Friday, April 11, 2014

And here's what my letter looks like...

In the post below, I urged you to write to Colorado legislators to express your support of HB1288 and to counteract the anti-vaccine rhetoric with which they've been deluged. Putting my money where my mouth is, here is what I've written. It's not perfect, it's not polished, but it's from the heart. Yours can be too!

Dear Senators,

My name is Ashley Shelby, and I am a mother of two. I am moved to write you today because it has come to my attention that you are receiving a great deal of contact from anti-vaccine parents and activists regarding HB1288, which strengthens immunization rules for the state that will protect children and infants, individuals going through immuno-suppressive therapies like chemotherapy, and the elderly from needless suffering. These anti-vaccine activists often refer to their beliefs as having to do with personal choice, personal liberty, informed consent, and other terms that mask the fact that they want the right to not vaccinate their children while still enjoying the public spaces, like schools, where their decision could harm others. To me, anti-vaccine parents who fight against HB1288 are like people who feel it's their right to shout "fire" in a movie theater, a right which has been denied by courts for decades. Your freedom may not infringe on my safety--and that's exactly what anti-vaccine parents are doing, so far without any obstacles thrown in their path. Their "personal liberty" is making it hard for me to exercise my own.

I am speaking up because these individuals do not represent parents. In fact, they are a vocal fringe group, who have an impact because of the nature of herd immunity. Although the overwhelming majority of parents support vaccines, even if five percent of parents choose not to vaccinate, diseases like measles, mumps, and pertussis gain a foothold in our communities. And they have. You are no doubt aware of the measles clusters in California and New York, the mumps outbreak in Ohio, and the pertussis cases all across the country. The majority of these cases started with and were spread by unvaccinated individuals. 

Please help parents protect their children from vaccine-preventable disease by voting yes to HB1288. Parents still have the right not to vaccinate their children--they just can't send them into schools and day cares. Voting no to HB1288 is not a vote for personal liberty. It's a vote that indicates that people can endanger public health with absolutely no consequence to themselves, and all the risk on the shoulders of people who are forced to share a public space with them. 

Thank you for considering my point of view.

Don't Let Anti-Vaccine Movement Sink Colorado Bill

Editor's Note: I made a mistake in my initial post--Colorado is not trying to eliminate personal belief exemptions (I wish)--the bill simply adds an educational component. 

We need your help.

Colorado is trying to strengthen immunization rules by adding an educational component to personal belief exemptions. These exemptions are the manner in which anti-vaccine parents can opt-out of vaccines and still enroll their children in schools and day care facilities, putting children and vulnerable members of our community at risk of vaccine-preventable diseases. We've seen the result of these exemptions: measles outbreaks, mumps outbreaks, devastating pertussis outbreaks that have killed infants.

And while support for the measure is strong in Colorado's House, its Senate is less likely to pass the bill, titled HB 1288, "Strengthening Personal Belief Exemptions for Immunization Requirements."
Part of the reason is because legislators are being deluged by phone calls and e-mails from anti-vaccine activists, purporting to represent parents. What's more, they are framing this debate as one over personal liberty. Missing from their arguments is the idea that with personal liberty comes personal responsibility, something anti-vaxxers do not exercise, and which is harming public health and the communities in which they live. Unfortunately, it turns out that several state legislators have bought into this personal liberty argument--and with the majority of the calls and e-mails they are receiving being from anti-vaxxers, they are more and more likely to vote against this important bill. 

Let's help. One approach is to talk about recent outbreaks of vaccine-preventable disease and how lack of immunization has lead to needless suffering. Another approach is to take apart the personal liberty argument that the anti-vaxxers are now using to stop this bill. Where does personal liberty bump up against the needs of the community--the anti-vaxxers want the right to yell "fire" in a crowded theater. 

The Colorado Senate State, Veterans, and Military Affairs Committee will vote on the bill on Monday.

