“When I undertook the study with the current vaccine strain on my own two triple-negative children and their three playmates, also triple- negatives, I thought: “I am going to do this very carefully now,” and, like Dr. Gear, I set up certain time schedules. I said: “I am going to start to give the vaccine now.” Every time I said “I am going to start to give it” and did not give it, two to three or four days later they came down with either pharyngitis, vomiting and abdominal pain, or a little fever.
I waited for approximately six weeks for those children to stop having some sort of febrile episode. I finally gave up. It so happened that after they got the vaccine they did not have any such episode.”
Albert Sabin on Recent Studies And Field Tests With A Live Attenuated Poliovirus Vaccine
When Albert Sabin was first researching his oral polio vaccine, he understood the problem. How could he really know if any signs or symptoms that occurred after he gave someone his vaccine were really caused by the vaccine, or just a coincidence?
“However, a report later to be given by Dr. Smorodintsev will deal with approximately 7,500 children who had received the vaccine and were carefully followed, as compared with another group, in similar number, who had not, for various types of illnesses which were occurring during the period.”
Albert Sabin on Recent Studies And Field Tests With A Live Attenuated Poliovirus Vaccine
The solution? They studied kids who had not gotten his vaccine.
You can just look at the background rate of a symptom or condition, and compare the periods before and after you start using a vaccine.
For instance, consider this study from Australia about using the HPV vaccine in boys, in which they made some predictions of what would happen after introducing the HPV vaccine.
Assuming an 80% vaccination rate with three doses per person — which equates to about 480 000 boys vaccinated and a total of 1 440 000 doses administered nationally per year in the first 2 years of the program — about 2.4 episodes of Guillain-Barré syndrome would be expected to occur within 6 weeks of vaccination. In addition, about 3.9 seizures and 6.5 acute allergy presentations would be expected to occur within 1 day of vaccination, including 0.3 episodes of anaphylaxis.
Clothier et al. on Human papillomavirus vaccine in boys: background rates of potential adverse events.
Most of you will have heard the maxim “correlation does not imply causation.” Just because two variables have a statistical relationship with each other does not mean that one is responsible for the other. For instance, ice cream sales and forest fires are correlated because both occur more often in the summer heat. But there is no causation; you don’t light a patch of the Montana brush on fire when you buy a pint of Haagan-Dazs.
When correlation doesn’t equal causation, then it’s probably a coincidence. Or it’s at least caused by some other factor.
And coincidences happen all of the time.
Is It a Vaccine Injury or a Coincidence?
That something could be a coincidence is not typically want parents want to hear though, especially if their child has gotten sick.
What does it mean that something happens coincidentally?
“Most sudden cardiac deaths that remain unexplained after necropsy are probably caused by primary cardiac arrhythmias.”
Sudden death in children and adolescents
Often it just means that it is unexplained. And that it is chance alone that it occurred as the same time as something else.
“In the absence of a specific etiology for ASDs, and a tendency among parents of children with a disability to feel a strong sense of guilt, it is not surprising that parents attempt to form their own explanations for the disorder in order to cope with the diagnosis.”
Mercer et al on Parental perspectives on the causes of an autism spectrum disorder in their children
Again, when folks blame vaccines, it is often because they have nothing else to blame.
“In some fraction of the American population, however, the belief in a link remains. One reason is a coincidence of timing: children are routinely vaccinated just as parents begin to observe signs of autism. Most vaccines are administered during the first years of life, which is also a period of rapid developmental changes. Many developmental conditions, including autism, don’t become apparent until a child misses a milestone or loses an early skill, a change that in some cases can’t help but be coincident with a recent vaccination.”
Emily Willingham on The Autism-Vaccine Myth
Think that it is too big of a coincidence that some infants develop spasms shortly after their four month vaccines?
Dr. William James West first described these types of infantile spasms in the 1840s!
And the “Fifth Day Fits,” seizures that began when a newborn was five days old, was described in the 1970s, well before we began giving newborns the hepatitis B vaccine.
But SIDS was only discovered after we began vaccinating kids, right?
