provide the information. It is the responsibility of the patient or her legal guardian to read it.

Anti-vaccine Claims and Responses

Anti vaccine activists like to claim that no informed consent is given before vaccinating. As explained above, these claims are incorrect. These individuals base their claims on three arguments, none of which is valid.

First, they suggest parents should be given the vaccine insert as part of the consent process. Second, they claim parents are not told that vaccines can cause a range of  side effects (side effects that have not been scientifically documented and, in the case of some, have been disproven) such as SIDS or autism. Finally, they criticize the fact that parents are often not informed of the ingredients before being the vaccine is administered.

I will take these objections one at a time.

Not giving the insert:

The insert – of a vaccine or a drug – is not a good document to base informed consent on. The insert is a legal document, heavily regulated by the FDA. It has substantial useful information, but can also mislead the patient (see: http://www.skepticalraptor.com/skepticalraptorblog.php/vaccine-package-inserts-debunking-myths/ for a detailed discussion of inserts). In relation to informed consent, at least two problems make inserts inappropriate: they do not explain the benefits of the procedure; and they must legally list any problem that occurred after the product was put on the market, whether or not causally related to the vaccine. The combination of not mentioning the benefits and mentioning unrelated bad outcomes can make the vaccine look much worse than the reality – substantial benefits and low risk – and misinform parents.

Not mentioning “side effects” like autism and SIDS

However much anti-vaccine activists would like to believe otherwise, extensive scientific studies have examined whether vaccines cause autism or SIDS– and no connection was found. That is why these risks are not mentioned on the Vaccine Information Sheet. Mentioning risks that are not supported by evidence is not promoting informed consent: it’s undermining it.

Not Providing Parents with a List of Ingredients

A list of ingredients is not part of informed consent requirements for any drug. If a patient has a known allergy to an ingredient, or a potential allergy, they should, of course, be notified of the presence of that ingredient. But otherwise, a list of ingredients alone – in the abstract – does not promote the patient’s understanding of the risks or benefits of a procedure, and does not advance the patient’s ability to decide if the procedure’s benefits outweigh the risks. It is therefore not a proper part of the informed consent discussion.

The informed consent process for vaccines is carefully regulated and thought through. A serious effort is made to provide patients with the information they need in a short, accessible format. As long as the healthcare provider performs the legal duty of providing the Vaccine Information Sheet before vaccinating, the patient – or parent – has before them the information necessary to make an informed decision.

Certain parents, because of language problems or other problems, may need more help, and should receive it; but that is true of any informed consent process.  It does not mean the process itself is in any way flawed.    

Author's Note: I'm grateful to Nathan Boonstra, Ashley Shelby, and Alice Warning Wasney for their corrections to previous drafts.

Dorit Reiss is a professor of law at the University of California. She has published writings on administrative law, and recently wrote "Compensating the Victims of Failure to Vaccine: What are the Options" Dorit is a member of Voices for Vaccines' Parent Advisory Board.

Anti-Vax Parents vs. Pro-Vax Parents in Minnesota

The Minnesota Department of Health has proposed changes to current state immunization rules. These changes would merely bring Minnesota Immunization Rules into line with current CDC immunization recommendations. Predictably, anti-vaccine parents have protested these changes, which, in fact, do not affect them in any way, since the changes do not touch the philosophical exemption clause (much to my disappointment). There will be a hearing on these changes on June 27th, 2013, because more than twenty-five people asked for one. Chances are the people who asked for this hearing are anti-vaccine voices. And, as is unfortunately routine, those proposing these much-needed changes to immunization law, are hearing almost solely from anti-vaccine voices. Here is an opportunity for pro-vaccine parents to step forward and speak up in favor of vaccines. If you are a Minnesota parent, please write a letter of support regarding these rule changes. And please attend the hearing on June 27th, 2013, at 9:30 am to make your voice heard. 

Below is my letter.

To Whom it May Concern:

I am a Minnesota parent who is fully in support of the Minnesota Department of Health's proposed new immunization rules strengthening Minnesota immunization statutes and bringing them in line with current CDC recommendations. In the past three years, we have seen measles outbreaks in Hennepin County due to undervaccination, as well as one of the highest pertussis rates in the country. As a parent, I find this abominable. The economic cost of these outbreaks is substantial; the human cost is infinitely higher. And these outbreaks are preventable, if parents would vaccinate their children on schedule. 

