BY KEN JAQUES (27)
This is the first in a series of takes from the front lines in the raging battle between those who question the safety of vaccines and those who believe the public interest outweighs those concerns. Later today we’ll feature an opposing view from Deductible Associate Editor Niran Al-Agba “In Defense of Pediatricians. (And a Word or Two of Advice for Public Health Types) ..” – The Editors
The “sides” are supercharged and it does not appear that there is an end in sight. Is it all out war, or is there room for a peaceful solution?
The ultimate goal in sharing a post like this is with the intent to bring two sides together in an attempt to end the vaccine debate. My goal is to be as neutral as possible. I don’t think that this ongoing debate is helping us, but I do think that an honest conversation, along with science, could put an end to the debate, in the best interest of all.
What’s a pro-vaxxer?
At the extreme end, a pro-vaxxer is one that is portrayed as believing every single vaccine works (almost perfectly) and is the best intervention ever created for disease prevention. None of these people wants to see epidemics or outbreaks of vaccine preventable disease.
The majority of “pro-vaxxers” are well aware of the history of polio and the polio vaccine, and have a similar belief. They understand and believe in the concept of herd immunity and believe that most people should be vaccinated against vaccine preventable diseases. While I can’t speak for all, I would assume that some believe in the concept of mandating vaccines, and others would not feel quite so strongly on mandates.
What’s an anti-vaxxer?
At the extreme end, an anti-vaxxer is one that is portrayed as believing that every single vaccine has risks that outweigh the (in their minds, perceived) benefits, and is something that the pharmaceutical companies are making a tremendous amount of money with.
Many of the vocal anti-vaxxers are parents of a child affected by a vaccine injury or death, or health care practitioners that have witnessed vaccine injury first hand, and they don’t want to see one more case of a child suffering the same outcome.
The majority of “anti-vaxxers” are also well aware of the history of polio and the polio vaccine, yet they have questions about the safety of vaccines, and the risk / benefit considerations of some of the vaccines. Most anti-vaxxers would not consider themselves as such, preferring the identification of “pro-safe-vaxxer”, or I’ve even recently seen the term “ex-vaxxer”. While I can’t speak for all, I would assume that some believe in some vaccines, but are more prone to question particular vaccines, the number of vaccines that are given, as well as the schedule in which they are given, including giving many vaccines at one doctor’s visit.
What are their goals?
I believe that this is the irony of the whole debate. Everyone has the same goal, no one wants to see another episode of disease in children, or in anyone. Happiness and health for their kids and for all is the common goal of each of the debaters.
For me it can be distressing to watch this debate unfold. Whenever the topic of vaccines comes up, you can almost see people lining up and taking sides, wielding their personal shields and weapons in preparation for the looming battle. Some people that might normally be in the “middle ground” end up choosing a side and line up with that side.
Sadly, others that just want to understand more about the debate end up “leaving the battlefield” completely because the anger that is shown by each side leaves them shaking their head and walking away from the discussion.
This is where I personally struggle the most. Each side is supercharged, yet each side is arguing for the same common goal. Does it really have to be this way? Does it really have to be a battle every time the discussion comes up? Or is there an opportunity for a “meeting of the minds,” to understand the differences in beliefs, to come together to find common ground amongst the common goals. And is there an opportunity for science to be used to resolve any outstanding issues?
I have personally labelled this era as the “Age of Disease.” We have allergies, asthma, autoimmune, ADD / ADHD, autism, and that’s just (some of) the A’s. People are looking for answers. There are no obviously simple solutions, and it is not easy to pinpoint the root cause of these diseases because it’s probably a combination of things in each case. Many people are looking for answers in the form of cures, while many others are looking for answers in the form of prevention. Vaccines are part of the discussion.
Vaccine Injury and Death
Vaccine injury and death are documented as “quite rare”. And to many in the developed world, so are injuries and death from vaccine preventable diseases. But from a debate perspective, this point is irrelevant to the parent of a vaccine injured child. It is also irrelevant to the people who have witnessed the death of an unvaccinated child from an occurrence of a vaccine-preventable disease. You can almost feel the anger that comes up in each of these people when they hear of “yet another case.” For many in the debate, they simply cannot get past their belief on either side of this, yet given the events they have experienced, that is quite understandable.
While vaccine injuries and death are quite rare, they are however real. They are not figments of the imagination as some in the debate have suggested. Instances are recorded in VAERS (Vaccine Adverse Events Reporting System) and payouts of over $3 billion have been made to injured parties. This is an important part of the conversation.
Are All Vaccines Created Equal?
I personally believe that this is at the crux of the debate, yet is often downplayed or ignored. I believe that the conversation would be quite different if the entire debate was limited to discussion of polio and the polio vaccine. There would still be a debate because the people on either side of the debate have differences of opinion, and the debate still might become quite heated because of the strengths of those beliefs in some.
Vaccines are not created equal. Some are created to prevent a specific condition (e.g. HPV vaccine to prevent HPV that that can lead to various cancers), while others are created to prevent outbreaks in populations (e.g. MMR – measles, mumps, rubella), involving the concept of herd immunity. Each has a documented efficacy rate (e.g. mumps listed as 88% effective with two shots), and each has potential side effects as listed on the package insert. Each has been created with an attempt to measure the benefits of the vaccine compared to potential side effects from taking the vaccine.
And each could be debated separately as a result of these factors. Having a debate about vaccines without setting context is almost surely to lead to unresolvable differences of opinions.
Also at the heart of the debate is the science around vaccines, and there are many issues that become hotly contested. These include:
- Has the complete vaccine schedule been properly tested?
- How effective is vaccine induced immunity vs acquired immunity?
- What is the effect of “vaccine shedding” on a population?
- Is the science of “herd immunity” fully agreed upon?
