A Closer Look at Pro and Anti Vaccine Arguments

What if I am not anti-vaccine? What if I am not pro-vaccine? How do I make sense of the arguments out there? What if I am pro-vaccine or anti-vaccine? What would I gain by understanding the issues the other side presents beyond the talking points?

When I wrote a previous article on risk, vaccines, and the law, the main objective was to outline the current statistics of disease to detail the crude risks so that I could use that information in a discussion about the topics surrounding risk — including the illegality of risk transfer. I stayed away from any of the big pro and anti vaccine arguments on purpose. I never intended to dive into the rhetoric to analyze the arguments from pro-vaxxers or anti-vaxxers. However, the responses to the article were either using it to support an anti-vax stance (which is beyond the scope of the article), or trying to debunk it based on popular pro-vax soundbites.

As I responded to the pushback of the article, I realized that the same types of arguments were being used by both sides across the entire vaccines spectrum. I started thinking that I could not be the only one who feels frustrated by all of this debate. Both sides of the vaccine debate use so many fallacies that it is difficult to get any real information from anyone or anywhere. Some even want to discredit certain conclusions because of the presence of fallacy in the arguments, but this, itself, is a fallacy. I decided to take a look at these arguments and see if I could make some sense of it. I am just trying to find the truth. (WARNING: I don’t find it.) In spite of the lack of a definitive solution in this analysis of the vaccine debate, weeding out the poorer — albeit most popular — arguments is worthwhile.

(I’m going to use MMR data, because that is the hot topic these days.)

“Vaccines cause autism.

Autism and Wakefield

This argument gets people very emotional.

The fact of the matter is, we do not know if vaccines cause autism. We have not found any causal evidence that vaccines cause autism. Proponents of vaccine-induced autism often cite Dr. Andrew Wakefield to justify a causal link between vaccines and autism. Dr. Wakefield’s study, which found some possible correlation between the MMR vaccine and a particular type of bowel disease which, in turn, correlated with autism symptoms, led Dr. Wakefield to publicly call for a halt in MMR vaccinations until further studies were conducted. While his original paper did not prove causality, his statement to the press caused a public panic, which did inspire a number of other studies to confirm or disprove his conclusion. What was found was not only were there significant ethical problems with Wakefield’s original study that he was eventually convicted of, but the data itself was reported unreplicable (a valid scientific study is one which can be reproduced, using the same methods and procedures, and achieve the same results). His study and subsequent conclusions and speculations are now widely dismissed.

Conspiracy

Many have argued that discrediting Dr. Wakefield was an act of retaliation and suppression from the fearful and frustrated pharmaceutical cabal wanting to hide its own villainy. Others have suggested that the burden on the government should autism link to vaccines would be too great for them to allow a connection. Could this happen? This is a good time, right at the beginning, to bring up conspiracy. Conspiracy is the basis of this “cabal” argument and all like unto it. A conspiracy is simply a secret plan by a group to do something unlawful or harmful. Proving conspiracy is very difficult, but was accomplished in cases such as MK Ultra, Operation Northwoods, and the Iran-Contra Affair, to name a few. Conspiracy is, however, a viable argument when it has verified evidence of its existence. Without real data or verifiable evidence (not anecdotal evidence), we do not have a substantial premise to base an argument for conspiracy on, and the argument dissolves into ad hominem and argumentum ad ignorantiam (appeal to ignorance) fallacies. This idea will be applied throughout the rest of this article. From now on, remember that unless there is verifiable evidence of something, it will not be used as a valid argument and will remain in the realm of conjecture. This is not to say that such ideas are inherently false, it is only to say that without evidence they ought not be used in debate.

Causation v. Correlation

Where vaccine safety is concerned, you are going to find very few causal studies done because purposefully trying to cause disease in humans for the sake of science is still considered unethical. The CDC has not conducted any studies comparing vaccinated children to unvaccinated children (here, important to note there are fallacious arguments used in this CDC hearing, such as appeal to authority and ad hominem, but the takeaway at this moment is that the CDC admits it has done no studies comparing vaccinated children to unvaccinated children). The official stance of the CDC is based on correlated data. However, this is not unique to the CDC, as all studies conducted to analyze the data relevant to humans are based on correlations and largely empirical. Correlated data lends itself to further hypothesis, but does not, in and of itself, provide absolute conclusions, particularly when the number of variables present (e.g. the many factors which affect a child’s health) is too great, the sample size is too small, or the findings are too insignificant to produce confidence.