I am also angry that my fully vaccinated children attend school with children whose parents have chosen not to protect their own offspring with vaccines, and therefore put their immuno-compromised classmates, and the infant siblings of others, at risk of contracting vaccine-preventable disease. There are so few obstacles to anti-vaccine parents and they bear no burden by not vaccinating. That burden is borne by the members of the community, including other children. I find that deeply unfair.

These proposed changes are reasonable and much-needed. I wish they would go further, and make it at least as difficult to opt-out of vaccines as it is to actually keep you kids on the CDC-recommended immunization schedule. I look forward to sharing my thoughts on this matter on June 27th.
Ashley Shelby

Madeleine and the Flu

Twelve little girls in two straight lines got the flu!

I was at a performance of Madeleine’s Christmas at a local theater the other day, my two children in tow. Madeleine’s Christmas is a charming book in the Madeleine series by Ludwig Bemelmans, written in 1956.  But as I watched the storyline unfold on stage, I found myself thinking like the MWV that I am, worrying about the eleven little girls suffering from influenza in an age when there was little to help them, besides the warm soup Madeleine (the only one unaffected) was able to serve them. I think my MWV radar was unusually sensitive that day, too, because my sixty-six-year-old father, who had received the flu vaccine this year, had just finished a bad bout with this year’s flu, and my children and I were struggling to kick a variety of different viruses as well.

Luckily, the eleven little girls—and Miss Clavel—all recovered in time to take a magic carpet ride around Paris, but the show did get me to thinking about how unusual this year’s flu season has been and why it’s so important that we see widespread vaccination, so that vulnerable people who might be more suspectible to the flu, even if they’ve been vaccinated (like my father), are better protected.

So I asked the folks at the CDC some of the questions that might be on your mind this flu season. The information below comes directly from CDC press releases, the CDC website, and communication with CDC representatives.

Why does the 2012-2013 flu season seem to be worse than previous flu seasons?

Flu seasons are unpredictable. The severity of influenza seasons can differ substantially from year to year. Over a period of 30 years, between 1976 and 2006, estimates of yearly flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people during the most severe season. Each year in the United States on average more than 200,000 people may be hospitalized during a flu season. The 2009 H1N1 pandemic is an example of how unpredictable the flu can be. Click here for more information about the 2009 H1N1 pandemic.

The 2011-2012 season began late and was relatively mild compared with previous seasons (see “2011-2012 Flu Season Draws to a Close” for more information). Most of the viruses characterized so far this season have been H3N2 viruses; which are typically associated with more severe seasons.

Did the 2012-2013 flu season start “early”?

Significant increases in flu activity in the United States have occurred in the last two weeks (editor’s note: refers to late November, early December), indicating that an early flu season is upon us. Influenza-like-illness (ILI) activity levels in parts of the country are already higher than all of last season. 5 states are already reporting the highest level of activity possible. Click here for information from the CDC that discusses flu activity thus far. 

How effective is the flu vaccine?

The composition of the flu vaccine is reviewed each year. If needed, the vaccine is updated to protect against the three flu viruses that research indicates will be the most common during the upcoming season. New vaccine is manufactured every season. The 2012-2013 flu vaccine will protect against an influenza A (H1N1) virus, an influenza A (H3N2) virus and an influenza B virus.

Two factors play an important role in determining the likelihood that influenza vaccine will protect a person from influenza illness: 1) characteristics of the person being vaccinated (such as their age and health), and 2) the similarity or "match" between the influenza viruses in the vaccine and those spreading in the community.

In general, the flu vaccine works best among young healthy adults and older children. Lesser effects of flu vaccine are often found in studies of young children (e.g., those younger than 2 years of age) and older adults. Older people, who may have weaker immune systems, often have a lower protective immune response after influenza vaccination compared to younger, healthier persons. This can result in lower levels of vaccine effectiveness in these people. (This might explain why my father, who got the vaccine, still got the flu).

The good news is that most of the viruses characterized at CDC so far this season are well-matched to the vaccine viruses.

I want to make one note about the basic science of flu vaccines. Every once in a while, you might find an anti-vaccine website, like NaturalNews, make a comment about the flu vaccine. Last year, it was a story on its site that said that the reason a new flu vaccine had to be created every year is because the scientists “couldn’t get it right.” Most of you probably see scientific illiteracy in this statement, but in case it’s not clear, the flu virus changes each year, unlike most other vaccine-preventable diseases, and therefore a vaccine must “match” the predicted influenza viruses likely to spread in the community during the upcoming flu season in order to be effective.

