Wednesday, February 20, 2008

Vaccination and Autism

You know what gets me about the whole antivaccine/vaccines cause autism bullshit?

Well, first of all, obviously vaccines don't cause autism, all the evidence has proved this over and over again. Besides, if it was caused by vaccines it couldn't be heritable, and it is (though not entirely). And kids still get autism even now that there's no mercury in the vaccines. Sorry, find a new scapegoat.

But even beyond that-- let's assume the autism really was caused by vaccines. Autism is a) non-contagious, b) non-deadly, and c) present in a spectrum, with most people within that spectrum perfectly capable of living a reasonably successful or normal life, although they're not really socially adept (neither am I, and I survive). Full blown autism is only about one in 1000 people. So in our hypothetical scenario, there is only a 0.001% chance that getting a vaccine will result in an autistic child.

Compare to the alternative, not getting the vaccine. Let's look at the DTP vaccine. Diphtheria has a 5-10% fatality rate in children under 5 years and a 20% fatality rate in adults over 40. Before the vaccine was invented, a person had a 0.002% chance of getting diphtheria. Also, diphtheria is a heck of a lot worse than autism (not that autism isn't horrible, but at least it doesn't involve open sores). And that is a single disease; things like pertussis, measles, and whooping cough add to the chance that an unvaccinated person will get SOME horrible illness. I mean, unvaccinated children living in our modern, vaccinated society manage to get polio, despite the fact that the virus can't easily perpetuate in a population that is immune to it.

So even using the false hypothesis that vaccines cause autism, it's STILL better to vaccinate, because an unvaccinated child has a greater chance of getting an illness that can be prevented by vaccines than a vaccinated child would have of getting autism. Also, most illnesses that vaccines prevent are far, far more painful, dangerous, and deadly than autism is, even at it's absolute worst.

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I'm not a huge fan of over-vaccination, which I define as vaccinating against things that aren't actually going to hurt you too much in the long run, like chickenpox (well, unless you're in your teens or older and never had it as a child), or things that could hurt you, but your lifestyle, age, and/or health make catching a bad case unlikely (like influenza for me, but not for my best friend, who often works with individuals who are high-risk for catching it).

But to prevent polio, diphtheria, rubella... there is no excuse for not vaccinating children against those illnesses. Not even religious objections (will God really stop a person from entering Heaven just because they got a shot? Wouldn't it be a worse sin to not get a shot, and catch and spread the illness, killing yourself and another? And can't you atone and describe yourself as some kind of martyr who was forced into it, anyway?).

Certain vaccines are a public health concern, they should NOT be optional. Even if it meant I had to take a flu shot every year, I'd support legislation that would force all parents to vaccinate their children without exception. If they object, force them to watch a movie about Typhoid Mary. When it comes to serious infectious disease, the government has a duty to restrict the rights of it's citizens enough to protect other citizens, and the more people we vaccinate against a disease, the more likely that disease will go the way of smallpox, no one will ever be at risk again, and we won't need the vaccine any more.

The only reasonable and safe way to stop the widespread vaccination of children is to continue it, even increase it, until it is no longer needed at all. Period.

15 comments:

Judit said...

Hi! I just started reading Vaccine: The Controversial Story of Medicine's Greatest Lifesaver by Arthur Allen who is neither a public health policy advocate nor an antivaccine activist, but seems to be quite familiar with both sides of the current controversy. His final chapter is his contribution to that debate. I will post a review on my little blog eventually.

While I agree with several points you make, I want to add that comparing an acute disease to a lifetime disability is like comparing apples to oranges, rendering a risk-benefit analysis a mostly subjective exercise which is arguably (arguably!) NOT unethical to leave to parents. There is simply no objective and absolute way to decree what is worse, and people will bring very subjective beliefs and fears into their decision making. That, too, is a fact.

By the way the polio case you link to was in a severely immunocompromised infant, which lends much weaker support to your argument than the way you present it. In any case, I *am* surprised that polio in any form exists in the U.S.; this is food for thought for me. But any given healthy american baby's chance of getting polio is still virtually nil, so the risk-benefit equation is still comparing nothing to nothing.

On a personal scale, a single individual not vaccinating isn't entirely irrational. Given the low disease rates, that one baby is enormously likely to do just fine. But on a societal scale, if significant numbers of individuals make that decision, everyone's odds to do fine will begin to diminish.