“But, with millions upon millions of doses given each year to infants in the first 6 months of life across industrialized countries and with sudden infant death syndrome being the most common cause of infant death among infants 1 month or older, the coincidence of SIDS following DTP vaccination just by chance will be relatively frequent. When the two events occur, with SIDS following vaccination, well-meaning and intelligent people will blame the vaccine. They seek order out of randomly occurring events.”
Jacobson et al. on A taxonomy of reasoning flaws in the anti-vaccine movement
Of course not.
Cases of SIDS have been described throughout recorded history and have been well studied to prove that they are not associated with vaccines.
“Some events after immunisation are clearly caused by the vaccine (for example, a sore arm at the injection site). However, others may happen by coincidence around the time of vaccination. It can therefore be difficult to separate those which are clearly caused by a vaccine and those that were going to happen anyway… Scientific method is then used to determine if these events are a coincidence or a result of the vaccine.
Vaccine side effects and adverse reactions
It is easy to blame a vaccine when something happens and a child was recently vaccinated. That is especially true now that anti-vaccine folks turn every story of a child’s death or disability into a vaccine injury story.
“Autism was known well before MMR vaccine became available.”
Chen et al. on Vaccine adverse events: causal or coincidental?
Blaming vaccines when it is clear that vaccines aren’t the cause doesn’t help anyone though. It scares other parents away from vaccinating and protecting their kids. And it doesn’t help parents who need support caring for a sick child or help coping with the loss of a child.
What to Know About Vaccine Injuries vs Coincidences
While all possible adverse events after getting a vaccine should be reported to VAERS and your pediatrician, remember that just because something happened after getting vaccinated, it doesn’t mean that it was caused by the vaccine.
It is bad enough that folks in the anti-vaccine movement use propaganda to scare parents away from vaccinating and protecting their kids.
“The anti-vaccine argument is wrong in both the scientific and moral sense.”
Sarah Kurchak on Here’s How the Anti-Vaccination Movement Hurts Autistic People
Many people also think that the anti-vaccine message is anti-autism.
How the Anti-Vaccine Movement Takes Advantage of Dead Children and Their Parents
But just when you thought that they couldn’t go any lower, folks in the anti-vaccine movement find new ways to demonstrate their lacks of morals.
As a physician, I assure you this story isn’t believable at any level. In my opinion, the “health officials” are conjuring meningitis fairy tales about an “unvaccinated” boogeyman to cover for the much more probable cause of this child’s death: VACCINES.
The much more likely cause is right in front of us: “The child had just received his 4-month-old vaccinations two days beforehand.”
“Notice that THREE of the vaccines given at 4 months are for organisms capable of invading the brain and causing MENINGITIS. Rotavirus is a live virus vaccine capable of shedding from recently vaccinated children. The vaccine pre-clinical trials lacked placebo controls and were associated with infant deaths.
It doesn’t take my medical degree to understand how flimsy are the claims in this story.”
While rotavirus is a live virus vaccine, rotavirus rarely causes central nervous system disease. And he died of bacterial meningitis. It shouldn’t take a medical degree to know that rotavirus is a virus, not a bacteria.
While two of the other vaccines routinely given at four months do actually protect you from meningitis, both Prevnar and Hib are sub-unit vaccines, so can’t actually cause disease. Unfortunately, at four months, he would have been only partially protected against Prevnar and Hib, having only received two of four dosages of those vaccines.
“They expect the general public to be ignorant of the fact that we can actually measure the presence of the meningitis causing organisms for which there are vaccines: Haemophilus influenzae, Pneumococcus, and Meningococcus. So, where are the tests that confirm the presence of one of these “vaccine preventable” organisms?! Where’s the spinal tap/CSF pathology report?
As hard as it is for a grieving family to conceive of an autopsy, I pray the family demands a confirmation of the farcical cause of death being contrived in this case.”
Has Jim Meehan heard of HIPAA?
Does he read any of the other messages when he is writing his own comments about this family?
Is Jim Meehan really a doctor? It shouldn’t take a medical degree to understand that carriers of a disease don’t usually have symptoms of the disease.
