Where to begin… well, I guess I’ll need to split this post up into sections. I’ll look at specific groups first, then move onto examples of vaccine scares.

Specific Groups

Different anti-vaccine groups do not necessarily share the same viewpoint and the individual members of these groups may also differ in their views on vaccines. The thing that links them all is that they are dangerously wrong on vaccination.

AVN: here, the Australian Vaccination Network are accused of providing misleading information and harassing parents:

The New South Wales Health Care Complaints Commission (HCCC) has compiled a damning report into Australia’s most prominent anti-vaccination group, the Australian Vaccination Network (AVN). The HCCC accuses the AVN of providing inaccurate and misleading information and selectively quoting research out of context to argue against vaccination. The report has also noted accusations that the AVN harassed the parents of a child who died of whooping cough last year, after the parents advocated the importance of childhood vaccination. [Italics mine.]

Providing inaccurate and misleading information and selectively quoting research out of context to argue against vaccination is the very essence of the anti-vaccine movement and it is this behaviour that makes them dangerous.

Harassing bereaved parents does not seem to be universal among those who are anti-vaccine but, if true, these allegations concern behaviour which I think most people would find deplorable. This comes from the ABC report I linked to above:

[Meryl Dorey of AVN] repeatedly says Dana “supposedly” died of pertussis, but the McCaffery’s say that is an offensive claim. “It’s the most offensive statement because I watched over five days my beautiful daughter suffer the most agonising death,” Ms McCaffery said. “Then to be put in a position where I have to prove that she died of pertussis, that’s even crueller.” Mr McCaffery says Ms Dorey is “diminishing the fact that pertussis can and does kill”. “It is going to lead to someone making a decision that could put their baby or their family at risk, and that’s not right,” he said.

VAN: http://www.vaccineriskawareness.com/. The Vaccine Awareness Network reported on a death following Gardasil (you have to scroll down quite a way to find this case – see also this PDF). This death will be familiar to those who read my post on the Sunday Express story on Natalie Morton.

VAN repeat several canards about Natalie Morton’s health and the non-existence of asymptomatic tumours, canards that are debunked in the blogpost I link to above.

While VAN report that “If the tumour was big enough to kill her immediately, it would have been causing symptoms and she was described as ‘healthy'”, Natalie’s step-father has said that she had been unwell for “some time” and that the family now believed the vaccine had not caused her death. Also, Natalie’s mother had said that “Natalie has been poorly for some time. She had not been to hospital but she was receiving medication and doctors have been involved.” [Telegraph]

That the misinformation on the VAN website is still present at the time of writing is sad, but not surprising. After all, as I wrote earlier, providing inaccurate and misleading information and selectively quoting research out of context to argue against vaccination is the very essence of the anti-vaccine movement.

Jabs: the Jabs group was set up originally as a self-help group for parents. The group also supported Andrew Wakefield’s now discredited claims that the MMR vaccine caused autism. In fact, investigative journalist Brian Deer reported that the parents cited in Wakefield’s 1998 Lancet paper arrived at Wakefield’s clinic in response to an advertising campaign led by the group.

Posters on the Jabs forum have on occasion provided dangerous medical advice to visitors. One memorable instance saw a poster on the forum advise a parent to cease the medical treatment their doctor had prescribed for their child, and to switch off or move any wireless devices – including baby monitors. [Link: Sample JABS thread. Note: backup pages for the JABS link are here as PDFs: page 1, page 2, page 3.]

Posters there tend to ignore reliable evidence, but rely on the word of websites that provide misinformation which fits in with the prejudices of the forum. Sites such as Child Health Safety and whale.to have, respectively, used abuse of statistics and perpetuation of conspiracy theories to misinform. These are the websites popular with posters on the Jabs forum.

Generation Rescue: Gen Rescue is a more recently established group, being set up in 2005 by Lisa and JB Handley. Their interests lie in pervasive developmental disorders, attention deficit hyperactivity disorder, and autistic spectrum disorders, but the website bills the organisation as “Jenny McCarthy and Jim Carrey’s Autism Organization”.

The group supports various fringe ideas – such as the hypothesis that mercury poisoning from the preservative Thimerosal was responsible for autism. The only citation they provide comes from the ‘journal’ Medical Hypotheses. Perhaps the most dangerous of these fringe ideas is that chelation can reverse autism symptoms. This treatment has already been implicated in at least one death.

Generation Rescue also recommends delaying vaccination. This would mean unnecessarily exposing your child to vaccine-preventable diseases, some of which can have very serious consequences indeed.

Other groups that have been associated with an anti-vaccination stance

Jehova’s Witnesses: this page has some comment on Jehova’s Witnesses and vaccination. While an early leader seems to have been quite strongly against vaccines (the statement that “Vaccination is a direct violation of the everlasting covenant that God made with Noah after the flood” once appeared in the Jehovah’s Witnesses’ periodical, The Golden Age), the condemnation of vaccination ended in the 1940s.

