Open letter to anti-vaccinationists

Some people have commented to me in person (and online) that I was a little brash in calling those violently opposed vaccinations as evil or ignorant. Also, that I might be completely shutting off dialogue and having people immediately list me as one of those pro-vaccination whores. I thought about this for a long time and concluded that they might be correct. But here’s why I said it:

My father and his sister in the kitchen/dining room/laundry of the house they grew up in (Picture taken by Thomas Tu)

My parents were Vietnamese immigrants, who came over to Australia during the Vietnam war. Some of my family have chronic hepatitis B (a vaccine-preventable disease) and may very well die of it. This is not surprising with the >20% prevalence of HBV infections in South East Asia. My family have seen a country without a strong vaccination or medical infrastructure; so when they came to Australia, they readily accepted the help and support of a developed medical program. This is what I want to emphasise in this series.

I do not gain anything from being a supporter of vaccination. If anything, I make a loss: if hepatitis B virus is wiped out, then I have nothing to research and I’m out of a job. My lab mates have been asked more than once “Why are you working on Hepatitis B? Isn’t there a vaccine for that already?”. The overwhelming majority of researchers are not funded by “Big Pharma”, but are government-funded and do it because they are passionate about their topic.

So why do I spend my time writing for no money about diseases and supporting vaccination on the Internet where the majority of people don’t care and some are outright opposed? I have experiments to do and a PhD thesis to write. I have an under-appreciated girlfriend. I have a social life that needs developing. Well, like both anti- and pro-vaccinationists, I am concerned with the welfare of others. Nobody wants people to suffer unnecessarily and everybody wants to leave the world in a slightly better state than they entered it.

The difference between the two sides is how we go about it prevention of suffering and how we understand the world. I chose my side with the most rigorous evidence for it: the pro-vaccination side. But I concede there may be dissenting views to that, as there have been for the last 200 years since the advent of the smallpox vaccine (see the reference for a good summary).

Yes, I may be brain-washed by the scientific machine in regards to the efficacy of vaccines. A fish does not notice that it’s swimming in water. But science is a field that rewards people for overturning the status quo: see Germ Theory of Disease, HIV as the cause of AIDS, Newtonian physics, etc.

As opposed to suing your opposition, in science, all one would have to do to silence the dissenting view is to provide definitive proof that vaccination does not work and it would all come tumbling down. Journals would trip over themselves to publish the biggest story in the past century because of so many copies that would sell. Billions of dollars would be laid at one’s feet for the rights to the non-vaccine thing that caused of disappearance of dozens of disease from 1st world communities. But this hasn’t happened yet. Many researchers are active in vaccination science and interested in sticking it to their competitors; so the overwhelming agreement that vaccination works tells me that vaccine specialists are probably not bullshitting me.

Yes, even with FDA (or similar) approval, there are side-effects associated with some vaccines. However, the diseases that people are vaccinated against also cause symptoms. We are encouraged to accept the minor risk of vaccine side-effects so that not only we ourselves, but also people with whom we interact are protected from the deadly symptoms of diseases.

Yes, there is an issue with freedom. What if you don’t want to take such a risk with your children? You shouldn’t be forced to. Recall the case of vaccination of men for rubella. Rubella is only deadly to the foetuses of pregnant women. Why should men bear a risk of having an adverse reaction to a vaccine when it might be easier just to catch rubella? Because we live in a society. There are times where we need to bear some small cost so that our societies are productive. For example, we pay taxes for roads to be paved and maintained so that society can benefit. Even if you walk everywhere, for society to maintain standards of living, we need roads. By bearing the small cost of vaccination and boosting herd immunity, these men and women ensured that their generation and generations after could be free from rubella congenital syndrome. So it is for other vaccine-preventable diseases.

These are my reasons for the overtly agitating sentence I used to start this series. Indeed, “unaware” (instead of “ignorant”) may have been a better word. Indeed, the majority of anti-vaccinationists are not evil and are pursuing the same goals that I am. I am not immune (ha ha) to having my foot moved to my mouth by passions; I am human. However, despite the unfortunate wording, I stand behind my argument. If you do not think it’s right, I encourage you to comment.

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Recommended reading

Greenberg SB (2000). ‘Bacilli and bullets’: William Osler and the antivaccination movement. Southern medical journal, 93 (8), 763-7 PMID: 10963505

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22 Comments

Filed under Thomas' Corner

22 responses to “Open letter to anti-vaccinationists

  1. I’m with you, but in a more anti-anti-vaccination group way. Pretty much they are killing people with their BS and should walk the plank.

    Weird thing is, I know some people who don’t believe in vaccinating their kids and they are really smart, well-intentioned people.

