“The implementation of rotavirus immunization programs will require scientists and health officials to work effectively with the media to ensure that the public is informed about both the risks and benefits of the new rotavirus vaccines, particularly since the media may be the public’s principal source of such information”- Clinical Microbiology Review, “Rotavirus Vaccines: An Overview”
The “I Was An Anti-Vax Crackpot” article from the New York Times. This little beauty has been making its way around the internet. But after reading it, I have my suspicions about its veracity. Here’s why:
The reasons this woman supposedly gives for not vaccinating are not typical of most non-vaccinating parents. This is the biggest red flag with this article, and I’m basing that on having interviewed literally hundreds of non-vaccinating parents over the past few years. I have yet to hear anyone say that they would rather someone else’s child suffer harm to save their own, relying on herd immunity for protection. Not once. (This is because we know that herd immunity is like Santa Claus- a nice story that doesn’t actually exist. Failure rates for many vaccines are such that there is no way to establish 80-99% immunity in a population and diseases like measles and pertussis in vaccinated individuals often don’t present with classical symptoms even though infected vaccine recipients can still pass these diseases to others. For examples from medical and public health literature, see here.)
Off the top of my head, the reason I have heard the most frequently is bad reactions after vaccination. Other reasons that I have heard frequently are that the parents had encountered research that showed that vaccines were not very effective at preventing diseases (negating the whole herd immunity sacred cow- no pun intended), their children were frequently sick despite receiving full and timely vaccines, they were second or third generation non-vaccinating families, or they were concerned about the MTHFR gene and the possibility of vaccine reactions. The explanation this woman alleges is more in line with the media perpetuated myth about why people choose not to vaccinate than the reality. Of course, most pro-vaccinating individuals don’t really know or attempt to understand why others refuse vaccines- personally I think it’s because they are afraid that our reasons have some validity.
Oh and BTW, many non-vaccinating parents are actually extremely fearful of your courageous little vaccinated angels spreading live viruses to their children through vaccine shedding. It’s one of the most common fears I hear about from non-vaccinating parents about vaccinated children. Table 5 from Edelman’s section on adjuvants in Vaccine Adjuvants: Preparation Methods and Research Protocols states that the spread of a live vectored vaccine to the environment is a “real or theoretical risk” with vaccines. (He doesn’t specify which.) For my part, my children went to a birthday party where they were around several fully vaccinated children (it’s very likely they were the only unvaccinated children present) and then came down with chickenpox about week later. (Where’s my Law and Order episode about vaccinated children getting my unvaccinated children sick with a deadly disease?)
This is a very convenient advertisement for Paul Offit and his rotavirus vaccine. It is extremely interesting that this woman claims that rotavirus changed her mind about not vaccinating and that she also claims that reading Paul Offit’s books helped her to “wake up”. Paul Offit is one of the inventors of the Rotateq vaccine- a vaccine that is relatively new for a disease that no one thought too much about in developed countries fifteen to twenty years ago. It is extremely necessary for Mr. Offit to keep reaping the financial rewards of his vaccine that people not question its usage. For its continued widespread use, people need to believe that rotavirus is a serious illness in developed countries for otherwise healthy children. This little New York Times piece is certainly trying to present that view.
For a sampling of Dr. Offit’s tactics, take a look at this interview PBS did with him for the ever so diplomatically named documentary, “The War on Vaccines”. You will actually read him calling not vaccinating for measles as playing Russian roulette. We’re talking about a disease with a fraction of the morbidity and mortality of cancer in the United States. For comparison, recall that the CDC states that “In the United States, measles caused 450 reported deaths and 4,000 cases of encephalitis annually before measles vaccine became available in the mid-1960s.” Here are the estimates of numbers for cancer in the United States for 2016 from the American Cancer Society: “About 1,685,210 new cancer cases are expected to be diagnosed in 2016 and… about 595,690 Americans are expected to die of cancer in 2016, which translates to about 1,630 people per day.” Another example of his biases include his claim that a study comparing parents who vaccinate and don’t vaccinate would be fundamentally flawed because parents who vaccinate and those don’t are so fundamentally different. Parent who don’t vaccinate, he claims would be less likely to think their child has a problem because they think that not vaccinating will prevent developmental problems and other health problems. He does not think that parents who vaccinate could be subject to the same bias in reverse.
Another assertion from his interview that I have not been able to find corroborating evidence for is the Delaware pertussis outbreak. He says that in 2006 there was an outbreak of pertussis in Delaware that was reported in the CDC’s Morbidity and Mortality Weekly Report and that most of the incidents of pertussis were in school age children ages 5-9. I have not been able to find a MMWR bulletin that meets this particular description. However, I did find one that detailed a pertussis outbreak in Kent County, Delaware in an Amish community during September 2004 through February 2005. This was published on August 4, 2006. This report details that most of the cases were preschool age children. (And in fact the charts published with this report showed that the breakdown by age group of pertussis cases in the Amish community differs substantially from the United States as a whole. The majority of the pertussis cases in the United States actually occur in adults with children ages 11-14 second.)
