All Your Burning Vaccine Questions, Answered! Part 2: Controversies Regarding Vaccinating
Thanks for joining in to read the second in our three-part series of vaccine blog posts. In our first post, I did more of a Q&A format that listed the most common questions and topics parents ask me about. Today, I’d like to dive in more about the controversies and linkages we all have heard about but may not know the details. I think arming parents with background of where these theories originated helps make the decision to vaccinate clearer than ever.
When parents tell me they’ve done their research on vaccines, I usually ask them what they are reading. This is purely out of a general academic curiosity. You see, in the medical field, research in topics and issues has to jump through a series of hoops before it’s even determined as “publishable.” So when we make a recommendation, it’s based off of recommendations that have undergone rigorous scrutiny. In fact, it can take majority of physicians years before their work ever gets published in the most highly regarded and esteemed medical journals.
This leads me to, of course, the infamous study on the linkage of MMR vaccine and autism. This study was published in 1998 in the esteemed British medical journal The Lancet by Andrew Wakefield. Andrew Wakefield, who is a British gastroenterologist, posted a connection between the measles component of the MMR vaccine and a new gut disorder, and then that gut disorder and autism. The paper itself was careful to say that there wasn't any mechanism that they had identified but that essentially this was a theory that needed to be studied and tested. It was nothing more than that, but in the press and publicity following, Wakefield held a press conference, where he essentially acted as if he had proven there was a connection. He told parents not to give their children the MMR vaccine, and that really started this period that we're still living in.
The UK press at the time also presented it in a “this party vs that party” perspective. So while multiple other pediatricians, the head of Andrew Wakefield’s medical school, and other authors on the paper all weighed in to say there wasn’t any evidence to indicate we should change our vaccination policies but needs to be studied more, the press presented it as an inconclusive matter where no one knew the right answer.
Some very serious medical research followed starting this era, and researchers took a closer look at Wakefield’s work. The data wasn’t only skewed and stating maybe, prematurely, that there was an association-It was downright fraudulent. As it turned out, Wakefield had been receiving money from a lawyer who was preparing a case against vaccine manufacturers. The lawyer was working with parents who believed that their children had been injured by vaccines.
His patients, which he claimed had been twelve random patients, one after another, who came in to his clinic — were actually sent specifically to him. Some of them were sent, by the very same lawyer who was trying to prepare a case against vaccine manufacturers.
Wakefield declared no conflicts of interests in the study. What he did not declare was that shortly before the paper came out, he had taken out a patent for a measles vaccine that contained only the measles vaccine. He knew this would be precisely what parents would want if they thought that something about combining the measles-mumps-rubella (MMR) vaccine was what made it dangerous, which was what he was arguing. In years following, w ten of the original thirteen authors retracted their support for the article and its interpretation.
So of course, the Lancet retracted and denounced the publication after multiple skeletons in the closet became evident. Andrew Wakefield lost his medical license and the ability to ever touch a patient as a physician again. Does he still tout propaganda? Absolutely. In fact, his propaganda is what influenced US celebrity Jenny McCarthy after she came forward with her own beliefs on vaccination. Her famous interview on Oprah in 2007 re-ignited the MMR vaccine and autism controversy.
But what happened in between those years? At least five major studies. The American Academy of Pediatrics (AAP) put together cross analyzed multiple vaccine studies in 2003. There was no way that a possible risk of autism and a vaccine could go together “theoretically.” That is a very serious accusation and needed to be investigated thoroughly. With multiple studies containing approximately 500,000 patients, no study has been able to link autism to a vaccine or preservative.
Still, many parents are concerned about the number of vaccinations their children receive. From what I’ve perceived in discussions with parents in my practice, the concern is two-fold: (1) the number of actual injections and (2) the number of antigens their child is exposed to. I think the first is easier to address and actually interesting in that there have actually been some very useful studies that study cortisol (hormone that naturally circulates in the body but is also secreted during times of stress) and other markers of stress when a child gets vaccinated. Whether the child gets one or three injections, they actually have the same amount of stress. So spreading the vaccines out and giving only shot each time just causes them to have stress more often than giving them multiple shots at one time. As a mother, I know it’s difficult to see your child getting an injection, let alone two to three. But it’s a quick stressful period, and their sensory and emotional processing centers of the brain have already processed it before they leave the doctor’s office.
So now for the second part – the number of antigens- Is it too much to overstimulate the immune system of that child? I’m going to discuss this first from the body’s immune system, then the vaccination schedule, and lastly, the actual vaccines. Now I’ll be honest-Thinking back to my immunology days in medical school is not a pleasant memory--the pathways, the numbers, the charts, the various cells in the body, their specific tasks, the list goes on and on! The immune system is an incredibly intricate but super capable system in the body. People have been researching it extensively for over 90 years, and we still don’t think we’ve begun to tap into the potential of what the immune system can do. In fact, only in the last 10-15 years have we begun to use antibodies for cancer therapies. Our body’s immune system has the capability to recognizing thousands and thousands of antigens at one particular time and make the right decisions about what it needs to do. Anybody with an auto-immune disease can tell you that therapy can be complex because physicians have to find a way to overcome the body’s immune system which is probably the best multi-tasker ever known. So rest assured, the body has developed the ability to be exposed to multiple antigens and figure out how to address each one independently to mount an immune response.
Now to focus on the actual vaccination schedule by the CDC. The CDC schedule (which is what all adult and pediatric physicians make their vaccine recommendations on) was based on large amounts of information obtained via multiple studies to support one important fact- The vaccines when given together result in the same level of response as if they were given separately. So there's no advantage of separating the vaccines out with respect to the ability for the body to see them and develop a protective response. As I mentioned earlier, if you do spread them out, you're just making your child stressed more frequently. Not to mention, by spreading out vaccines, you are also increasing the chances of your child contracting one of these invasive infectious diseases. The CDC schedule is a proven recommended schedule and any alternative schedule is unproven and therefore, not recommended. Alternative schedules will remain unproven because it would be unethical to study any alternative schedule that does expand the time between vaccines because it would a large number of children at risk. For example, a child in the study could get liver failure from Hepatitis B, simply because his vaccination time was prolonged for the sake of studying an alternative schedule. An alternative schedule carries a very high risk of putting children’s lives at risk.
So before we talk about the antigens within a vaccine, I think it’s important to point out a key point for perspective. If somebody gets a strep throat, the amount of antigens that they get exposed to by the streptococcus being there actually far exceeds how many antigens with all the vaccines we have together put in one. We have made large strides in vaccine development. Across the board, if you look at how many antigens we present to the body via vaccination today compared to 50 years ago, it is many times lower because of the processing of the vaccines now allows companies to reduce the number of antigens. For example, the pertussis vaccine in the 1960’s used the “whole cell” form of the pertussis vaccine. Today, we use the “acellular” form, which actually contains much, much less of the bacteria and actually decreases the risk of febrile seizures that used to be associated with the older vaccine, making it an even safer injection.
Lastly, one crucial point I like to review with my parents is that the vaccine uptake rate in this country. When I ask parents, many guess that it’s 60-75%. It’s actually closer to 90%.
I think even just letting parents know that it's not just the majority of parents, but a vast overwhelming majority of parents vaccinate their kids, helps make this decision clearer. I want to help parents’ minds feel at ease and know that they are doing something right by their child. I also try to have a discussion on vaccines before there is a needle anywhere in the room. I don’t want parents to feel pressured, but instead, educated and armed with the accurate knowledge. If you have any questions, make sure to contact your child’s pediatrician so you can rest assured that you are taking the right decision for them.