What Does Climate Change Have to Do with Vaccines?

I come from a family of science-loving, science-minded people. While none of us went into the sciences as a profession, some of us have gone into professions in which science literacy matters. One hot-button issue in our family is climate change—specifically, climate change denialism. We’ve seen the damage done by these anti-science zealots whose aim is to create enough doubt in the minds of the regular citizen to thwart legislation that could help halt the relentless march toward global disaster. We’ve watched as journalists, for many years, decided to present the climate change issue as a controversy requiring equal air time for both the climate change scientists and the denialists, prolonging this period of doubt. The result? While more than 98% of scientists are in agreement that our planet is warming, people in the United States are split about 50/50 on the issue. This will have devastating impacts on our future, and it deeply bothered members of my extended family, as well as myself. Several members of my family are particularly vociferous about how damaging denialism is in the climate change discussion, rivaling perhaps only me in my drive to counter anti-vaccine rhetoric. They do not let any opportunity pass them by in which they don't speak up in favor of the science. It's one of the many things I admire about them.

So what does this have to do with vaccines? Well, there is an interesting parallel between the climate change “controversy” and the vaccine “controversy.” Namely, that the so-called controversy was manufactured in both cases despite the fact that there exists remarkable scientific consensus; that this resulted in doubt sown in the minds of the public that was not backed by science; and that the results will be harmful to human beings. The parallel is so complete that even the media’s handling on both of issues is strikingly similar. Nowadays, the media does not, for the most part, feel that journalistic balance is achieved when a climate change story features a denialist. If anything, it puts the whole story out of balance. Over really the last year or so, the media has stopped featuring anti-vaccine activists in every vaccine story published or produced. But the media has been complicit in both cases of misrepresenting science. This parallel is something we talk about with some regularity in my family.

Then this happened: one of my "climate change guru" family members went to the doctor after contracting pneumonia. In the exam room, she decided to ask the nurse her advice regarding vaccines. She tells me that the nurse replied: “I think there are too many.” I'm not sure what else the nurse said, because Climate Change Guru immediately realized this was about to turn into a "conversation." I was sick to my stomach that a health professional would sow fear and doubt about vaccines in an exam room. I was sick because I knew exactly how powerful this nurse's doubt about vaccines could be. I'd been in that position before--a scared new parent with a baby, looking to any and all medical professionals in the clinic for information about vaccines and vaccine safety. I know a great deal more about vaccines and the lies of the anti-vax movement now than I did as a new parent. I have no doubt that if a nurse had said these words to me in that lull between the doctor’s exam of my child and the administering of the vaccines, I would have been filled with fear. I know I would have delayed the vaccine in question, perhaps even skipped it altogether.

To my mind, a nurse is a member of the medical establishment, and if there is widespread disagreement in the medical establishment about the safety of vaccines, I would never put my child in what I had been convinced, by a medical professional, was harm’s way. But by walking out that door with my child left unvaccinated, I would have left him vulnerable to any number of devastating illnesses. How would I have made sense of things if my son had contracted, say, pertussis during the seemingly constant pertussis outbreaks? Or measles, during the various measles outbreaks we've experienced? If he'd been hospitalized, and the doctors caring for him asked me why I hadn't vaccinated him in order to spare him this pain and suffering, I would have said: "A nurse told me there are too many vaccines and I got scared." And I would have felt betrayed by the medical establishment I trusted. 

“This nurse speaks to countless patients,” I told my Climate Change Guru. “I am certain some of them are parents. What if a parent chooses not to vaccinate based on what this nurse says and the child contracts pertussis? What if that child passes pertussis on to an infant? What if the infant dies?” I could feel my heart racing, the anger coursing through my body. “You have to say something,” I continued. “You have to write a letter.”

            “I will not do that.”

            “What?” I sputtered.

            “I’m not going to get a nurse fired for sharing her opinion with me.”

            “You don’t get her fired. You don't even have to mention her by name. Hell, write it anonymously if you want. The head of the clinic may take it as an opportunity to clarify clinic policy. She can’t be allowed to continue saying this stuff in a medical setting. She’s entitled to her own opinion, but it is flat-out wrong for her to spout misinformation in a medical setting to patients. There is absolutely no evidence to back up her opinion, and all kinds of evidence to the contrary.”

            My Climate Change Guru abruptly ended the conversation and walked out. She would not mention this experience to anyone at the clinic, and was, I could tell, regretting even telling me it had happened.

            I’m still angry. I’m disappointed. And I’ve done a lot of thinking about this experience over the last few days. I’ve realized that the climate change/vaccine parallel continues in ways I hadn’t even considered, and it’s helped me pinpoint why, exactly, I’m still angry.

