Vaccine fear
Vaccine fear has been gaining in the headlines again with Swine Flu (H1N1) topping incidence rates of 'seasonal' flu. My knee-jerk reaction to the vaccine fear is to call it a paranoia of the privileged, just so you know my view on the matter: full disclosure. However, knowing full well that science is fallible and adverse events are more than possible, I decided to take a look at the evidence. I have done my homework to begin to understand why people, many of them well-educated, well-meaning, some health professionals and some parents, refuse to get vaccinations.
Firstly, I learned of the association that autism had to early childhood vaccinations for MMR (Measals, Mumps, and Rubella). Dr Wakefield, in 1998 published an article in the Lancet regarding research that he did finding correlation between immunisations against MMR and onset of autism in children. This created quite a stir, as you can imagine: not only is a lot of money from pharmaceutical companies tied up in vaccines, but millions of people's lives around the world, most of them children, could be considered to be affected. So lots of research went into figuring out if this correlation was actually causal: if MMR vaccines increased a child's risk of developing autism.
I should stop and explain to the non-epidemiologists out there that the first rule of the science is 'correlation does not equal causation', which means just because things are related does not mean that one thing happens as a result of the other. For example, if someone goes to the beach when the sun is shining and that person drowns, does that mean that the sun caused the person to drown? No. Sure the sun is in there somewhere, related to the incident, but sun did not directly cause the drowning; someone can only drown in water.
So, back to MMR and autism. Following this publication scientists began to do what we love to do so much: dissect a study to prove its merit. It was soon found, as Lancet later reported, that the study did not have much scientific merit: the study sample was quite small and only among children who had gastrointestinal problems, neither of which leads it to be indicative of the general population of children who get MMR vaccinations. Still, the studies findings were so disturbing, found to merit a closer look by the scientific community, that the study was replicated following the strictest scientific guidelines, and the results showed conclusively that MMR did not lead to autism. Yet more studies were done, looking around all the possible corners to see if anything could have been missed and now, years later, numerous scientifically rigorous studies have been done and there is absolutely no conclusive scientific evidence to say that a child's vaccination against MMR will make him/her any more likely to develop autism. The research that has been touted to show causation of 'live virus' vaccination (such as MMR) to autism does not stand up to scientifically rigorous review. Yet thousands of parents refuse to give their children MMR vaccinations because they are afraid this might cause them to develop autism. I guess now would be a bad time to mention during my time in rural Ghana the kids who were seeking immunisation that we had to turn away due to lack of supplies or manpower. These mothers walked more than 20 kilometres to protect their kids from getting these diseases.
Back to the flu. So, if I get a flu shot and then I feel ill, is it the vaccination that caused the illness or something else? The injectable H1N1 vaccine has an inert (read: dead) virus, so it is biochemically impossible to get the H1N1/Swine Flu from this shot. Even with the live virus inhalant version, the risk of actually getting flu from the shot are minimal. It is true, however, that people getting the flu shot are usually at higher risk than the greater population to get the flu. Of course it is possible to already have the flu (yet not be fully symptomatic) when you get vaccinated. It is also possible to have the common cold before during or after getting a flu shot. Correlation does not equal causation. Epidemiological models show that when a significant portion of those most at risk are vaccinated the virus' chance of dying out rise exponentially (this is how diseases are eradicated, such as polio). Yet in NYC, most parents refuse the vaccine for their children. And, even more shocking, health care workers- those most likely to get -and spread infection refuse the vaccination even going so far as to win a legal suit over mandatory vaccination. So, essentially, my nurse has a right to choose not to get vaccinated but my choice is reduced to placing myself at risk of getting H1N1 by seeing her if I go in for something completely unrelated or not seek health care at all.
I'm not saying people should blindly follow any advice, even if it comes from the doctor. However, if you're concerned and reading this then you have access to a plethora of information right at your fingertips. Don't allow your fear to turn into real illness.
