Vaccine Nation

 A Manual for Hesitant Parents and Polite Response To Vaccine Skeptics

Remember your grandmother
The years she was a little girl
There were classmates with polio
And measles, but not any more

Travel around the world
As recently as last year
Millions of children die
Of diseases vaccines can cure

You no doubt have known
Rumors and tales, cynics and fears
But I just like you, care for your child; I want you to hear
The data is clear, for vaccination, vaccination

What about thimerosal
It’s not in vaccines any more
And there’s much less aluminum
In shots than in breastmilk and formula

Don’t fear immune overload;
Total proteins have decreased 20-fold
Kids have the ability
To tolerate 100x more

In Denmark, half a million
Kids with MMR, had no more autism
My kids got vaccines on time,
I don’t make a dime.

This is a big topic – and I won’t pretend that I can settle all of the arguments in 2 verses, a chorus and a bridge.  For those of you who spend hours on websites titled “Vaccine Truth” and already have point-by-point rebuttals drafted in your heads, this song may not be for you.  For you, there are many websites (that I will reference below) that address the issues I raise in exhaustive detail.  I am also not going to engage in minutiae about obscure studies in the comments area of this page (although you, loyal reader, are welcome to!).   Of course, this should not be a problem since I generally get about 3 hits per day.  In summary, I’m just a general pediatrician – and this is just a broad discussion of a complex topic.

Rather, this song is mostly for those of you who are hesitant about immunizations and aren’t sure what to think.   Hopefully this information will give you a starting point for understanding why your provider is recommending vaccines for your child.  Of course, it’s also for you who agree with me – enjoy!

In this song, I think I address what I believe are the major themes for most parents who are concerned about their children’s immunizations.

Remember your grandmother
The years she was a little girl
There were classmates with polio and measles, but not any more

In case you’re wondering why your kid needs immunizations: here is some data from the Center for Disease Control (CDC) regarding the effectiveness of the immunizations that have been around for years (DTaP, HiB, polio, MMR).  This data is obviously nearly 20 years old – it’s not intended to give you accurate numbers of today’s disease prevalences.  Rather, I’m just trying to demonstrate the amazing effectiveness of vaccines.

The data for newer immunizations such as Prevnar (and the even newer HPV) is still emerging but thus far, encouraging.  Because Streptococcus pneumonia exists in many different strains and causes many different diseases, it’s hard to explain its effectiveness in a sound bite.  I’ll just say that Prevnar seems to reduce the amount of serious pneumococcal disease by 89% (this is from a 2009 article from the journal Pediatrics), and also decreases diseases such as ear infections and pneumonias – but by a lesser amount since these diseases are caused by lots of diseases other than Streptococcus pneumonia as well.

Since human papilloma virus (HPV) vaccine is so new, there are no studies showing how the world has changed since the advent of HPV, but I can say that the vaccine works (New England Journal of Medicine, 2007).  For those patients who have not yet been infected with HPV, the vaccine was 100% effective in preventing disease caused by HPV such as cervical cancer.   There was an interesting study in Pediatrics in July 2012 which demonstrated in one community that HPV vaccination not only decreased HPV in the vaccinated young adults, but also the unvaccinated ones (from 30% to 15%) – demonstrating herd immunity, the idea that vaccinating some of a community effectively protects unvaccinated members of the community by decreasing the overall disease burden.  That is, of course, part of the argument for immunizing boys as well as girls (even though boys won’t get cervical cancer).

I’m not going to talk about meningococcal vaccine – that one isn’t very controversial (everyone is against meningitis) and it’s not given to babies, so generally it flies under the radar.

I’m also not going to talk about the influenza vaccine; while it is occasionally controversial, being a yearly shot it is different than the childhood vaccines on which my song is primarily focused.  In short, I recommend the flu shot too – but there’s so much to say about this topic that it really needs a song of its own.  Fortunately, someone has already done that.  Obviously, Zdogg has a different audience (read: crasser) than mine, so be warned – and watch it yourself before sharing with your kids!

Travel around the world as recently as last year
Millions of children die of diseases vaccines can cure

You should also know that these diseases still exist throughout the world, primarily in areas with low rates of vaccination.  See the figure to the left from the World Health Organization.   Click here if you are wondering which countries fall into each the categories listed below.  The US is included in AMR.

What about thimerosal
It’s not in vaccines any more

Based on the questions I get from my patients, it appears that much of the controversy surrounding thimerosal (a form of mercury used as a preservative in vaccines) has gradually dissipated after the Andrew Wakefield article that started it all was debunked (I found this article in the British Medical Journal fascinating).  Moreover, in order to just avoid the argument all together, thimerosal is no longer in any of the immunizations that your child will likely receive (with the exception of injectable influenza vaccine from a multi-dose vial).  I’ll talk later about one of the many compelling studies demonstrating the absence of a link between thimerosal and autism.

