The Case for Vaccination

It's worth pointing out that John McCain's embrace of discredited autism-vaccine connection theories isn't just an odd display of ignorance, it's a positive public danger. As Arthur Allen spelled out in a September 2002 Atlantic article, communities where immunization rates dip below a critical threshold see the re-emergence of endemic diseases that modern public health techniques are perfectly capable of stamping out.

There are millions and millions of people in this country strongly predisposed to believe that John McCain wouldn't run around saying there was "strong evidence" that getting your kids vaccinated might put them at risk for autism unless there was, in fact, such evidence. Some of them will have their children avoid vaccination, and a price will be paid. Link via Jerry Taylor.

Comments

I must say, I admire Matt's workmanlike consistency in hammering McCain. How many negative posts on the old Senator so far in the last few days? Dozens? Maybe as a reward, if Obama wins, the Obama administration can detail Matt to the First Lady's office, where he can edit her written work for her.

Posted by Fred | March 7, 2008 11:33 AM

McCain's stupidity on this is disappointing, but is it really all that surprising? The current cultural environment we live in seems to be fertile ground for health-based "scares"--just take some anecdotal evidence that can't be scientifically verified; mix in some activist group zealots who denouce the lack of empirical evidence as itself evidence of a conspiracy; stir in a lazy, scientifically ignorant media that treats the zealotry of the activists as some kind of confirmation of the luddite position; and top it off with--you guessed it--trial lawyers determined to soak the vaccine makers for obscene amounts of money no matter what the science says, and you've got what passes for modern American discourse.

Posted by Claudius | March 7, 2008 11:34 AM

My understanding is that McCain was speaking specifically about thimerosal, which is no longer a part of vaccines in the U.S.

Posted by calling all toasters | March 7, 2008 11:36 AM

This seems like really piss poor timing for this post...

Are we supposed to pretend that the last few days haven't happened, and the government didn't just announce a possible connection between the two?

Posted by Soullite | March 7, 2008 11:36 AM

Whether these vaccines actually cause the disease, or trigger it in people who are carriers and make it worse for people who already have it, the Average American won't see a difference. Functionally, there won't be one.

Posted by Soullite | March 7, 2008 11:38 AM

ALL ABOUT THE HOME SCHOOLERS AND CHRISTIAN RIGHT -- who make up most of the anti-vaccinationists, so that's who he is pandering to here. It is incredibly irresponsible, esp. since about 5 major studies by premier groups like the Institute of Medicine have demonstrated that there is no connection between thimerosal and autism. Plus because of the hint of a connection, before it was unproven, thimerosal was removed from all vaccines more than 5 years ago.

Posted by minna | March 7, 2008 11:40 AM

Are we supposed to pretend that the last few days haven't happened, and the government didn't just announce a possible connection between the two?

Oh good grief. No, the government announced the exact opposite actually.

Posted by Barbar | March 7, 2008 11:43 AM

My wife, who is in the medical profession and studies this kind of stuff all the time, was absolutely irate at the way the media covered the vaccination judgment last night. ABC portrayed it as showing a link that vaccines cause autism, when it the judgment really concluded that the vaccines exacerbated a pre-existing condition causing autism. Also there was no mention that the agent that supposedly causes autism is no longer present in vaccines. Or that other countries that put a moratorium on vaccinations found autism rates increased (as well as polio!)

Just sloppy, irresponsible journalism that will cause millions of parents to avoid vaccination needlessly.

Posted by Jayhawk Max | March 7, 2008 11:43 AM

Great points, Minna. The part that drives me crazy is that Thimerosal was used in combined vaccines, where multiple vaccines are given in a single shot. If you didn't want Thimerosal, you could still get your kids vaccinated, but with more shots. I live in Texas, and I know quite a few knuckleheads who don't get their kids vaccinated.

Posted by Eric | March 7, 2008 11:45 AM

Great points, Minna. The part that drives me crazy is that Thimerosal was used in combined vaccines, where multiple vaccines are given in a single shot. If you didn't want Thimerosal, you could still get your kids vaccinated, but with more shots. I live in Texas, and I know quite a few knuckleheads who don't get their kids vaccinated.