You might also hear some people—even people in the world of public health—denigrating the current flu vaccines as ineffective. This shouldn’t be interpreted as a call to forgo the vaccine. Most of the time, when public health authorities, or leaders in the world of epidemiology, such as Michael Osterholm of the University of Minnesota, criticize the flu vaccine, they are advocating for a universal flu vaccine, or at least a better seasonal flu vaccine, both of which scientists are working on. 

I will take 60% protection over nothing any day, having lived through flu myself in years previous. And, without question, I would offer my children that same protection. I’m pretty sure that if that rug merchant in Madeleine’s Christmas had been peddling flu vaccines instead of magic carpets, the twelve little girls in two straight lines would have had a healthier Christmas, too.

Moms Who Vax: Why Am I So Certain?

By Gillian Tarr

People who don’t vaccinate their children intrigue me. If I knew any personally, and was on good enough terms to have a frank discussion, I would be so tempted to put them under a microscope and try to understand where the wires had gotten crossed.  Perhaps that’s why I don’t know anyone who’s ever admitted to me that they don’t vaccinate their children.

Being a typical 21^st-century denizen of the Internet, I’m aware of the wide variety of arguments often used against immunizations.  Whether they’re being spouted by some swindler trying to sell garbage to bamboozled parents or by the bamboozled parents themselves, I haven’t yet read a line I would buy, and certainly none I would stake my children’s lives on.  

Gillian and one of her daughters.

Why am I so certain?  You see, I’m not just the lucky mommy of two amazing little girls.  My first passion in life was infectious disease epidemiology, and I’ve had the great opportunity to work directly with vaccine programs. I also have a Masters degree in epidemiology, as well as a graduate certificate in vaccine science and policy.

My education and all the reading required by my training and the original research I’ve conducted left me assured that immunization was one of the greatest triumphs of public health.  So when it came time to vaccinate my own children, I didn’t hesitate.  I was that parent making the special appointment to get my daughter Prevnar 13 when it came out despite her having already completed her series of Prevnar 7 (protection against six more strains of Streptococcus pneumoniae!). I was that parent convincing our pediatrician to give my 22-month-old daughter FluMist off-label (higher efficacy than the inactivated vaccine in children).

While I made sure my own family was as protected as we could be, I didn’t start paying much attention to the anti-vaccine movement till I was working on a phase 4 vaccine trial with a state health department. Part of my job was to telephone pertussis cases and potential pertussis cases. I talked to hundreds of families.  Anyone can find a website with a description of what pertussis does to a person, but hearing it first-hand was a completely different experience.  Parents described how their children had suffered, and how they felt powerless to help them.  Some even openly lamented their previous choice not to vaccinate their children.  Having my own children, I can’t understand how some parents can set their children up to suffer, leave them open to preventable diseases.

But of course, they think they’re saving their children from something worse. There are so many websites, blog posts, Facebook rants on one side or the other.  Almost everyone claims they’ve read "the literature" and that “science” supports them. Of course there’s also the conspiracy theory folks who purport the published literature is filled with lies and everyone’s in Big Pharma’s pocket. If these people knew how vaccines are developed and studied, they would realize they’re talking about thousands and thousands of people that would have to be paid off.  People like me.  I won’t even go into how little folks in public health are paid...

If you’re making a potentially life-or-death decision for your child, whom do you trust?  Do you trust the random blogger who pulls out choice sentences from studies to prove her point but neglects the rest of the study that negates it?  What about the folks that list dozens of animal studies on some vaccine your child wouldn’t even receive?  Dr. Bob Sears, whose only credentials as a vaccine expert are of his own making?  Are you reading the literature yourself and substituting your understanding of it over that of the specialists who’ve devoted their lives to science and the analysis of scientific research?  Do you dismiss the advice of the CDC, the AAP, and the doctors and researchers who have devoted their lives to understanding and improving vaccines?  If so, why?

When did the experts become the ones you can’t trust and the amateurs--many of whom are just trying to sell you something—become the ones you bank your children’s lives on?  

On the rare occasion that I do discuss vaccines with someone, I don’t try to convince them that vaccinating is the right choice.  I simply give them resources so they can see for themselves what the true experts say and try to point out the difference between the consensus of the scientific community and the opinions of a few.

Gillian is the mother of two glorious little girls and trained as an infectious disease epidemiologist. She currently works in the private sector but remains passionate about public health.