Paul Offit on the Vaccine War

Paul Offit

On Tuesday night, Frontline broadcast The Vaccine War which examined the science of vaccine safety and the increasingly bitter debate between the public health establishment and a coalition of parents, celebrities, politicians and activists who are determined to resist pressure from the medical and public health establishments to vaccinate, despite established scientific consensus about vaccine safety.

Among those interviewed for the program was Paul Offit who is the author of Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure and chief of the division of infectious diseases at Children’s Hospital of Philadelphia. Offit is one of the leading experts on the importance of vaccination and draws on scientific and medical evidence to show the dangers posed to both individual children and the community at large when parents decide not to vaccinate their children.

Here are some excerpts from the interview:

What do you say to parents who are vaccine skeptics?

I think it’s reasonable to be hesitant. It’s very hard, I think, for a parent to watch their child get 26 inoculations in the first few years of life, five shots at one time, for diseases they don’t see.

What I say to those people is that a choice not to get a vaccine is not a risk-free choice. It’s just a choice to take a different risk. And what is that other risk? For example, even though we hadn’t seen measles in this country for 10 years, we finally got to the point where enough children weren’t vaccinated that children started to get measles in 2008, as many as 140, and some of those children were hospitalized, and one of those children almost died. And you don’t want that to be you. And the only way that you can accept, I think, a vaccine for diseases that frankly are virtually gone from the United States, like measles or diphtheria or polio, is if those vaccines are incredibly safe, have a wonderful safety profile. And these vaccines do have that. Doing nothing is doing something. It is, in this case, taking a risk that’s unnecessary.

In some communities, vaccination rates have dropped a lot. What’s behind this?

I think we were starting to see over the past few years communities that are choosing not to vaccinate their children. It tends to be highly educated groups who are relatively well off, upper middle class, who don’t see these diseases and aren’t compelled by them, and just believe that they shouldn’t get the vaccines. And Vashon Island, [Wash.,] is one example; Ashland, Ore., is another example; Southern California, there are communities; and in New York, in suburban New York, there are communities. And so there’s a risk. And the risk is not theoretical anymore. What you’re seeing is, you’re seeing outbreaks of diseases that were one time much better controlled. …

There was one outbreak [of pertussis] in Delaware that was particularly worrisome. It occurred in 2006. It was written up by the Centers for Disease Control and Prevention in their journal called Morbidity and Mortality Weekly Report, and it had one sentence in it which was particularly frightening, because what it said was, if you looked at that outbreak, it occurred primarily in 5- to 9-year-old children, which is really not something that we see in the vaccine era. And the statement was, this is the epidemiology of what one typically saw in the pre-vaccine era.

And now we’ve had a handful of children who have died of Haemophilus influenzae type b, died because their parents were more frightened of the vaccine than they were of the disease. They chose to leave those children vulnerable, and those children paid the ultimate price for that choice. It’s not OK anymore. It’s really unconscionable. We have gotten to a tipping point where enough people now are making this choice that they are affecting not only their own children but children who come in contact with their children.

What’s the anti-vaccine movement?

One could argue that the birth of the modern American anti-vaccine movement occurred on April 19, 1982. That’s when an NBC producer named Lee Thompson put out a one-hour documentary called DPT: — diphtheria, pertussis, tetanus — Vaccine Roulette. And the point of view of this movie was that the pertussis vaccine, the whooping cough vaccine, was causing permanent brain damage, was causing children to have epilepsy, was causing children to have mental retardation.

And the film was frightening. I mean, it showed a series of children who had spastic, withered limbs, who were wearing bicycle helmets, who were seizing, who were gazing up at the sky, who were drooling — all presumably based on having received this whole-cell pertussis vaccine.

And there were a group of people — Jeff Schwartz, Kathi Williams and Barbara Loe Fisher — who were watching this movie, lived in the D.C. area, and formed together something called Dissatisfied Parents Together to try and make not only other parents but this country aware that the whole-cell pertussis vaccine could cause permanent harm.

Now, it took a long time for the science to mature. Frankly, it took about 10 years to do the kinds of epidemiological studies that showed that the whole-cell pertussis vaccine didn’t cause epilepsy, didn’t cause mental retardation. But from the standpoint of those parents, reasonably they were convinced by the show, there weren’t data in hand, and they ultimately, I think, formed a consumer activist movement that moved us away from the whole-cell pertussis vaccine, frankly, to a safer, so-called acellular vaccine. Although that old vaccine didn’t cause permanent harm, still the new vaccine was better, and I think that was a good outcome of that movement. And it led to something called the National Childhood Vaccine Injury Act, which included the Vaccine Adverse Event Reporting System. Many good things came from that original advocacy.

The problem, I think, came with what has been the continued advocacy of that group that we have simply exchanged infectious diseases for chronic problems, and then that by using vaccines, we now have an increase in autism, attention deficit disorder, hyperactivity disorder, multiple sclerosis, diabetes, rheumatologic diseases, all of which are caused by vaccines.

Now, no scientific data have supported that notion, nor frankly does it make biological sense. And I think that we, as a health care community, as an academic community, have constantly done studies trying to address those concerns, and none of those concerns, I think, have ever been realized. And I think it’s too bad, because I think that movement now has scared parents unnecessarily, scared them into fearing vaccines which they shouldn’t fear, scared them into not vaccinating their children to the point that we now have outbreaks that are hurting us.

Talk about social media. How do things like [talk show host] Bill Maher and the YouTube video with Desiree Jennings change the dynamics?

I think social media has dramatically changed [things], and I think certainly we in the public health community and academic community are just catching up, especially we older folks. But Twitter and YouTube definitely has an impact. I spoke recently at a high school near here. There were about 200 people in the audience, and I asked them how many had gotten the influenza vaccine, and about half raised their hands. Of the half that didn’t raise their hands, they said that they didn’t get it because on YouTube they saw a Redskins cheerleader [Jennings] say that she had gotten the vaccine and had a so-called dystonic reaction. Now, the influenza vaccine doesn’t cause dystonic reactions. I mean, any neurologist who looked at this particular film would —

This is the lady who walked backward?

This is the lady who could walk backward but not forward, right. I think that was the story. Her collection of symptoms didn’t make neurological sense. It didn’t make biological sense. And I think any neurologist who looked at that would say that. And then she suddenly got better when she gave herself chelation therapy. I mean, it was all sort of bogus and kind of hoaxical.

But the point is that these students who sat in that room were much more likely to believe something they had seen on YouTube from a Washington Redskins cheerleader than they would have believed something that they would have heard from the Centers for Disease Control and Prevention or the American Academy of Pediatrics. That’s a little frightening.

I mean, somebody like Bill Maher — who tweets the notion that anybody who gets the novel H1N1 vaccine is, in his words, “an idiot,” and then writes a piece very quickly on Huffington Post, listing as his sources of information not a single person who has any expertise in vaccines — is frightening. It’s frightening that it has that kind of traction. It’s frightening that we put so little value on expertise, that because, I guess, of Google, that anyone’s an expert — or alternatively, no one’s an expert.

Bad ideas can be contagious and go viral in the same way that organisms can.

Yeah, I guess that’s right. Bad ideas can go viral. In fact, I would argue that that’s probably the worst aspect of the novel H1N1 virus. What’s more contagious: the novel H1N1 virus or the bad information surrounding it?

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