Andrew Wakefield, his claims to the contrary, is antivaccine to the core. To be honest, I’m not sure if he was always antivaccine. After all, around 20 years ago when he was doing his “research” into whether the MMR vaccine causes autism, he was being generously funded by a barrister seeking to sue vaccine manufacturers and he was developing a competing measles vaccine (for which he filed for a patent) that would be unlikely to be profitable unless the MMR became discredited. In retrospect, knowing what I know now about these aspects of Wakefield’s “research,” I consider it highly likely that Wakefield was cynically making money where he could. However, somewhere along the line, whether it was due to the celebrity or the adulation he received from antivaccine mothers of autistic children who viewed him as a hero for giving them something to blame for their children’s condition or the lucrative nature of being an autism quack, Wakefield did become truly antivaccine. Now, he’s traveling the country promoting VAXXED: From Cover-up to Catastrophe, a documentary that is in reality an antivaccine propaganda movie spewing the same old antivaccine pseudoscience coupled with the newer “CDC whistleblower” myth, to communities that can ill afford the return of vaccine-preventable diseases.
When last we left Andrew Wakefield, he was with his old friend and ally Polly Tommey and his new buddy and producer of VAXXED Del Bigtree spreading antivaccine misinformation to a largely African-American group in Compton, CA, complete with the mayor and an African-American woman featured in the film named Sheila Ealey, who believes that vaccines caused her son’s autism and buys completely into the “CDC whistleblower” conspiracy theory. Worse, he peddled the intellectually dishonest “vaccines didn’t save us from infectious disease” gambit. His words are worth repeating here because they lead into what I’m going to discuss:
The mortality and the morbidity—that is, the illness associated with infectious disease—of virtually every infectious disease—measles, mumps, rubella, typhoid, chickenpox—was coming down dramatically before vaccines were ever introduced. The morbidity and mortality from measles had come down by 99.6% before vaccines were introduced. If we had not introduced vaccines, would they have come down to zero? We’ll never know, because we intervened with vaccines, and they claim it was vaccines that caused the improvement. It was nothing to do with vaccination. OK, that may have produced an incremental improvement. Are they necessary for life? Absolutely not!
This is, of course, utter bollocks (to borrow a word from Wakefield’s native land). The sleight-of-hand is to point to declining mortality from infectious diseases, which was due to improvements in medical treatments that allowed more children to survive these diseases, with incidence of infectious diseases, which did decline markedly for each disease for which an effective vaccine was introduced at exactly the time one would expect, shortly after the widespread use of the vaccine took hold. Unfortunately, I learned recently that Wakefield just expounded on this little snippet on the VAXXED website in a little ditty called Notes on Herd Immunity from Andrew Wakefield. Basically, it’s a compilation of the “greatest hits” of antivaccine lies about herd immunity presented as a bullet list. Basically, Wakefield tries to claim that “natural” herd immunity is better than herd immunity due to vaccination and fails risibly and despicably.
So let’s look at Andy’s rationale, such as it is. Before I do, however, I can’t help but note that at no point does he provide links to his sources for his claims. For instance, Wakefield claim that in the developed world “As a consequence of natural Herd Immunity, in the developed world measles mortality had fallen by 99.6% before measles vaccines were introduced.” This is probably a not entirely unreasonable estimate of how much mortality had decreased. Then, Wakefield goes off the rails, saying, “A fall in morbidity will have paralleled the fall in mortality (mortality is the extreme of morbidity).” Um, no. You can’t make that claim. An equally plausible outcome is that, as more children survive measles, the survivors live with more morbidity. Think of it this way with another disease, polio. As more children survived polio, thanks to iron lungs, more survived to face the possibility of permanent weakness and paralysis. Mortality might well have declined, but morbidity in the survivors stayed the same or increased because more children survived to face that morbidity. Also, there is long-lasting morbidity due to measles virus infection in the form of immunosuppression that lasts two to three years after infection and predisposes to death from infectious disease. In other words, the benefits of measles vaccination go beyond just measles.