The website I link to quotes from Watchtower (1952):

The matter of vaccination is one for the individual that has to face it to decide for himself….And our Society cannot afford to be drawn into the affair legally or take the responsibility for the way the case turns out. After consideration of the matter, it does not appear to us to be in violation of the everlasting covenant made with Noah, as set down in Genesis 9:4, nor contrary to God’s related commandment at Leviticus 17:10-14.

Steiner/Waldorf: in this outbreak of measles, most cases were linked to unvaccinated children in a Waldorf school. I note that the authors hoped “that the outbreak will stop soon and not extend far beyond the Essen Waldorf community, which has a critical attitude towards vaccination”. Here is a link to a statement on vaccines and the full statement (both via Google Translate).

The Coordination Office of Rudolph Steiner Schools in Switzerland and Liechtenstein apparently wishes to wash their hands of the matter (“Regarding vaccinations, it is for parents to take their responsibilities”), while at the same time stating that “In Steiner schools we do not recommend vaccination”.

It has been claimed that Rudolf Steiner believed that gnomes are real creatures active in our world, and not just mythical creatures and that teachers at Steiner schools speak of children using rather odd language such as “right now, his soul is black”. I personally find the stance on vaccination more worrying though, as it could lead to serious physical harm to the children of parents who may be influenced by the Steiner position of not recommending vaccination.

Pertussis / Whooping Cough

Resembling in some aspects the more recent MMR scare (which I’ll come to shortly), the pertussis vaccine scare also came about because of a single report.

Breath Spa for Kids has a quote from Paul Offit:

The British media hailed Wilson’s report as fact and the percentage of children immunized dropped from 80 to 30. During the next few years, 300,000 children in England were hospitalized and 70 killed by pertussis. […] Subsequent studies of hundreds of thousands of children showed that the risk of permanent brain damage was the same in children who had not received the vaccine as in those who had.

Here is what happened: “…immunisation coverage [dropped] to 30% in 1975 resulting in major epidemics in 1977/79 and 1981/83. As a result, there were more than 200,000 extra notifications and 100 deaths in 1970s and 1980s.” (See also this graph.)

You can see from this table that there were outbreaks of pertussis in 1978 and 1982 – in these two years alone, there were 130,000 notifications of pertussis and 26 deaths. This mortality rate of around 1 in 5,000 is similar to that of measles and, as with measles, has changed little in recent years.

In the first five years of the 1990s, as vaccination rates continued to climb (vaccine coverage went from 84% to 93% during this period), there were around 30,000 notifications of pertussis and 11 deaths.

6,000 cases of and 2 deaths from whooping cough per year are not to be sniffed at but we should be grateful that the number of cases and deaths dropped so dramatically as vaccine coverage rose, when compared with 1978 and 1982. Those two years saw outbreaks of pertussis leading to 65,000 cases and 13 deaths per year. Pertussis vaccination prevents outbreaks of a disease that is far from trivial.

Brian Deer has a detailed account of the pertussis scare on his website. It includes this:

Surprisingly, some of the children on whom Wilson reported suffered their first neurological symptoms before their DTP jabs. But the most striking feature of the series that he presented concerned the identical twins. Both were diagnosed with an inherited condition called Seitelberger’s disease. And although their cases helped to trigger one of the century’s great health panics, neither child ever had a whooping cough jab.

I agree with Mr Deer that the most remarkable point is that two of the cases that sparked a scare involved children who could not possibly have been injured by the vaccine.

The other interesting element, meanwhile, highlights another similarity with the MMR scare – in which some of the children who were claimed to have regressed following vaccination had actually shown signs of regression before being vaccinated. It is remarkable that, in both scares, the fact that symptoms were reported prior to vaccination was ignored.

As Offit and Deer both report, dubious claims of damage caused by vaccination were leapt on by the media, vaccine coverage fell, pertussis incidence rose, and a number of deaths followed. This scenario was more serious than the MMR scare – because vaccination coverage dropped lower (to 30% in the case of pertussis, compared with 80% for MMR), incidence of disease was higher, and there were more deaths.

Despite the clear flaws in the reports of vaccine-damage and the obvious benefits of the pertussis vaccine, such as reducing the number of unnecessary deaths caused by a preventable illness, some anti-vaccination lobbyists still make remarks like this:

From my own experience I am not very happy about the safety of pertussis vaccine, nor is it very effective. Of course, I care about infants dying.

I imagine that, well, everyone cares about infants dying. In my opinion, downplaying the effectiveness of the pertussis vaccine can only be counterproductive in terms of preventing infant deaths.

