1. Haters Gonna Hate. And Post. A Lot. You can find anything on the internet. Anything. If you want someone to validate your distaste for cute, cuddly, perfect Cocker Spaniel puppies, just Google it. You’ll probably find an article called “20 Things I Hate About Cute, Cuddly, Perfect Cocker Spaniel Puppies” in about 2.2 seconds. It will be full of compelling reasons to hate puppies and, if you weren’t a puppy hater before, by the end of the article you’ll certainly be considering it. It’s easy to find both sides of any argument on the internet. And it’s even easier to share said argument with 500 of your closest friends. Most of the time, the articles are well written and authoritative. Most of the time, they are nothing more than opinion pieces written by someone who lacks the credentials to have an actual opinion. (Case in point: former Playboy model Jenny McCarthy. Yes, I went there.) Harsh, I know, but true. Admit it.

2. Haters Wanna Benefit from Everyone Else. Haters be like “I got Herd Immunity.” Aww, nah. Herd immunity is like that lane on the interstate that’s closed 500 feet ahead. There’s always that one guy who drives up the lane and cuts in at the last second, causing all the cars behind him to have to slow down. Dude. It’s 7:50 on Monday morning. Everyone is running late. You are no more important than anyone else on the road right now. Notable exceptions are as follows (in no particular order):

1. The pregnant woman in active labor, extra points if the baby is crowning. Negative points if the woman is driving herself—that’s just all kinds of dangerous.

2. Any emergency vehicles (this is an obvious one), especially if they are going to fix the problem that got the lane closed to begin with.

3. The unfortunate sufferer of food poisoning, viral gastroenteritis, or even an especially bad flare-up of IBS.

4. The person who will suffer serious consequences if they are late. This category is on the honor system. You usually know deep down if your situation justifies trumping everyone else on the road. Examples include those going to a job interview, an important meeting, his or her own wedding (e.g. the bride or groom – everyone else in the wedding party is going to have to roll in late).

But I digress. Herd immunity, where enough people are immune that an outbreak doesn’t occur in the first place, is to be enjoyed only by those who can’t safely get vaccines. I’m talking about the immune-compromised, the very young, the seriously allergic, the pregnant (in some cases, not all). Otherwise, it just doesn’t work. The goal vaccination rate for the total population is 90-95% for herd immunity to work. We got a first-hand look at this breakdown in herd immunity with the 2015 outbreak of measles beginning in California. It can be quite scary for those of us with children too young to be vaccinated.

3. Haters Don’t Really Get It. They be like “Vaccines are bad for you.” This is actually a three part argument.

3a. Haters say vaccines give you the infection you’re trying to avoid. We’ve all heard some iteration of the following: “I never got the flu until the one year I actually got the flu vaccine.” Seems like a compelling argument. Either the vaccine gave your friend the flu or, at the very least, it didn’t protect him against it. Here is an example of similar logic: I got in a car accident while wearing my seatbelt and suffered an injury. Oh man, must have been because you had the seatbelt on. Or at the very least, the seatbelt didn’t protect you. Or what if the seatbelt actually caused the accident?

Everyone reading this can appreciate the flawed logic in the above statement. There is no cause and effect. Just coincidence and perhaps some unrealistic expectations. And while the seatbelt may not have kept you from getting injured, it may have just saved your life. The flu vaccine often keeps one from contracting the flu in the first place, but it also lessens the severity of the illness in those who get infected despite receiving the vaccine. In the case of the flu, this protection is often as important as the prevention aspect. Some years, despite their best efforts, the vaccine developers don’t get the match quite right because of mutations that occur after the strains are chosen for the vaccine.

And as for whether the flu shot causes the flu, it doesn’t. It just doesn’t. While the intranasal form of the vaccine has a theoretical risk of causing a flu infection (because it is an altered form of the live virus and therefore has the afore-mentioned propensity for mutation), the injection is a dead virus. And viruses are not zombies. They do not come back alive for one last hurrah terrorizing humans.

There are over 300 million people in this country. Everyone has heard a story from someone about the flu shot “making them sick,” but in the end it’s all about odds. They were going to get sick, anyway. It’s just coincidence. And if it was at least two weeks after the shot, then they can be grateful because it could have been a lot worse.

3b. They say vaccines cause autism: This is the argument that’s gotten the most press recently. Autism rates have increased at alarming rates over the past two decades. Over the same time period, the number of recommended vaccines has increased. Again, correlation does not prove causation. A lot has changed in that time frame. One notable change was in the criteria used to diagnose autism. Another was in provider awareness of the disorder. These two things don’t actually change the prevalence of a disease, they just change the perceived prevalence.

A now infamous study by Andrew Wakefield claimed to show a connection between vaccines (specifically, the MMR vaccine) and autism. Usually, doctors evaluate the quality of a study based on its ability to prove its hypothesis by how well it was designed: were there enough patients? Was it randomized? Was all potential bias removed? You get the point.

However, this study failed on several more serious counts. The study authors began the study in an attempt to provide a basis for a lawsuit to win money. That’s just a bad start. Then, patients were recruited by an anti-vaccine group. This is an example of selection bias. Then, medical records were intentionally falsified. Wait, isn’t that?…Why yes. Yes it is quite illegal. It’s called fraud. And that’s why the article was retracted by the original journal in which it was published.

But people still want to trust lying, cheating Andrew Wakefield over the doctor they have chosen to care for their child in all other aspects. The doctor who has taken a Hippocratic Oath to “first, do no harm.” The doctor who, dollars to donuts, has vaccinated the crap out of his or her own children. Yes, there are bad people in medicine. Just like there are bad people in every profession. But the law of probabilities would argue that we can’t all be bad. If it’s true that the entire medical community can’t be trusted, then society has much bigger problems than anyone realized.

