Tag: confirmation bias

How the Anti-Vaccine Movement Takes Advantage of Dead Children and Their Parents

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.”

Jim Meehan

What is Dr. Jim Meehan talking about?

A four-month-old who recently died of bacterial meningitis in Chesterfield County, Virginia.

“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.”

Jim Meehan

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.”

Jim Meehan

Has Jim Meehan heard of HIPAA?

Does he read any of the other messages when he is writing his own comments about this family?

Why should this family have to come out and give an explanation for how their child died?
Why should this family have to come out and give an explanation for how their child died?

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.”

Jim Meehan

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.”

Jim Meehan

Why is a family that just lost their child getting harassed by anti-vaccine folks?

This is the modern anti-vaccine movement.
This is the modern anti-vaccine movement.

One clue is that Jim Meehan is pushing the idea that there is a Big Pharma conspiracy behind this child’s death.

An anti-vaccine parenting group helping spread misinformation about this baby's death.
An anti-vaccine parenting group helping spread misinformation about this baby’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.

Even infants who die of vitamin K deficiency bleeding because they skipped their baby’s vitamin K shot all of a sudden have a vaccine injury.

They turn every story of a child’s death or disability into a vaccine injury story.

Shame on them all.

More on the Vultures of the Anti-Vaccine Movement

Anti-Vaccine Censorship on Facebook

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.

This toddler might end up with tetanus because of bad information in this anti-vaccine group.
This toddler might end up with tetanus because of bad advice in this anti-vaccine group.

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.

Anti-Vaccine Censorship

It is no accident that folks get uniform advice against vaccines in these so-called vaccine “education” groups.

The comment that got me banned from posting on Phyicians for Informed Consent.
As often happens on anti-vaccine sites, my comment about tetanus shots was quickly deleted and I was banned from posting further messages.

Anyone who goes against the “vaccines are dangerous” mantra of these groups typically has their comments quickly deleted and gets banned from the group.

Why?

“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

To create an echo chamber of anti-vaccine myths and propaganda and help reinforce all of their anti-vaccine beliefs. And of course, to help scare parents who might be on the fence about vaccines.

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.

More on Anti-Vaccine Censorship

Are Anti-Vaccine Folks Smarter Than the Rest of Us?

For the overwhelming majority of us, it seems like a simple decision – get your kids vaccinated and protected and avoid all of the risks of vaccine-preventable diseases.

After all, we understand that vaccines are safe and necessary.

But folks who choose to skip or delay vaccines want to do what is best for their kids too, even as they come to the exact opposite decision, so who is making the smarter choice?

Are Anti-Vaccine Folks Smarter Than the Rest of Us?

Not surprisingly, anti-vaccine folks think they are smarter.

Why?

“In the end we are left with a powerful sense of knowledge – false knowledge. Confirmation bias leads to a high level of confidence, we feel we are right in our gut. And when confronted with someone saying we are wrong, or promoting an alternate view, some people become hostile.

The Dunning-Kruger effect is not just a curiosity of psychology, it touches on a critical aspect of the default mode of human thought, and a major flaw in our thinking. It also applies to everyone – we are all at various places on that curve with respect to different areas of knowledge. You may be an expert in some things, and competent in others, but will also be toward the bottom of the curve in some areas of knowledge.”

Steven Novella on Lessons from Dunning-Kruger

While it is easy to blame it on the Dunning-Kruger effect, a study that appeared in the July 2004 issue of Pediatrics, Children who have received no vaccines: who are they and where do they live?, is often used by anti-vaccine folks to reinforce the idea that they are smarter.

“Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city. Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding 75,000 dollars, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children”

Children who have received no vaccines: who are they and where do they live?

But the part of the study that is often quoted is comparing unvaccinated vs undervaccinated.

In the same study, the education level of unvaccinated vs vaccinated is virtually the same.

And the differences for the unvaccinated vs undervaccinated kids was about their living near the poverty level. If these families grew up with less money, they likely had less opportunities to go to school, and unfortunately, had less opportunities to keep their kids up-to-date on their vaccines.

One study, Maternal characteristics and hospital policies as risk factors for nonreceipt of hepatitis B vaccine in the newborn nursery, did seem to associate a higher education level with refusing the newborn hepatitis B vaccine, but an even bigger factor was being born in a facility that actually had a policy that offered the vaccine.

“Likewise, vaccine refusal now appears to be less a function of socioeconomic status than it once was. Previously, maternal education was strongly associated with vaccine refusal, but now mothers without a high school diploma are even more likely than college graduates to have unvaccinated children . Also, unvaccinated children are no longer found primarily in the highest income households (perhaps a function of income data being top-coded at $50,000), but now are equally likely to live in households with more moderate (or even below poverty) incomes.”