And there’s much less aluminum
In shots than in breastmilk and formula

Okay, take a deep breath because this is the big one.  Many vaccine skeptics have moved on from thimerosal to aluminum as the object of their concerns.  They fear that the levels of aluminum that children receive in vaccination could potentially be harmful.   There is a huge amount of research (if you’re into reading hundreds of pages of toxicology on aluminum, check out – I read it for you – yawn!) on toxicity levels of aluminum.  Here it is boiled down for you: if your 12 pound child got all of his/her shots from her 2, 4 and 6 month immunizations all on the same day, it would still be less than the minimum risk level for aluminum for exposure in a day.  Of course, spread over 6 months, it is hundreds of times lower.  Additionally, these minimal risk levels are estimated conservatively – that is, they “may be as much as 100-fold below levels that have been shown to be nontoxic in laboratory animals.”  Here are these numbers in a pretty handout.

Another way of looking at it – we eat A LOT more aluminum every day than is in vaccines, even babies do!  A serving of cornbread apparently has about as much aluminum as all of the 2 month shots!  If you scan the toxicology link above, you’ll see the aluminum content of a lot of your favorite foods.  Above is the amount of aluminum your kids eat every day (again from the toxicology link).  In the charts above, you can also get a better sense of the relative amount of aluminum that is actually in the vaccines.

The quote below and charts above are taken directly from this article on the Children’s Hospital of Philadelphia’s (CHOP) excellent educational website.  Here is the quote:  “The aluminum contained in vaccines is similar to that found in a liter (about 1 quart or 32 fluid ounces) of infant formula. While infants receive about 4.4 milligrams of aluminum in the first six months of life from vaccines, they receive more than that in their diet. Breast-fed infants ingest about 7 milligrams, formula-fed infants ingest about 38 milligrams, and infants who are fed soy formula ingest almost 117 milligrams of aluminum during the same period.”

CHOP has this nice handout that summarizes and references some of the research on aluminum.  It also addresses one tricky point that vaccine skeptics pose – since 0.1% of the aluminum you eat goes into your bloodstream and 100% of the injected aluminum goes into your blood stream, how can we extrapolate safe levels of injected exposure from safe levels of oral exposure?   This is a new question (relative to thimerosal, which is now an old question), although it is partially addressed by the Agency for Toxic Substances and Disease Registry tome quoted above.  Here is a new study that addressed this.

My point, in short: while aluminum research is ongoing, thus far a large volume of research and reliable experts demonstrate that the small amount of aluminum in immunizations does not appear to be harmful to children.

Don’t fear immune overload;
Total proteins have decreased 20-fold
Kids have the ability to tolerate 100x more

This fear seems somewhat rational.  If vaccines are so great and generate such a robust immune response as to protect my child from these scary diseases, could giving them all at once be too much for my tiny bundle of joy?

Point #1 is straightforward: No, you can’t overwhelm their immune system: a baby’s body has the capability to tolerate 10,000 immunizations at the same time!  CHOP does a better job of explaining why than I could.

Point #2: While children are getting more actual needles in their thighs/arms than they did 50 years ago, improved vaccine technology has dramatically decreased the actual amount of immunity producing proteins and sugars that they are receiving.  So, in a sense, while the amount of diseases from which a child is protected from tripled between 1960 and 2000, the amount of actual vaccination that a child receives has decreased over 20 times.  See the chart below.

In Denmark, half a million
Kids with MMR, had no more autism

Here, I’m referring to a 2003 study in the Journal of the American Medical Association that looked at 467,450 children – approximately 1/3 of them got thimerosal containing vaccine and the other 2/3 received thimerosal free vaccine.  In just reading the study right now, I realize that I messed up the lyrics a little bit.  In Denmark, the only vaccine that contained thimerosal was pertussis; so the study was actually comparing children who received pertussis vaccine with and without thimerosal.  Oops – so it wasn’t MMR.  But, of course, pertussis doesn’t rhyme with Denmark – so that wouldn’t have worked!

Anyway, the children that received thimerosal actually had a slightly lower prevalence of autism than the group that did not receive any thimerosal.  I find this data compelling – if thimerosal really increased the risk of autism, kids that were injected with thimerosal should have had more autism – and they didn’t!  In my mind, this should close the case.  But in case that’s not enough for you – there are many more studies for you to read with the same findings.

My kids got vaccines on time, I don’t make a dime.

The first clause is just to prove that I actually believe what I’m telling you.  The second is to demonstrate that I don’t have a conflict of interest. . .

So, the money issue: Vaccine skeptics also sometimes make a big deal about the money people make from vaccines, suggesting that profits from vaccines have led organizations to push dangerous chemicals on the general populace.  I hunted around and saw lots of circumstantial conspiracy theories, but very little hard data, mainly because a lot of the financial information that you would need to prove a conspiracy isn’t publicly posted on the internet.  Go figure!