Once passed by this Committee, as is likely, the bill will be considered by the full Senate. It here that the bill looks to be in trouble, when it reaches the full Senate. 

This is where you come in. Please contact Colorado Senators as soon as possible to urge them to support House Bill 1288. Here is the CO general assembly senate directory:  Colorado General Assembly Senate Directory

Because the majority of calls and e-mails right now are angry anti-vaxxers, all Senators, even the ones who look like they will vote yes, need to hear from you. Encouragement for those likely to vote yes, reasoned and compelling (and personal) words for those likely to vote no. Here is the list of senators we believe are most in need of a call or e-mail.

Senator Cheri Jahn (D); Cap: 303-866-4856 E-mail:
Senator John Kafalas (D) Cap: 303-866-4841; E-mail:
Senator Mary Hodge (D): Cap: 303-866-4855; E-mail:
Senator Jeanne Nicholson(D): 303-866-4873 E-mail:
Senator Ellen Roberts (R)Cap: 303-866-4884 E-mail:
Senator Bernie Herpin (R)Cap: 303-866-6364; E-mail:
Senator Steve King (R) Cap: 303-866-3077; E-mail:
Senator David Balmer (R) Cap: 303-866-4883 E-mail:

If you have any questions, please contact Stephanie Wasserman, Executive Director of The Colorado Children's Immunization Coalition at   

Monday, March 3, 2014

Telling Anti-Vax Parents They're Wrong Only Makes Them More Anti-Vax

By Karen Ernst

Today, a study in the Journal of Pediatrics seemed to point out that what pro-vaxxers are trying to do is all wrong.  It might seem to suggest that debunking vaccine-autism myths, explaining relative risks of disease, and demonstrating the effects of vaccine-preventable disease is ineffective.  

The study tried to influence parents’ decisions about vaccines using four strategies, all utilizing online resources: correcting misinformation about the MMR-autism myth, giving information about the risks from vaccine-preventable diseases, presenting first-person narratives about children who had contracted VPDs, giving visuals of those risks. After being presented with one of these four strategies, parents were surveyed about how much more likely they were to choose an MMR for their children.  The information used came from the CDC, although the source of the information was not given to the parents surveyed.  The parents participating in this study came to the study with a wide variety of beliefs about vaccines, and almost none of them left with their beliefs being changed.

In short, the Pediatrics study found, in summary, that:

1. Showing ardently anti-vaccine parents proof that vaccines don’t cause autism only made them less likely to vaccinate.

2. Explaining the risks of vaccine-preventable diseases does not increase the chances that parents would agree to the MMR in the future.

3. Showing parents visuals about disease risk or giving them stories about children suffering from vaccine-preventable diseases did not make them more likely to vaccinate their children.

Those findings seem pretty damning for the pro-vaccine message, but I think we should take heart.  There is so much this study didn’t cover, and so much we can do that would work. Here are my thoughts on the findings:

1. Anti-vaccine parents have a broad range of concerns about vaccines beyond the vaccine-autism myth. Hitting one discussion point only irritates their sense of “they don’t get us.” The study might also fail to nudge ardently anti-vaccine parents because there is no human component, and the targeted parents have no opportunity to feel that someone took the time to genuinely hear out their concerns and address them in a personalized way.

2. Emphasizing risks often feels to parents like “fear-mongering,” and parents who refuse vaccines might feel that they are able to continue refusing vaccines since they live in communities with high vaccination rates where the risk of their child actually contracting a vaccine-preventable disease is low.  Just the other day on our Voices for Vaccines Facebook page, one mother commented, “I do not vaccinate, but would definitely consider it if traveling overseas.”  Anti-vaccine parents believe that their risk for contracting diseases is greater where those diseases are endemic, and trying to convince them that their children are at risk for complications from diseases they are unlikely to catch at home is problematic.

