Joe Mercola attacks vaccinations again. Film at 11.

Joe Mercola is antivaccine, through and through, and, unfortunately, his website is one of the largest repositories of antivaccine quackery on the Internet. While it’s true that, unlike the antivaccine crank blog Age of Autism, Mercola doesn’t limit his advocacy of quackery to just antivaccine quackery, he has recently teamed up with Barbara Loe Fisher, founder of the Orwellian-named National Vaccine Information Center (NVIC) and the grande dame of the antivaccine movement. Indeed, Mike Adams has got nothing on Joe Mercola when Joe decides he wants to go on an antivaccine tear, which he did yesterday in a full-throated, lame-brained, full frontal assault on the pertussis vaccine, entitled Mounting Evidence Shows Many Vaccines are Ineffective and Contribute to Rise of Outbreaks Caused by Mutated Viruses. The article is a black hole of antivaccine misinformation, innumeracy, and pure pseudoscience, all rolled up into a vile little package designed to “go viral” on antivaccine websites, blogs, Facebook pages, and Twitter feeds everywhere. Basically, against all evidence, Mercola tries to blame outbreaks of pertussis on the acellular pertussis vaccine itself.

I kid you not.

Mercola starts with the 2010 outbreak of whooping cough in California. It was one of the largest pertussis outbreaks in 50 years and very worrisome. Of course, to Mercola, conspiracy theorist that he is, all the public health measures to encourage vaccination are a “scare campaign” that was “launched in the California by Pharma-funded medical trade associations, state health officials and national media, targeting people opting out of receiving pertussis vaccine, falsely accusing them of causing the outbreak.” While it is true that the pertussis outbreaks depend upon more than just the number of children left unvaccinated (for instance, pertussis outbreak tend to be cyclical in nature, and there is the issue of waning vaccine-induced immunity in older children and adults), it is also true that having pockets containing large numbers of unvaccinated children to serve as reservoirs for the organism, Bordetella pertussis, that causes whooping cough is not a good thing because it contributes to outbreaks, regardless of other factors that might or might not contribute.

To Mercola, however, it is always simple (and simple-minded). To him, the vaccine does not work. To support his claim, he cites a study published last March examining the California pertussis outbreak by David J. Witt and colleagues at Kaiser Permanente and commenting on the shorter-than-expected duration of immunity from the acellular pertussis vaccine. I note that I had to figure out for myself which study Mercola was citing because Mercola has a really annoying habit of not including is citations, either as links or reference links. He does, however, include a list of “Internet Resources,” which include the usual suspects of antivaccine websites, such as that of the NVIC.

In any case, here’s how Mercola spins the study:

In fact, the study showed that 81 percent of 2010 California whooping cough cases in people under the age of 18 occurred in those who were fully up to date on the whooping cough vaccine. Eleven percent had received at least one shot, but not the entire recommended series, and only eight percent of those stricken were unvaccinated.

Needless to say (but I’m going to say it anyway), Mercola is being disingenuous here. For one thing, the authors stated quite clearly:

In reviewing cases confirmed at our medical center during this outbreak, we noted effective protection of younger children.

Basically, this study found that the vaccine was highly effective in children between 6 months and five years of age but that its effectiveness waned, such that vaccinated children between 10 and 12 were as likely to develop pertussis during this outbreak as unvaccinated children:

Among the 58 cases of pertussis in children aged 10-12, 55 (95%) had received five or more doses of pertussis vaccination. Eight of these 58 (14%) children had received their sixth booster-dose prior to onset of disease. In the 13-18 year age group and in the entire cohort of those 2-18 years of age, there was a highly significant increase in cases in unvaccinated children (p = 0.009 and 0.01 respectively). See table 1.

It should be noted that in all age groups, the attack rate in the unvaccinated and undervaccinated groups were higher than in the fully vaccinated group, but that this difference only reached statistical significance in the 13-18 year group, where the attack rate was nearly five times higher in the unvaccinated/undervaccinated group. Moreover, when taken as a whole, the attack rate was also statistically significantly higher in unvaccinated/undervaccinated children from ages 2 to 18. In other words, the vaccine works, but there is a period (age 10-12) during which there appears to be a hole in the coverage, such that waning immunity after the last dose results in decreased protection, protection that is reactivated by the booster dose at 12 years. Indeed, there was a very strong correlation between the interval between onset of pertussis and last acellular pertussis vaccine dose, with the interval peaking at 11 years. The authors conclude:

In the case of the recent California epidemic, it appears that the effectiveness of the current vaccine schedule, when paired with the imperfect vaccination rate, may be insufficient to prevent an epidemic. Earlier vaccine booster doses may be required to provide adequate herd immunity, absent an increase in vaccination rate, efficacy, or durability. Earlier booster doses could prevent immunity from waning, and address disease in the 8-12 age group.