Anyway, my take on this (with a grain of salt, of course): pharmaceutical companies and doctors make money.  Whether vaccines or medications or tests, someone will always make money from every medical intervention.  Thus, you should be cautious in whom you place your trust – however, by itself, this does not prove the presence of a conspiracy.  My feeling (perhaps you will think me naïve) is that a world-wide conspiracy involving the public health agencies of nearly every country in the world as well as the World Health Organization and all of the professional medical organizations that I am aware of (AAP, AMA, AAFP) – orchestrated by the pharmaceutical companies to boost revenue in a small portion of their portfolios – would be too big to keep secret.  Although I’m early in my career (obviously), I have met and trained with some of the doctors and researchers that actually make these recommendations.  Sure, they could all be elaborate con artists – but having worked alongside them for years, I really believe that they (like me and you) actually care for kids and want the best for them!  What would they have to gain?

Additionally, in the interest of full disclosure – in the medical system that I work within, I don’t receive any extra compensation for having kids vaccinated.  So the only way I’m going to make any money from vaccinations is if I can get 100,000,000 YouTube hits for this video.  Please share this video to make me the Justin Bieber of immunizations!

 You no doubt have known
Rumors and tales, cynics and fears
But I just like you care for your child, I want you to hear
The data is clear, for vaccination, vaccination

The rest of this essay is more philosophical than empiric, but please bear with me. . .

You love your child.  All of your hesitancy and fears are because you want to make sure that you would never willingly make a choice that would harm them.  I applaud and encourage that mindset.  I hope you apply it to your choices for your children regarding TV viewing, discipline, nutrition and exercise with the same rigor that you apply it to vaccines.

Here is the crux of the issue though: you will never be able to answer all possible questions and eliminate all possible risks for anything you ever do for yourself or your children.  Just like every time you decide to assume the risks of riding in a car to achieve the benefits of reaching a destination, you need to decide whether the risks (generally theoretical i.e. – “no one has ever shown that kids are harmed by aluminum, but they could be”) outweigh the benefits (excellent effectiveness in decreasing the morbidity and mortality of infectious disease) of vaccination.  You will never be able to prove that aluminum in vaccines cannot harm children, you can only demonstrate that it has never happened before, and thus is exceedingly unlikely to occur in the future.  I will quote the CDC Parents Guide to Childhood Immunizations (also an excellent resource) regarding vaccines and autism, a point that is also relevant to aluminum: “It would be nice to simply say that vaccines don’t cause autism, but it wouldn’t be good science. A basic principle of science is that you can’t prove that something is not true. We all believe that if you let go of an apple it will drop to the ground. But that belief is based on the observation that it has always happened that way in the past. It doesn’t prove that the next time you try it, the apple might not fly up into the air instead.

So to say that vaccines don’t cause autism would be scientifically dishonest, regardless of how sure we are that they don’t.

What we can say is that at least a dozen rigorous scientific studies – designed to detect a connection between vaccines and autism – have been published in reputable, peer-reviewed journals; and these studies have overwhelmingly failed to show any connection between vaccines and autism.”

So when you hear someone say something like “no one has ever proven that there won’t be long term side effects of aluminum that we have just never seen yet,” you can answer, “that is because such a proof is impossible.”  You can’t prove that something won’t happen in the future (just like the apple might fly up in the air if you dropped it one more time); you can only say that on the basis of extensive research and experience, the proven benefits of vaccination appear to outweigh the possible, unknowable risks.  Perhaps not as strong as you might like, but that’s the best that you (or I) will ever be able to do.

I also get that some of you are automatically skeptical of organizations such as the AAP, CDC, WHO and so forth.  They are big, anonymous and in some cases financially massive (not really the AAP).  You are unwilling to trust the opinion of vaccine experts and researchers without having irrefutable evidence placed in front of you.  This is a reasonable position – but unfortunately it can be paralyzing.  For most of life’s decisions, you can’t wait until the data is perfect before you make a decision; in many cases, this would result in you never making any decision at all – which may be worse.

For some of us, our cynicism results in a threshold of proof that can never be exceeded.  Although the data strongly suggests that vaccines will be beneficial to your child, and experts in the field advise it – they will never be convincing enough.  There can always be one more side effect or conspiracy that hasn’t yet been exposed.   To you, I only ask you to examine your reasoning – if your bias against immunization prohibits you from objectively evaluating the data, try to take a second look with an open mind.  While writing this essay, I tried to do the same.  I’m not asking you to agree with me, only to carefully consider what I have to say.

So there you have it – my song, with a little bit of background.  Okay, maybe more than you wanted to know.  But whatever you think about it, thanks for reading this far.

Please think about this, share with your friends and feel free to ask me honest questions (on this site, I may or may not have time to answer, but in clinic, I’ll do my best every time!).

Special thanks to Dr. Matt McLean for letting me use his vaccine lecture as a source for a lot of these references.


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