Conversely, anti-vaccine parents are likely to disbelieve in herd immunity. As Amy Parker’s mother once did, anti-vaccine parents often rely on organic foods and healthy living to protect their children from diseases that are often airborne and highly contagious. Those of us providing the cover of herd immunity to their children only make it easier for them to continue to delude themselves into believing that their lifestyle is the deciding factor. And because allowing children to become ill to prove our point is wrong in every sense of the word, it’s simply unlikely that anti-vaccine parents will change their minds due to fear of risk from disease.

In reality, what these anti-vaccine parents are doing is increasing the risk that these diseases will come back and that someone will suffer from a serious complication.  The parent who already vaccinates does so not only out of concern about serious complications, but also because they want to prevent illness in their children. But only ardent pro-vaccine parents are typically also passionate about the power of protecting her whole community.  However, maybe we can use pride in protecting the community not as a way to motivate parents to vaccinate but to motivate vaccinating parents to take pride in their actions and speak up about them.

3. Images and stories about children in peril because of disease only makes parents look for other dangers.  I call this the “Law and Order: SVU” effect, named so because after I have watched episodes of this show where children were in peril, I tend to see dangers for my children everywhere--beyond the scope of the subject of the episode.  

The researchers call this the “danger-priming effect.”  Priming parents for danger doesn’t make them more likely to take the solution you are offering, according to this theory.  It makes them more likely to look for dangers everywhere, including in that syringe you are holding out to them.

4. This study was limited in what it could reasonably do to ease fears about immunization because it was online and impersonal. There’s simply no way to quantify all of those conversations that occur on the playground among parents or around the Thanksgiving table or even between friends on Facebook.  

Parent-to-parent communication is entirely different than the communication in this study.  Think about what we know about ardently anti-vaccine parents:  They are more likely to believe conspiracy theories and thus less likely to believe officially sanctioned scientific evidence.  They are more likely to have a social network guiding them toward vaccine refusal, and providing them positive social reinforcement for their decisions.  The cold, impersonal online survey has no chance for success in the mind of a parent whose decisions are socially reinforced and are based on a distrust of official stances.

So what can we, as pro-vaccine lay-advocates, do? Are we likely to make parents less likely to vaccinate through our advocacy?  

I do not believe so.  In fact, I think lay-advocates--everyday parents and citizens--are key. Recent research shows that normalizing immunization works.  So let’s do that. Let’s let people know that we happily vaccinate our children because we understand the science behind it is clear and because we value our children’s health.

And vaccinating is normal.  Well over 90% of parents vaccinate on-time. If anti-vaccine parents feel that their position is being reinforced by their social network, then we as parents are not doing our job to protect our children and their friends. If every parent with fully vaccinated children simply stated that their children were vaccinated on-time, there would be a groundswell. The voices of these parents would drown out the fear-mongering and lies of the anti-vaccine movement, and concerned parents would feel more confident to join our ranks.

In other words--speak up. It just might work.

Monday, January 20, 2014

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

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.

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: 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.

Friday, January 3, 2014

How Anti-Vaxxers will Help the Pro-Vax Movement in 2014

For anti-science movements, such as the anti-vaccine movement, conspiracy theories are lifeblood. In fact, many of these movements would not survive if it were not for their unique kind of science fiction so implausible it would make Philip K. Dick blush. The anti-vaccine movement survives on several of these conspiracy theories, most of them so far-fetched that the majority of reasonably intelligent parents who read about them can dismiss them out of hand.

For example, we have the worldwide conspiracy of pharmaceutical companies, every government on the face of the earth, the global medical community, all medical schools, medical journals and other medical organizations, every state public health department, the Centers for Disease Control, the FDA, the Gates Foundation---and I'm out of breath. That conspiracy claims that vaccines are dangerous, but this aforementioned cabal somehow organized in the shadows, away from the prying eyes of the public and a scandal-hungry media, to whitewash the dangers of vaccines and act as if they are live-saving interventions. As someone who volunteers for a non-profit, I can tell you that it takes my partner weeks to schedule a simple phone call between the five members of our Scientific Advisory Board. Chances are, a conspiracy this vast--the largest conspiracy in the history of humanity, by the way--is the stuff of science fiction. But, as I said earlier, most science fiction writers would realize that no reasonable reader of fiction could suspend disbelief long enough to buy into such an idea.

