vaccines? yay! nay! uhhh….
March 24, 2008 § 3 Comments
Ever since the first smallpox scab was pulverized and scratched into the skin of a healthy person, the process of inoculating someone with a disease in order to prevent that disease has seemed, to some portion of the public at least, inherently unsafe and unnatural. (Imagine, for a moment, offering your child up for such treatment–the dirty barn, the fever that followed, the white-knuckled wait until the symptoms subsided and immunity was conferred.) Vaccines have never been without risk; this fact is not disputed by anyone. Almost everyone has a story about somebody they know whose child reacted badly to a vaccine.
These days, articles on vaccines in most mainstream parenting magazines tend to read like bullet points off the American Academy of Pediatrics and CDC websites–which is to say, unequivocally in favor of vaccination. Articles in “alternative” parenting magazines tend not to stray very far from the “vaccines are poison” dogma of the anti-vaccination camp.
That camp pitches a pretty wide tent. In the years since the childhood vaccination schedule expanded past just the measles, mumps, rubella (MMR) and polio vaccines, many, many groups have formed to question the safety of vaccines. Most were started by parents who believe their children were severely damaged by vaccines, such as Barbara Loe Fisher of NVIC; Sallie Bernard of SafeMinds (Sensible Action for Ending Mercury-Induced Neurological Disorders); and J.B. Handley of Generation Rescue. These people have poured their pain into a formidable purpose: raising awareness of vaccine risks, asking tough questions of the Food and Drug Administration (FDA) and the CDC, taking out full-page ads in national newspapers, contributing to government studies and funding their own.
Their questions, charges and countercharges, which are myriad, center on several key topics.
First we have the issue of the use and effect of ingredients other than the antigen (the active ingredient) in a vaccine. The most controversial of these is the mercury-based preservative thimerosal. Parents currently facing the vaccination question can rest a little easier because thimerosal has been removed from all pediatric vaccines in the United States (other than certain flu shots; be sure to ask), but the thimerosal debate shows no signs of cooling off (see “Thimerosal 101” in the magazine for more information).
Thimerosal isn’t the only suspect ingredient. Aluminum, which is used to enhance the immune response to the vaccine, is also under scrutiny, along with formaldehyde, fetal calf serum, neomycin, polymyxin B, egg protein, and human serum albumin, to name a few. Most of these ingredients are present in such tiny amounts that they aren’t expected to cause any harm except for allergic reactions, and bovine products are required to be sourced from countries free of bovine spongiform encephalopathy.
Aluminum, however, is a telling example of the gaps in our knowledge about vaccine ingredient safety. Here’s the deal: Aluminum is ubiquitous in the environment and thought to be harmless when ingested (many antacids contain it). Studies in animals, premature babies, and people with kidney problems, however, have shown that injected aluminum can accumulate in body tissues and cause bone disease and symptoms of central nervous system toxicity, such as developmental delays and encephalopathy.
In fact, the FDA limits the concentration of aluminum in IV feeding solutions to twenty-five micrograms per liter. Consider that an adult on an IV would receive about a liter per day; this means the maximum amount of aluminum that an adult should receive in a particular day is twenty-five micrograms.
Robert Sears, one of the Sears family clan of physicians, recently published The Vaccine Book: Making the Right Decision for Your Child. He points out that a two-month-old baby receiving her first big round of shots will receive a total aluminum dose of 295 to 1875 micrograms, depending upon the brands and combinations of vaccines given. The same applies to the shots commonly given at four and six months of age. “No one has actually studied vaccine amounts of aluminum in healthy human infants to make sure it is safe,” he writes.
In other words, the disconnect between what we’re doing with children and vaccines, and what we know about the effects–not just of individual vaccines, but vaccines in combination–is jaw-droppingly large.
The second major topic of controversy focuses on the effects that vaccinations may have on the immune system. The rise in chronic immune problems such as asthma, allergies, and autoimmune disorders has caused some parents to question whether vaccinating actually weakens the immune system, either by overloading it, by causing it to mount a more inflammatory response to antigens (as in allergies) or to our own cells (as in autoimmune disease), or by depriving it of the opportunity to strengthen itself by fighting off childhood infections naturally.
The debate here centers on the difference in the way the immune system is presented with and responds to vaccines versus the way it fights natural illness. The concern is that vaccines actually shift the developing immune system to a more harmful, inflammatory response, which can give rise to atopy, the medical term for allergies, asthma, eczema, and the like.
The Institute of Medicine (IOM), a component of the National Academy of Sciences charged with providing (according to its website), “unbiased, evidence-based, and authoritative information and advice concerning health and science policy,” rejected a causal link between vaccines and type 1 diabetes (an autoimmune disease) in 2002 but could neither accept nor reject a relationship between vaccines and allergic disorders, particularly asthma. The scientific literature since then presents mixed conclusions on whether vaccination or childhood infections increase atopy later in life.
Next we come to the effects that vaccines may have on the nature of the diseases they target. Measles is one good example of this effect; another is chickenpox.