UK NHS fact sheet on MMR and Autism link
CDC fact sheet on MMR and autism
No effect of MMR withdrawal on the incidence of autism: a total population study
Wakefield's article
About.com article on MMR and autism
Time - H1N1 flu: Be A Little Afraid - but not of an unproven vaccine
An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All
In Choosing Who Survives Flu, Developing World Most Likely To Suffer
Firstly, I learned of the association that autism had to early childhood vaccinations for MMR (Measals, Mumps, and Rubella). Dr Wakefield, in 1998 published an article in the Lancet regarding research that he did finding correlation between immunisations against MMR and onset of autism in children. This created quite a stir, as you can imagine: not only is a lot of money from pharmaceutical companies tied up in vaccines, but millions of people's lives around the world, most of them children, could be considered to be affected. So lots of research went into figuring out if this correlation was actually causal: if MMR vaccines increased a child's risk of developing autism.
I should stop and explain to the non-epidemiologists out there that the first rule of the science is 'correlation does not equal causation', which means just because things are related does not mean that one thing happens as a result of the other. For example, if someone goes to the beach when the sun is shining and that person drowns, does that mean that the sun caused the person to drown? No. Sure the sun is in there somewhere, related to the incident, but sun did not directly cause the drowning; someone can only drown in water.
So, back to MMR and autism. Following this publication scientists began to do what we love to do so much: dissect a study to prove its merit. It was soon found, as Lancet later reported, that the study did not have much scientific merit: the study sample was quite small and only among children who had gastrointestinal problems, neither of which leads it to be indicative of the general population of children who get MMR vaccinations. Still, the studies findings were so disturbing, found to merit a closer look by the scientific community, that the study was replicated following the strictest scientific guidelines, and the results showed conclusively that MMR did not lead to autism. Yet more studies were done, looking around all the possible corners to see if anything could have been missed and now, years later, numerous scientifically rigorous studies have been done and there is absolutely no conclusive scientific evidence to say that a child's vaccination against MMR will make him/her any more likely to develop autism. The research that has been touted to show causation of 'live virus' vaccination (such as MMR) to autism does not stand up to scientifically rigorous review. Yet thousands of parents refuse to give their children MMR vaccinations because they are afraid this might cause them to develop autism. I guess now would be a bad time to mention during my time in rural Ghana the kids who were seeking immunisation that we had to turn away due to lack of supplies or manpower. These mothers walked more than 20 kilometres to protect their kids from getting these diseases.
Back to the flu. So, if I get a flu shot and then I feel ill, is it the vaccination that caused the illness or something else? The injectable H1N1 vaccine has an inert (read: dead) virus, so it is biochemically impossible to get the H1N1/Swine Flu from this shot. Even with the live virus inhalant version, the risk of actually getting flu from the shot are minimal. It is true, however, that people getting the flu shot are usually at higher risk than the greater population to get the flu. Of course it is possible to already have the flu (yet not be fully symptomatic) when you get vaccinated. It is also possible to have the common cold before during or after getting a flu shot. Correlation does not equal causation. Epidemiological models show that when a significant portion of those most at risk are vaccinated the virus' chance of dying out rise exponentially (this is how diseases are eradicated, such as polio). Yet in NYC, most parents refuse the vaccine for their children. And, even more shocking, health care workers- those most likely to get -and spread infection refuse the vaccination even going so far as to win a legal suit over mandatory vaccination. So, essentially, my nurse has a right to choose not to get vaccinated but my choice is reduced to placing myself at risk of getting H1N1 by seeing her if I go in for something completely unrelated or not seek health care at all.
I'm not saying people should blindly follow any advice, even if it comes from the doctor. However, if you're concerned and reading this then you have access to a plethora of information right at your fingertips. Don't allow your fear to turn into real illness.
UK NHS fact sheet on MMR and Autism link
CDC fact sheet on MMR and autism
No effect of MMR withdrawal on the incidence of autism: a total population study
Wakefield's article
About.com article on MMR and autism
Time - H1N1 flu: Be A Little Afraid - but not of an unproven vaccine
An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All
In Choosing Who Survives Flu, Developing World Most Likely To Suffer