Anti-vaxxers, on the other hand, do nothing but suspend disbelief. Anti-vax organization, National Vaccine Information Center (which tries to trick parents by naming itself in a way that makes it seem objective), has been trying to convince visitors to its Facebook page that Voices for Vaccines is a "pharmaceutical front group" because Paul Offit is on the Scientific Advisory Board. I'd like to know how that actually works. Dr. Offit receives no royalty from his rotavirus vaccine (which, incidentally, has saved hundreds of thousands of lives, particularly in the developing world). He is, in fact, a vaccine pioneer. Naturally, we'd like someone with that level of knowledge about vaccines and vaccine-preventable disease to look over our posts before we publish them, unlike National Vaccine Information Center, which relies on people who have no medical or science backgrounds, to write their propaganda. We choose to include the most knowledgable people in the world of infectious disease because we care about, you know, truth and science. And they come to Voices for Vaccines as volunteers, receiving no pay for their advice and bringing absolutely no pharmaceutical money to the endeavor. We are a small organization, led by parents and sustained entirely by small donations from our members.

I can state unequivocally that Voices for Vaccines has never taken money from a pharmaceutical company. Ever. Now, by not taking pharmaceutical money, we are not suggesting that organizations that do are somehow in those companies' pockets. They are not. However, we chose not to muddy the waters, because that would only give an AVers an opportunity to create doubt. But magic realism is immune to facts. If they don't like the facts, they make up their own. As they've done with Voices for Vaccines--an organization that terrifies them to such a degree that they and Age of Autism are beginning to publicly writhe and froth, even attacking pro-vaccine parents. (Reading the Age of Autism post should offer a reasonably objective reader a peek into the paranoia-soaked brain of the most strident anti-vaxxers). I am confident that once the mainstream media notices these ad hominem attacks, the negative publicity that results from news coverage will scare new parents away from the anti-vaccine camp. After all, if they are willing to publicly attack ordinary parents like Karen Ernst for simply choosing to speak up for a public health intervention, how reasoned and reliable can their information--and their leaders--be?

I've publicly challenged NVIC and Age of Autism to produce proof of pharmaceutical payments to our grassroots, volunteer, parent-led organization. It has yet to do so.

Another conspiracy is that doctors are always "pushing" vaccines on new parents because they are getting the big bucks from pharmaceutical companies. I think most of us know where the big bucks are when it comes to pharmaceuticals--after all, we're bombarded by ads for these products during NFL Sunday and reruns of The Bourne Identity. Erectile dysfunction drugs, drugs for conditions seen in later middle age, such as rheumatoid arthritis, and drugs for mental health issues. I have yet to see a commercial from a pharmaceutical company for a childhood vaccine. The reality is that vaccine companies don't make much money from vaccines. And "Big Pharma's" largesse doesn't extend to secret under-the-table payments to your local pediatricians. Suggesting otherwise will immediately make a reasonable parent suspicious of the organization or person making such a suggestion. Especially when their pediatricians are rolling in to the clinic in their Honda Civic.

But here's why I know that pro-vaccine advocates are going to have a great 2014, and why the anti-vaccine movement is in a state of disarray. Not only is there a great deal of infighting among the more visible members of the anti-vaccine movements, it also has suffered some staggering defeats, especially in the latter part of 2013. For example, the vaccine hearings that were going to be headed by Darrell Issa, who has enjoyed nearly $40,000 in donations from the anti-vaccine Canary Party, were called off after Issa and his staff were bombarded with calls from concerned constituents. Another example was what happened when Katie Couric sacrificed her journalistic integrity for ratings on her fast-sinking talk show (which was canceled a couple weeks later) by doing a sensationalistic segment on the HPV vaccine. The outcry was nearly universal; media outlets that had once given anti-vaccine activists equal time in stories about vaccines criticized Couric and her producers; and even Couric distanced herself from the show.