If this is the outbreak of pertussis he was referring to, there is something very ironic about it and that is that pertussis was still present in vaccinating households. Of the 123 patients ages 6 months to 5 years in the interviewed Amish households, almost one in four (24%) had records of receiving three or more doses of DTP or DTaP. (And another 5% had records of receiving 1 or 2 doses of DTP or DTaP.) The rate of vaccination for the interviewed households where clinical pertussis had been discovered was 45% not vaccinating any children, 42% vaccinating at least some children and 14% declined to give information about vaccination status. So out of the 40 households with at least one clinical pertussis case reporting at least some level of vaccination, 35 cases of pertussis were present. And out of 43 households with at least one pertussis case reporting no vaccination, 88 cases were present. But then of course, this may not account for vaccinated cases that do not meet the clinical definition see this news story, this dispatch from the CDC and this study.
But let’s take her story at face value, that there are no other competing interests and she is genuinely telling the truth. There are still several problems with using this tear-jerker as a rationale for the necessity of vaccination:
Rotavirus is deadly- if you live in a third world country. Malnutrition, poor healthcare and bad living conditions all contribute to rotavirus’ death toll in less developed countries. However, even the Clinical Microbiology Review in their overview of rotavirus and its vaccines state that rotavirus is generally not deadly in developed countries and that the goal of the vaccine isn’t necessarily to prevent death, but rather decrease hospitalizations for rotavirus. So unless she has been starving her children and permitting them to live in squalor or they are otherwise immunocompromised, rotavirus is not actually deadly for her children. (And she grew up just fine without the vaccine herself.)
The Rotavirus vaccine actually causes slightly greater rates of gastrointestinal upsets like nausea vomiting and diarrhea. It’s considered successful because there are fewer hospitalizations for rotavirus, not because it actually prevents the disease. I’m not joking. Again this comes the Clinical Microbiology Review in their overview of rotavirus and its vaccines. Direct quote: “Pooled data from the large phase III and two smaller phase III trials showed that in the week following the first dose of RotaTeq, the incidence of fever and irritability did not differ between vaccine and placebo recipients. Diarrhea and vomiting occurred more frequently among vaccine recipients than among placebo recipients (10.4% versus 9.1% and 6.7% versus 5.4%, respectively).” And rotavirus is only deadly to children in developed countries in the loosest sense: “Rotavirus gastroenteritis results in only 20 to 70 childhood deaths per year in the United States.” The CDC places the number of deaths of children in the US under the age of five to be 1 in 200,000 before the advent of mass rotavirus vaccination. (They don’t specify how many are immunocompromised out of this number). For a point of comparison, consider that the Vaccine Injury Compensation program has awarded 556 payouts for 2016 so far. So far more people are receiving vaccine injury payouts annually than are dying from rotavirus. Rotavirus accounts for about 600,000 deaths worldwide annually- slightly less than the number of deaths from heart disease in the United States annually, for a point of comparison.
Another direct quote from Clinical Microbiology Review: “A realistic goal for a rotavirus vaccine is to duplicate the degree of protection against disease that follows natural infection. Therefore, vaccine program objectives include the prevention of moderate to severe disease but not necessarily of mild disease associated with rotavirus. An effective rotavirus vaccine will clearly decrease the number of children admitted to the hospital with dehydration or seen in emergency departments but should also decrease the burden on the practicing primary care practitioner by reducing the number of office visits or telephone calls due to rotavirus gastroenteritis.” Rotavirus vaccination is not completely about eliminating the disease and creating herd immunity, but rather decreasing hospital and doctor visits.
The quote I used at the beginning of this post goes on to say that information from the media must be factual and accurate to gain support. However, if people were told the full story of rotavirus and its vaccines- that the disease is almost never causes death to American children and that the vaccines don’t necessarily keep children from developing gastrointestinal symptoms- rotavirus vaccination might be less popular. And if people started questioning rotavirus vaccination, they might start questioning measles, mumps, rubella, varicella, hepatitis B, pertussis, and tetanus for 2 month old babies.
Pieces like this are probably not written to convert non-vaccinating individuals to vaccination- no care has been taken to actually address the concerns of non-vaccinating parents. Since this article plays to the perceptions and fears of vaccinating parents, I think it is more likely that the goal of this piece is to keep vaccinating parents vaccinating by presenting people who question vaccines as morally corrupt and ignorant.
As for me, well, the only time my kids have ever had severe diarrhea was when we all got food poisoning- and no vaccine would have helped that one!