In other words, this study doesn’t show that the vaccine doesn’t work. Rather, it suggests that immunity from the vaccine wanes sooner than expected, that this region of California doesn’t have a high enough vaccine uptake rate to prevent epidemics, and that the vaccination schedule should probably be changed to provide earlier boosters in order to protect older children and teenagers. Indeed, an accompanying editorial by Dr. Alfred DeMaria, Jr. agrees:

Continued widespread outbreaks of pertussis in the United States, with disruption of school and work, as well as with the significant threat to infants, begs the question of more effective use of Tdap on a population level. Experience with Tdap vaccine has diminished concerns about adverse events [12], but the duration of protection with Tdap is not yet known. Reasonable consideration should be given to the suggestion of earlier, more frequent booster doses, as well as the replacement of Td by Tdap as the routine adult “tetanus shot” [13, 14]. With US adolescent Tdap coverage of 69% [15], there is still more to do to achieve full implementation of current recommendations.

Indeed, a study by Winter et al just published this month in the Journal of Pediatrics more or less agrees. Basically, it found similar results, specifically a stepwise increase in pertussis among children aged 7-10 years who had completed the DTaP series but who had not yet received the Tdap booster recommended at age 11-12 years, along with a stepwise decrease in cases among adolescents from ages 11 to 14. The authors concluded that preadolescents are susceptible to waning immunity with the current schedule and that the adolescent Tdap dose is effective in protecting younger adolescents.

Again, the conclusion is not that the vaccine doesn’t work, but rather that our current vaccination schedule is probably not aggressive enough, particularly in children aged 6 to 10, where another booster would likely be a good idea. Moreover, what Mercola completely ignores is that, although vaccinated children can still be susceptible to pertussis, they are less infectious, have milder symptoms and shorter illness duration, and are at reduced risk for severe outcomes, such as requiring hospitalization. In any case, if you want to see a statement that’s so wrong it’s not even wrong, get a load of what Mercola concludes from all this:

So, as clearly evidenced in this study, the vaccine likely provides very little, if any, protection from the disease. In fact, the research suggests those who are fully vaccinated may in fact be more likely to get the disease than unvaccinated populations.

In a word: No.

Mercola then leaps and cavorts about in his usual merry way, attacking the pertussis vaccine. First, he cites an article (which, alas, I can’t seem to access now because the server is down) that lists several potential reasons for “inflated” estimates of the efficacy of the acellular pertussis vaccine, namely that less severe cases were excluded in the definition. The author of the paper, J.D. Cherry, sounds like someone with a bit of an axe to grind, at least if the excerpt cited by Mercola (again, without a link to the actual paper) is any indication. In any case, milder cases of pertussis are not the main concern. What we as physicians want to prevent with the vaccine are the severe cases, the cases that land babies and children in the hospital, the cases that kill infants. Consequently, it is not unreasonable to have a definition of the disease that requires laboratory confirmation and 21 days of paroxysmal cough. In this, I would tend to trust the judgment of pediatrics infectious disease experts rather than a woo-loving D.O.

From there Mercola goes his merry way to cherry pick an article critical of the varicella vaccination program and claim that the pertussis vaccine is creating “superbugs” by giving B. parapertussis, which can also cause whooping cough and is not protected against by the vaccine, free rein. Of course, the solution to that problem, if problem it even is, is to develop a pertussis vaccine that covers both organisms. Finally, Mercola makes fun of a study suggesting that the HPV vaccine might already be reaching levels that contribute to herd immunity. The particularly hilarious thing about this particular mocking of a study is that Mercola doesn’t believe herd immunity really exists. At least, he doesn’t think vaccines can confer herd immunity. Oh, no. To him it has to be “natural” herd immunity. Of course, one can see the difficulty achieving “natural” herd immunity if greater than 90% of the population have to get the disease and recover from it in order to achieve it? In any case, Mercola quotes BLF going straight for the naturalistic fallacy:

The fact that manmade vaccines cannot replicate the body’s natural experience with the disease is one of the key points of contention between those who insist that mankind cannot live without mass use of multiple vaccines and those who believe that mankind’s biological integrity will be severely compromised by their continued use.

… [I]s it better to protect children against infectious disease early in life through temporary immunity from a vaccine, or are they better off contracting certain contagious infections in childhood and attaining permanent immunity? Do vaccine complications ultimately cause more chronic illness and death than infectious diseases do? These questions essentially pit trust in human intervention against trust in nature and the natural order, which existed long before vaccines were created by man.

This is, of course, a classic false dichotomy. Vaccines complications are very rare, and there is no evidence that vaccines cause chronic illness, much less more chronic illness and death than the diseases they protect against. In fact, vaccines are among the very safest of medical interventions, with serious adverse reactions being very rare. None of this stops Mercola from ranting about how it is a massive pharma conspiracy driving the movement to limit nonmedical exemptions to vaccine mandates.

Unfortunately, as badly argued, badly reasoned, and full of cherry-picked and misrepresented scientific evidence as Mercola’s article is, it will probably sound superficially persuasive to many. That’s because Mercola’s a slick propagandist. He knows how to come up with the big lie and repeat it relentlessly until it seems like the truth, at least to those who don’t know any better.