Skepticism and vaccines

If there were anything I could do as a scientist, it would be to clarify the role of skepticism. I’m a big believer in skepticism. I truly believe that it is the responsibility of every citizen in this society to clearly examine their opinions and decisions of our day to day lives. The things we buy, the people we vote for, and the values that guide our daily decisions all have very large implications for society as a whole. And this is no more apparent than in the decision of parents to vaccinate their children.

Hannah just got her one year immunizations, and even with my background it goes against all my instincts to let a stranger near my baby girl with a sharp instrument. I HATE Hannah getting her shots. But even worse would be her getting bacterial meningitis (Haemophilus influenzae B, Streptococcus pneumonia, Neisseria meningitidis), whooping cough (Pertussis), or measles. I understand that vaccines are overwhelmingly safe and have reduced childhood mortality to levels not before seen in human history.

An article came out in the Globe and Mail recently about dropping vaccination levels in the western world. In the US, 39 percent of parents admitted to delaying or omitting at least one vaccine. One quarter of these parents said that their decision was based on fears of the vaccine causing autism, a worry that has no scientific basis (Fewer Toddlers getting all their vaccines, CDC says). However, the dropping levels of vaccination are reducing herd immunity, meaning that there are now sufficient numbers of unvaccinated children to support outbreaks of diseases that had become extremely rare.

The story of how vaccines came to be the autism movement’s favorite whipping boy is fascinating, and succinctly retold in the blog tallguywrites. In short, in 1998 Andrew Wakefield was the lead author on a small study published in the Lancet examining the link between the MMR (measles, mumps and rubella) vaccine and the onset of regressive autism. The study involved twelve children and the anecdotal recollections of their parents. The study was tenuous, at best, and concluded that there was not enough evidence to support a link between the MMR vaccine and autism. However, at a subsequent press conference, Wakefield recommended separating the combined MMR vaccine into single doses to multiple doses in order to protect children against autism. Without disclosing the conflict, in fact he had patented a single dose vaccine, which would have been of no interest if he hadn’t scared parents out of using the triple dose vaccine. Furthermore, he had been paid by a lawyer to find a link between the MMR vaccine and autism in order to further a law suit. Finally, he subjected the 12 children in the study to unnecessary and invasive medical procedures including lumbar punctures and colonoscopies. Wakefield was stripped of his medical license, settled a malpractice suit stemming from severe complications arising from his tests on an autistic child, and in 2010, the Lancet retracted his paper.

And yet, children are still not getting the required vaccines, and fears over autism are widespread.. Typically, as scientists, we often think of people who refuse vaccination as, frankly, stupid. I still insist a decision to not vaccinate your child is stupid, and that only in the age of vaccines do we have the luxury of forgetting how perilous childhood used to be due to these infectious diseases. But there’s more to the issue of why parents refuse vaccination and parents who refuse vaccination cannot be dismissed as paranoid hippies or conspiracy theorists. Clusters of non-vaccinated children are often located in affluent neighbourhoods, and have well educated parents. People who should be able to interpret evidence are not doing so.

In our generation there are few people who remember what childhood diseases were like and how risky childhood used to be. What people do remember are the numerous and serious scientific missteps of recent ages: thalidomide, BPA, Vioxx. We are a generation who have been lied to by many authorities, and distrust is a healthy modern virtue. Also, science deals with the probability of disease drug side effects on a population level, while medical decisions are profoundly personal (Vaccine Anxieties, Bulletin of the World Health Organization, 2008, 86). All of these reasons factor into a complex issue that is quickly becoming a very serious public health problem.

In this debate, as tempting as it is to dismiss vaccination fears as irrational, it clearly is not helping. As distasteful as it seems, fears of vaccines are concerns that the medical community has to take seriously. The drop in vaccination rates cannot simply be dismissed as people believing the research of one shockingly unethical doctor published 12 years ago. Vaccination fears are borne on a wave of profound distrust of science and authority that has a rational basis.

We’ve all heard that scientists need to communicate their findings better. But what that means is not simply describing “what you’re researching and why it’s important” but the more subtle and crucial distinctions of the scientific method: what’s my evidence, what’s the uncertainty, what are my assumptions, and how do they figure into the conclusions. This issue shows that it’s not just communication of the results that failed, but how to interpret the science that failed.