Autism and Vaccine Correlation

There is no causal evidence that scientifically links autism to vaccination, but there are a few studies (other than Dr. Wakefield’s) which claim correlation between vaccination and autism and other possible causalities. In one of the studies conducted by the CDC, there was no statistically significant correlation found between the MMR vaccine and autism, but one of the authors of the study, Dr. William Thompson, called foul on the data analysis process and claimed that some data was ignored in the report. Dr. Brian Hooker reanalyzed the data from the study and reported that one subset of the children studied, African American boys receiving their first MMR vaccination before age 36 months, showed an autism rate 3.4 times greater than those who received their first MMR vaccination after 36 months. This report was later retracted by the journal that published it citing competing interest problems and concerns about the validity of the methods and statistical analysis. The other authors of the original report said they did not include that data because they did not find it statistically significant given the small sample size of the subset and possibility of other factors producing the same results. One of them, Dr. Frank DeStefano, defended the original report and said that all of the author’s agreed on the analysis and interpretation before the study was published, but he added that he will go back and review his notes to determine if the data should be analyzed again (we do not know exactly what this means or what will come of it). Dr. Thompson has been granted whistleblower immunity and will most likely testify before Congress at an undetermined date in the future.

Just because we do not have causal evidence for a link between autism and vaccinations, and there is no government-reported correlation between the two, does not mean that vaccines absolutely do not affect autism rates. What it does say is that we do not know that it does. We do not know that it does not. Considering the age at which we usually diagnose autism is around the same time children are vaccinated, we may never know, but due to the number of variables involved in developmental disorders, it is reasonable to say that 1 in 68 children diagnosed with autism do not have it simply because they were vaccinated.

“Vaccines are safe and effective.”

The truth is, nothing we do is safe. Not even natural things are considered 100% safe. In this context, and nearly every other context, you have to talk about relative safety. Are vaccines relatively safe? If the numbers we get from the CDC are correct, then you are looking at 1 in a million or less that die from the MMR vaccine, 1 in a million have a severe allergic reaction, and 1 in 365,000 develop a serious neurological disease. It is reasonable to consider this relatively safe, though not absolutely safe. It is certainly better than the 3 in a 1000 death rate in measles patients that was reported in the last 13 years.

You can get slightly higher vaccine injury rates if you look at VAERS, The Vaccine Adverse Event Reporting System, which is a national vaccine safety surveillance program co-sponsored by the CDC and the FDA. VAERS is a post-marketing safety surveillance program, collecting information about adverse events (possible side effects) that occur after the administration of vaccines licensed for use in the United States. It does not establish causation, nor does it take into consideration possible vaccine-related injuries which occurred significantly after the date of vaccination, nor any number of unreported cases for that matter.

Are vaccines absolutely safe? No. According to current data, are they relatively safe? Yes. Are there possible huge long-term risks that we have not seen yet? Yes. We simply do not have enough data to determine just how absolutely safe or unsafe vaccines really are.

As for efficacy, this is usually related to the belief that vaccines have had dramatic effects on the disease landscape, and that they are effective at the individual level, too. The correlated data suggests vaccines have had significant impact on disease incidence, though some results will be delayed (like in the case of hepatitis, because the vaccination age is about 15 years before the age at which we see significant incidence, so there is a 15 year gap between introduction of the vaccine and a reduction in incidence rates). There is also evidence that individually, the vaccines are not as effective as they claim — as discussed in the next section.

“Vaccine-producing companies do not always use good methodology to test the safety and efficacy of their vaccines.”

In 2012, a couple of Merck (the company that produces the MMR II vaccine purchased by the CDC) employees came out and accused the vaccine-maker of using flawed lab methodology to produce vaccine efficacy rates of 95% (for the mumps portion of MMR). Not only did they accuse Merck of fraud under the False Claims Act, but they brought a lawsuit against them on behalf of the United States. This is called a qui tam lawsuit. Its primary purpose is to give whistleblowers a way of helping the government protect itself against fraud. It also rewards the whistle-blowers monetarily if the case is won.