Posted by Eric | March 7, 2008 11:48 AM

If anyone doubts the negatives consequences of insufficient vaccination, they should travel to India and see them first hand. Of course, such a person would be wise to get vaccinated first, or risk getting a whole host of diseases that are cured here in America but widespread in India. Or you could take the safer route and check out Lonely Planet's extensive health advisory for the country. But seeing it first hand is rather stunning. The number a beggars with polio is really unbelievable. And, as you might expect, it is the religious fanatics that prevent India from reaching the critical point where a disease does not re-emerge. Even Laos has seen the light on vaccination. We should too.

Posted by fostert | March 7, 2008 11:49 AM

what i'd like to know is how many of the journalists who bring us the "straight talk express" myth every day will listen to the great "straight talker" on this matter? because, after all, he's john mccain: he talks straight.

Posted by howard | March 7, 2008 12:02 PM

I, for one, am pleased to hear Matt's commitment of using sound statistical analysis when analyzing issues of public health.

Perhaps then he will come out against alternative medicine, homeopathy, crystals and other favorites of the left-leaning.

Posted by Klug | March 7, 2008 12:07 PM

Clearly McCain should be denounced as a schmuck for making such an idiotic statement. However, as the attached link demonstrates, the other two candidates are better only in degree.

http://www.ageofautism.com/2008/03/obama-and-clint.html

Posted by SLC | March 7, 2008 12:10 PM

Perhaps then he will come out against alternative medicine, homeopathy, crystals and other favorites of the left-leaning.

Hilarious. Do you people have any cultural knowledge of less than forty years vintage?

Posted by Mike B. | March 7, 2008 12:13 PM

Perhaps then he will come out against alternative medicine, homeopathy, crystals and other favorites of the left-leaning.

I imagine he will (except perhaps for "alternative medicine", which covers a huge swath of disparate methods), just as soon as a presidential candidate endorses one of those "favorites".

Posted by KCinDC | March 7, 2008 12:19 PM

Mike:

If you're referring to the folk Americana (both sides of the aisle) belief in alternative medicine, yes, I do.

Posted by Klug | March 7, 2008 12:24 PM

"Perhaps then he will come out against alternative medicine"

Alternative medicine ain't what it used to be. Some of what used to be considered "alternative" treatments are now pretty standard. In my field of spinal surgery, about half of our surgeons won't perform a surgery unless the patient has already tried acupuncture first. These aren't hippie doctors, they are genuine, board certified orthopedic surgeons (and usually conservative rednecks). They obviously lose some patients because the acupuncture works for many people, but spinal surgeons aren't exactly hurting for either patients or money. And they are actually acting in their patients' interests.

Posted by fostert | March 7, 2008 12:26 PM

"Perhaps then he will come out against alternative medicine"

Alternative medicine ain't what it used to be. Some of what used to be considered "alternative" treatments are now pretty standard. In my field of spinal surgery, about half of our surgeons won't perform a surgery unless the patient has already tried acupuncture first. These aren't hippie doctors, they are genuine, board certified orthopedic surgeons (and usually conservative rednecks). They obviously lose some patients because the acupuncture works for many people, but spinal surgeons aren't exactly hurting for either patients or money. And they are actually acting in their patients' interests.

Posted by fostert | March 7, 2008 12:30 PM

"Perhaps then he will come out against alternative medicine, homeopathy, crystals and other favorites of the left-leaning."

Not astrology, though, which in recent history has tended to be a right-wing speciality.

Posted by ajay | March 7, 2008 12:53 PM

Hi, Klug! You can raise your issue when the presidential nominee for the Democrats endorses those things! Till then, take your lumps when you have to see the Republican make an anti-scientific fool of himself!

Posted by Tyro | March 7, 2008 12:59 PM

Agree with Matt's post. The problem with vaccines is that they can't be guaranteed to give perfect individual immunity or guaranteed to never have adverse reactions.

But they are near-perfect in giving what epidemiologists call herd immunity. That is, if 1985 out of 2000 kids are vacinated against, say, polio, besides the 15 unvaccinated ones, you have 35 perhaps that failed to get any immunity or significant resistance to polio despite being vaccinated. But by herd immunity, they are pretty safe if one person becomes infected because they have very low chances of encountering the original vector person AND others that encounter the person do not get the affiction and serve as cutouts so the disease does not spread in a large population but dies out. It doesn't even get a chance to affect a significant level of kids even in a small, localized place.