“Again, from the article: “Health care officials told Dempsey they BELIEVE an unvaccinated person was carrying meningitis and Killy happened to come into contact with that person.”
They “believe”…give me a break. It should have said, “they made-up a story to cover for the real cause.”
SECOND, people don’t walk around with meningitis. They lay in their beds in a dark room and writhe in pain.
THIRD, the likelihood that an unvaccinated individual was walking around with meningitis is vanishingly small. To even list that in the top 100 options of a differential diagnosis is pure fiction.
FOURTH, where is this hypothetical unvaccinated meningitis shedding “patient zero?” He or she would have been so obviously sick that there is no way new parents would not remember the likely suspect…unless the suspect never existed.”
In this case, with a meningococcal infection, which is what the infant is thought to have, about 10% of people are carriers, asymptomatically having the Neisseria meningitidis bacteria in their nose or throat.
In the United States, we have two types of meningococcal vaccines, neither of which is routinely given to infants:
Menactra and Menveo – meningococcal conjugate vaccines that protect against serogroups A, C, W, Y and first given when kids are 11 to 12 years old, with a booster at age 16 years.
Bexsero and Trumenba – meningococcal conjugate vaccines that only protect against serogroup B and can be given to kids at increased risk and teens and young adults who want to reduce their risk of getting MenB disease
The only other possibility, since they mentioned that exposed people received antibiotics, would be the Hib bacteria.
“In the prevaccine era, Hib could be isolated from the nasopharynx of 0.5%–3% of normal infants and children but was not common in adults.”
CDC on the Epidemiology and Prevention of Vaccine-Preventable Diseases
Again, these carriers can be contagious, even though they don’t have any symptoms.
“It’s likely that these “health officials” are covering for the pharmaceutical/vaccine industry that pays them so well. It’s “health officials” like this that for decades have pretended that sudden unexplained infant death syndrome (SUIDS), not only has no explanation, but it couldn’t possibly be related to the injection of neurotoxic doses of aluminum into the bodies of tiny baby humans. They can ignore the clustering of infant deaths that occurs around the same times that CDC recommends multiple (5-13) vaccines at one visit, but I won’t.”
Why is a family that just lost their child getting harassed by anti-vaccine folks?
One clue is that Jim Meehan is pushing the idea that there is a Big Pharma conspiracy behind this child’s death.
And there are many anti-vaccine parenting groups that are helping spread his message around.
Of course, this isn’t the first time this has happened.
Anti-vaccine folks routinely hound parents who die of SIDS and shaken baby syndrome, working to convince them that vaccines caused their deaths.
If you ever wander into a holistic parenting group or a vaccine group that claims to offer “both sides” to educate folks about vaccines, you will, or at least you should, quickly notice that all of the posts and replies sound eerily alike.
If a parent asks about a tetanus shot for their child’s wound in one of these groups, no one will suggest that they rush to their pediatrician and get it.
The only disagreements you might see are whether they should treat the wound with colloidal silver, black salve, garlic, urine, activated charcoal, tea tree oil, raw honey, essential oils, or some other non-evidence based therapy.
It is no accident that folks get uniform advice against vaccines in these so-called vaccine “education” groups.
Anyone who goes against the “vaccines are dangerous” mantra of these groups typically has their comments quickly deleted and gets banned from the group.
“Echo chambers abound for many other conditions which are not medically recognised, from chronic Lyme disease to electromagnetic hypersensitivity. But perhaps most worrisome is the advance of anti-vaccine narratives across the web. The explosion of dubious sources has allowed them to propagate wildly, undeterred by debunking in the popular press. We might take the current drastic fall in HPV vaccine uptake in Ireland, driven by anti-vaccine groups like REGRET, despite its life-saving efficacy. While organisations including the Health Service Executive have valiantly tried to counter these myths, these claims are perpetuated across social media with little to stop them.”
Echo chambers are dangerous – we must try to break free of our online bubbles
After all, it is easier to feel confident in your decisions when you think that everyone else is doing the same thing. Of course they aren’t though. The great majority of people vaccinate and protect their kids.
