In my morning internet wanderings, I found a couple of articles at Mothering about whooping cough. The first was by Lauren Feder, MD, and the second by Jay Gordon, MD. I have things to say about both of them, but right now I’m going to talk about the second one.

It’s not quite clear to me what Dr. Gordon’s goal with this article was. The entire thing seems to boil down to “there’s a lot of uncertainty and disagreement in the medical community, talk to your doctor.” For the most part it just seems to muddy the waters. But after reading it, and particularly these parts, I want to talk a bit about the how and why of vaccination programs.

If vaccines work—and I believe they do—then vaccinated children are not endangered by unvaccinated children.

…points out that vaccinated children have still contracted whooping cough. The reasons for this include the bacterium adapting to the vaccine and thus negating its protection…

I think the phrase “adapting to the vaccine” is misleading, it kind of suggests that the vaccine sits around in your bloodstream waiting for an infection to stop. In fact a vaccine appears, from your immune system’s point of view, to be a genuine infection. Your body learns to develop anti-bodies to combat such an infection, so that later when the real thing shows up it’s already prepared. Sort of like training an army to fight against a specific enemy or specific tactic.

Now germs do evolve, for example the flu virus mutates so quickly that last year’s flu shot won’t offer much protection against this year’s strains. So the phrase isn’t meaningless, just a poor choice of words if you’re a stickler for detail like I am.

Also “If vaccines work” is a loaded phrase, because we know damn well that the concept is sound and at least some do. Just ask smallpox. But it sort of lumps them all together, doesn’t it? Every disease is different, and there is often more than one vaccine developed for a disease. You can’t consider them all the same thing, each vaccine is different. It’s easy to forget that in discussions like this.

Dr. Gordon also talks about side effects, when he should really be saying potential side effects. I don’t know if he’s really trying to discourage vaccination, but it does kind of feel that way. Looking him up elsewhere on the internet he claims to not be anti-vaccination, and yet his own words suggest otherwise, more about that later. Here’s the CDC information on possible side effects from the pertussis vaccine.

Nobody wants to think that they hurt their child. Adverse reactions to vaccines do happen, and it’s easy to think that this is worse than if the kid got sick naturally, because our own actions led to it. I can understand the feeling, but your child still has better odds if you vaccinate.

You should understand that getting a vaccine does not guarantee immunity, they’re not 100%. Maybe that particular dose was a dud, maybe your immune system dropped the ball, maybe the wrong planets were in retrograde for that phase of the moon, but for whatever reason, sometimes you can get vaccinated and still be susceptible, though usually more resistant. It’s not common, but it happens. If you’re thinking the whole thing sounds like a scam if it can’t guarantee immunity, you’re making the mistake of thinking of this on the individual level.

Vaccines aren’t for individual people, they’re for populations.

The concept is called “herd immunity“, and it’s not to difficult to visualize. The idea is that if enough members of the population are immune to a disease, then for practical purposes the population as a whole is immune. You might get the odd case here and there, but it won’t be able to spread, certainly not spread widely. This is why it’s important for as many people as possible to get vaccinated, so that their immunity will protect the people who, for whatever reason, cannot get the vaccine.

And I do mean protect. Dana McCaffery was only four weeks old when she died of pertussis, too young to be vaccinated herself. She might be alive today if vaccination rates had been higher, protected by the immune systems of her community.

But what about autism?

Although he doesn’t mention it in his article, Dr. Gordon is one of those who believe vaccines cause autism, so I might as well discuss that while I’m here. This is where I start to think he really is anti-vaccine, because that is the heart and soul of the autism/vaccine believers.

In 1998, one Andrew Wakefield published a paper claiming a link between the MMR vaccine and autism. Wikipedia has a good breakdown of events here. The short version is that Wakefield made it up.

He not only deliberately lied in a peer-review publication, enough to get any scientist ostracized for life, but he had undisclosed financial conflicts of interest and also involved children in his studies without proper ethical procedures. His work has been thoroughly discredited, the medical journal retracted the paper fully, and he has been barred from practicing medicine in the UK. Wakefield said it was a conspiracy. He’s moved to Texas and become something of a folk hero to the anti-vaccination crowd.