- Are vaccines tested against a “proper inert placebo” or against an “improper placebo”?
- Are vaccines only tested within a “healthy population”?
- What can happen with vaccines given to someone who is immune suppressed?
- Are vaccines “fast tracked” in some cases and not fully tested in clinical trials?
- Is the combination of vaccine injections as given at a single doctor’s visit properly tested?
- Are the adjuvants (aluminum, thimerosal, etc.) properly tested?
- Is it proper that the same dose of a vaccine is given to a baby regardless of weight?
- Is spreading out the vaccine schedule a way to help improve vaccine safety?
- Should vaccines be given to children whose siblings were adversely affected by a vaccine?
- What is the effect of “waning immunity” of vaccines and need for boosters?
When a debate (the hotly contested version) ensues, these are some of the key “weapons” that each side takes a stance on. I personally believe that these are many of the areas where it is in the best interest of all to bring the sides together and do whatever science is necessary in order to end the debate. Admittedly this could be a very daunting task, but could be full of rewards.
Correlation and Causation
Another topic that is part of the debate is correlation and causation. While there have been correlations (happened at about the same time and results appear like they could be linked) shown, there are no scientific studies showing that vaccines (one or many) CAUSE allergies, autism, ADD/ADHD, asthma, autoimmune, etc. on their own. However there are also no scientific studies that can eliminate the possibilities of vaccines in combination with other factors, contribute to these conditions.
Fueling the Debate
“The Science is In (Settled)”
These are a few great ways to generate anger, and start an argument that gets people lining up to take sides and start throwing barbs back and forth at each other. This is one of them.
To me the phrase “the science is in” implies that, using science, all possible options have been evaluated and there is no way to interpret the scientific results differently. Yet by definition, science cannot possibly test all possible permutations and combinations.
From a debate perspective, it does not appear to be as clear if there is enough science to suggest vaccines and their adjuvants are in no possible way contributors to autism or other conditions affecting the brain. Once all vaccines and all of the adjuvants have been tested in combination with other potential contributing factors will the phrase “the science is in” apply to the vaccine debate.
Until then, I would suggest that this phrase be removed from any debate on vaccines.
The hashtag #VaccinesWork is the other great way to start an argument. What does it mean? No vaccine works 100% of the time, each vaccine has its own “efficacy rate”. Some people who have received particular vaccines end up with the condition they were vaccinated for. Also, side effects are possible with every vaccine, and while quite rare, there are many documented cases of severe side effects and even death from vaccines. Whenever the parent of a vaccine injured child sees the phrase #VaccinesWork, how could it not bring up very painful and angry emotions? This hashtag should be removed or modified for clarity, options could include #VaccinesWorkMostOfTheTime
Sharing the Facts
There are a number of people that are really working hard to end the debate. A phrase I’ve often heard described as one that’s not working is when pro-vaxxers will suggest that a good approach is to share the facts, but this is often followed by explaining reasons that this hasn’t worked. This also has the ability to cause divisiveness in the conversation, because each “side” believes that they are “sharing the facts.” Arguably the issue is that, in an environment where the facts are not 100% clear, people share their belief of the facts as they understand them. But if there is not enough information to clearly state that these are indeed facts, then people’s interpretations can be quite different.
I think it is a really good idea to share the facts in this debate, I also think it is a good idea to acknowledge when the “facts” are less than 100% clear.
Over the past two years there have been quite a few mumps outbreaks in Canada and the U.S., often occurring in university settings. While originally blamed on anti-vaxxers, in a very high percentage of cases the outbreaks are occurring amongst the fully vaccinated. This has fueled another debate as to whether vaccines are as effective as they have been reported to be, or whether this is a case of waning immunity. However, this is clearly not a case to be laid at the feet of the anti-vaxxers.
HPV and Gardasil Vaccine
This is also a very (make that VERY) hotly contested vaccine. There have been many vaccine injury cases documented in VAERS regarding the Gardasil vaccine, as well as news stories about countries that have removed the vaccine from their vaccine schedule. There have also been suggestions that the vaccine is given to young girls (and boys) too early, and that the efficacy of the vaccine has waned by the time it would be needed to prevent cancer. Another suggestion is that the vaccine may help to prevent HPV (which CAN lead to cervical cancer), it is not the only cause and studies to suggest that HPV prevents cervical cancer are not available (vaccine hasn’t been around long enough to have results). On the other hand, there are also many reports and studies highlighting that the vaccine is safe and effective, further fueling the debate.
The point here isn’t to question this particular vaccine, rather it is to highlight a difference in one particular vaccine, and how one particular case can influence an overall discussion. Each vaccine could be examined from a similar lens.
Andrew Wakefield and Jenny McCarthy
Is the rise of the “anti-vaxxer” to be blamed on Andrew Wakefield and Jenny McCarthy? While I believe that these two figures have fueled the debate, I think it’s time to move past these arguments. I would suggest that it doesn’t matter where it started or how the celebrity influence has fueled the flames of the debate, the fact is that there is a debate.
Could Honest Conversations and Science End the Vaccine Debate?
Back to the original question, can honest conversations and science end the vaccine debate?
I’m calling bullsh++. Given the increased prevalence of health conditions facing kids and adults alike, now is as good a time as any to have the conversations and ramp up the scientific research. It is okay to question vaccine safety. It is okay to dig a bit deeper. Whether it’s our food, our environment, one or more of the vaccines, the adjuvants, the vaccine schedule, or some combination of things, our kids AND we are getting sicker. It may be none of these, let’s find out. Let’s bring the sides together. Let’s end the debate. Let’s get answers.
Ken Jaques is a Canadian patient activist and the founder of myhealthcommunity.ca You can find him on Twitter at @kenjaques.