Before the vaccine against it was created, chickenpox was a normal, if uncomfortable, childhood rite of passage, and the virus was constantly circulating within the community, giving everyone’s immune system frequent natural “boosters” over the years and conferring lifelong immunity. Now the CDC recommends that children be vaccinated against chickenpox at around age one, with a booster shot around age five. Because this is a relatively new vaccine, we don’t know how universal vaccination will affect the possibility of adults catching chickenpox when their vaccine-derived immunity wanes. It’s also not yet known whether the lack of re-challenge from the naturally circulating virus will result in a rise in shingles, a painful resurgence of the chickenpox virus later in life.
A vaccine for shingles has recently been licensed, which could be good news for those now at increased risk. It’s also possible, on the other hand, that the chickenpox vaccine itself could provide protection from shingles. At this point, nobody knows for sure. In either case, it seems fair to wonder whether it would have been better to just have accepted chickenpox as a normal part of childhood and left well enough alone.
All of these issues tie into a more social side effect of vaccines: the rising mistrust of the government agencies charged with vaccine safety. This particular emotion is rampant among the anti-vaccination crowd, perhaps for good reasons.
In 2000, the House of Representatives Committee on Oversight and Government Reform investigated conflicts of interest in the FDA and CDC scientific advisory committees on vaccines. The investigators found numerous instances in which committee members with financial ties to vaccine makers were given waivers to participate in the decision-making process. In fact, all members of the CDC’s Advisory Committee on Immunization Practices (ACIP) were granted annual conflict-of-interest waivers as a matter of course. The conclusions of the House Committee’s Majority Report stated: “The FDA standards defining conflicts of interest are ridiculously broad. . . . That is why a committee member receiving $250,000 a year from the maker of the Rotavirus vaccine, Wyeth Lederle, was granted a waiver and voted in the [FDA advisory committee] deliberations. The CDC has virtually no standards because all ACIP members automatically receive annual waivers.”
Another big problem: The CDC is charged both with promoting vaccination and ensuring vaccine safety, two objectives that can often be at odds.
In early 2004, scientists in the vaccine safety branch of the CDC complained to an aide from CDC Director Julie Gerberding’s office that “conflict of interest was complicating their work” and that “higher-ups scrutinized their findings excessively when they showed harm from a vaccine,” reports Arthur Allen in his 2007 book Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver.
That summer, Neal Halsey, director of the Institute for Vaccine Safety at Johns Hopkins University in Baltimore and a strong advocate for the removal of thimerosal from childhood vaccines, co-authored a paper in the American Journal of Public Health calling for vaccine safety oversight to be removed from the CDC and given to an independent government agency modeled after the National Transportation Safety Board.
The CDC’s response? It chose not to create a separate agency, but to move the safety branch into the director’s office in 2005–a change in reporting lines, but not the sort of sweeping change that could ameliorate the agency’s credibility problems, at least in the eyes of vaccine skeptics.
So, that was some homework assignment. Given the depth and breadth of anti-vaccine concerns, why would any parent who’s done a similar amount of research opt to have his or her child vaccinated?
Simple, say vaccine proponents. You’re keeping your baby safe from the ravages of contagious disease that are still killing children every day in the developing world or, perhaps worse, from the effects of diseases in the U.S. for which we already have vaccines.
Dr. Gregory Poland, head of the Vaccine Research Group at the Mayo Clinic in Rochester, Minnesota, outlines his own reasons on his website. “As I went through medical school and residency,” he writes, “I knew right then and there that the warrior I was meant to be was the warrior taking on infectious diseases, to prevent them–because I just have a really hard time with death. Unwarranted death, the unexpected death.”
Thankfully, most of us live in an insular world in which the death of a child from an infectious disease is a horrific, unnatural phenomenon rather than an everyday occurrence. This great privilege can be attributed to clean water, good nutrition, and medical care–and, yes, at least in part to vaccines. And every day, untold numbers of children are vaccinated (cue ominous music) . . . with no ill effects whatsoever. It’s just that their parents aren’t writing blogs about it.
Most of us raising kids today have no firsthand knowledge of the illnesses our kids are vaccinated against. We don’t know what it is to watch a tiny infant convulsing and gasping for breath as her airways close up with the thick mucus of pertussis, nor have we ever seen a polio ward full of children in iron lungs. So it may be that our perception of risk from the vaccine looms greater than our understanding of the risks associated with catching the actual disease.
While some vaccine critics argue that allowing children’s bodies to experience the actual disease helps boost their immune systems, others like Jessica Snyder Sachs, former editor of Science Digest and author of the 2007 book Good Germs, Bad Germs: Health and Survival in a Bacterial World, disagree:
Scientists now understand [that] the immune system is brought up to full strength by the harmless bacteria that normally colonize the human body. In other words, getting sick isn’t a necessary part of the equation. Harmless bacteria bring the immune system into a state of readiness without triggering harmful inflammation.
Studies also show that the more infections a child has in early life, the greater his or her risk of inflammatory disorders, heart disease, cancer and premature death in later life. . . . It’s important to realize that there’s nothing ‘natural’ about a childhood full of infections, at least if by ‘natural’ you mean what’s been normal over the bulk of human evolution. Only with the advent of civilization, the last 5,000 years, has contagious disease taken such a central part in our lives.
In other words, Sachs argues that while letting your kid get chickenpox and measles might be the “natural” thing to do, it may be less healthy for them in the long run than helping them avoid those diseases altogether.