Imagine this: My Climate Change Guru attends parent-teacher conferences for her child. In that parent-teacher conference, she asks her child’s teacher about his teaching philosophy regarding the science of climate change. The teacher replies: “Well, I believe climate change is a hoax, but I teach ‘both sides of the issue.’” My Climate Change Guru would not leave that classroom until she’d given the teacher a piece of his mind. She’d likely go to the principal and complain, perhaps pull her child from the class. It’s not just about her child. It’s about all the other children this teacher is educating. In a position of power and influence, he is capable of affecting these children’s educational outcome, even their world view. His views on climate change could “infect” his students. Would Climate Change Guru walk away quietly?

Not a chance.

            Then why did she walk away from the nurse? What is different in this scenario? After all, the parallel is complete. The nurse is in a position of power and influence. What she says and does can have a substantial impact on a child’s health outcomes—and by extension the health outcomes of the entire community. If a family chooses not to vaccinate because of her opinion that there are too many vaccines, that family could contract a vaccine-preventable disease. They could then pass that disease on to others in the community. The response to this? A shoulder shrug. It was the nurse’s “opinion.” Climate Change Guru wasn’t going to make trouble.

           Of course there are anti-vaccine nurses, just as there are anti-vaccine teachers, anti-vaccine car mechanics, anti-vaccine postal workers. In fact, since beginning work in this vaccine world, I’ve come to understand that there are far more nurses who believe vaccines are harmful than I could have dreamed possible. This is one reason why groups such as Nurses Who Vax are so crucial. What bothers me most is my family member’s decision to say nothing, in her failure to see the parallel. We have a moral obligation to speak up at moments like this—which is exactly what my Climate Change Guru would have me believe about the climate change discussion. “We can’t let this happen on our watch,” is something she’s said to me before. I challenge her, and anyone else who has heard similar sentiments in the exam room: will you let anti-vaccine rhetoric echo in the halls of medicine on your watch?

Another Media Failure: Invisible Threat Edition

By Karen Ernst

Despite how feisty I can be, I really do have sympathy for journalists writing about immunization. The impulse to try to please everyone in order to avoid the firestorm must be very strong.

But some stories are clear-cut. Take the documentary Invisible Threat. This documentary was created by high school students as part of a school-sponsored extracurricular project, funded by a Rotary Club grant. When the project was announced two years ago, it was simply going to be about the immune system. But immediately anti-vaccine crusaders pounced, so the students decided--on their own--to take a deeper look into the issue, and the result was a remarkable 40-minute documentary about immunization and the controversies surrounding it.

The release of the film didn’t quell anti-vaccine protests of course. In fact, the protests got uglier with many anti-vaxxers claiming that the students hadn’t even produced the film, that it was instead some nefarious project funded and produced by Big Pharma.

Among those rallying against this high school film project was Becky Estepp, who claimed that she was contacted by CHSTV students two years before the project was conceived. Becky Estepp is the communications director at the Elizabeth Birt Center for Autism Law and Society, which hosts the annual AutismOne conference, and through AutismOne and their friends at Focus Autism, she launched a PR attack against these high school students. I just want to highlight again--these anti-vaxxers launched an attack against children.

The outcry in traditional media has been deafening. Attacking high school students is deplorable and out of bounds.

But hang on. I should qualify the above sentence. The outcry hasn’t been universal. One station local to the students aired the controversy, and then interviewed Becky Estepp, allowing her to make defamatory accusations and innuendos. The journalist left them in the piece unchallenged. The unchallenged accusations included: the children are Pharma Shills; they were pawns of the adults who really made the movie. The news station, the NBC affiliate in San Diego, aired these accusations with absolutely no qualification, fact-checking, or opportunity for the students or their advisors to respond.

That this is a failure of journalism is obvious. But the failure goes beyond false balance. Airing falsehoods and accusations like this is intimidation. The repercussions will affect every child who wants to make a school-sponsored film and gain national attention for such a monumental task. I should not have to explain why a television station giving a platform to an adult seeking to intimidate high school students is wrong.

I wrote an email to the journalist responsible for the piece, Candice Nguyen, as well as her General Manager, Dick Kelley.

From info@voicesforvaccines.org

To candice.nguyen@nbcuni.com, dick.kelley@nbcuni.com

Dear Ms. Nguyen,

I am writing to express concern about a recent story you aired about Carlsbard High School documentary, Invisible Threat: http://www.nbcsandiego.com/news/local/Carlsbad-HS-Students-Caught-in-Vaccine-Controversy-270898341.html

As you noted at the beginning of the story, the students involved in this project were harassed by anti-vaccine activists trying to intimidate them out of doing the project. Once the project was complete, the campaign against these students continued.