The claims made against Merck were not only that they lied to the CDC, but that they did so because they knew keeping a supposed 95% efficacy rate would prevent any other vaccine-makers from entering the market — thus, maintaining a monopoly. Considering the CDC reuses the data it gets from Merck and publishes it as official, a lower than 95% efficacy rate also has statistical implications when public health analysts attempt to make recommendation for vaccination schedules and programs which aim at disease eradication. Merck tried to get these cases dismissed, but a Federal Court in Pennsylvania denied their claims and has agreed to hear the case, as of September 2014. A trial date has not been set yet.

We will have to see how that plays out, but it brings up an interesting idea. How much do we trust these companies to be honest about their products? This is not the first, and will not be the last lawsuit against a vaccine-maker. Some are lost. Some are won. Does this call into question everything that we have been told about how safe and effective these vaccines are? Cautiousness is certainly worthwhile. Does it mean they necessarily lied about everything else that they have told us? No.

“The risks associated with the diseases are far worse than the vaccines.”

We have discussed the risks of the vaccine in contrast to the risks of the disease. If all of the CDC numbers are accurate, then the vaccine is safer than the disease. However, the argument that the vaccine is safer than the disease is often accompanied by stories and media aimed at creating fear of the disease. This reduces the argument to an appeal to emotion, and the hearer either latches on out of fear or completely dismisses it because they do not like being scared. We have got to get the fear-mongering out of it.

This argument also does not take into consideration how people look at their current risks. It requires the arguer to create fear because current risk is not based on the dangerousness of the disease alone. We must also measure how likely it is that we will get the disease. If we factor in the likelihood of contracting measles, then the risk of getting the vaccine is higher than the risks of not getting the vaccine. In the general population, the risk of getting the measles is 2 in 1,000,000 (644 reported measles cases last year divided by the population of the United States). If you multiply this by the 3 in 1000 death rate, then the actual risk of death by measles is 6 in 1 billion. That is much less than the 1 in a million deaths from the vaccine.

This is slightly deceiving, however, because it can change, and does change, with localized outbreaks and other risk factors. However, even if there is an outbreak and you see something like the 68 recent cases which were reported in 4 Southern California counties, most tied to the Disneyland outbreak, you are still only looking at a 4 in 1 million incidence rate (68 divided by the population of those 4 counties). Multiply that by the 3 in 1000 death rate and the risk of death by measles during this outbreak is 12 in a billion, still far less than the risks associated with the vaccine.

Normalizing the risks of the measles for measles incidence flips the argument that the risks associated with the disease are worse than the risks associated with the vaccines on its head. To be reasonable, it is true that if the incidence rate increased dramatically (we would need 136,000 reported cases in a given year), for any reason, than this argument might be valid again like it was back in 1962, the year before the vaccine was released. Back then, there were 2.4 in 1 million deaths from the measles, which is more than the 1 in 1 million deaths seen from the vaccine. The difference is hardly statistically significant. Only .3% of the population reported actually contracting measles. It is widely argued that the measles was a very common childhood disease before the vaccine. 3 in 1000 is hardly “common.” Okay, so what if we say that all of those who got the measles were children? In the early 1960s, 31% of the population were under 15. That brings the incidence to 3 in 310, or 1% of children. Still, hardly common.

One 1962 public survey study (the only one referred to in current studies) reports a 90% measles incidence rate in Americans. If the public survey study is accurate, than the other risks associated with the measles might be significantly greater than the risks associated with vaccination, though it is hard to tell by how much because only .3% of the population sought physicians’ care and were reported. If 90% actually got the measles, this discrepancy of 89.7% suggests that the general consensus was that measles was common and/or treatment was limited enough to not seek physicians’ care. Further, measles cases are reported more now due to the current availability of treatments and a culture of seeking medical care, suggesting the incidence levels we see now should influence the death per case ratio to show less deaths per reported case. However, the data shows the opposite is true.

If we assume 90% incidence in 1962, that would make the death per case rate 2.4 in 1 million (408 measles deaths in 1962 divided by 90% of the population of the United States in 1962). Today, we have a 2650 in 1 million death per case rate. Either (1) 99.9% (2650 minus 2.4 divided by 2650 and multiplied by 100 to get a percentage) of deaths from the measles were not reported as such, (2) the virus we have now is more virulent than the one experienced pre-vaccine, (3) no where near 90% of the population had the measles pre-vaccine, or (4) there is something seriously wrong with our standard of care for measles patients these last 13 years.

Regardless, the data shows that the argument that the disease is riskier than the vaccine is invalid when the risks are normalized for current incidence rates.