Wakefield’s claim is without evidence and rests on an assumption that is completely backwards. That’s even leaving aside the fact that getting sick is morbidity! Seriously, if you get sick with measles, even if you recover (as the vast majority do), you have suffered significant morbidity, and if there’s a vaccine suffering that morbidity is potentially preventable! Basically, Wakefield redefines morbidity as only permanent sequelae to make this deeply dishonest argument. I could much more reasonably define morbidity as being ill with vaccine-preventable disease (because that is morbidity, albeit temporary) and point out that, since the measles vaccine was introduced in the US, morbidity has declined by 99.9% and mortality by very close to 100%, while morbidity and mortality from polio have declined 100%. Meanwhile, worldwide, thanks to the measles vaccine, mortality has fallen dramatically since 2000, from an estimated 733,000 deaths in 2000 to 164,000 in 2008 to an estimated 96,000 in 2013, thanks to a worldwide vaccination program.
Let’s look at Wakefield’s “reasoning.” Wakefield makes the claim that “high dose exposure” due to natural infection (you know, complete with the replicating virus that makes you sick) results in better herd immunity:
- High dose exposure occurs because, in the absence of viral immunity, viral replication is unimpeded in the multiple susceptible human reservoirs in which it thrives. High doses of measles virus are transmitted from one person to the next. Added to this, socioeconomic circumstances contribute to high dose exposure. This includes high population density (easy transmission) and poor antiviral defenses (e.g. low vitamins A, D, and C). An example is the ravage of measles in Confederate soldiers amassed in barracks and hospitals in the American Civil War.
- Over time, as measles becomes endemic (constantly circulating) in a population with typical 2-yearly epidemics, Herd Immunity increases rapidly. Natural exposure leads to long term immunity. Immunity limits viral transmission and opportunities for viral replication. Concomitantly, developed countries have experienced an improvement in nutritional status and consequently antiviral immunity. Dose of exposure falls and a dramatic reduction in morbidity and mortality is observed.
I haven’t used this in a while, but truly it is appropriate now. The stupid, it burns.
Herd immunity (or the newer, more preferred term, community immunity, a term that doesn’t liken us to cattle) is not defined by morbidity and mortality of a vaccine-preventable disease. It’s defined by the incidence! Guess how many cases of measles there were in the US before the introduction of the vaccine? Between 1952 and 1963, there were an estimated 530,217 cases per year (with 440 deaths). Apparently that “natural” herd immunity didn’t work so well back then. What about now? A few hundred cases, thanks to the Disneyland measles outbreak, fewer before. That’s thanks to the measles vaccine and thanks to community immunity.
But wait, it gets stupider:
Let us look at an example of how natural Herd Immunity operated to provide age-appropriate immunity.
- Infants less than one year of age have a limited ability to generate adequate immunity and are susceptible to serious measles infection.
- In the pre-vaccine era mothers conferred good passive immunity on their infants by transplacental and breast milk transfer.
- This passive immunity protected infants through a period of vulnerability until they were better able to cope with measles through the generation of their own active immunity.
Yep, that passive immunity worked so well that measles still ran rampant through the population. Just let the kids get sick after whatever passive immunity they had from breast milk wears off! And the price of that passive immunity is only a half a million sick kids a year and a few hundred deaths. What a bargain. Of course, one can’t help but point out the dichotomy here. Antivaccine activists like Wakefield will wax indignant over a single vaccine injury or death and scoff at any argument that vaccines are safe enough because only 1 in a million suffers a serious adverse event, but then will turn around with brain dead arguments that “natural immunity” is worth hundreds of deaths a year.
Now look at Wakefield’s characterization of the “vaccine era,” in which, as Wakefield tells it, “natural herd immunity” has been destroyed. Never mind that “natural herd immunity” is an oxymoron when describing one of the most easily transmissible infectious diseases out there:
- The increasing Herd Immunity associated with natural measles and the accompanying decrease in morbidity and mortality, has been interrupted by vaccination. This makes it difficult to predict how vaccinated populations might respond to, say, a new strain of measles virus that has escaped the ‘protection’ conferred by measles vaccine (escape mutant). Because that population is not immune to the escape mutant we risk high morbidity and mortality from measles once again.
- Vaccinated mothers do not confer adequate passive immunity upon their infants (< 1 year of age). Infants are unable to generate an adequate immune response to measles vaccine and in the absence of passive maternal immunity, are unprotected during the first year, putting them at risk of serious measles infection.
- Unlike natural measles, measles vaccine does not provide lasting immunity and a substantial proportion of measles cases are reported in those who have been vaccinated against measles.
- Boosting of immunity using repeated doses of measles vaccine is not sustained and falls off rapidly. The only answer to this diminishing return that is offered by the regulators and manufacturers is to give more and more vaccines. The vaccine is highly profitable in terms of volume of sales, precisely because it is inadequately effective.