Further reading

Brian Deer hosts on his website an extract from a case before the US Court of Appeals relating to a claim against a manufacturer of DTP. The extract includes some discussion of a rather interesting error on the part of Mark Geier.

Pertussis (Pink Book PDF) – http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf

MMR Hoax

The consequences of the MMR hoax were not so severe as those of the pertussis scare, as vaccine coverage did not drop to such dangerously low levels. There were still unnecessary deaths though, in 2006 and 2008. (HPA) These were the first deaths from acute measles in England and Wales since 1992.

As with pertussis, the MMR scare arose from a single paper. That paper has now been fully retracted [PDF], with the Lancet editors stating that several elements were incorrect, with two claims having been proved to be false.

Between the beginning of the scare and the full retraction of the paper, there was plenty of research conducted into MMR and autism (much of which, sadly, was not reported on by the media). There was also a partial retraction of the Lancet paper.

This PDF presents a rough overview of the evidence on MMR, inflammatory bowel disease, and autism: here (note that 25 studies do not support Wakefield’s hypothesis and of the three that do, one was his own Lancet paper – a paper that had been partially retracted in 2004).

The partial retraction (no abstract, full text apparently paywalled) came from 10 of the 13 authors and is explained here:

“We consider that now is the appropriate time that we should together formally retract the interpretation of the data suggesting a link between autism and the MMR.”

Damningly, Brian Deer revealed that several of the children whose cases formed the basis of the Lancet paper that was the beginning of the MMR scare had symptoms reported by Wakefield et al as occurring after administration of the MMR vaccine, but medical records which suggested otherwise.

Child One, Child Two, Child Six, Child Seven, and Child Eight all had documented issues such as symptoms of autism, fits, and brain injury prior to vaccination. The descriptions in the Lancet paper simply did not match their medical records. It beggars belief that children who were reported as having symptoms of autism or brain injury prior to vaccination formed the basis of a vaccine scare.

That this was at least the second time that a vaccine scare had been based on children with problems that predated vaccination was remarkable – and something I find quite worrying. If it’s happened twice, how can we be confident it won’t happen again? We appear not to have learned from the pertussis scare, so I do not have high hopes that we will learn from the MMR hoax.

The blame game

Some people have ridiculed parents for believing that MMR causes autism and blamed them for outbreaks of measles. I think that this is unhelpful and unfair.

Those people who were exposed to media reports of the scare, but were unaware of both the flaws in Wakefield’s research and the published research that does not support a link between MMR and autism were, quite understandably, concerned.

I don’t think it’s unreasonable for someone unaware of the evidence against the hypothesis (evidence that the mainstream media have often failed to mention to their readers), but exposed to scaremongering stories in the media, to believe that MMR might cause autism.

The Daily Mail, on the other hand, called parents who refused to vaccinate “morons” for believing, well, what the Daily Mail had told them.

I disagree with the Mail – unlike them, I do not think that parents who did not vaccinate their children are morons worthy of ridicule.

I’m not sure I feel quite the same way about those anti-vaccine campaigners who continue to repeat untruths about the benign nature of measles (a disease which is anything but benign) and the ‘risks’ of vaccinating against this disease (risks which do not in fact have any link to vaccination).

Andrew Wakefield, the anti-vaccine lobbyists, and the mainstream media should in my opinion share the blame for the drop in vaccine coverage and subsequent outbreaks of measles. Quite frankly, they should be ashamed of themselves.

Further reading

Measles Pink Book PDF – http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf

Here’s a PDF showing (on page 6) the rates of complications of measles in comparison with vaccination and (on page 2) graphs showing the rates of measles, mumps, and rubella prior to and since vaccines were introduced.

Ben Goldacre has written extensively on what he calls the media’s MMR hoax. I particularly recommend this post, an extract from his book Bad Science.

What Next?

Well, this extract from the BMJ reports on resistance to the introduction of Hib vaccine in India:

The Hib organism, which can cause severe bacterial meningitis and pneumonia, is estimated to kill more than 370 000 children worldwide each year, GAVI said. Nearly 20% of these deaths occur in India.

Then there’s the recent outbreak of whooping cough in California: As of June 15, California had 910 recorded cases of the highly contagious disease this year, and five babies – all under 3 months of age – had died.

Comment on vaccine coverage in Marin County (where, as of July 7, there had been 209 pertussis cases) here: In 2009, 437 kindergartners in the county, or 13 percent, had not had the required shots for whooping cough.

It seems that resistance to vaccination and outbreaks of preventable diseases will be with us for some time yet.

There are things we can do though – we can keep a wary eye on articles in the media on vaccination (which all too often contain errors and misinformation), we can remind people of the scares over pertussis vaccination and MMR that turned out to be unfounded, and we can counter the nonsense promoted by those who are opposed to vaccination. Any other suggestions would be gratefully received.