Vaccine Fearmongering

I feel the need to go on a mini-rant based on a poster I saw at our pediatrician's yesterday, and a post today from Brian Leiter. Both of these are examples of common practices in the public health community that verge on fearmongering, and make it difficult for parents to act critically in making decisions about vaccinating their children.

I want to be clear: My children get vaccinations. I do not think that vaccines cause autism. So I am not trying to say that encouraging vaccination is in itself fearmongering, and I am not saying that parents shouldn't vaccinate their children. In most cases they should.

That said, our children are on an adjusted vaccine schedule, and we have gotten pushback about this at nearly every check-up. I've had to sign forms saying "I realize that I'm endangering my child against the doctor's recommendation," and I've received my share of glares and eye-rolls. Not because I refuse to vaccinate my children, but because I don't think there's a reason to give multiple invasive shots at every check-up during the first year of life. We put off vaccines for a year and a half, and started introducing them more slowly. We weren't worried about autism or anything life-threatening, but we were worried about needless side effects in our very young children... rashes, cold symptoms, etc. It's not as big a deal for a three year old to have these side effects the way it is for a newborn, or a six month old. And there's no reason for a newborn to get a Hep B vaccine in their first hours of life unless there is some risk of getting it from the mother, or some other environmental factor.

This sort of measured opinion never seems to register with the medical community, though. Either you follow the doctor's schedule without discussion, or you're a pot-smoking hippie/paranoid homeschooler. I get that part of this mentality is a wider-scope public health measure. Some parents may really sit down and read the literature on vaccination scheduling, but it's safer to push a standard and aggressive schedule on everyone so that a baby isn't sent home from the hospital into a dangerous situation only to contract Hep B a few weeks later. In pursuing these aggressive campaigns, though, vaccine education can reach some pretty low lows.

Take the poster from Texas Children's Hospital, for instance. It is a sobering story, but it engages in the same sort of anecdotal argumentation that is skewered in those who insist that vaccines cause autism! The poster even ends with, "Had she received a flu vaccine, Denise and Gary strongly believe that Breanne might still be alive today." [!!!!!] The problem isn't that this conclusion is unlikely... they may very well be right about their daughter. But surely Texas Children's Hospital has more to offer than anecdotes of strongly held beliefs! The only statistic on the poster mentions that 10-40% of healthy kids will contract seasonal flu each year. There is no mention of how many deaths occur each year, what percentage of those who contracted influenza actually had the influenza vaccine, what percentage of vaccinated kids contracted influenza, and what percentage of those who died from influenza were vaccinated. How is anyone supposed to be educated from this poster? As an appeal to pathos, I get it... but again, it seems to me that such appeals become hypocritical when they are condemned in others, and are of limited use when only supported by anecdote.

As for the article linked by Leiter, again, there is some good and some bad here from what I can tell. Of course it's a problem if widespread non-vaccination leads to increased mobility of disease... but I always get annoyed when advocacy of herd immunity turns into something of a mob mentality. Vaccinated students are directly "put at risk" by imperfect vaccines. Non-vaccinated students are directly "put at risk" by lacking any sort of vaccination protection whatsoever. But there's only so far that you can go in claiming that a minority of unvaccinated individuals present a risk in some direct way to the wider vaccinated community. No one gets a signed guarantee of controlled sociological factors when they go to get vaccinated, and the public health problem of herd immunity needs to be distinguished from the medical problem of immunization. 

Then there's always the situations where outbreaks happen in entirely vaccinated situations... when I was working at Wheaton College, there was a mumps outbreak among the students, with 94 undergraduates contracting the illness. All of the students who were diagnosed with mumps had been vaccinated against it. Does that mean one shouldn't get the MMR vaccine because it's useless? Of course not. Many more students would have probably contracted mumps if no one had been vaccinated. What it does mean, however, is that a mob mentality response to a threatened herd immunity needs to recognize the inherent limitations of any immunity that requires a herd situation in the first place.

All this is to say, again, not that vaccination causes autism, or that it shouldn't be done... but that the medical community shouldn't be so reactionary against pseudoscience that it ends up discouraging the development of an informed and critical citizenry through its fearmongering.