And people that refuse to get vaccinated or their kids vaccinated rationalize it as some god-given or civil liberties right to avoid any risk - assuming enough other people will be vaccinated, to prevent their exposure. But they not only endander themselves, but endanger other humans who follow public health and public saftety precautions. If instead of 15 of 2000 refusing vaccination, you get 115, then you could have person to person transmission in school, the workplace, and in public possible of the unvaccinated AND a portion of the vaccinated.

AND have enough vectors that the disease does not remain locaized, but spreads as the number of infected contact points increases logarithmically.

Sorry to say, but this is one area where the "individual right to choose" clashes with public safety and we must act as our brothers keeper and isolate the people who voluntarily become unprotected potential vectors from schools, workplaces, and even be confined to their homes by law if a breakout of something like polio occurs, as it has in two religious communities here and one in the Netherlands in recent years.

No one is going to point a gun at people and force-vaccinate - but the anti-vaccine people should realize with their freedom comes significant consequences of isolating them to the extent public safety demands.

Posted by chris ford | March 7, 2008 2:56 PM

As a factual matter, I'm not at all sure that Thimerosal has been completely eliminated from vaccines. The policy was changed, but existing stock was not removed as far as I know.

The typical scenario would be a multi-dose package which needs something like thimerosal to ensure that if the needle used for the first dose introduced something, the thimerosal would kill it so the second dose would remain clear of the contaminant.

If those multi-dose vaccines are still sitting on pediatricians' shelves, then we may still be administering it to susceptible children. Or at least there was probably a substantial lag time between the change in manufacturing practices and the actual end of new exposures.

If anyone has reliable information on this, I would be interested to find out about it.

Posted by STS | March 7, 2008 5:38 PM

As a factual matter, I'm not at all sure that Thimerosal has been completely eliminated from vaccines. The policy was changed, but existing stock was not removed as far as I know.

The typical scenario would be a multi-dose package which needs something like thimerosal to ensure that if the needle used for the first dose introduced something, the thimerosal would kill it so the second dose would remain clear of the contaminant.

If those multi-dose vaccines are still sitting on pediatricians' shelves, then we may still be administering it to susceptible children. Or at least there was probably a substantial lag time between the change in manufacturing practices and the actual end of new exposures.

If anyone has reliable information on this, I would be interested to find out about it.

Thimerosol hasnt been completely eliminated but its been drastically reduced by orders of magnitude since 1999. Autism is by definition diagnosed by age 3, so if thimerosol was responsible, then the number of autism cases should have gone down since 1999.

However, thats not what happened. Autism cases have gone up every single year since 99.

All vaccines except flu are available in thimerosol-free versions that can be requested by parents.

Posted by joe blow | March 7, 2008 8:00 PM

joe:

Thanks for the reply. The fact that Thimerosal is available in versions that "can be requested by parents" sounds reassuring, but is actually a bit disquieting. What are the odds that parents actually do that? Or that the pediatrician doesn't just look at them blankly if they do? "Why would you want that? There's NO evidence it matters ..." (and besides it's SUCH a pain to restock our supplies ... good god, the insurance billing issues alone!)

I'm not so much concerned that people who are already anti-vaccination for irrational reasons won't get their precious thimerosal-free product. What about somebody who just trusts the all-knowing doctor and gives a genetically vulnerable child an injection of poison?

I know this is probably well below most M.Y. readers' threshold of "important problems." The next basketball game probably counts for more. You're probably mostly too young to even have children, much less personal experience of autism.

The broader societal problem is that our world is chock full of toxic s&*t and it is starting to surface in all manner of behavioral and outright physical disorders in our children. Any clues we can find deserve some urgency. Not smug brush-offs based on condescending attitudes towards the religiously misled.

Posted by STS | March 7, 2008 9:12 PM

STS, even if you get the thimerosol version of the vaccines, the mercury content is about 150 times lower than it was in 1999.

the fact that autism cases keep going up while mercury exposure has plummeted means that the mercury in vaccines is not responsible for autism.

Posted by joe blow | March 8, 2008 6:19 PM