Vaccines & Trumpism

"A foreign substance is introduced into our precious bodily fluids without the knowledge of the individual. Certainly without any choice. That's the way your hard-core Commie works." General Jack D. Ripper, in Stanley Kubrick's Dr. Strangelove

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Let's talk about vaccines for a bit — even though doing so in public forums always risks going down a rabbit hole of anti-science, conspiracy theories, and endless random nuttiness.

That doesn't happen in truly scientific and medical forums, as such people are trained to look at evidence and draw conclusions from there. And the conclusions are conclusive — that vaccines have saved so many lives that they are one of the top discoveries of human history and that the downsides of them, in terms of some negative reactions, do exist but are utterly dwarfed by the collective benefits.

Yet controversy continues in some circles (understatement of the week, that). This has always been true — reading objective histories of vaccination reveals an ongoing theme of emotional objection going back centuries now — but in the past couple of decades the objection has been fired up by the wholly-discredited autism non-link to vaccines, new laws requiring some vaccines for school kids, and now by, of course, Donald Trump and his seemingly random Tourette's-like talk of putative vaccine problems.

Trump apparently has considered creation of a vaccine commission, including or even chaired by Robert Kennedy Jr., an attorney who has done great environmental work but who has no scientific training and has started from wholly erroneous scientific misinformation on his own statements on the topic (and had one of his own articles withdrawn due to such falsehoods). Kennedy announced he would serve but Trump's people said, no, not so fast. Anti-vaccine people jump at Kennedy's endorsements though, and at the prospect of such a panel, even though existing such groups at the the Centers for Disease Control and Prevention already exist and follow a scientifically rigorous and open process to evaluate all aspects of vaccine safety. (and yes, anti-vaxxers cooked up a so-called "whistleblower" scandal at the CDC, also fully discredited — even by the supposed whistleblower). But if you don't like what the real expert consensus is, go find somebody of your own liking, with little or no relevant expertise — that seems to be the Trump model in general.

It makes a perverse sense that Trump might embrace anti-vaccine views, given that he also rejects climate science consensus, seeks to destroy all environmental regulations, and gut healthcare itself. In 2012, Trump tweeted (of course) that vaccines constitute "doctor-inflicted autism." He's met with the guy who reignited the modern anti-vaccine movement, Andrew Wakefield, a man so scientifically and ethically challenged that his research was judged fraudulent and unethical, then withdrawn, his medical license stripped, and the fact revealed that he had big financial interests in what he was doing, with his writing sponsored by attorneys who planned to sue vaccine makers. But he attended one of Trump's inaugural balls, where he no doubt fit right in. At least two other of the most-mentioned anti-vaccine "researchers" have similar histories of withdrawn papers and financial conflicts.  But they still publish in the growing number of bogus journals where anybody can pay to get their so-called "research" out there to fool the gullible. And these are the guys who say "big pharma" and the entire medical and public health professions are corrupt about vaccines. The irony here is monstrously huge.

Now, I'm no fan of the pharmaceutical industry's marketing and other practices, and some of my work is focused on the problems of toxic chemicals, but again, vaccines are non-controversial not only in scientific circles, but among the majority of the public; a recent PEW survey shows that 82 percent of Americans support requiring students in public schools to be vaccinated for measles, mumps, and rubella, at a minimum, with almost nine of out ten saying the benefits outweigh any risks. Not only that, but in these fractured times, Republicans and Democrats are about equally likely to support a school-based vaccine requirement — how often does that happen?

The pollsters note that among those most opposed to vaccines, "low scientific background"/lower educational levels in general and non-white ethnicity are factors. The former is obvious, and overlaps the latter in many cases. Among the latter, distrust of authority in general and healthcare systems in particular are factors, and have often been justified — but not with respect to vaccines. But it's an interesting fact that anti-vaccine sentiment (that's what it is) is somewhat "U-shaped" with respect to socioeconomic status — the poorer and richer are more susceptible to this infection, for various reasons. "New age" and organic-types can be more likely to suspect vaccines, while also being willing to pay for and ingest all sorts of untested and unproven "supplements" — which, unlike vaccines, have been shown to include items like rat feces, lead, and so on, and perhaps to smoke pot laced with pesticides and other unknown but demonstrably unhealthy substances.

Controversy in California has been heightened by a new law requiring kids to be vaccinated to enter public school, absent valid medical exemptions (not "personal belief" ones). A small vocal group protested loudly that this was "forcing" kids to be stuck with needles and toxics; but actually, it just forces parents to make responsible choices, as nobody is going to hold a kid down to vaccinate them. But the state senator who authored the bill, a pediatrician, was subject to death threats and a recall effort that was so feeble it went nowhere.