As a responsible citizen meeting my end of a social contract, I vaccinated both my babies, but I did not start them as newborns. Purposefully making a newborn even mildly ill seems unwise (and as a parent, unkind) to me. Besides, life is long, the statistics include people of all ages, so my kids still have plenty of time ahead to 'enjoy' that lifetime immunity.

Basiorana said...

"[C]omparing an acute disease to a lifetime disability is like comparing apples to oranges"

Many of these illnesses have the potential to permanently disfigure and harm an individual. Polio comes to mind, or even measles (I know one older woman whose face was permanently and severely scarred from a bad case of measles as a child). Not to mention death. I would be stunned if a person said "Well, I'd rather die a painful death or become permanently disfigured and suffer the related stress and emotional issues my entire life than have Aspberger's." Severe autism, maybe, but most ASDs result in difficulty socializing and bonding, not complete withdrawal. Regardless, autism and vaccines are not linked-- it was a thought experiment.

The fact that these illnesses exist at all in this country means they are still threats, and it will continue to be threats until they are at least eradicated from first world countries (I'm not going to pretend we need vaccines when the last known case was ten years ago in some third-world backwater). We have many non-vaccine preventions against illnesses, such as chlorination of pools, however, vaccines are still the number one preventative method we have. The article I linked was not designed to say "See, polio will kill children!" but more "Polio, a disease thought to be essentially eradicated in the US, still exists even here, and as long as it exists here, there is a potential for infection."

Besides, the anti-vaccine movement is growing. It can go one of two ways-- let people decide for themselves to vaccinate their children or not before the diseases are actually eradicated, and slowly lose what ground we have gained until we have another outbreak, or simply make them mandatory for all, eradicate the disease, and no one ever needs the vaccine again. The only real danger of vaccines is the small chance that the manufacturer made an error and sent a live virus, in which case said manufacturer should be severely prosecuted.

Also, I am perfectly fine with people waiting until their children are older before vaccinating them; I think some vaccines are given a bit early, considering the fragile health of infants and the fact that most of them aren't really exposed to large groups who may be carriers. As long as children are vaccinated before they are exposed to a school system, a summer camp, or some similar event with lots of germ-sharing, I don't really care when it happens.

Judit said...

Thanks for coming to see my blog :)
We agree on a lot! I just don't have the answers and the confidence that you do. I meant to say with my apples and oranges analogy that even if you are right, neither you nor public health officials can count on people to follow the line of thinking you deem valid. (I realize it was all a thought experiment; incidentally I don't currently have an opinion on whether or not the autism-mercury link is spurious because I haven't read the studies.) One thing is clear from the book I'm reading: antivaccination movements are as old as vaccines themselves; their existence reflects some of the same social phenomena that are features of the current movement. People will always be people. Compulsory vaccination has inherent social-ethical problems, it was difficult to establish, and near universal rates remain a challenge to maintain. This is a social issue though, not one of immunology or epidemiology.

Oh by the way funny you should say "I'm not going to pretend we need vaccines when the last known case was ten years ago in some third-world backwater" the Bush administration did, and went further, when they launched their failed smallpox-vaccination campaign a few years ago. Another interesting vaccine story!

Basiorana said...

Whether mercury causes autism is irrelevant anyway, thimerasol is no longer used in vaccines and children are still getting autism who have never been exposed to it.

I know it's a social issue, but I'm arguing that it shouldn't be, it should be an issue of public health and safety. We have the opportunity to irradicate some horrible diseases, and prevent future generations from ever worrying about them. Thus we have a moral and ethical responsibility to do so, to eradicate them now so we don't have to vaccinate people in the future, or cure them. Vaccinations are a lot better than the only viable alternative, quarantine.

Requiring vaccines for entrance into schools and universities was the best thing they did and it did maintain a fairly high rate of vaccination. If we didn't allow children to be exempted on religious or personal grounds, the only ones who would not be vaccinated would be home-schooled children who never go to college, and that's a very tiny percentage of the population, present in very small pockets scattered across the country. Small enough, even, that it's unlikely an epidemic could form amongst them. Do this worldwide, and you could eradicate these diseases within a few generations. It's not universal, but it's closer than the current system.

Also, the Bush administration are a bunch of morons. I remember that issue, and I remember thinking they were idiotic at the time, since there wasn't any real evidence that smallpox was going to be used as a biological weapon. The medical community didn't really support that move at all, which is a pretty strong indication.

chris said...

The Flu of 1918 killed more people than the plage. Flu can be deadly. Tetnus is a horrible thing too.

Liked your argument, thou. Very interesting.

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