    It’s getting to the stage in Australia where we really need to get on top of it. I hear some areas are about (or already have) fallen below levels needed for herd immunity against some diseases.

    I’d love to do a science communication project to tackle the problem properly.

  2. Colin S

    I think you are quite justified in your opinion. I feel quite strongly the same way. Unfortunately I think this is more a matter of belief so there is a difficulty in convincing people of the effectiveness of vaccines, regardless of the data.

    I hope your family aren’t affected too badly, and good luck with your work!

  3. Not as kind

    You know what I’ve noticed? Every time a community builds up a critical mass of anti-vaxers, usually not more than a small cult, there is an outbreak of a deadly, preventable disease from the 19th century (cholera, diphtheria, measles, mumps, rubella or typhoid). Inevitably, several kids die because their parents did everything right except live in the same community as anti-vaxers.

    Anti-vaxers are murders by omission.

    Vaccines are not my profession and I write this without passion: I respect your moderation, but anti-vaxers have no place in modern society. If they go off and live in a medieval commune away from the rest of us, that’s just fine with me. I’ll be happy to send them medical aid when they have an outbreak of polio or bacterial meningitis. Until then, I intend to treat them like the antisocial moral deviants they are.

  4. Thanks for your opinions, guys.

    Yes, there is understandable frustration from your perspectives. And there is a definite need to educate people about it before it really gets out of hand.

    BUT the entire point of this post was to show some empathy; to accept that you may think that I’m threatening children’s lives and there are reciprocal feelings. If people are going to be convinced, you need to see where they are coming from. Otherwise it just devolves into shouting “baby-killer!” at each other and complete dismissal of whatever the other person is saying.

    Sure, you could throw your hands up and say that there’ll be no convincing them, but I guess I’m hopeful that some dialogue could alter some perspecitves. In that way, I think this might be one of the most optimistic posts I’ve ever written.

    @Skellet: I think a sci comm project about vaccination would be good and I’d be happy to help out.

    TT

  5. Genevieve

    Thanks for writing this Thomas! I am much more inclined to be sympathetic to your viewpoint now…

    Unfortunately I haven’t read the posts on vaccines yet, but I will. So maybe once I cease to be ignorant/unaware, I will change my mind about vaccines – I’ll let you know.

    Although actually I don’t really consider myself anti-vaccination, I just think that it’s a difficult decision, as I can see good points and both points sides. Whatever option you take, there may be some kind of horrible outcome/side effect, and I think that it must be really hard to be a parent and have to decide what to do, and be responsible if your child suffers as a result of your decision. Probably, most parents make the decision with the best interests of their child in mind, and I think that the benefits and risks of both vaccination and non-vaccination are close enough that it should be up to individuals to decide what to do, without being judged for their decision.

    • Genevieve

      By the way, when I say ‘I will change my mind about vaccines’ I think I actually mean ‘I may change my mind about vaccines’…

    • Genevieve,
      Whatever option you take, there may be some kind of horrible outcome/side effect

      Getting in the car and driving can have a horrible outcome.

      The point is that everything has risks, and these can be quantified and evaluated.

      What is the risk of having, say, a “bad outcome” from actually acquiring the disease versus the risk from having been vaccinated against the disease?

      Since I’m from California, where we are having an epidemic of whooping cough (pertussis), let’s just talk about pertussis.

      What is a “horrible outcome” of having a disease? Is it having the disease itself, or more serious consequences? Having seen videos of infants with pertussis, I’d argue that acquiring the disease itself is a “horrible outcome”. But it gets worse.

      According to the CDC,

      In infants younger than 12 months of age who get pertussis, more than half must be hospitalized. Hospitalization is most common in infants younger than 6 months of age. Of those infants who are hospitalized with pertussis approximately:

      * 50% will have apnea
      * 20% get pneumonia
      * 1% will have seizures
      * 1% will die
      * 0.3% will have encephalopathy (as a result of hypoxia from coughing or possibly from toxin)

      OK, what’s the risk of a “horrible outcome” from being vaccinated against pertussis? Here’s where the discussion gets complicated. Originally pertussis vaccines were made with whole-cell preparations, which were more effective in producing antibodies, but had a higher rate of serious side-effects. Accordingly, the vaccine was re-formulated with acellular preparations, which is less effective in producing anti-bodies but had a lower rate of serious side-effects.

      I believe the acellular pertussis vaccine was introduced in 2002. Helpfully, the US Health Resources and Services Administration publishes data on reported adverse outcomes compensated by the “Vaccine Court” at http://www.hrsa.gov/vaccinecompensation/statistics_report.htm

      Since 2002, 359 cases have been submitted for compensation, and 98 cases have been compensated.

