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    Crikey! Anti-Vaccination Down Under
    By Josh Witten | August 7th 2009 09:23 AM | 7 comments | Print | E-mail | Track Comments
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    Welcome to the home of the rugbyologist. Come along as I wander far and wide (and near, too), stop to smell the roses of intellectual fancy, and...

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    There has been a fight brewing Down Under over vaccinations.  Areas of Australia have dangerously low vaccine compliance rates leading to the recurrence of completely preventable diseases like whooping cough (pertussis).   

    Despite its innocuous name and its own claims to be "pro-choice", the Australian Vaccination Network (AVN) is definitively anti-vaccination.  The AVN is just as willing as our own American anti-vax zealots, like Jenny McCarthy, to lie (knowingly or not) and spread misinformation in order to drive down vaccine use.  The result in Australia has been an increase in the rates of whooping cough, resulting in the deaths of 17 children under a year of age since 1993, three in the past year including the death of 4 week old Dana McCaffery in March 2009. 

    Dana McCaffery was too young to be innoculated against whooping cough.  She was dependent for her safety on herd immunity to keep whooping cough out of her community.  Thanks in part to the misinformation spread by the AVN, that community failed Dana.

    Many people reading this will be too young to understand the fear that vaccine preventable diseases like whooping cough created in parents.  This complacency is one of the side effects of the success of vaccination programs.  Thanks to the not-universally-pleasant stories of my Grand Dad, who was a small county doctor in southeastern Ohio, my family has maintained familiarity with the fear and horror that these once common conditions could generate.  Whooping cough inspired fear among his patients and with good reason.
    After one to two weeks, the coughing develops into uncontrollable fits,
    each with five to ten forceful coughs, followed by a high-pitched
    "whoop" sound as the patient struggles to breathe in afterwards (paroxysmal
    stage). Coughing fits are commonly followed by vomiting, and can lead
    to malnutrition. Fits can occur on their own or can be triggered by
    eating; they usually occur in groups, with multiple episodes every hour
    around the clock. This stage lasts two to eight weeks, and sometimes
    longer. . .Infection in newborns is particularly severe, with a death risk of up to 3%, often caused by severe pulmonary hypertension. 
    -Wikipedia (Pertussis)
    Whooping cough is very difficult to treat, with treatments focused on mitigating symptoms and reducing infectivity.  To be blunt, low vaccine compliance not only killed Dana, but made this innocent child suffer, needlessly.  I know the heart-wrenching pain of a parent when my own daughter has been unable to sleep at night due to a simple cold.  I cannot even imagine the suffering that the McCaffery's have endured.  My heart bleeds for them on a daily basis.

    Make no mistake about it, anti-vaccination zealots have gone on record declaring that deaths like Dana's are acceptable losses in the fight against the evils of vaccinations.  Public health policies are the result of cost-benefit analyses, which includes some concept of acceptable cost for a benefit.  Vaccination can precipitate, in extremely rare cases, negative side effects, which in a public health debate are greatly overshadowed by the benefits.  What is the difference between these two points of view?  Evidence.  The costs and benefits of vaccines are well defined scientifically.  Vaccine advocates actually have data to show that the course of action that they are supporting is the one that does the most good for the most people.  By "the most good", I mean the single greates life saving medical innovation ever.  The anti-vaccinationists may be well intentioned, but they are simply making up their evidence.  And killing babies.  

    Click for larger versionResponsible people are fighting back.  The AVN is currently under investigation for spreading misleading propaganda.  Kevin Rudd, the prime minister of Australia, has joined the Dana McCaffery Facebook group.  And, now, businessman Dick Smith has sponsored an ad to bring this issue to the forefront of public attention.   

    *Thanks to Phil Plait at Bad Astronomy for pointing out this ad.  Phil has been covering this situation from the begining.  So, I would encourage you to visit Bad Astronomy to get the whole story.