It is only in these echo chambers of anti-vaccine misinformation that anyone would think that it would be okay to not get an unvaccinated toddler proper treatment for a cut, to skip a rabies shot after exposure to a rabid bat, or to not get travel vaccines before visiting high risk areas of the world.
That’s the power of confirmation bias.
And whether or not you realize it, confirmation bias is likely one of the reasons that you aren’t vaccinating and protecting your kids.
That’s why you need to step out of these echo chambers if you want to understand that vaccines are safe and necessary.
What to Know About Anti-Vaccine Censorhip
Anti-vaccine groups routinely censor, ban, and block messages from people who correct misinformation about vaccines and vaccine-preventable diseases.
To counter vaccine hesitancy, you likely first need to understand what it means.
“Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific varying across time, place and vaccines. It includes factors such as complacency, convenience and confidence.”
SAGE Vaccine Hesitancy Working Group
So it means someone who is anti-vaccine, right?
“Although many may characterize all individuals who eschew vaccines as “anti-vaccine” or “vaccine deniers,” in reality there is a broad spectrum of individuals who choose not to have themselves or their children vaccinated.”
Tara C Smith on Vaccine Rejection and Hesitancy: A Review and Call to Action
Many of the folks who are vaccine hesitant aren’t truly anti-vaccine. They are likely being misled by anti-vaccine myths and propaganda, but at least they aren’t the ones spreading it across Facebook or on their own blogs and anti-vaccine websites.
How To Counter Vaccine Hesitancy
How do you counter vaccine hesitancy?
“It’s unfair for anyone to expect me [or any parent] to take the word of the pharmaceutical companies who have much to gain from and industry worth billions without question – and then have to dismiss any concerns of my own.”
“Well, if you’re going to inform yourself about vaccines, I think anybody who’s truly informed will realize that getting a vaccine is much better than not getting one. If you’re choosing not to vaccinate your child, it’s because you’re getting, frankly, bad information about vaccines.”
Paul Offit, MD
You also make sure that parents, teachers, nurses, doctors, pharmacists, reporters, and everyone else gets good information about vaccines.
Have you ever heard that your child has more of a chance of getting hit by lightning than getting measles?
Since getting struck by lightning is rare, folks like to use it in comparisons to other things that they also think are low risk when trying to make a point.
There are problems with this type of argument though.
Understanding Risk Perception
In an age when many folks are overly anxious about things, it is important to understand the difference between real and perceived risks. Unfortunately, our biases often lead us to worry about the wrong things, sometimes with tragic consequences.
“No intervention is absolutely risk free. Even the journey to a physician’s office with the intention to receive a vaccination carries the risk of getting injured in an accident. With regards to risks of vaccination per se, one has to distinguish between real and perceived or alleged risks.”
Heininger on A risk–benefit analysis of vaccination
Comparing Lightning Strikes to Vaccine Preventable Diseases
How common or rare do you think it is to get hit by lightning?
odds of being hit by lightning – 1 in 1,171,000 (each year)
odds of ever being hit by lightning – 1 in 14,600 (lifetime risk)
on average, 26 people die after being struck by lightning each year (since 2007), which is down from a recent historical average of 45 deaths per year (30 year average) and way down from when we used to see 400 lightning strike deaths each year before 1950
on average, 252 people are injured after being struck by lightning each year
Although 26 people dying after lightning strikes sounds like way too many to me, especially since one recent death was a 7-year-old boy in Tennessee playing under a tree, with 1 in 1,171,000 odds of getting hit, it sounds like we are pretty safe.
But is it fair to use those odds to justify your decision to keep your kids unvaccinated?
Of course not!
Why is our risk of getting struck by lightning so low?
What happens when we hear thunder or see lightning?
When Thunder Roars, Go Indoors!
What happens when a thunder storm approaches and you are at your kids soccer or baseball game?