That last bit really angers me, because children are dead and right now children are dying, because this man lied. It may be hyperbole to say that Dana McCaffery would never have contracted whooping cough if not for Wakefield’s fraud, we can’t know that, but it’s not to say that children have died because of him and the panic he set off. He killed statistically.

Wakefield’s work attempted to establish a link between measles vaccines, measles-related gastrointestinal disorders and autism, and has been discredited. The other big claim, starting over here in the US about the same time Wakefield was falsifying research, was that autism was caused by heavy metals, specifically the ethylmercury in the chemical thimerosal which was used as a preservative. We would know by now if thimerosal caused autism, because it hasn’t been used in vaccines since 2000. (It was never used in the MMR, incidentally)

The only other suggested cause I can think of off the top of my head is the “too many, too often” hypothesis, which suggests that combo vaccines on a tight schedule are either interacting with each other harmfully, or overwhelming the systems of sensitive children. It’s by far the most plausible, but studies have found no link.

Science does not happen in a vacuum. After Wakefield’s paper in 1998, there was a flurry of research on vaccines and autism. No link has been found, no testable mechanism has been suggested. There have been a few papers that claimed a link, or at least a correlation, but they don’t stand up well under scrutiny, are vastly outnumbered by the dozens finding no link, and many of the empirical ones have Wakefield’s name on them. Fourteen years of study after study has failed to find a link.

So why do so many people believe there is one?

I’m sure a big part of it is parental fear and confirmation bias. Think about it this way, symptoms of autism first show up about the same time kids are getting vaccinated. Imagine that moment when you can no longer convince yourself that there isn’t something weird going on with your child. Some of you don’t have to imagine, I’m sure. Picture it in your mind, the fear that you don’t know what’s happening to your child, the dread that it might be your fault, the terror that your loved one is going to get worse and worse. You’re going over everything that’s happened, trying to think of something you could have done differently, trying to find a cause. Well, there was that vaccine… But memory is treacherous, once we decide that it started here, we might forget some incidents that happened earlier, or rearrange them in our mental timeline.

It doesn’t make you stupid, or dishonest, it’s just something people are prone to doing. The kind of mistake we make easily. Once the possibility of a link was in the public consciousness, it’s really no surprise that parents started being sure their child first showed symptoms right after vaccination, even when there’s documentation that they started earlier.

There are also people making money. I’m not going to say they’re all dishonest, probably most of them genuinely believe that they’re helping, they’re making a living doing real good in the world. When you make your living doing something you care passionately about, it can be very easy to brush off critics without really listening to them, partly because you’re so sure you’re right, so why bother listening, and partly because of how devastating it would be to learn that you were wrong. I get that.

But deliberately or not, these people do a lot of harm with dodgy treatments and even more just by spreading misinformation. It’s especially confusing because there’s often a little grain of truth, just enough to muddy the waters. For example, I don’t think it’s possible for drug companies to manufacture the kind of cover-up needed for the conspiracy against Wakefield to be real, and I don’t think it would be profitable for them to do if they could, but I honestly wouldn’t put it past them to do something that dirty for profit. They really do seem to be exactly that bad.

Something I found interesting, during my quick & dirty Google research for this essay, was the vast difference in results you get if you search for a link between vaccines & autism, or if you search for the cause of autism. Vaccine searches were filled with controversy, about half and half results of “link found” and “no link found”, heated discussions and flame wars and shit flinging. Searching for causes of autism alone, though, found almost entirely uniform answers in the tone of “We don’t know, but right now it looks like it’s genetic.”

I’ll be honest, though, even if it were true that some or even all vaccines cause autism in 1% of those who get them, I’d still vaccinate and recommend every else does, at least until we can find something better. Because higher autism rates would still be a much better world than the one that needed these.

Polio ward in Rancho Los Amigos hospital, 1953

Most of the patients in those iron lungs were children, and most of them spent the rest of their lives in those machines, unable to breathe on their own. Autism would seem a small price to pay in comparison, but it seems probable that we won’t have to pay that, because there’s no good reason to think that vaccines cause autism.