“If vaccines are so ‘safe and effective’, why do you care if I don’t get vaccinated?”

As stated above, vaccines are not absolutely “safe and effective” but only relatively “safe and effective”. That said, if the CDC number of 99% efficacy is accurate and we vaccinated 100% of the population who could receive the vaccination with 2 doses, then we would see 1% of those vaccinated still susceptible to the disease (measles), another 1% or so susceptible due to medical contraindication in receiving the vaccine (which is a very rough estimate because reporting on this subset is weak, but we are talking about anyone who falls into one of the following categories: allergy, known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy or patients with human immunodeficiency virus [HIV] infection who are severely immunocompromised), or a history of thrombocytopenia or thrombocytopenic purpura), and another 8% or so of the entire population susceptible because they are too young to have received their full immunization. That makes roughly 10% of the population at risk when an outbreak occurs, even if everyone who could receive the vaccine received 2 doses of the vaccine. The argument is that that 10% of the population matters and relies on others to “play their part” in disease elimination so everyone can be safe. Of course, every life matters.

“The unvaccinated put everyone at risk.”

No, not “everyone”. If you want to make this argument, you need to specify that it is only that 10% discussed above who are really at risk. In this recent outbreak linked to Disneyland, 45% of those affected by measles were unvaccinated due to personal, philosophical, or religious objections. 9.6% were those too young to receive the vaccination. These numbers do not tell us much about who to blame, but it does show that the burden of illness is currently on the unvaccinated, and that there are other risk factors involved besides simply being unvaccinated. (For the record, these percentages do not tell us anything about the efficacy of the vaccine because there is no data on how many were exposed and did not contract the disease, nor how many of those exposed were unvaccinated.)

“Vaccines are risky.” 

Yes. They are. We talked about those official numbers earlier when we discussed vaccines being “safe and effective”. However, how risky is the relevant topic. What is your acceptable level of risk? What is it for a group of individuals in a population? Even the WHO has a hard time with acceptable risk, because it is necessarily a very individual thing. You have to weigh the risks involved in this complicated issue. Most of the time, acceptable risk for a population is determined by a group of individuals making decisions for the whole because it is not possible to consider each individual’s level of acceptable risk. If you are interested in this issue, read about the medical history and the studies done on public-based acceptable risk by the WHO.

“What would people who suffered from these diseases think about you not wanting to be protected from them?” 

There is no quantifiable way to answer this. This is not the first time people have been up in arms about vaccines. The debate is as old as vaccines themselves. This also is not all about death rates. Quality of life does matter. Do vaccines improve our general quality of life? Quite possibly. Does that outweigh some of the other concerns with vaccines? Maybe. Maybe not. In the meantime, this argument is unduly assumptive.

“The disease incidence rates were dropping before the vaccine came on the scene.”

Actually, they weren’t. It went back and forth, a lot, but the incidence rate did not drop significantly (statistically) before vaccines were introduced. The death rate, however, is another story. In the early 1900s the death rate was 25 out of 1000 (.25%) cases. By 1962, it was only 1 out of a 1000 (.1%). That’s a 96% reduction in mortality. Certainly statistically significant, and very important, however, not the same as a reduction in measles incidence.

“Vaccines are responsible for low disease rates.” 

Technically, all we have is correlation between the introduction of vaccines and a reduction in incidence. It is, however, a really strong correlation, and it continues to maintain its correlation. It is statistically improbable that the significant drop in measles incidence after the introduction of the measles vaccine in 1963 was not caused by the vaccine, but we do not have causal evidence.

It is also pretty important to understand the difference between elimination and eradication. In the early 2000s we declared ourselves to have eliminated endemic transfer of the measles virus. This means we interrupted its progression and have reduced its endemic presence to close to zero. Not zero; close to zero. In fact, technically, it just means that we do not have chains of transmission which continue for 12 months or more. This is not the same as eradication. Most news sources love to say how we “eradicated” the measles. We did not. We “eliminated” it in the general population. Measles can come back.

“The diseases mutate too fast to maintain vaccines effectiveness.”

While mutation is a real biological phenomenon, it does not realistically apply to most of the diseases we have vaccines for. Some diseases mutate at such a slow rate that we are theoretically able to eradicate the disease before it mutates — if mutation were the only factor. Eradication takes more than just vaccinating a lot of people. Eradication means there is no wild-type of an organism left in nature. Other diseases, like influenza, mutate rapidly, and it is really quite difficult to stay ahead of it. The measles mutates relatively quickly like most RNA viruses, but these mutants have all responded to the vaccine. This argument’s main flaw is its generality.