    Comments

    Stellare
    When my son was borne I was confronted with the choice of following the vaccination program that actually is compulsory in Norway. In principle, I like to decide myself on any matter concerning me and my family and immediately considered not following the program. I mean when someone try to force me I refuse - out of principle :-) Luckily I'm not only stubborn and extremely independent, but also have a brain that works. It is beyond any doubt that vaccination is there for a reason - to save lives of young children. It wasn't hard for me to make the right decision for my son. We followed the vaccination program.

    For those who are afraid of negative reactions to vaccination, the authorities in Norway take that seriously. The children are put under surveillance for a while immediately after injections and followed up in the days after.

    Yes, I like to make my own decisions - but above all I'd like my son to live. Simple as that!

    I'm glad there are many people, like you Josh and Phil,  who advocate vaccination when people with deathly fixed ideas misuse their fame...
    —
    Bente Lilja Bye is the author of Lilja - A bouquet of stories about the Earth
    Bente Lilja Bye | 08/09/09 | 09:22 AM
    kerrjac
    Lumping all vaccines together is almost as difficult as lumping all medical drugs together. It's important to remember that past vaccines have had dangerous side-effects, including those for swine flu (1970's outbreak), lyme disease, and anthrax. That's not to say that they're all dangerous; but it is to emphasize the variability across vaccines, even those of the same type.

    The problem with vaccines is that they somehow escape the absurdly high safety standards that we have for most medical drugs. In the rush to push them through - time inevitably being of the essence in preventing infectious disease - it's easy to overlook their safety. Imagine if any drug company were able to completely reconstitute its product every year.

    Growing concern over swine flu is pure hysteria over rationality. By all measures, it doesn't look like swine flu is deadly at all, and there's evidence that older people are immune to it due to a similar mild outbreak. Nonetheless, money has been funneled into developing a quick&dirty vaccine for it rather than common sense containment strategies (such as increased testing). This is a recipe for disaster in the face of something that isn't much of a threat.

    The answer to this problem doesn't lie in better efforts to selling vaccines to the public. It lies in good science and keeping one's cool. Although we face real and timely threats from the outside world, good science is built on rational careful thought and healthy skepticism, not alarmist reactions to the public. Good science, not campaigns, will sell itself.
    kerr jac | 08/09/09 | 15:23 PM
    Hank
    The problem with vaccines is that they somehow escape the absurdly high safety standards that we have for most medical drugs.
    Pharmaceutical company marketing departments are certainly not above exploiting the goodwill of lifesaving vaccines to instill a culture of fear in parents about new ones - HPV being the perfect example where too many in science and government have chosen to ignore the lack of any real benefit in trade for billions of dollars in cost and unknown side effects.
    —
    Want more no-nonsense, independent science? Buy Science Left Behind
    Hank Campbell | 08/09/09 | 15:28 PM
    jtwitten
    It is does not necessarily follow that issues with vaccines in the past mean that vaccines now have the same issues.  Technology tends to progress.

    You should also clarify your statement about medical standards, as this is a complicated issue.    Vaccines go through extremely rigorous testing for safety and efficacy testing.  Once established modifications to vaccines, such as the season flu and swine flu, do not repeat this testing.  Among other reasons (including that almost all of the components of these vaccines do not change and are well tested) is that the time needed for this level of testing would prevent the use of the vaccine to protect the public.  This has been a carefully weighed decision.

    FYI, reputable infectious disease specialists are concerned about swine flu, while accepting all the accurate information you presented.  The lack of latent immunity among young adults poses little risk to this not particularly virulent strain.  If, however, the swine flu mutates to a more virulent variety, the effects could be quite dramatic.  

    The tendency to extrapolate from the discussion of specific vaccines or incidents to a general discussion of all vaccines and incidents, without concern for the particulars, is disturbing.

    While it is idealistically pleasing to hope that cool reasoning will win out and achieve good outcomes, it is not realistic to assume that this will compel individuals to make good decisions.  Those opposed to reason use the appeal to emotion to great effect.  They may be bad at science, but they are good at marketing.  I suggest that you read Saul Alinsky's Rules for Radicals.  I'm sure the anti-vax movement has.
    Josh Witten | 08/10/09 | 09:54 AM
    kerrjac
    The relative safety record behind regular flu vaccines is likely b/c they're targeting variations to viruses that have plagued mankind for generations. The problem with new vaccines (that target novel threats) with unexpected side effects, as I understand it, is not the manufacturing techniques (or however they may slightly vary) but the antibodies that the vaccines produce. Unexpected autoimmunity to vaccine-induced antibodies is what proved to be dangerous about the previous swine flu vaccine (http://www.nytimes.com/2009/05/09/health/09vaccine.html). This is why, I would think, we have to be especially cautious when making vaccines for emerging threats that likely had less or no formative roll in shaping our immune system over past generations.