“Postpone or suspend activity if a thunderstorm appears imminent before or during an activity or contest (irrespective of whether lightning is seen or thunder heard) until the hazard has passed. Signs of imminent thunderstorm activity are darkening clouds, high winds, and thunder or lightning activity.”
UIL on Lightning Safety
Many ball fields now have lightning detectors to alert officials of nearby storms. And just about everyone has access to weather apps on a smart phone that can alert them to an approaching thunder storm or nearby lightning strikes.
The point is that most of us understand that lightning is dangerous, so we go far out of our away to avoid getting hit. The risk of getting hit by lightning isn’t 1 in 1,171,000 with folks running around outside waving golf clubs in the air during thunder storms or sitting on their roofs under an umbrella watching the storm.
The risk of getting hit by lightning is 1 in 1,171,000 because most of us go inside once we know lightning is nearby.
“Based on the media reports of the fatal incidents, many victims were either headed to safety at the time of the fatal strike or were just steps away from safety. Continued efforts are needed to convince people to get inside a safe place before the lightning threat becomes significant. For many activities, situational awareness and proper planning are essential to safety.”
A Detailed Analysis of Lightning Deaths in the United States from 2006 through 2017
And the same is true with measles and other vaccine-preventable diseases. They aren’t as common as they once were because most of us are vaccinated and protected.
Folks often misuse lightning strikes when they think about risks, not understanding that the risk of getting hit by lightning is low because we take a lot of precautions to avoid getting hit by lightning.
What actually happens when a pediatrician has a vaccine policy that requires parents to vaccinate their kids or face dismissal from the practice?
Not surprisingly, there are a lot of myths about the controversial issue of pediatricians dismissing families who don’t vaccinate their kids.
1 ) It is a myth that the American Academy of Pediatrics has a policy encouraging pediatricians to dismiss families who don’t vaccinate their kids.
There is no such policy.
Instead, in 2016, about 400 leaders from AAP chapters, committees, councils, and sections voted on a resolution at the 2016 AAP Annual Leadership Forum (ALF) to support pediatricians who dismissed families who didn’t vaccinate their kids.
RESOLVED, that the Academy support, in their policy statements and clinical guidelines about immunizations, pediatricians who decide to discharge patients after a reasonable, finite amount of time working with parents who refuse to immunize their children according to the recommended schedule or who fail to abide by an agreed-upon, recommended catch-up schedule, and be it further RESOLVED, that the Academy continue to support pediatricians who continue to provide health care to children of parents who refuse to immunize their children.
Resolution #80.81SB Supporting Pediatricians Who Discharge Families Who Refuse to Immunize
The resolution also voiced support for pediatricians who didn’t dismiss these patients.
2) It is a myth that pediatricians dismissing families who don’t vaccinate their kids is a new thing.
Although it is getting a lot more attention now, since that 2016 resolution and a report on Countering Vaccine Hesitancy that soon followed, dismissing or firing families who don’t vaccinate their kids is not new.
A 2005 AAP report, Responding to Parental Refusals of Immunization of Children, discusses the issue.
“In general, pediatricians should avoid discharging patients from their practices solely because a parent refuses to immunize his or her child. However, when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists, the pediatrician may encourage the family to find another physician or practice.”
Responding to Parental Refusals of Immunization of Children
And a study, Dismissing the Family Who Refuses Vaccines, also published in 2005, made it clear that many pediatricians “would discontinue care for families refusing some or all vaccines.”
3) It is a myth that dismissing families who don’t vaccinate their kids is an evidence based policy.
There is nothing beyond anecdotal evidence that families, when faced with the decision of getting vaccinated or getting dismissed from an office, will choose to get vaccinated.
Again, the latest resolution supporting the idea of dismissing families came because it was voted on and became an official Annual Leadership Forum resolution. In general, only the top 10 ALF resolutions are acted upon urgently by the AAP.
At the time, many pediatricians felt constrained by the previous statements from the AAP that discouraged dismissing these families.
4) It is a myth that pediatricians dismiss families who don’t vaccinate their kids because they don’t want to be bothered talking about vaccine safety.