Laura Blakeslee on Trends and Characteristics of Unvaccinated Children in the United States : The National Immunization Survey, 2002 − 2010

Other studies have either showed a higher level of college graduates for those who vaccinated their kids or no difference.

What about all of the experts in the anti-vaccine movement? Remember that the heroes and so called experts of the the anti-vaccine movement mostly includes celebrities, some doctors and scientists who are practicing way out of their field of expertise when they talk about vaccines, and others whose work is not supported by the great majority of experts in their field.

That’s not necessarily the end of the story though.

Yet another study (a small survey), Parental Delay or Refusal of Vaccine Doses, Childhood Vaccination Coverage at 24 Months of Age, and the Health Belief Model, found that as compared to parents who vaccinated their kids, those who delayed or refused vaccines:

  • were less likely to think that vaccines were necessary
  • were less likely to think that their kids would get a disease if they weren’t vaccinated
  • were less likely to believe that vaccines are safe
  • were more likely to believe that vaccines caused serious side effects
  • were more likely to believe that children get too many vaccines

And surprisingly, considering that the above things are basically anti-vaccine talking points that are easily disproven, they were actually more likely to have gone to college and to be a college graduate. It is not a surprise that they were less likely to have a good relationship with their doctor and were less likely to believe that their doctor had their child’s best interest at heart.

Parents unknowingly gave their infants teething powder made with mercury, causing pink disease or mercury poisoning.
Parents unknowingly gave their infants teething powder made with mercury, causing pink disease or mercury poisoning. Ironically, a decrease in illiteracy levels might have been the cause.

So maybe some anti-vaccine parents are indeed well-educated about some things, but that just gets us back to the Dunning-Kruger effect, as they certainly aren’t making smart decisions about vaccines.

Fortunately, this is still a very small, although very vocal, minority of people, as most parents vaccinate and protect their kids.

What to Know About Anti-Vaccine Intelligence and Education

Parents who choose to skip or delay their child’s vaccines are not making smart decisions about vaccines.

More on Anti-Vaccine Intelligence and Education

Dear Anti-Vaxxers,

As someone who has always understood that vaccines are safe and necessary, who vaccinates his children, I’m asking you to hear me out.

Dear anti-vaxxers. Vaccinate your kids.

I don’t think that you are either stupid, uneducated, crazy, or that questioning vaccine safety is always associated with  believing in conspiracy theories.

I understand and appreciate that you do care about your children, that you care about their health, and that you want what’s best for your family.

I actually do get that. I really do.

But I know that while you believe that you have done years of research and investigation to help you decide that the potential benefits of vaccines don’t outweigh their risks, going out of your way to find information to support your decision and ignoring all of the rest that says you are wrong, isn’t really doing research.

Whether you have never set foot on a college campus, you have a PhD in immunology, or you are a toxicologist, I know that you are still vulnerable to the same cognitive biases, heuristics, and logical fallacies as everyone else, and those can keep you from coming to a truly informed decision.

And I know that you are mostly motivated by fear, anger, and mistaken ideas of vaccine injury, vaccine induced disease, and unexplained illness and sudden deaths.

We all care about our children and families. The difference between us is that you still believe that there are two sides to the vaccination debate.

There isn’t.

Vaccines are safe, necessary, and they work well to protect our kids from life-threatening vaccine-preventable diseases.

No, vaccines are not 100% safe and they don’t work 100% of the time, but neither are they responsible for all of the things you see in vaccine scare stories or all of the so-called vaccine induced diseases we hear about.

“What if doctors never actually learn about vaccines, their ingredients, or adverse events, in medical school? What if the medical textbooks are written with an enormous amount of funding from the pharmaceutical industry? What if the CDC owns patents on vaccines? What if the pharmaceutical industry is corrupt and funds studies which conveniently stop monitoring test subjects before adverse effects begin to manifest? What if vaccines contain toxic substances at levels which can cause chronic illness when children are repeatedly injected with them? What if we are trading temporary illness for the development of autoimmune and neurological disease later in life? What if the threat and danger of these “preventable” diseases has been inflated to push more vaccines? What if these vaccines are not even truly effective as we have been led to believe and we will always need more booster shots to try to make up for that fact? What if there is evidence for all of the above, you just haven’t seen it yet?”

Ashley Everly Cates

Listen.

If you don’t want to vaccinate your kids, then don’t.