    As for the danger that the virus will mutate, my understanding is that the more contagious viruses tend to be, the less likely they are to mutate into a new more dangerous form. The fact that an older cohort of people seem to be immune to it should further nullify this concern, as it didn't seem to mutate into a greater threat back then. In all likelihood, the world-wide disruption caused by the swine flu will remain relegated to it having shown up on the world's ever more sensitive diagnostic radar screen, rather than by its actual effect on humans.
    kerr jac | 08/10/09 | 22:12 PM
    jtwitten
    There are legitimate concerns about autoimmunity arising from new antigens.  Vaccine production has improved greatly on this front.  Even though we give more vaccines to more diseases today than ever before, there are actually fewer antigens in the vaccines than there used to be.  Essentially, the vaccines are much more efficient.  The swine flu vaccine is being tested.  It is simply not possible to arrange the largest clinical trials in the time frame required.

    I'm not sure that the correlation between contagiousness and virulence is a true correlation.  High virulence reduces the ability to be contagious essentially by killing the carrier.  This is why Ebola will not be a global threat in its current horror movie form.  Highly contagious diseases do not have to become highly virulent to be devastating.  In 1918, the "Spanish flu" infected 500 million people and killed 50 million.  That is a 10% death rate, which is not low, but is not ridiculously high.  Mutation is random.  The fact that a more virulent strain did not occur in the previous strain does not mean that it is an unlikely event in the current strain.
    Josh Witten | 08/11/09 | 09:53 AM
    kerrjac
    Mutation is random.  The fact that a more virulent strain did not occur
    in the previous strain does not mean that it is an unlikely event in
    the current strain.
    Perhaps I'm naive in asking this as I really don't know, but what was the last flu-like outbreak of a seemingly new virus that mutated into something more dangerous?
    In 1918, the "Spanish flu" infected 500 million people and killed 50
    million.  That is a 10% death rate, which is not low, but is not
    ridiculously high.
    Today the rate, regardless of vaccines, would be somewhat lower due to sanitary conditions, containment,&ability to treat immune issues, be it bacterial infections or over reactive immune responses.

    Just as seemingly low death rates can have large effects over many people, so can a very rare side effect from vaccines (or drug). Moreover the base population receiving the vaccine is likely to be much larger than the population infected, even in a worst case scenario.

    Ultimately a vaccine might still be worth it, but the case isn't immediately intuitive. One has to factor in the probability of a worst case scenario occurring, rather than simply relay fear that it is somewhat more probable with the emergence of a single new threat. Even if we're relatively better at producing vaccines (which, in weighing benefits/risks, seems to be the only added benefit of preventative response since 1976, relative to other drug/treatment improvements since then that downplay the risk; plus there still doesn't seem to be an answer as to the previous vaccine's side-effects), that doesn't guarantee that they're the best response.

    Additionally, you can't downplay the public's concern about dangerous side effects. Imagine that (with our improved modern medical surveillance) we come to spot a new such "potential" threat once every 5 years.&every time, the outcome is similar to that of 1976, where no dangerous outbreak occurs, but several hundred vaccinated people get a rare severe neurological condition. Certainly after a few years, the public - even the most loyal&abiding citizens - will see such public health efforts as crying wolf, and will respond as if there is no wolf. Should a real wolf come, they certainly won't believe it,&for good reason. Of greater concern, however, is whether in retrospect there was ever a wolf in the first place, so much as a man-made estimate of a probability of an event whereby certain environmental conditions would make the materialization of the wolf more probable than the chance of its materialization under random conditions.
    kerr jac | 08/18/09 | 22:18 PM