“We need people to keep getting vaccinated to prevent future outbreaks that will affect everyone.”

We only need to keep getting vaccinated because the disease has not been eradicated (measles). If it were, we would hopefully end our vaccination program. It is true that outbreaks affect everyone, whether directly or indirectly. If we assume vaccines are as effective as has been claimed, then it is also likely that vaccines can prevent outbreaks in certain populations. There is also the risk of a mutation which will not respond to the vaccine. Even if vaccines are effective, it would only be our best effort at preventing outbreaks. We should in no way think or argue that getting vaccinated prevents all outbreaks, at least pre-eradication.

“Vaccines do not give you the same type of immunity that you would get naturally.” 

This one is complicated, and it is going to vary depending on the vaccine. However, addressing the MMR and measles, the MMR vaccine is a live attenuated vaccine. This means they have grown a version of the virus which is much less virulent but which still provokes the same immunological response. Kind of. In most cases, the immunity we get naturally after contracting a disease can last longer than immunity gained through immunization because the response to a more virulent form of the disease is also stronger. Do you get the exact same type of immunity? No. Is it close enough for all realistic purposes? Yes, though vaccine-induced immunity does not last as long as natural immunity.

“Herd immunity protects everyone.” 

Herd immunity is a real biological principle of ecology, so you cannot argue it does not exist. It has applications with both natural and vaccine-induced immunity, though the latter is significantly more difficult to calculate. However, just like most biological principles of ecology, it requires a few assumptions.

The first is that the population is homogenous. The second is that it needs to be a closed population (no immigration or emigration), which is only achieved at the global level unless we officially close our borders for good. The third, is that the populations immunity has to be greater than (1-(1/R0), where R0 is the number of people that one (1) infected person will most likely infect (the reproduction rate, or transmission rate). For measles, R0 is 12-18.

The herd immunity threshold for the measles is 92-94%. This means we need 92% to 94% of our population to be immune to the measles in order to achieve herd immunity and see the disease eradicated. The question is two-fold. Do we currently have herd immunity, and if not, can we achieve it?

Do we have herd immunity?

The most recent calculation of the population’s immunity rate is 93%. This would put us in the herd immunity threshold range. However, 12.6% (14% of the population is over 65, which the CDC says is not at high risk due to being exposed to the virus as a child, times the 90% who were supposedly infected back then) have natural immunity, and .8% of the population under 7 months have passive immunity due to their mother’s immunity. The rest of the immunity we have is vaccine-induced. This is important because there is one factor we have not yet accounted for. There is a subset of adults who were vaccinated before 1995 for whom we do not know immunity. This is because 2 doses of the MMR vaccine is reported to provide immunity for “more than 20 years”. The two-dose vaccination schedule was not implemented until 1992, meaning that a little more than 50% of the population — those in the 25 to 65 years old range — have mostly only had a single dose of the vaccine and the “more than 20 years” of immunity does not necessarily apply to them. We don’t know what their immunity actually looks like, though theoretically it would be 95% if the vaccine provides at least 65 years of immunity in people who have only receive 1 dose of the vaccination. That is very assumptive. But since there is no way of knowing exactly how immune they are, the factor of vaccine-immunity length is usually overlooked. Just know that if effective immunity for the 25 to 65 year olds is zero because the vaccine waned after 20 years, then actual vaccine efficacy in the population changes from 95% to 38% and our immunity rate is actually somewhere around 37%, well below the herd immunity threshold. Of course, a 0% immunity rate for that age group is also assumptive, but even if the actual immunity rate is somewhere in the middle, we are still under the herd immunity threshold.

Can Herd Immunity Be Achieved?

If we are assuming we do not have herd immunity because of the 25-65 year olds whose vaccine-induced immunity has waned, then all we need to do is vaccinate them all again.

Current Outbreaks

We continue to have outbreaks because we do not have 100% immunity and the measles virus still exists. This does not mean that the measles is back (it was never really gone — we achieved elimination, not eradication). If elimination of endemic disease is determined by chains of transmission which last longer than 12 months, then the measles is still eliminated in the United States, even though our incidence rate has gone up from 1 in a million to 2 in a million and we are currently experiencing an outbreak. Another reason we continue to have outbreaks is disease importation. Since 2001, 88% of the measles cases in the United States have been imported from other countries. Without a closed population, we will continue to see this effect.