Meanwhile, resurgence of vaccine-preventable diseases in various areas are increasingly tied to more people foregoing vaccination for kids and sometimes themselves. No amount of both biological and epidemiological evidence seems to convince those with a PBF (Precious Bodily Fluid) conspiracy mindset. But, just for the heck of it, here is the conclusion of the most recent sweeping analysis of research, published in Canada in January:

We identified over 50,000 publications, but after ineligible studies were screened out, 315 articles remained. Most of these studies examined physiological factors, followed closely by chemical factors, and to a much lesser extent, nutritional and social factors, associated with Autism Spectrum Disorder (ASD). Despite a vast literature and many heterogeneous studies, several risk factors emerged consistently: chemical factors such as traffic-related air pollutants; physiological factors including advanced parental age, preterm birth, low birth weight, hyperbilirubinemia and clustering of pregnancy complications; and maternal immigrant status. Despite extensive research on vaccines, findings overwhelmingly demonstrate no support for an association with ASD.

Note that — NO link between vaccines and autism. Zero. But — notably — consistent links with air pollution and some more personalized factors. There is vast research underway regarding autism factors, with vaccination now discarded as one of them. Pollution, though, as noted, remains in the running. Anti-vaccine advocates concerned about autism could do much better by focusing on industrial and chemical pollution, regulation thereof, and the like — factors all likely to become much worse, or at least harder to deal with, under Trump (especially if he vanquishes the EPA).

This is not to say there are NO risks.  As a National Academy of Sciences report in 2011 noted, "An analysis of more than 1,000 research articles concluded that few health problems are caused by or clearly associated with vaccines. A committee of experts convened by the Institute of Medicine to review the scientific literature on possible adverse effects of vaccines found convincing evidence of 14 health outcomes -- including seizures, inflammation of the brain, and fainting -- that can be caused by certain vaccines, although these outcomes occur rarely."

A new report in JAMA notes "Vaccines are extremely safe and harm is rare. Worldwide, more than 30,000 vaccine doses are delivered per second through routine immunization programs, which, in turn, prevent an estimated 2 million to 3 million deaths annually. The occurrence of serious adverse events, such as those that result in death, threaten life, require inpatient hospitalization, or result in significant disability, are rare (eg, <1 adverse event occurs per 10 million doses for tetanus toxoid vaccines, 1-2 adverse events per 1 million doses for inactivated influenza vaccine, and none for hepatitis A").

That's safer than just about any medical or other intervention extant. But the authors still endorse a global vaccine injury compensation system to pay for those rare negative impacts — a system now existing to some degree in some places — and misconstrued by anti-vaxxers as tacit admittance that vaccines are dangerous -which can only be argued from a point of statistical ignorance.

350 medical, public health, and yes, autism organizations just wrote to Trump urging him to follow real science and not alarmist conspiracy theories. They included many references and other resources; hopefully somebody in the White House might read it to him (since he's proudly says he doesn't read much, not that this wasn't already obvious). But he should also be read a new article by journalist Laurie Garrett, who first became renowned in 1995 with her book The Coming Plague: Newly Emerging Diseases in a World Out of Balance. She also wrote a book on anthrax and articles on ebola and bioterrorism and earned a Pulitzer. In January, the journal Foreign Policy published a scathing piece of hers titled Donald Trump and the Anti-Vaxxer Conspiracy Theorists. A few excerpts follow, but the entire piece deserves reading:

Things are getting down and dirty now. And millions of lives are at stake. I cannot possibly state strongly enough how dangerous it is that President-elect Donald Trump has embraced the notion that vaccination is the cause of autism...

I bitterly recall walking through pediatric wards in northern Tanzania in 1983, filled to capacity with tiny children, covered in measles rash, fighting for their lives.... But since 2000, measles vaccination has spared 17.1 million children's lives. If worldwide contributions to vaccine efforts stay on course, the combined impact of all immunizations from 2011 to 2020 will be 23.3 million lives saved, most of them babies...

Trump should know that the most virulent anti-vaccine force on Earth is the Taliban, which has executed, bombed, kidnapped, and maimed about 10 times more polio vaccinators in Pakistan and Afghanistan since 2005 than there are children who have contracted polio. In Nigeria, Boko Haram has blocked immunizers and spawned outbreaks of polio and measles...

Mumps outbreaks are cropping up all over the USA, according to the Centers for Disease Control and Prevention. Measles caseloads are also increasing, and more than half are linked to parents' refusal to vaccinate. Whooping cough, or pertussis, is soaring across America – another disease prevented with proper vaccination...

Vaccine-refusal rates are highest in American communities of wealth, such as Marin County, California. Those school districts are most likely to have elected boards of education that offer families opportunities to opt out of immunization, while still enrolling their youngsters to sit with other children in the classroom... 

They are, of course, wrong. Unimmunized children are already growing up, going to college, and falling victim to whooping cough, measles, mumps, and other microbes lurking in their dormitories, gyms, and elsewhere... 

Taking any steps that lend credence to the anti-vaxxers' conspiratorial fears will only prompt more parents to resist giving their children the same life-saving treatments as were given to them, decades ago. Shame on anybody who would dream of putting children's lives at risk, all over the world, for the sake of political expediency or the fears of rich white people.

Strong words. But true ones, too. Somebody should inject them into the awareness of our so-called President.