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This post was prompted by being involved in two discussion threads about immunisation yesterday, one on FB and one on Twitter (the latter still progressing). They’re not the first, and I very much doubt they’ll be the last. I started writing this as a FB post, and when it grew, decided it would be better here – partly because of its length, partly because I wanted to insert a couple of sources, and partly because this way it may have a wider audience. If so, I hope it’s useful.

To eliminate any doubt, I am a proponent of vaccinations – I have the fluvax every winter (and the one year I didn’t, through chance not intent, I contracted H1N5), and I paid to have a pertussis vaccination because there are small children in my life. Even if I wasn’t concerned about the health and welfare of my father (who’s on immunosuppressant medications for an autoimmune disease, and who had an emergency splenectomy three years ago, so is double compromised), my infant nieces (born early and living in one of the lowest vaccination areas in the US), myself and my colleagues (daily exposed to infectious disease, sometimes undiagnosed on presentation), and my patients (transplant recipients, people with cancer, people with diabetes, people with autoimmune disease, people with HIV), I’m concerned about my community. As a tax payer I’m concerned about the massively higher cost of treating, rather than preventing, these diseases.

And as a nurse…
VaxIt’s clear that many people who oppose vaccinations do so out of fear and concern for their children’s safety, and I understand how, if you haven’t seen these rare-but-returning diseases, the threat of some nebulous something bad happening that you facilitated feels more real than childhood illnesses like chicken pox that you had and survived intact. Vague theories about herd immunity, and protecting other people’s children feel a lot less important than the safety of the child in front of you – your child.

And a lot of the components sound alarming – until you realise that formaldehyde is also made by your body, and is present in far higher quantities in everyday foods, like apples and pears.
Formadehyde - pears

“But,”I’ve been told, “that’s naturally occurring formaldehyde, not synthetic.” In some cases that may make a difference – at a molecular level (and formaldehyde’s a molecule), a molecule’s a molecule.
Formadehyde - synthetic vs natural
Or that the foetal bovine serum is a growth medium for live culture, present at miniscule levels within the attenuated virus, and that insulin used to be manufactured from porcine and bovine sources. Or that insulin today contains “glycerol, phenol, meta-cresol, zinc chloride, dibasic sodium phosphate dihydrate, sodium chloride, sodium hydroxide, hydrochloric acid” but we don’t see people refusing insulin until they have proof it’s safe. (Here’s a FDA link explaining why vaccination components are needed).

While many of us would be ashamed or embarrassed being labelled illiterate, there’s sometimes a kind of pride in being innumerate (mathematically illiterate or sub-literate), and the same, perplexingly, goes for scientific illiteracy. We can’t all understand my astrophysicist brother-in-law’s research (I certainly don’t), but fundamental scientific knowledge should be, well, fundamental – like the fact that everything’s made up of chemicals, even natural, unadulterated, organic, raw food.

 

Chemicals

Chemicals are not, as a group, dangerous, scary, undesirable, or possible to avoid. Their names can be long and complex, but they’re part of everything around us, and they are us.

The people writing this skewed information have to know that, while its true a high salt diet causes hypertension in genetically prone adults, alarmingly listing ‘sodium chloride’ as a “Toxic vaccine”ingredient, with the described effect of “Raises blood pressure and inhibits muscle contraction and growth” when it’s present in a smaller amount than is in a handful of corn flakes, is at best misleading, and almost certainly false. They certainly know that vaccinations aren’t “injected directly into the blood stream,” too – as everyone who’s ever received any vaccination knows, they’re injected into muscle, in either the upper arm, thigh or (rarely) buttock.

If their evidence of risk is robust enough to mean parents shouldn’t immunise their children against the known and real risks of infectious diseases, why muddy the waters with clear distortion, mistruth and fearmongery?

Everything we do has an element of risk. We reduce that risk as much as we can, particularly when it comes to our children – the risk of death is only 1% of infants hospitalised with botulism, but we don’t give honey to babies under 12 months (even breast-fed ones, and even organic honey, even in tiny doses) because their gut’s immune system can’t fight Clostridium, even though most honey doesn’t contain it.

It’s true that vaccinations are not without risk. They’re as safe as we can make them, but there will always be some risk to some people. When it comes to vaccinations, most of the adverse reactions are mild – redness or low-grade (treatable with paracetamol/acetaminophen) pain at the site, low-grade fever, a harmless rash – and considerably milder than the disease they’re protecting against.

In very rare cases a person may develop anaphylaxis, a life-threatening histological response that causes swelling of the airway – this occurs almost immediately, which is why there’s an observation period after receiving any vaccination, and why immunisers are trained in anaphylaxis management. The rate of anaphylaxis for the measles vaccine is 3.5-10/1,000,000. There are also risks of febrile convulsion* (generally one, with no ongoing problems) at a rate of 1 per 1,150-3,000, and possibly a rare blood disorder, thrombocytopenia (source for both stats as before).

For comparison, I wanted to provide the anaphylaxis risk of other agents, including peanuts, bee stings and ant bites, but though their incidence (and the incidence of other food allergies) is increasing, particularly in Australia and New Zealand, actual risk-per-exposure figures don’t seem to be easily sourced – te closest I found was this update from the Australasian Society of CLinical Immunology and Allergy. I suspect that’s because vaccinations are more highly scrutinised than other potential allergens; whatever the reason, though I can’t provide figures, there’s no question the reaction rates are higher for these hazards, by many times, than even the mildest response from vaccinations.

However, we already know that facts rarely sway people who have made decisions based in part, or in whole, from emotion, particularly fear. Indeed, facts can make them feel attacked, and more strongly hold on to their position. So the two-fold points of this post (at last!):

The first is for people who are concerned that the risks of vaccination outweigh the risks of preventable disease:
– why do you mistrust the opinions of the overwhelming number of experts?
– conversely, why do you place more faith in the opinions of people who have, on the face of it, less knowledge and fewer qualifications?
– what kind of evidence or argument would give you cause to reconsider?
– are you opposed to/concerned about all vaccinations, or some?
– if the latter, why them?

And for those of us in health, government and public policy:
– what strategies can we utilise to enhance listening and engage concerned parents?
– how can we more effectively educate the public about the risks of diseases, and the comparative safety of immunisation?

If you’re reading this and have an opinion, whether you fall into one of these groups (concerned or practitioner – or both!), please comment – I value information about this.

And on a far bigger level – we must, must, must increase numeracy, scientific literacy, and critical thinking across the board. People who understand the concepts underlying theories (including herd immunity and climate change), who can assess statistics, and who can detect invalid arguments and faulty premises, are better equipped to make informed decisions about all aspects of their lives, from taking out short-term, high interest loans (the topic of another rant) to deciding on vaccination.

*I had a febrile convulsion as an 18-month old, as the result of a nasty cold – children under the age of two have more trouble regulating high temperatures than adults do. I had no complications, and have never had another seizure.

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