      To understand risk, you have to know the exposure. How many doses of Tdap have been given? We are going to have to approximate here. There have been about 33 million children born in the US since 2002 (extrapolating from published data through 2005).

      To overstate the risk, you need to have the numerator as large as possible, and the denominator as small as possible. So I’ll collapse all doses of Tdap into one (to decrease the size of the denominator) and assume an 80% complete vaccination rate (rates vary, of course).

      So 359/(33,000,000*0.80) = 1.35985E-05, or 1.35985 per 100,000.

      Wow.

      I couldn’t find much on the risk to infants from pertussis. This article, covering 1993 to 2004, has a clue:

      http://pediatrics.aappublications.org/cgi/content/abstract/121/3/484

      “The incidence of infant pertussis hospitalization obtained from the Nationwide Inpatient Sample and Kids’ Inpatient Database was ~2 times greater than that obtained from the passive reporting system. Infants 1 to 2 months of age had the highest incidence (239 hospitalizations per 100,000 live births in the 2003 Kids’ Inpatient Database). An annual average of 2,678 hospitalizations occurred in 2000 and 2003; 86% occurred in infants ≤3 months of age. Among those with ages provided, 95% of infants who required mechanical ventilation and all of those who died were ≤3 months of age.”

      To sum up, the risk of “horrible outcomes” from receiving vaccinations has been, well, marketed by people who reject the benefits of vaccines. The risk of “horrible outcomes” from the diseases vaccines protect against has been (in my view) understated.

      Disclosure: I was born in the 1950s, before vaccines for most childhood diseases were available. My grandchildren are all fully-vaccinated for their ages

      • I had every intention of picking up on that same quote;

        Whatever option you take, there may be some kind of horrible outcome/side effect

        But looks like you beat me to it. Thanks for your very detailed response 🙂

  6. Uwe

    In short people who do not vaccinate effectively are working against the good of society, Germans have a nice word for this as they often do “Volksschädling” (antisocial parasite), Adolf used it regularly.
    Unfortunately political correctness and weak spineless politicians are not prepared to make it illegal to not vaccinate your child. Give your child a slap on the behind and all hell breaks loose let it dies from a vaccine preventable disease and it all so sad. I have to say Thomas your article was once again a great read but to be honest you do not even have to respond to anti-vaccine lobby it’s a black and white issue. Lets find a nice island and put them there, then they can all die sooner or later a happy death with bodies not fouled by evil vaccines.

    • Thanks Uwe for your contribution of German grammar.

      While social parasitism isn’t really a disease that I specialise in, I can tell you why addressing the anti-vax arguments are necessary: a Google search for “Should I vaccinate my child?” gives 5/10 pages where they’re telling parents not to vaccinate their children (including the 1st link); “Vaccine side-effects” gives 4/10 pages that are anti-vax. Parents who are scared by these media reports are going to come up with these pages first and be swayed. I know you are being facetious, but it’s something we do need to address by talking to them face-to-face.

      While a good swear-filled tirade feels very good, there’s a time and a place for these arguments. Paradoxically, the more pro-vax’ers talk down to anti-vax’ers, the more legitimacy they feel they have. The underdog or persecution effect comes into play.

      TT

      • Uwe

        “Don’t argue with idiots. They’ll drag you down to their level and beat you with experience”

        I think this more or less sums up my opinion on the anti-vaccine lobby.

        However as a Ph.D. student your used to beating your head against a wall until the wall gives way so I do understand your attempts to respond to the anti-vaccine lobby and commend you for it.

  7. Xien_Rue

    I feel bad of the comment you received. Side effect is not a very good reason to abandon the vaccination idea. I haven’t read all your post about vaccine prevented disease (I only have read about RUV) but honestly, I agree with your view about vaccination. For me, to completely condemn vaccination to be a bad thing is illogical.

    There is a side effect, yes. You can not really blame it on the vaccine because everyone has different genetic make up that make them differ in their respond to a specific vaccine. There is no way to make vaccine that would be compatible with everybody on the Earth. That’s mean more research to do, not an instant condemnation.

  8. campbell

    Its game theory – there will always be a percentage that cheat the rest, because the system permits it. Parasitic, just as Uwe states. Great articles guys.

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  10. Uwe

    If anyone is just on News.com.au you will no doubt have heard about the child which just died of a vaccine preventable disease. I see James managed to get his point published well done. Again I can only shake my head at the anti-vaccine mob another death which in my opinion they can take credit for due to a lack of herd immunity driven by unfounded fear campaigns.

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