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Friday, December 29, 2017

A brief history of anti-vaccinationism

Vaccination is taking a "dead" or "deactivated" virus and exposing a person to it in order to achieve immunity.  Before there was vaccination, there was inoculation*.  Inoculation is exposing someone to a live disease in an effort to cause a mild form of the disease, which would hopefully induce immunity but be less destructive than the full-blown disease.

People inoculated children for smallpox by placing infectious pox scrapings into small skin cuts.  This more commonly resulted in a milder case of the illness than acquiring it naturally, although it did carry a risk that the illness could become severe and fatal (there was a ~2% risk of death after inoculation vs ~20% after natural infection).  Some argued that the lower risk of dying did not justify the possible risk of causing a fatal illness by inoculation.  Benjamin Franklin's son died of smallpox before he could be inoculated in 1736, and he later wrote about inoculation:



In 1796, Edward Jenner vaccinated a boy with cowpox and then exposed him multiple times to smallpox, proving that this provided protection from the disease without having to cause the disease itself.  Vaccination with cowpox became recommended over inoculation as the cowpox disease was much less severe in humans and did not carry a 2% mortality rate.


This is a cartoon from 1802 by James Gillray criticizing Jenner's method of vaccination.  Some critics of vaccination argued that the science wasn't correct--at the time the germ theory of disease was not universally accepted, and so the reasons vaccination would work were suspect.  Some argued that the practice could spread syphilis, or that it did not work as well as it needed to.  Others believed that vaccination circumvented the "natural" order and that suffering from smallpox would be morally superior to avoiding that fate.  Complicating the issue of whether everyone should be vaccinated was mandatory vaccination programs that started in the late 1800s, which led some to argue that for the sake of personal freedom it shouldn't be the case that everyone must be vaccinated.  Because of its efficacy and safety compared to the prior option of inoculation, vaccination did become very widely used during this time, although many mandatory programs were made voluntary.

In 1974, a small case study of 36 children who developed neurological disorders (seizures, coma) after the DTP (diphtheria, tetanus, and pertussis combined) vaccine was published.  Concern developed that the vaccination, especially the pertussis component, was responsible for severe permanent neurological reactions.  Documentaries and books were published declaring the vaccine unsafe.  Large scale studies were performed which did not bear this out; however, public opinion against the vaccine turned.  Nonpermanent reactions like swelling at the injection site or even scary febrile seizures were associated with vaccination, and so an effort was made to make the vaccine safer by using parts of the pertussis bacteria (an acellular vaccine) instead of the whole bacteria.  In the 1990s an acellular pertussis vaccine was developed, and today the vaccines commonly used in the U.S. are DTaP or TdaP, which produce fewer minor reactions of which the whole cell pertussis vaccine was guilty.

In 1998, just in time for the DTP anxiety to blow over, Andrew Wakefield published a study claiming a link between the MMR (measles, mumps, and rubella) vaccine and autism.  It eventually came out that he had acquired his study subjects unethically, made up much of his data, and had a financial incentive to obtain results that would show vaccines harmed children.  His study was retracted from the medical journal that originally published it.

In 2005, Dan Olmsted wrote an article claiming that the Amish community did not vaccinate and that they were never diagnosed with autism.  As it turns out, the Amish do vaccinate their children and sometimes are diagnosed with autism.

Also in 2005, Robert F Kennedy Jr wrote an article for Rolling Stone outlining the government's conspiracy to hide findings that thimerosal, a preservative and ingredient in vaccines, had caused autism.  The article misrepresented the removal of thimerosal from vaccines in 2001, an action taken to improve public support for vaccines because thimerosal contains mercury.  Although no evidence showed that the thimerosal containing vaccines had caused harm, it was thought that concerns would be allayed by removing this preservative from all pediatric vaccinations except for some flu vaccines.  Instead, this action was treated as evidence that vaccines caused harm and needed to be changed to become safer.

In case you thought criticism of vaccines left the cartoon medium two centuries ago,
here is the illustration that accompanies RFK Jr's article in Rolling Stone by Ed Sorel.
Click on the picture to see it full-size on the website.
In 2007, Jenny McCarthy announced on Oprah that her son had been diagnosed with autism and that she believed vaccines had triggered the condition.  She became an advocate for finding treatments for autism, including some therapies that were much more likely to cause harm than benefit, like chelation therapy for presumed mercury poisoning.

Also in 2007, Dr. Bob Sears published The Vaccine Book, which suggested an "alternative vaccine schedule" based on the fear that some people had that vaccines were given "too many, too soon."  The schedule was not in any way based on science or studies suggesting the alternative schedule would be safer, and was more likely to leave kids unprotected from vaccine-preventable diseases.

There are other articles, interviews, celebrities, etc. that likely reached a wide audience and influenced thousands of people to be suspicious of vaccines, but these are the biggest ones that I am aware of.

I've heard people blame mainly Wakefield and McCarthy for being the originators of the current anti-vaccine movement, but anti-vaccination feelings have been around for two centuries (longer if you count anti-inoculation sentiments).  Without their superstars anti-vaccinationism would likely still have legs--there's just something that bothers people about it.  For two hundred years people have argued that vaccination was unnatural, unsafe, and unscientific.  And for almost two hundred years it has been large governments and organizations--those who have the power to do great things and also, the power to limit freedoms and take advantage of the public--who organize mass vaccinations.  Arguments against vaccination will likely continue regardless of who has their medical license revoked.

Here is a pet peeve of mine: McCarthy's prior employment as a Playboy model is frequently cited as proof that she is dumb and uneducated, and many people claim that they would never be as dumb and uneducated as to follow her. However, in speaking about her son she comes across as a very caring mother who wants the best for her child, and gets her point across very clearly in every interview.    In the discussion section of the 1974 article about complications after the DTP vaccine, the authors state, "It could be argued that any illness in infancy will bear a temporal relation coincidentally to such events as teething and inoculation," and this temporal relation in early childhood of developmental or health problems being diagnosed after vaccination is cited over and over in current anti-vaccination stories.  Patting yourself on the back because you don't believe someone who once took naked pictures doesn't make you smart, it makes you a snob, and it makes you vulnerable for making the same mistake everyone else does when it's not a Playboy model but non-Playboy model Ms. Smith giving the same story.  Jenny McCarthy isn't wrong because she took naked pictures, she's wrong because noticing symptoms of a neurological problem after vaccination does not prove causation.  The evidence shows vaccination is safe.

*Nowadays, people use "inoculate" to mean "inject," so the terms can be a little interchangeable.

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