So I was shocked that, in your story, you gave air time to one of the activists who worked hard to spread unsubstantiated innuendo in order to discredit these students. Furthermore, you left her unsubstantiated claims unanswered, even though each point she made was demonstrably exaggerated or false. In fact, the anti-vaccine activist you put in the story is a contributing editor of one of the organizations that has campaigned against the students and this film.

I want to emphasize that these students were in high school when they completed this school project. As with all extracurricular activities, these students had adult advisors. When a football team wins the state championship, no one asks why the coaches were there, too, and whether or not the championship was actually won by the adults. If people did raise those questions, no journalist would ever allow those detractors air time without proof of such allegations--especially allegations made against children.

I write a lot of reporters, and I understand the difficulties in reporting about immunization and in wanting to appeal to a very broad audience. However, your piece was the most egregious piece of journalism I have yet encountered because it gave airtime to someone who sought to poison the well against a group of children and had no proof of her allegations.

The only acceptable recourse is to air a full retraction of your segment. Please let me know when you plan on airing such a segment, and I will publicize far and wide your commitment to telling the truth and to protecting children against adult harassment and intimidation.

Sincerely,

Karen Ernst

Voices for Vaccines

I sent this X number of days ago. I have yet to get a response.  I will update if I hear anything from the station. It might take many more voices writing in to them for them to understand that such bad reporting is a big deal. Here is the link to the piece, which is still available on the NBC San Diego website. The email addresses are above should you be moved to e-mail your thoughts on the piece.

The Costs of the Fight Against the HPV Vaccine

By Dorit Reiss

This post stems from an HPV thread on the Katie Couric show. When I joined it, was a series of heart-rending stories by parents about the harms they believe the HPV vaccines caused to their daughters. There’s not a lot you can say to stories like these that will not sound heartless and cruel. But, after reading some, I felt that I had to try and speak up. This decision resulted in me spending several hours a day, from the Wednesday before Thanksgiving and through the weekend, commenting and, especially, responding to comments.

The thread on the Katie website is still going strong. I concluded that rather than engaging further I should write a more systematic explanation of why we need to speak up and respond to the claims of harm made against this vaccine, however painful it might be to the parents commenting to hear someone say there is no evidence that the vaccine caused their daughters’ illnesses, and however unpleasant the discussion becomes. Because as real as the pain of these parents and daughters is, without objective evidence of causation, their belief that this vaccine is to blame does not justify rejecting it in the face of substantial scientific evidence supporting its safety.

Let’s start with the basics. The HPV vaccines prevent infection with several strains of a virus that, at worst, can cause cancer. The virus is responsible for nearly all the cervical cancers in the United States and for “90% of anal cancers, 40% of vulvar, vaginal, or penile cancers, and 12% of oral and pharyngeal cancers.” (all data is available here.)

Most HPV infections clear up on their own. Infections can be detected and cancer prevented early with regular pap smears. But HPVis still responsible for tens of thousands of cancers a year and over three thousand deaths a year in the United States alone. Preventing those cancers and deaths seems like a good, important goal.

The vaccines were tested in clinical trials with over 30,000 women for over 7 years and found to have high rates of effectiveness and no serious problems. They cover strains responsible for a large percentage of those cancers. It has already reduced infections. You can find more in depth discussion of the HPV vaccines in a series of excellent posts by the Skeptical Raptor.

Why oppose something that can do so much good? Well, part of the opposition stems from religious objections having to do with a perceived connection between the vaccine and sex. But that was not what this battle was about.

Shortly after the vaccine came out, several parents of girls who suffered medical conditions or died claimed that the causes of their deaths or harm was the vaccine. The stories are both scary and heartrending. And as these stories became public, more parents heard them and started associating their daughters’ illnesses with the vaccine. I do not doubt the real suffering and distress of these families. My heart goes out to them. How can one not sympathize with a parent grieving because a 17-year-old girl is dead, or a teenager in constant pain? 

But feeling for hurting girls, and hurting families, does not mean that one uncritically accepts claims that the vaccine was the cause of their suffering. In fact, the causation claims behind these stories are often extremely problematic. Sometimes, even the temporal connection is weak (e.g. Gabi Swank developing symptoms weeks after the vaccine). The problem is that bad things happen to teenage girls regardless of the vaccine. They can suffer a variety of medical conditions, and sometimes, healthy teens do die. The question in each case like this is: do we have evidence that the vaccine caused the harm? And the answer in these cases is often no. These stories generally do not have medical evidence supporting the connection between the vaccine and the alleged harm. Nor do they suggest a plausible biological mechanism by which the vaccine could cause the harm.

