Vaccines

Last week at my preceptor visit, a boy came in the office for his yearly check-up. The doctor assumed the child would be receiving his flu shot until the mother broke in, "No. Not the flu vaccine! We go through this every year." The doctor tried to quickly give the spiel as to why it's good, why it's safe, etc. but the mother would have none of it. The doctor conceded this fight - she had more people to see, this kid was fairly healthy and this mom was very stubborn.

While the doc went to answer a phone call, I sat in the waiting room. The mom from earlier came into the room with her son and found another woman that she knew, who was taking her daughter to a similar appointment. Somehow the topic of vaccines came up and Mom #1 told Mom #2 that she had refused to let her son get it. Mom #2 exclaimed, "Oh! I didn't know you could do that. I've never really liked the idea." Sure enough, ten minutes later the doctor came back to the office complaining that yet another person has refused the flu shot. The patient herself had refused, but the mother hadn't insisted either.

This little bout of contagious denial is incredibly frustrating for anyone with a background in public health. It is so easy to convince someone to opt out of vaccinations and so hard to fight back. No one likes vaccines themselves. You get stabbed with a needle, your arm usually hurts, some people don't feel 100% in the following days and, with a disease like the flu, you sometimes get sick anyways. I can't prove to you that you personally avoided getting the disease, or that you avoided passing it to your family. I can't prove to you that if you did get the flu, it was less severe.

All of the benefits of vaccines are statistical. If a large percentage of the public gets a vaccine, disease rates go down, death rates go down, and the duration and severity of illness is decreased. These benefits are proven in enormous, comprehensive studies which are repeated every few years. The same studies look at side effects. Yes, there are side effects. Some, like soreness around the injection site and a mild fever are fairly common; others, like deadly allergic reactions are so rare they can barely be shown as anything more than a statistical fluke. But on average, these reactions pale in comparison to effect of the diseases being targeted.

Take the flu, the mildest disease vaccinated against. The flu kills between 3,000 and 49,000 people in the US a year^[1] varying greatly depending on the active strains. The majority of these deaths are in the elderly population, but even children, who are typically robustly healthy by comparison are susceptible. Between 50 and 200 children die each year of the flu^[2] in the US alone. Over 40% are totally healthy at the time of infection. Over a third die within 3 days. 84% were unvaccinated.

Furthermore, a vaccine-defender can find him or herself battling a Gish Gallop. This is a type of argument where an attacker rapidly spouts over-simplified falsehoods so quickly that a defender cannot keep up because each reply requires a nuanced explanation of a complicated issue. Here are a few common claims and (relatively) quick rebuttals:

• The risk from the vaccine is greater than that of the disease. Here are some data from the CDC comparing the risks for common diseases/vaccines:
• DISEASES
• Measles
• Pneumonia: 6 in 100
• Encephalitis: 1 in 1,000
• Death: 2 in 1,000
• Rubella
• Congenital Rubella Syndrome: 1 in 4 (if woman becomes infected early in pregnancy)
• Diphtheria
• Death: 1 in 20
• Tetanus
• Death: 2 in 10
• Pertussis
• Pneumonia: 1 in 8
• Encephalitis: 1 in 20
• Death: 1 in 1,500
• VACCINES
• MMR (Measles, Mumps, Rubella)
• Encephalitis or severe allergic reaction: 1 in 1,000,000
• DTaP (Diphtheria, Tetanus, Pertussis)
• Continuous crying, then full recovery: 1 in 1000
• Convulsions or shock, then full recovery: 1 in 14,000
• Acute encephalopathy: 0-10.5 in 1,000,000
• Death: None proven
• Natural immunity is better than vaccinated immunity. This one's tricky. Yes, natural immunity often lasts longer, but the added risks of a wild infection far outweigh any added risk of having to get a vaccine booster on occasion (see above statistics).
• Giving someone more than one vaccine at a time can overload the immune system. Compared to the amount of antigens that a person is exposed to daily, vaccine introduced antigen levels are very small. Also, an activated immune system is more capable of resisting additional infection, not less.
• Something something something... Sudden Infant Death Syndrome (SIDS). This myth shows the pitfall of our human tendency to confuse causation with correlation. Children receive their DTaP vaccinations at around the same time that SIDS deaths spike. The exact same proportion of kids who have and have not received their vaccinations die of SIDS. After extensive studying, no causal correlation has been found.
• Something something something... autism. No vaccine has ever EVER been shown to cause autism. The one guy who published the one paper was shown to have purposefully altered the data. The paper was redacted and the guy fired and disgraced.
• Big Pharma/doctors/etc are making tons of money off all these vaccines. Nope. If the medical industrial complex wanted to make more money, they'd hold off on the vaccines and treat patients for the conditions they'd develop. Vaccines are so unprofitable, only a handful of companies even manufacture them anymore. The big money for pharmaceutical companies is in chronic conditions like heart disease and arthritis.

Back in my preceptor's office, I tell the two doctors what I had seen in the waiting room and my preceptor's partner, being so fed up with this dangerous trend asks for the girl who refused her flu shot to come in and talk to her. The doctor starts by saying that she doesn't need to get the flu shot today, but then explains how dangerous the flu can really be, citing the same studies I linked to above. It's the best we could do at the moment. Hopefully next time she comes in, she will choose the shot, even if her stubborn mother doesn't understand the risks she is taking with her child.

If anyone has any unanswered questions regarding any vaccine, leave a comment or send me an email. I will happily research an answer and respond.