If 93% of the population is immune, 13.4% coming from natural immunity, then the burden of immunity which lies on vaccines is only 79.6%. Currently, the vaccination rate is reportedly 91.9%. It was 90.5% in 2000 when endemic measles was declared eliminated (we should remember that there were cases of endemic measles (in the United States), but it was determined this was a low enough number to still warrant a declaration of elimination). Though 91.9% vaccination is lower than the 92.3% rate we had 9 years ago, it is only a .4% difference. Considering elimination was achieved with only a 90.5% vaccination rate, this .4% reduction attributed to anti-vaxxers is insignificant.

Homogeneity

One of the major assumptions of herd immunity is that the population’s diversity is spread out evenly geographically. This means there are no pockets of higher risk. However, in the United States, we love sending our babies to preschool and daycare and our sick to the hospitals. These subsets of the population are at risk regardless of the vaccination rate because they do not have natural immunity and cannot receive vaccine-induced immunity. The only way to help these people is to eradicate the disease and stop all outbreaks. We certainly can eliminate it for certain subsets of the population, even for most subsets of a population, but eradication is not possible through vaccination alone. There exist other factors at play and we would need a different vaccine schedule.

Perverse Effects

In situations where populations attempt to achieve herd immunity through vaccination and they fail, there are perverse effects. Yes, “perverse effects” is a technical term. In diseases which are more severe in adults, like the measles, if eradication is not achieved before the vaccine-induced immunity begins to wane, then your vaccination program may actually cause more deaths and complications because the outbreaks will affect people later in life than it would have otherwise. This is where natural immunity has an edge over vaccine-induced immunity. How much effect will these perverse effects have? That is still unknown.

Further, the percentage of the population over 65 is diminishing. Currently, .8% of the population die every year. 7 out of 10 of those are in the older age category (over 65 years old). This translates to the 14% of our population 65+ years older with 90% natural immunity diminishing by .56% every year. This means that by 2040 we will no longer have any of our population with natural immunity. Again, the significance of this is yet undetermined.

Are anti-vaxxers ruining our herd immunity? No, we probably do not even have herd immunity. At least not for the measles. Technically, herd immunity would protect everyone as it would result in disease eradication, but whether or not we can achieve herd immunity for measles still has practical complications. It would certainly have to be done on the global level considering the prevalence of importation.

“Vaccines can shed and get people sick.”

Yes, vaccines can shed. They all do so at different rates with different virility. In the case of the measles, shedding can happen, though it would be very, very, very rare for the attenuated virus to infect anyone else with a full blown case of the measles. I realize this is all a lot less scientific than the previous section, but that is because we don’t know all the nitty-gritty details mathematically. It is possible an outbreak could be created by a recently vaccinated individual, but it is also highly unlikely.

“You have a responsibility to do what is best for your kids and protect them from these diseases.”

Absolutely. This is what both sides of this debate are trying to do. This certainly is not a good argument, nor is it ever effective in persuading others. So let’s stop using this one, okay?

“My child had severe adverse reactions to vaccines.”

Sadly, this does happens, but, unfortunately, anecdotal evidence cannot be translated to populations.This experience is far more than anecdotal to families suffering from vaccine reactions, and we all should extend more consideration to such raw feelings. Especially where the health of our children are concerned.

“I almost died from disease.”

Again, tragic, but anecdotal fallacy.

“We do not know what the long-term effects of injecting these chemicals into our bodies are.”

True. It has been 44 years of careful surveillance for MMR, and it is unlikely anything new is going to pop up now. But we do not know that for sure. The weight of this fact might be overwhelming for some. All vaccines, all drugs even, are subject to continued study for long-term effects and efficacy, but this argument is an appeal to ignorance.

“Doctors want what is best for their patients and would not recommend vaccines if they were unsafe.”

Most doctors try to do what is best for their patients. A few weirdos make the news, but most pediatricians really are trying to help kids. The problem with this argument is not about the doctor’s sentiment and desire to help, it is the idea that doctors always know what the right thing to do is, which is nothing more than an appeal to authority. The history of medicine proves that doctors are not infallible.