As a side note, the preservative thimerosal has also received a bad rap lately because it contains mercury in very small amounts. Again, there has been no literature to prove a negative effect of this, but as a precautionary measure, the AAP/USPHS recommended removing thimerosal from several vaccines to reduce the cumulative exposure over time. So to recap, the regulatory boards recognized a potential health risk, albeit one that had not been proven, and decided to err on the side of caution and eliminate the possibility of this preventable risk.

3c. Haters say vaccines overwhelm the immune system: Some worry that children are exposed to too many antigens at once, that it weakens the immune system or causes it to be oversensitive and lead to illnesses such as autoimmune conditions or asthma. Again, there is just no evidence to support this.

Anyone who knows me knows I am a huge proponent of letting my children eat dirt, lick the floor, etc. I wholeheartedly believe we shouldn’t follow our children around, sterilizing each surface they come into contact with. There is a benefit to challenging their little immune systems so they aren’t completely taken off guard when they finally come into contact with a more dangerous bacteria or virus.

But a vaccine is a challenge to the immune system in the purest sense. It simulates a “first” infection so that it will then respond much more quickly if exposed a “second” time. Scientists figured out this is the way immunity works and used it to our advantage. Science is awesome that way.

And while I do believe in encouraging natural exposure to infections at an early age, if given the opportunity to test this theory with potentially fatal illnesses in my children, my answer will always be, “Thanks, but no thanks.” I’ve seen enough to know better. In my opinion, that would be akin to letting child jump off a 100 foot bridge to teach him not to jump off 100 foot bridges in the future.

If you’re still not convinced, I’ll share this interesting fact: with ongoing vaccine development, the number of antigens children are exposed to today is about 10% of what it was in 1980.

4. Haters haven’t learned from the past. They think vaccines are irrelevant. Who’s scared of polio, anyway? Do you even know anyone who has polio? Exactly. But let me assure you, people used to be plenty scared of polio. And the measles, mumps, rubella…I could go on, but in the interest of time I won’t. Everyone has a grandparent or great-grandparent who had a sibling or child die when he or she was a child. The cause of death for most of these children, if it didn’t occur during childbirth, was usually some sort of infection. In fact, the leading causes of child mortality in 1900 were infectious diseases—a whopping 61.6%. In 1998, death attributable to infectious disease was only 2%. During that same time period, the absolute death rate plummeted from >3% to <0.2%, reflecting an even greater absolute (total) reduction in infectious diseases. While this decline reflects many changes during that time period including improved antiseptic techniques, antibiotic development and cleaner living conditions, vaccines played a major role in this shift.

And, lest we forget that not all vaccine-preventable infections end in death, other potential consequences include but are not limited to hearing loss, increased susceptibility to other infections, encephalitis, pneumonia, ear infections, bronchitis, dehydration, vomiting, difficulty breathing…it’s a little reminiscent of the disclaimer at the end of a Viagra commercial, isn’t it?

5. Haters say doctors just want to give a bunch of medications.

Vaccines are actually a prime example of preventative medicine. Yes, they come in a vial. But when used correctly, they significantly lower the need for hospitalizations, antibiotics, and other therapies. Like a healthy diet and lifestyle, in an ideal world, vaccines should lead to fewer doctor visits and interventions.

In conclusion, medicine is not black and white, as much as we would often like it to be. There are times when we have to choose the best for our patients based on a risk-benefit analysis. And based on the information available, the benefits of getting vaccinated far, far outweigh the risks. And so we will carry on, spending extra time educating our patients, cringing when we hear of the next outbreak that could have been prevented, and praying for the children and the parents of the children who fall ill or even die from a preventable illness.

Disclaimer: The opinions expressed in this blog post are not meant to offend, but to reinforce proven information in an entertaining way. The facts presented in this blog post are facts.

The following resources were referred to during the preparation of this post:

CDC.gov

Deer B. How the case against the MMR vaccine was fixed. BMJ 2011; 342:c5347. (An interesting article by the investigative reporter who uncovered Andrew Wakefield, et al., had committed fraud.)

DeStefano F, Price CS, Weintraub ES. Increasing exposure to antibody-stimulating proteins and polysaccharides in vaccines is not associated with risk of autism. J Pediatr 2013; 163:561.

Guyer B, Freedman MA, Strobino DM, Sondik EJ. Annual summary of vital statistics: trends in the health of Americans during the 20^th century. Pediatrics. 2000 Dec; 106(6): 1307-17.

Iqbal S, Barile JP, Thompson WW, DeStefano F. Number of antigens in early childhood vaccines and neuropsychological outcomes at age 7-10 years. Pharmacoepidemiol Drug Saf 2013; 22:1263.

Lieberman JM. Myths regarding immunization. In: An Ounce of Prevention: Communicating the Benefits and Risks of Vaccines to Parents. Infectious Diseases in Children. Slack Incorporated, Thorofare, NJ 2003. P.6.

Lyren A, Leonard E. Vaccine refusal: issues for the primary care physician. Clin Pediatr (Phila) 2006; 45:399.

Offit PA, Quarles J, Gerber MA, et al. Addressing parents’ concerns: do multiple vaccines overwhelm or weaken the infant’s immune system? Pediatrics 2002; 109:124.

Vaccines.gov

Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351:637. (The original article “linking” vaccines and autism which was later retracted.)

*There have been many large studies and reviews showing no link between the MMR vaccine and autism, too many to list here. If you are interested, please contact me for a comprehensive list.