The anti-vaccine movement knows its in trouble, and that's why it has been pushing its conspiracy theories even harder now. Not so long ago, it could act as if it were a legitimate movement questioning the drug safety. But the media, and, increasingly, parents, have caught on. The fatal flaw in their bet on the success of conspiracy theories is that the more detailed their theories, the more strident they sound in promoting them, the crazier they sound. It becomes less and less likely that a concerned parent will buy into the theories. When they engage in activities, such as actively working to ban Facebook users who comment on vaccine stories, they come across as defensive and nutty. Parents see that pro-vaxxers do not work this way. You will not see a pro-vaccine Facebook page "ban" a user who spouts anti-vaccine rhetoric. Why? Because the more these people talk, the more damage they do to their cause--and, crucially, the more opportunities they offer pro-vax voices to correct their misinformation with facts and science, giving parents questioning vaccines on the page a chance to weigh both sides.

Here's what you will not find coming out of the pro-vaccine movement: Conspiracy theories. Attempts to censor conversations about vaccines (this would work against us, because we welcome vaccine-hesitant parents into the fold; we want to answer questions, not shut them down). Personal attacks. Baseless accusations, such as Karen and I field on a regular basis, that we are "in the pocket of Big Pharma."

Parents notice this. And this is why the anti-vaccine movement is going to continue to lose relevance and visibility. So when a group of anti-vaxxers have decided to build a brand-new conspiracy theory that Voices for Vaccines' parent-contributor Amy Parker, a mother from northwest England who wrote about her experience growing up unvaccinated, is actually a CDC mole because a woman with the same name collaborated with Paul Offit on something, it will do far more harm to their cause than it will to ours. In order for this idea to gain traction with a parent, she would have to suspend disbelief enough to believe that Karen and I know this Amy Parker at CDC (whom I've never heard of), convinced her to write this false first-person account of growing up in an idyllic Lake District community in northwest England, tweak the language enough to make it sound like it's written by someone born and raised in England, then steal a picture of some unsuspecting mom off the internet to go with the story--and then, after all that subterfuge, use the CDC mole's real name.

Logic and reason have never been the strongest aspects of the anti-vaccine movement, and parents are catching on. UPDATE: We are now fielding e-mails from people telling us that anti-vaxxers have told them Amy Parker "does not exist." Keep it coming, please.

My fervent hope for the anti-vaccine movement in 2014 is that it will keep the conspiracy theories coming. That it will continue attacking parents who are pro-vaccine. Keep working on that picaresque that has everyone who vaccinates his or her child and then chooses to speak out about it being the "Pharma Shill." Fan the flame that keeps that vast, worldwide conspiracy of silence about "the dangers of vaccines." Keep it coming, because it's swelling the pro-vaccine ranks every day.

Author's Note: I want to make clear that the criticism of the anti-vaccine movement in this piece deals with anti-vaccine activists, not the more "casual" non-vaccinating parents whose decision not to immunize their children is made out of concern, fear, and misunderstanding. I get it. I was almost one myself.

Friday, December 13, 2013

Mandatory Flu Vaccination: In My House It's the Law

Today marks the last day of National Influenza Vaccination Week, and in keeping with my standard M.O., I've waited until the very last minute to talk about the influenza vaccine. (Luckily, this didn't extend to the vaccine--my kids were vaccinated in August and I got mine in early November).

Over at Shot of Prevention, Voices for Vaccines Parent Advisory Board member and leader of Nurses Who Vax, Melody Butler reminded readers what, exactly, is at stake when it comes to children and the flu. Last year, 169 children died from flu. "To put that number in perspective," Melody wrote, "that's more than six kindergarten classes." 