Is there anything supporting them besides the parents’ belief in the harm? Well, a small number of studies looking at a tiny number of cases and conducted by anti-vaccine scientists supported the claims. Each of them when analyzed by scientists was found incredibly flawed. For example, this study by two anti-vaccine activists, looking at the deaths of two girls. This study, by a doctor, looking at one single case, ignoring other possible causes of the harm to the girl in question. Another study was addressed here.

In contrast, not only did the clinical trials – ongoing since at least 2001, covering tens of thousands of participants – not find serious risks, but two large studies addressing the question found none: A Kaiser study with almost 190,000 young women given 350,000 doses of the vaccine that compared harms in vaccinated women to the general rates in the population found no difference; and a Swedish study with hundreds of thousands young women comparing vaccinated and unvaccinated found similar rates.  Over forty million doses of the vaccine have been administered in the United States alone with no clear evidence of problems. Scientists’ best assessment is that the only side effect consistently connected with the vaccine is fainting on the day the vaccine is administered, and local reactions.  

This evidence paints a picture of a very safe vaccine. But the only way to make that point is to point out the weak evidence for the parents’ claims that the vaccine caused harm. This is bound to offend those parents: their belief in the evils of the vaccine is very strong, and they are may have difficulty considering that they may be wrong. In fact, they have been told in no uncertain terms that they are right. In the thread itself, they received support from anti-vaccine activists who rallied to their support, using the tried and true tactic of personal attacks on anyone speaking in support of the vaccine, accusing them of being heartless, shills, trolls, ignorant, Hitler, and so forth. I’m mentioning this as fair warning to parents who may want to jump in: this discussion is often conducted with high levels of vitriol (it’s even worse than French Revolution discussions; and people could be very passionate about the French Revolution).

Most pro-vaccine people do not enjoy dealing with vitriol or having their workplaces contacted, though I am sure there are some people who enjoy the conflict for conflict’s sake. And nobody that I know wants to hurt parents who have already been through so much with their suffering daughters, or who lost a child. But we are not going to stop speaking. And I think it is important for many of us to speak up about the HPV vaccines. It’s the same reason that you should speak up for vaccines generally, but let’s make it specific.

The grieving parents want us to accept their word that it was the vaccine that caused their daughters’ suffering. It is more than natural for them to look for a cause for their misfortune, and the vaccine is an easy target. But most of them have no medical evidence behind their belief the vaccine caused the harm. In some cases there are alternative explanations that their doctors pointed out. Explanations the parents, in their grief and pain, reject. The problem is that with these stories they want to convince other parents to reject the vaccine—that is, to choose not to protect their children against a virus that has been proven to cause cancer.

When that is what we are asked to do, a responsible parent not only can but should demand hard, credible data that the vaccine actually causes the alleged harm. Because there is a cost to not taking the vaccine. A cost in suffering and lives.

And there is no such hard evidence.

When it’s my child for whom I’m making the decision, rejecting a vaccine that can save him or her from needless suffering is a dereliction of duty. I owe my child the best protection available against dangers, health, and otherwise. There are too many things I can’t protect him against. But modern medicine offers a safe, effective prevention against some of the most dangerous types of HPV infections. My child deserves it.

There is a reason to speak up for the sake of these grieving parents, too: they do not deserve to feel guilty for vaccinating their children, or feel betrayed by the system, when the evidence does not indicate that the vaccine caused the illness. We should explain the evidence in the hope of reducing their guilt and anger. And hope some will listen.

Arguing for the safety of vaccines is worth the time and effort it takes, because it’s about our children, their health, and welfare. Vaccines protect them. They’re not perfect, and not 100% risk-free. No medicine is. But vaccines are remarkably effective and compared to pretty much every other drug we have, extremely safe.

So we need to keep asking, and pushing, and demanding. When a parent says the HPV vaccine harmed her child, we must ask for evidence that the harm came from the vaccine. Especially when the story is followed by a warning not to get the vaccine for your child. If someone asks you to leave your child unprotected against a dangerous virus that is completely preventable, tell him or her "I'm sorry, but I can’t make such a choice based on your belief, scientifically unsupported, that the vaccine hurt your child."

For my children’s best interests, I need to follow the data. I don’t want my child to become a cancer statistic.

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