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.
The Debate
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?
Today’s World
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.
Science
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.
#VaccinesWork
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.
Mumps Outbreak
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.
Thank you! I appreciate your viewpoint and comments on this.
Ken,
If it’s impossible to test all permutations and combinations, you’re setting an impossible bar to clear. How can anyone act in the public benefit and provide warnings if you demand that everything be 100% buttoned up before you can say the science is in?
Also, could you explain why you believe this to be a debate? Are you seriously claiming that the government bodies responsible for protecting us (Health Canada, FDA, etc) haven’t considered the questions you’ve listed?
-Jason
Actually Jason, believe it or not, the CDC has absolutely NOT considered the questions that Mr. Jacques has asked? I know because I have asked them. They don’t know their a$$ from their elbow. Most of those I have spoken with have not given an immunization to a child even one time over the last decade. That is no expert in my book. Sorry but that is the truth.
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Jason, I’m curious about this comment in your post: ”While I categorically disagree with Mr. Jaques conclusions and interpretations regarding vaccinations” …
My conclusion was that honest conversations, science, and bringing sides together could end the vaccine debate.
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I disagree with your interpretation that you need to prove that “all possible options have been evaluated and there is no way to interpret the scientific results differently” because you’re creating doubt about the vast scientific consensus that exists.
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That’s a fair comment, that part of the post could be worded better. I’ll update.
Is that the only thing you “… categorically disagree with Mr. Jaques conclusions and interpretations regarding vaccinations” about?
On vaccinations, as a former public servant, I don’t share the same scepticism of the testing and approval process as you seem to.
However, I do agree with you that public health actors do a poor job of communicating complex facts and explaining the process to the public.
I think the “honest conversations” treats each vaccine differently, just like each drug is treated differently. The testing and approval process for each vaccine hasn’t been the same.
I think we’re on the same page on the latter part.
I understand your point from an expert level. But public health marketing, like all marketing, can’t be quite as parsimonious as that to be effective.
Would you be alright with a blanket positive statement on some vaccines (perhaps the most important ones for children)?
I understand your point on marketing as well.
I think we are at pretty much blanket positive on some vaccines. The task then is to define which ones.
I also think we’ll get to the point where we can pre-screen for risk. Perfect world?
Is it possible to reframe the issue? Given that Health Canada or other administrative body has already looked at the issue, which are the vaccines that would/should give some people pause?
Yes, I think it is possible to reframe the issue, along the lines of your previous tweet. Without wading in too far, we would need the honest conversations to answer the second question. It’s not you and me.
It sounds like your experience as a patient led you to ask questions about the safety of vaccines. Can you tell me a little about what happened?
Close. My experience as a patient led me to wonder why so many people have been diagnosed with chronic disease. I inadvertently stepped into a vaccine debate thread on twitter and have been watching the vitriol for 2 years. Tired of watching propagandists and denialists discrediting anything outside the status quo (sick care, profit care, big food, big ag) under the guise of science. We have a population health crisis, we’ll need to work together to solve it.
Why do you think public health advocates react to you in the way you do? There’s clearly considerable anger on their side. Has the debate changed over the time you’ve been following it? It seems like people have been getting much angrier and the vitriol worse in recent years ..
It feels to me as though Wakefield’s film was the gasoline on the fire. I think a lot of people on their side thought the fight had been won .. And then this guy shows up and makes a film, and the whole thing starts spiraling out of control … people start watching the movie and talking … and saying there’s this movie that’s “they” don’t want you to see ..
Not sure, but I’m guessing a lot more people ended up seeing that film than otherwise would have seen it.
John, in regard to your comments about the movie Vaxxed. No one talks about the fact, that most of the children were ill when they received immunizations. I can still hear one mothers statement that her son was on antibiotics when he received the MMR vaccine. That is a no-no in my opinion. I have never had a problem in 17 years of giving immunizations with MMR, however I respect the fact it is a live virus vaccination and insist children (including my own) are not ill when they receive it. Mr. Jacques raises really important questions in this piece that have not been addressed. It is time those were answered, however the public health and policy people think everything is settled…. Nothing in science is settled. Ever.
Vax debate has been ongoing for years. Wakefield is the “convenient villain”. As more are exposed to suspected vax injury, social media makes it easier to speak out.
There are a lot of very powerful forces that don’t want honest conversations to happen. They have far too much to lose financially. They repeat things often enough, inject a reference to a scientific study or two, and people start to believe it to be true. Get some powerful voices to spread the message, and voila, scientific consensus.
Why do they react to people like me in the way they do? We challenge the status quo. We change the question. We challenge their beliefs. They don’t want to be wrong. Their egos are often too big to look at alternative suggestions, even as science evolves.
The pharma angle is an interesting piece of this. Elsewhere in public health and in government, people are asking really tough questions about the role Big pharma plays in the healthcare system. In many cases, they’re challenging the role pharma plays in the research process and asking tough questions about conflict of interest, and drug pricing and availability of new medicines. But this is different. No one wants to acknowledge that things are complicated. Why do you think that is?
Kool aid. By most accounts, the initial vaccines had very good results. They’ve been “so good for so long”, and “greatest medical invention”. The story is “solid”, everybody fears outbreaks of any kind. The perceived benefits are extremely high. Nobody wants to question the risks.
You’ve doubtless heard of the Danish study that came out this week that some people are pointing to as conclusive evidence that there is no vaccine / autism connection. Have you seen it? Any thoughts?
I have seen the study and some of the commentary. The one that keeps coming up is that the study was orchestrated by a pharmaceutical company. like they were able to test susceptible children in this study in order to determine that the vaccine does not trigger autism in those children. This should be great news for ending the debate.
How was the study able to come to the conclusion that MMR does not trigger autism in susceptible children? Did they test in on susceptible children? How did they know the children were or were not susceptible?
The other issue that I think is an elephant in the room is the use of the autism diagnosis as what is being tested. For example, and I’m not suggesting there is or is not, is there a link between the MMR (or multiple vaccines in one doctor visit) and any condition on the ASD spectrum? To the best of my knowledge this is never discussed or studied, leaving the scientists and pharma the convenient answer of “that’s not autism”
Mr. Jacques is correct, no one wants to question the risks. Because what happens then? What happens when the healthcare system admits they do not have all the right answers after saying they did for years…. well the system falls apart.
But guess what? We would still have doctors and we will still have patients…. and we will still have the magical relationship between the two — which is the most trans-formative part of medicine in existence today. That relationship is absolutely untouchable — no AI, EMR, or telemedicine gimmick will ever replace what my great uncle did riding through the countryside on his horse and buggy visiting homesteaders in Oregon, or my grandfather doing home visits in Tacoma, WA, or my father or me.