Sometimes we accept as “common knowledge” what we later discover is error. Some examples are asbestos, twilight sleep, thalidomide, and hormone-therapy for homosexuals. Of course, we seem to get it right more than we get it wrong, but we do get it wrong enough to introduce considerable uncertainty. What is worse is that the knowledge of the error trickles out into the general body of knowledge which our doctors possess. Some doctors stay on top of current research, and some do not.

For example, we now know the amount of blood serum cholesterol is not an indicator of risk for heart disease. Neither is blood LDL count. You actually need to know what size those LDL particles are in order to accurately predict heart disease. This is why seemingly healthy people with normal cholesterol levels will drop-dead with atherosclerosis — completely undetected by their doctors because their doctors didn’t know they were looking at the wrong tests.

Doctors are generally good people, and they certainly have more medical training than the layman, but they are just people. They make mistakes. In fact, sometimes the entire medical community makes a mistake. So maybe this argument would be better if it read, “Doctors want what is best for their patients and would not recommend vaccines if they thought they were unsafe.” Even then, it would still constitute an appeal to authority.

“Vaccine-makers use aborted human fetuses to make the vaccines.”

True. Some vaccines have aborted human fetal cells in the injection itself. All of this is found and is accessible on official government sites, so there is no conspiracy. Particular to the MMR vaccine, it is the diploid lung fibroblasts from a female fetus aborted because the family felt they had too many children in 1964 — called WI-38. These cells are used in the culturing of the vaccine and are not listed present in the injection itself. Is this unsafe? We do not know (and the relative safety of vaccines has been discussed previously), but one study published in 2014 suggests that the residual presence of human DNA in the vaccines might cause immunological responses — including possibly autism.

Is it ethically disturbing? Perhaps. That is going to vary based on each individual. The Vatican does a whole write up on it in 2005 and basically concludes you should avoid all vaccines which contain these cells, or have used these cells in their process, and “continue to fight and to employ every lawful means in order to make life difficult for the pharmaceutical industries which act unscrupulously and unethically.” However, they also say that the burden of these fights should not fall on the children, and that if children are in actual and immediate harms way then it would be okay to use these vaccines temporarily. Otherwise, you should find alternatives or abstain.

But really, it is up to the individual to decide how they feel about these issues. There are going to be quite a few people who this is not an issue for morally, but they are still unsure of its safety when the fetal cells are actually a part of the vaccine. It is just another unknown.

“Pharmaceutical companies would make more money if the diseases were prevalent than they do from vaccines.”

Not necessarily. This assumes that the same companies who make the vaccines are the same ones who make treatments for the symptoms of the disease. This is not always the case. It does bring up another point though. If eradication of a disease is accomplished, then the vaccination program is halted. The company stops selling vaccines nearly completely. They lose a huge market. So, ethics aside, it would behoove their bottom dollar to let the disease live just enough to keep their vaccine labs cranking out doses, but not enough as to discredit their vaccine and shift the market towards buying treatments from the other guys. At this point, it all becomes political, economic, and medical conspiracy theory, which we said we would not get into.

“Thimerosal, formaldehyde, aluminum, etc. can hurt you. Having it removed means the government admits it was dangerous.” 

There are two things going on here. First, the accusation that the trace amounts of these substances can hurt you. We know that in large amounts they can. The second accusation is that the government knows its bad for us so they have removed it. In the early 2000s, there was some debate on this topic and a lot of public outcry. The stated reason for the pull of thimerosal was to remove the contention, just in case.

To be clear, not all vaccines contained thimerosal. MMR never has. Some vaccines still contain trace amounts. As for the other chemicals, the evidence suggests that trace amounts of the particular quantities, types, and combinations of formaldehyde, aluminum, etc are not dangerous to your health.

In this same train of thought is the discussion about peanut allergies. The claims begin with the idea that certain vaccines use oil-in-water emulsions as adjuvants. The attenuated measles virus is not strong enough on its own to promote a strong response and subsequent immunity. An adjuvant is a foreign substance which the immune system will respond to, and they are needed to provoke the immune system into reacting stronger and producing real immunity to the attenuated virus also contained in the vaccine. This is all true. The claim goes further by saying that the use of peanut oil in vaccines will provoke the immune system into developing antibodies against peanut proteins, thus creating a peanut allergy. While in theory this may happen, oil-in-water emulsions are not approved for use in vaccines in the United States. Any of the claims that the vaccines do contain peanut oil in spite of its disapproved status are unsubstantiated.