But don’t be influenced by folks who say they have done their research and don’t believe in conspiracy theories, but use a book by Neil Z Miller as a reference and push every major anti-vaccine conspiracy theory.

And don’t expect that your vaccine choice will be consequence free, including that your child will be at increased risk to get a vaccine-preventable disease, you will be putting others at risk to get a vaccine-preventable disease if your intentionally unvaccinated child gets sick, and you may be kept out of daycare or school if you live in a state that doesn’t allow non-medical exemptions.

I hope that you will keep an open mind and genuinely take time to look into this for yourself, beyond the myths and claims of anti-vaccine heroes who ignore or are unaware of the massive amount of evidence that contradict their claims.

Please take caution and know that I don’t do this to be popular. I don’t do this to make friends, get likes on my Facebook page, or sell vitamins and supplements in an online store.

Truly. The only reason I speak out is to protect my children and your children from unnecessary harm.

After all, is it really so hard to believe that the great majority of pediatricians, infectious disease specialists, immunologists, toxicologists, and public health experts in the world and throughout history are right about vaccines?

More for Anti-Vaxxers

Are You Too Scared to Vaccinate Your Kids?

These days, if a parent suggests to their pediatrician that they might want to skip or delay their child’s vaccines, it is typically not because they are afraid of any association with autism, or because they have been influenced by Jenny McCarthy or Andrew Wakefield, or even because they have done a lot of research.

It is mostly because they are scared.

Are You Too Scared to Vaccinate Your Kids?

What are they scared of specifically?

“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

Surprisingly, there often isn’t anything specific that they are scared of. That’s unfortunate, as it makes it harder to offer reassurance when they don’t have specific questions or concerns.

Still, something is scaring these parents, sometimes to the point that they have panic attacks if they even think about vaccinating their kids.

“…many parents are inundated with horror stories of vaccine dangers, all designed to eat away at them emotionally while the medical and scientific communities have mounted their characteristic response by sharing the facts, the data, and all of the reliable peer-reviewed and well-cited research to show that vaccines are safe and effective.”

Federman on Understanding Vaccines: A Public Imperative

What has them so scared?

Could it be:

Whatever it is, it builds up to the point to where these parents fear the risks of vaccines more than they fear the risks and complications of vaccine-preventable diseases.

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

That’s not surprising.

After all, why fear polio, measles, diphtheria, or tetanus, etc., if you have never had or known anyone that has had one of these now vaccine-preventable diseases? Why fear them, if you have never known anyone who has died with one of these now vaccine-preventable diseases?

And why trust that you should vaccinate your kids when you are likely inundated with messages about vaccines being poison, a Big Pharma conspiracy, or that you can just heal your child with some garlic and essential oils if they get sick?

Reducing Anxiety from Vaccinations

Have any ideas on how to get over your anxiety about vaccinations?

To start, learn that vaccines are safe, necessary, and they work to protect your kids and that all of the messages you are hearing about vaccines that have been scaring you aren’t true. You have probably already realized that on some level, but there are cognitive biases, heuristics, and logical fallacies that work together to change our perception of risk, keep us believing things aren’t true, and in this case, can keep you from vaccinating and protecting your kids.

It can also help to learn to think critically and be more skeptical about the things you see and read about vaccines, especially if you aren’t sure about the source of the information.

“The Internet has been identified as an important source for parents to seek and share vaccine information. There are concerns that parental fears or hesitancy on childhood immunizations are increasing due to the popularity of social media and exposure to online antivaccination sentiment.”

Tustin et al on Internet Exposure Associated With Canadian Parents’ Perception of Risk on Childhood Immunization: Cross-Sectional Study

Don’t let a small, yet vocal anti-vaccine minority scare you into a poor decision about your child’s vaccines.

What to Know About Being Too Scared to Vaccinate Your Kids

Parents who are inundated with anti-vaccine messages and misinformation sometimes get too scared to vaccinate their kids, fearing vaccines more than they fear the diseases they prevent.

More on Being Too Scared to Vaccinate Your Kids

Using Pubmed to Do Research About Vaccines

A lot of the vaccine research that folks do is on PubMed.

Using PubMed to Do Research About Vaccines

And that’s not necessarily a bad thing.

“PubMed comprises more than 27 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.”

All of the studies that say that vaccines are safe, that vaccines work, and that vaccines are necessary are in PubMed.

So are the studies that show that vaccines are not associated with autism, SIDS, and other so-called vaccine induced diseases, like ASIA.