Opponents of vaccination would quickly point out that those deaths likely represent children who had an underlying condition or were immune-deficient, that most healthy children can fight the flu. The brutality--and the astounding ignorance--of such a statement is likely self-evident, but let's unpack it anyway.

First, those children with underlying conditions or who were immunocompromised are the very reason we should vaccinate our healthy children. By cocooning these kids who are battling illnesses, like cancer, we can reduce the chances that they will contract the flu, which, for them, can be extremely serious. 

Second, opponents of vaccination are caught in a double-bind--they aim to convince as many people as possible not to vaccinate their children, yet the health of their own unvaccinated children is utterly dependent on high vaccination rates. 

But what about the canard that the flu vaccine doesn't work? Is it perfect? Of course not. The nature of the flu itself makes a universal vaccine an exceptionally complex proposition (though it may be on the way). But if you could reduce your child's chances of suffering--and believe me, dealing with influenza comes with a great deal of suffering, whether you're a child or an adult--by any percentage point, even one, wouldn't you do so? Apparently, in some circles, the answer is no. And I find that hard to wrap my mind around. 

So here's my yearly plea: whether flu vaccine reduces your child's chance of getting the flu by 60% or 6%, it's worth the trip to the pediatrician's office, the local big box minute clinic, the local pharmacy, etc. 

And a last note: in my house, vaccinations are mandatory--and my kids are getting old enough now to understand why. Yes, they don't want to get sick, but what fills me with pride is that they care even more about keeping their friends and family healthy as well. They understand how vaccines function in this regard. They are not old enough to fully understand why parents might not vaccinate their children (frankly, I'm not either), but they have been told that these unvaccinated children are in need of protection as well, that these peers of theirs are, in a sense, immunocompromised themselves. Choosing vaccination because you care about your own health, as well as the health of the community, is a lesson in compassion and community all children should learn. 

Wednesday, December 4, 2013

In the Media, A Bad Day for Vaccines

By Karen Ernst

I write this at the end of a bad day in the media for vaccines. It’s not that there was bad news about vaccines; it’s that the good news was ignored in lieu of anti-vaccine misinformation. The most disappointing of these media stories occurred on Katie Couric’s daytime talk show, Katie.

For weeks, the Canary Party (a group of anti-vaxxers who have actually formed a political party based on being anti-vaccine) have been shopping around an anti-HPV vaccine video on the heels of the cancellation of Congressional Oversight Committee hearing they had so hoped for. Katie Couric and her producers, in a cynical attempt to buoy her dismal ratings, bit.

To say I am disappointed in Couric would be an understatement. Since losing her husband to colon cancer 15 years ago, Couric has championed cancer prevention through colonoscopies. That she would allow a ratings ploy to trump journalistic integrity on the subject of a vaccine that prevents tens of thousands of HPV-related cancers each year in the U. S. boggles the mind.

The segment began with Canary Party Executive Committee member Emily Tarsell describing the death of her daughter, Christina, eighteen days after she received the Gardasil vaccine. Truly, nothing is as traumatic and devastating as losing a child in the prime of her life. The need for answers is more than understandable, it is necessary; and I can even understand parents seeking answers in and holding fast to a theory that makes sense to them, even if the theory doesn’t hold up scientifically. I want to be absolutely clear that I do not blame those parents for this. Instead, I blame the anti-vaccine movement for exploiting their stories in order to support their own wrong-headed ideas about immunization.

But because she brought her daughter’s story to a large, public forum, it is fair to investigate it to see if Emily Tarsell’s account holds up to scrutiny. Many facts surrounding Christina’s death are unavailable because Emily Tarsell is seeking compensation from the National Vaccine Injury Compensation Program. However, this court order from the NVICP judge indicates that the story does not support the theory that Christina died from an HPV-vaccine reaction. In it, the judge notes that despite Emily’s recall of her daughter’s unusual fatigue, “there is no evidence suggesting that Christina was so tired (or fatigued) that her health affected her daily activities.  For example, none of [those] who observed Christina while she was in Maryland . . . asserts that she changed plans due to tiredness.”