Although few pediatricians would want to talk to a parent who is arguing that vaccines are poison, aren’t necessary, and never work, fortunately, most vaccine-hesitant parents don’t actually talk like that. They are usually on the fence or simply scared because of all of the anti-vaccine propaganda they are exposed to and need a little extra time to understand that vaccines are safe and necessary.
And most pediatricians give them that extra time and do talk to them about their concerns. Despite the perception from some of the headlines you might see, families typically don’t get fired after one visit because they refused one or more vaccines.
5) Pediatricians who don’t dismiss unvaccinated families are supporting the use of alternative vaccine schedules.
While this is certainly true for some providers who actually advertise that they are “vaccine-friendly” and encourage parents to follow a non-standard, parent-selected, delayed protection vaccine schedule, most others understand that there is no evidence to support these alternative schedules and they are simply tolerated until the child can get caught-up with all of his vaccines.
6) It is illegal to dismiss a family who doesn’t want to vaccinate their kids.
While some pediatricians think that it is a bit of an ethical dilemma, the legal issues are very clear.
Physicians can’t simply abandon a patient so that they go without care, but they are typically free to end the physician-patient relationship after giving them formal, written notification, and continuing to provide care (at least in emergency situations) for a reasonable amount of time, giving the family time to find a new physician.
Of course, state and federal civil rights laws protect families from being terminated because of sex, color, creed, race, religion, disability, ethnic origin, national origin, or sexual orientation.
7) It is a myth that dismissing families who don’t vaccinate their kids will protect those families who do vaccinate and protect their kids.
This is often the main reason that pediatricians use to justify dismissing families who don’t vaccinate their kids. After all, it isn’t fair to the families who come to your office, those who do get vaccinated and protected, if someone who is intentionally not vaccinated gets measles and exposes them all, right?
There seem to be several problems with this idea though:
relatively few exposures during outbreaks actually occur in a pediatrician’s office. Looking at most recent measles outbreaks, for example, exposures were more likely to occur while traveling out of the country, in an urgent care center, emergency room, somewhere in the community, or in their own home.
infants who get pertussis are usually exposed by a family member
while measles is very contagious and the virus can linger in an exam room for hours, other vaccine-preventable diseases are far less contagious. Mumps, for example, typically requires prolonged, close contact, which is why you are unlikely to get mumps at your pediatrician’s office.
when dismissed by their pediatrician, there is a concern that families might cluster together in the offices of a vaccine-friendly doctor or holistic pediatrician, making it more likely for outbreaks to erupt in their community if any of them get sick
And that’s the key point. Just because families get dismissed from a pediatrician’s office, it doesn’t mean that they leave the community. Your patients might still see them at daycare, school, at the grocery store, or walking down their street.
With RSV, strep, cold viruses, and everything else that kids have in the average pediatrician’s office, it is best to take steps to reduce the chances that kids are exposed to all of them. How do you do that? Don’t have a waiting room full of kids that are exposing each other to germs!
8) Most families don’t vaccinate their kids because they don’t trust their pediatrician.
“In today’s world, smallpox has been eradicated due to a successful vaccination program and vaccines have effectively controlled many other significant causes of morbidity and mortality. Consequently, fear has shifted from many vaccine-preventable diseases to fear of the vaccines.”
Marian Siddiqui et al on the Epidemiology of vaccine hesitancy in the United States
“With all the challenges acknowledged, the single most important factor in getting parents to accept vaccines remains the one-on-one contact with an informed, caring, and concerned pediatrician.”
“…nearly half of parents who were initially vaccine hesitant ultimately accepted vaccines after practitioners provided a rationale for vaccine administration.”
“Developing a trusting relationship with parents is key to influencing parental decision-making around vaccines.”
“Pediatricians should keep in mind that many, if not most, vaccine-hesitant parents are not opposed to vaccinating their children; rather, they are seeking guidance about the issues involved, beginning with the complexity of the schedule and the number of vaccines proposed.”
“Because most parents agree to vaccinate their children, this dialogue, which can be started as early as the prenatal interview visit if possible, should be an ongoing process.”