As hard as it is to believe, I’ve been blogging nearly nine years. Indeed, my nine-year anniversary is coming up in just over a week. It’s been almost a decade! Early on during near-decade that I’ve been laying down bits of Insolence, Respectful, and Not-So-Respectful, I developed an interest in the antivaccine movement. Antivaccinationism, “antivax,” or whatever you want to call it, represents a particularly insidious and dangerous form of quackery because it doesn’t just endanger the children whose parents don’t vaccinate them. It also endangers children who are vaccinated, because vaccines are not 100% effective. The best vaccines have effectiveness rates in the 90%-plus range, but that still leaves somewhere up to 10% of children unprotected. Worse, because herd immunity requires in general approximately 90% of the population and above to be vaccinated against a vaccine-preventable disease to put the damper on outbreaks, it doesn’t take much of a degradation of vaccination rates to put a population in danger of outbreaks. That’s why, even though overall vaccine uptake is high in the US, we still see outbreaks, because there are areas with pockets of nonvaccinators and antivaccinationists who drive vaccine uptake down to dangerous levels. We’ve seen this in California and elsewhere. Other countries have observed even more dramatic examples, the most well-known being the way that fear of the MMR vaccine stoked by Andrew Wakefield’s bad science and the fear mongering of the British press led MMR uptake to plummet. The result? Measles came roaring back in the UK and Europe, from having been considered under control in the 1990s to being endemic again by 2008.
As much as I get chastised by concern trolls for saying this, to antivaccinationists it really is all about the vaccines. Always, always, always, always. They blame vaccines for autism, other neurodevelopmental conditions, and a wide variety of chronic diseases, without evidence that there is even a correlation. They even falsely blame sudden infant death syndrome (SIDS) on vaccines, even though there is no evidence of an association and, indeed, existing evidence suggests that vaccines likely have a protective effect against SIDS more than anything else. No matter what happens, no matter what the evidence says, antivaccinationists will always find a way to blame bad things on vaccines, even going so far as to claim at times that shaken baby syndrome is a misdiagnosis for vaccine injury.
One thing, however, that is often forgotten, is that antivaccinationists also do their utmost to downplay the beneficial effects of vaccines. One such tactic is for antivaccinationists to claim that the pertussis vaccine doesn’t work because we are seeing resurgences of pertussis even in the face of high vaccine uptake. For example, another common trope is what I like to refer to as the “vaccines didn’t save us” or the “vaccines don’t work” gambit, in which it is pointed out that the introduction of vaccines don’t correlate tightly with drops in mortality from various diseases. Julian Whitaker even used this gambit when he debated Steve Novella. The fundamental flaw in this trope neglects the contribution of better medical care to the survival of more victims of disease, which decreased mortality. If you look at graphs of disease incidence you will see a profound and powerful effect of the introduction of vaccines on specific vaccine-preventable diseases. In other words, vaccines work.
Over the Thanksgiving long weekend here in the US, there appeared a study that simply emphasizes once again that vaccines work. More importantly, it estimates how well they work. I’ve frequently said that vaccines are the medical intervention that have saved more lives than any other, and this study by investigators at the University of Pittsburgh’s graduate school of public health, published on Thanksgiving Day in the New England Journal of Medicine (NEJM) and showing up on the news the day before provides yet more evidence to support my assertion. In one way, it’s a shame that it was published over a long holiday weekend here in the US, where it was unlikely to garner as much attention as it normally might have at another time. On the other hand, it was Thanksgiving, and if there is anything we should be thankful for it’s that so few children die of vaccine-preventable diseases anymore. This study simply underlines this.