Unfortunately, there are also poorly done studies in PubMed that do purport that vaccines are associated with autism and that ASIA is a real thing.

Can You Use PubMed to Do Research About Vaccines?

Kelly Brogan didn't make history in getting a case report published in a low impact journal who's editorial board includes a Reiki Master, chiropractors, and naturopaths.
Kelly Brogan didn’t make history in getting a case report published in a low impact journal who’s editorial board includes a Reiki Master, chiropractors, and naturopaths.

Just like anyone can put up a website or Facebook page and say whatever they want, almost anyone can get a study or article published in a journal and get it indexed in PubMed.

While PubMed is an index with over 27 million citations, it doesn’t do anything to evaluate those citations to see if they include studies with design flaws, conflicts of interest, or are simply fraudulent.

That means that you need to know that a study does not get a badge of legitimacy for simply being in PubMed!

And it does not automatically mean that the evidence and conclusions from the article are of high quality just because it is listed in PubMed.

So use PubMed to find articles to help you do research about vaccines, but then read the article from beginning to end, not just the abstract, and make sure it is an article you can trust:

  • Was it published in a legitimate journal, like Vaccine or Pediatrics, and some of these high-impact journals? (good)
  • Was it published in a predatory journals?  (bad)
  • Does it involve simply looking at VAERS data?  (usually bad)
  • Is it written by folks with a conflict of interest that makes the article biased?  (bad)
  • Has it already been refuted by other people because it wasn’t designed properly or had other major flaws?  (bad)
  • Is it written by people who have expertise on the topic they are writing about? (good)
  • Has it been retracted?  (very bad)
  • Is it a case report (a glorified anecdote), case series, or animal study (lowest quality evidence) or a systemic review or meta analyses (highest quality evidence)?
  • Is it a case control study, cohort study, and randomized controlled trial, which lie somewhere in between case reports and reviews on the hierarchy of evidence scale?

Are you ready to get educated about vaccines?

That’s great, but PubMed shouldn’t be your first stop, or your only stop.

As you do your research or get bombarded with a list of links or abstracts from PubMed, remember that there is a hierarchy of evidence to consider before deciding if a paper or study is really evidence of anything. And finding a case report, study on rats, or an invitro study won’t win you an argument about vaccines when there are randomized control trials and systemic reviews on the other side.

What to Know About Using PubMed to Do Research About Vaccines

PubMed is a giant index of journal articles, but simply being in PubMed doesn’t mean that an article or study is reliable or of high quality, whether it is about vaccines, a vaccine-preventable disease, or any other medical topic.

More on Using PubMed to Do Research About Vaccines

Immunization Education Agreement

Having disagreements about getting kids vaccinated and protected are not rare these days.

“Many parents have questions about their children’s vaccines, and answering their questions can help parents feel confident in choosing to immunize their child according to the CDC’s recommended immunization schedule.”

CDC on Talking to Parents about Vaccines

They never were though.

The anti-vaccine movement, concerns about the pain from the shots, and worry about side effects have been around for as long as there have been vaccines.

Options When You Disagree About Vaccines

So what should you do if you disagree with someone about vaccines and you don’t want to get your child vaccinated?

It depends on who it is.

For example, if the person you disagree with is your pediatrician, then simply arguing about it likely isn’t a good idea, on either side.

Most pediatricians understand that many vaccine-hesitant parents are simply scared because of things they read and see on the Internet and they want to help you get educated, see through the myths and misinformation that are out there, and eventually get caught up and vaccinated.

They understand that terminating the physician-patient relationship over vaccines truly is a last resort for “when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists.”

Immunization Education Agreement

So what can you do besides arguing?

Will you agree to get educated about vaccines?
Will you agree to get educated about vaccines using recommended and reliable sources of information?

Pediatricians and other health care providers can agree to get better educated about all of the different ways to talk to vaccine-hesitant parents.

And vaccine-hesitant parents can agree to get educated about vaccines and vaccine-preventable diseases using books and websites that are recommended by their provider.

Reassure your pediatrician that you are not done talking about vaccines and agree to get educated about vaccines:

Immunization Education Agreement Form

Even if you think that you have already done enough research, do just a little more. And then talk to you pediatrician again. And again if you have to.

Vaccines are safe. Vaccines are necessary. Don’t let anyone scare you into thinking that they aren’t.

What to Know About the Immunization Agreement

Whether you find yourself on opposite sides about immunizations with a friend, your spouse, an ex, or your pediatrician, agree to get educated about vaccines using these recommended and reliable sources of information and then talk about it some more.

More on the Immunization Education Agreement