“You should have to get the vaccine before you can be allowed to go places like schools.”

Schools are breeding grounds for disease. They just are. You put a lot of kids in a small room with one another, mixing the exposures every hour or so, for 6 to 8 hours a day, 5 days a week, and 9 months out of the year. It is a real-life, real-time microbiology lab. There are two purposes behind banning unvaccinated children from schools. The first is to try to eliminate the disease in the school population. This is theoretical, at best, because it is not a closed population system.

The second is to protect the unvaccinated from an outbreak. This seems valid, but only during an outbreak. Those who use this argument generally mean all the time, not just during an outbreak — without exemptions. There are enough risks and controversies (fetal cells, medical injections, etc) associated with vaccines to warrant an exemption system for those who believe strongly about it, but education itself is not a natural right. The right to seek an education, yes, as much as we have the right to seek happiness.

If we limit our discussion to natural rights, the state has no moral or constitutional duty to provide an education for you. Most states have ruled otherwise due to public pressure for a free educational system using the justification of general welfare. In the case that the state decides to require children to attend school, it has an obligation to do what it has determined is best to protect the health of those children. When you opt in to public education, you opt in to all of the rules and regulations that go along with it, just like any government program, because even though public school advocates will try to convince you that it is a right, it really isn’t. So, you might have to stay home from school.

“You can’t trust the government to give you all of the information, or always give you good information.”

Sure, but this ad hominem does nothing to promote or diminish the case for vaccines.

“There ought to be a law.” 

This has a lot less to do with vaccines, and a lot more to do with law. This is a very long conversation, so I’m going to reference my previous article again. Basically, you can’t force anyone to do something which might cause them harm and infringes upon their rights, no matter what the perceived benefit to the whole might be. You can seek to promote education, you can lead by example, you can cease to associate, but you can’t make a law. Or at least you ought not.

In 1905, the Supreme Court ruled that in the case of an outbreak, when the threat was real and immediate, vaccinations could be made mandatory by the state affected and enforced with police power. This was not without public outcry, of course, but it set a legal precedence which has been cited 61 times in favor of police authority to impose public health measures by force. There are limits to this, however. The vaccine cannot pose a reasonable risk to the individual receiving it. Groups of people cannot be targeted. The threat must be real and immediate. The means used to protect the public health must not be a plain and palpable invasion of rights. In the 1905 case regarding Henning Jacobson being forced by the state of Massachusetts to receive the smallpox vaccine, these conditions were apparently met according to the court. It is worthwhile to mention that the decision was 5-4.

Jacobson v Massachusetts was not the first nor last time the courts have sided with public health over individual liberty. There is a strong legal precedence for public health enforcement authority. Should it be that way? Would the framers of the constitution agree with these decisions? Not even the judges at the time agreed. Clearly, the answer is not so absolute depending on which principles you adhere to, and precedence is a powerful thing. It should be noted however, that the precedence still has those four limits I mentioned above. As for the argument that vaccination ought to be the law, it is hopelessly vague and useless in the debate.

“I have the right to do whatever I want with my body, and to make those same decisions for my children.” 

Yes, you do. However, the rights of one end where the rights of another begin. If someone actually infringes on another’s rights by getting them sick and causing them harm because they made a willful choice to remain unvaccinated knowing the risks, then that person can be held liable in a court of law. Of course, they have to actually get someone sick and it has to be proven that the one caused the illness of the other. This is good old fashioned American justice. The stuff the country was built on. So, yes, there are self-determination rights, but an extension of that is tort law.

There might also be a moral obligation to do what you can to help others as well. What is the threshold for that? Does that apply right now when the risks from the vaccines outweigh the risks from remaining unvaccinated? Does that apply during an outbreak? What about epidemic levels? This type of morality is subjective. Some of us will run into the burning building to save trapped children. Some of us won’t.

In conclusion

Everyone has different worldviews and values, and weighs their personal risks differently, however, through proper argument assessment, a common ground on the topic of vaccination can be reached. Our public discourse should be more respectful, and more evidence-based. By evidence-based, I mean all of the evidence, not just the evidence that supports confirmation bias. We should exert greater effort to reconcile the discrepancies and contradictions in the data and find consistency for analysis. I hope that as new evidence comes to light, we will all be able to look at it rationally, and with deference to each others’ worldviews and subjective morality.