In fact, the findings note that Christina seemed anything but fatigued: “While in New York, Christina worked her part-time job for 18.75 hours.  On Thursday, June 17, 2008, Christina stayed up until midnight or 1:00 A.M. having dinner with her apartment mates.  Her apartment mates did not tell the police officers investigating Christina’s death that she appeared unusually tired.  Her apartment mate’s recollections suggest that, to their knowledge, Christina was normal.” In this document, there is also evidence that Christina may have suffered from a preexisting heart condition, but there was never a definitive cause of death.

Next up on Katie, Couric handed the floor over to Dr. Diane Harper, who made a number of spurious claims about HPV vaccines. The first claim was that HPV vaccines only offer protection for five years. Initial studies, however, do not support Dr. Harper’s claim, some showing that an HPV vaccine can offer protection for at least 8.5 years. And we may find that the vaccine offers protection for much longer as more evidence rolls in.  

Dr. Harper also asserted that pap smears are sufficient in detecting pre-cancerous cells which, she claimed, are 100% curable. However, between 2004 and 2008, 26,000 HPV-related cancers were diagnosed each year in the United States. 11,500 of these cancers were cerivcal cancers. In 2010, nearly 12,000 women died from cervical cancer. Despite Dr. Harper’s optimistic view of cervical cancer screening, it is far from perfect, and it would be vastly better to prevent infection than to try to cure the results of it.

Dr. Harper’s subsequent instructions that parents weigh the benefits and the risks of the vaccine is only sage advice if parents are receiving accurate information about the benefits and risks. The benefits, of course, are preventing cancer and death. The risks, as Couric presented them, were completely out-of-whack. A study of nearly one million girls who had received HPV vaccines found no significant health risks involved.

And it only got worse.  After talking to Dr. Harper, Couric provided air time to yet another anti-vaccine leader--this time SaneVax director Rosemary Mathis. SaneVax has a history of promoting misinformation and particularly horrible science. Inviting Mathis as a guest on a show about vaccination is the equivalent of inviting my kindergarten-age son as an expert on Tokyo because of his interest in Godzilla.

But it couldn’t all be a big commercial for anti-vaccine propaganda could it?  There must be hope because this is Katie Couric, right? As somewhat of a reprieve, Dr. Mallika Marshall provided some wonderful and accurate information about HPV and its vaccine. And she was brilliant. She was followed by a mother-daughter pair who endorsed the HPV vaccine.

The segment ended with Dr. Harper encouraging parents to get their daughters gift certificates for pap smears for their 21st birthday and Dr. Marshall encouraging parents to vaccinate.

Couric may have considered this balanced coverage since she presented two sides about this vaccine. But you probably know that I’m not going to let her off the hook that easily.

In 1998, Andrew Wakefield hoodwinked journalists into reporting on a shiny new theory about vaccines causing autism. As you might remember, it was all a grand fraud from which Wakefield continues to profit. And the media helped him, even after studies were rolling in discrediting the theory that vaccines cause autism, the media continued to structure their news stories to create balance. On one side, a family that claimed their children became autistic because of vaccines. On the other side, people in lab coats saying this just could not be the case. The anecdote too often trumped the evidence, as often happens in cases of false balance. CJR’s Curtis Brainard discussed how these “subtly bad” media reports perpetuate myths about vaccines. These myths threaten us all.

Katie Couric’s television show threatened the lives of young girls and boys. Because their parents are being frightened away from a safe and important vaccine, there will be men and women in the future who will die from HPV-related cancers, and who could pass HPV on to unwitting partners. Today, Katie Couric gave the anti-vaccine movement a huge forum, and I am already mourning the lives that will be affected because of it.