There’s a whole lot of hand waving going on here which is silly in the extreme. In particular the first bullet point almost made me bleed from my ears, as the ignorance in it assaulted my neurons. If a new strain of measles virus were to evolve it would be difficult to predict how any population might respond to it because it’s a new strain. It could be more virulent, cause more harm, or be potentially more deadly, or it could be less so. There would be no way to predict a priori in a vaccinated or unvaccinated population. Also, the unvaccinated population wouldn’t be immune to the “escape mutant” either. Seriously, Wakefield isn’t even trying here, but his followers will lap this idiocy up. As for the implication that measles immunity rapidly declines, that’s not true. It lasts over 20 years after two doses of MMR, and the CDC only recommends one adult dose if there is no evidence of ongoing immunity, which implies that a significant part of the population is immune much longer than 20 years.
After dumping this load of antivaccine nonsense on us, Wakefield can’t resist moving on to the mumps vaccine. Railing against the mumps vaccine as being ineffective and referring to mumps as being a “trivial disease in children” but not trivial in post-pubertal males because of its ability to affect the testicles and cause sterility, he claims that “natural Herd Immunity” (which he inexplicably keeps capitalizing) has been destroyed by mumps vaccination. I can’t help but note that the incidence of mumps has fallen 96% since the pre-vaccination era; so Wakefield’s claim that the mumps vaccine is ineffective is, as the rest of his claims, deceptive. Truly, though, Wakefield can do an excellent Gish gallop, as he continues to do with chickenpox and shingles:
The chickenpox virus (varicella zoster) causes a mild self-limiting disease in healthy children. The virus frequently establishes latent infection in the cell bodies of sensory nerve roots where it has the potential to episodically reactivate and cause shingles, a very painful and debilitating condition. Shingles can cause blindness. Historically, shingles was an uncommon disease occurring in, for example, people with immune deficiency due to cancer or immunosuppressive drug therapy.
Reactivation of zoster is inhibited by an adequate level of immunity to this virus which, in turn, is maintained by boosting of immunity in parents and grandparents by re-exposure via children with chickenpox. Natural epidemics of chickenpox maintained Herd Immunity by ‘wild-type boosting’ (referring to the natural virus) of adults which prevented shingles in otherwise healthy individuals. This is no longer the case.
Widespread chickenpox vaccination has removed natural Herd Immunity by preventing epidemics, eliminating ‘wild-type’ boosting, and allowing immunity to fall in individuals to the point where shingles is now much more common, occurring in young, apparently healthy people. Vaccination has created a new epidemic to which Merck’s response is, ‘we’ve created a market; now let’s make a vaccine to prevent shingles.’
First of all, chickenpox is not nearly as benign a disease in children as Wakefield represents it. It can produce real complications, including:
- bacterial infections of the skin and soft tissues in children including Group A streptococcal infections
- infection or inflammation of the brain (encephalitis, cerebellar ataxia)
- bleeding problems
- blood stream infections (sepsis)
These complications can be serious enough to require hospitalization and can even cause death in otherwise healthy children. Such complications might not be common, but when large numbers of children get chickenpox, there will be these complications. Aside from that, having the chickenpox is just plain miserable. I got it when I was around seven, and its one of the few things I remember most vividly about that age because it made me so itchy, feverish, and downright sick. I still have a couple of scars from pox that I scratched open. But what’s the suffering of millions of children compared to an antivaccine ideology valuing “natural” immunity?
As for the rest of Wakefield’s argument, Skeptical Raptor does a good job of dismantling the rest of Wakefield’s argument, which is basically antivaccine boilerplate about chickenpox and shingles. First, I agree with the scaly one that it is morally repugnant to use children as a vehicle to immunize adults by maintaining a pool of infected children through not vaccinating, particularly when the cost is that some children will become very sick and some children will even die. Again, antivaccinationists, who wax so morally righteous at the thought that one in a million children receiving vaccines might have a serious adverse reaction seem unconcerned about more children (particularly the immunosuppressed) suffering and even dying to protect adults. More importantly, as our scaly friend put it:
Previously, scientists thought that the potential immune effect against shingles by recurrent chickenpox infections in children would last around 20 years. Based on real immunological and virological data from individuals, a new model of chickenpox vaccine and shingles, developed by the scientists in Belgium, shows that the effect only lasts for about two years.
So, if one could argue that putting children at risk for chickenpox just to protect adults was morally acceptable, the effect is so short-term that adults would essentially need to encounter a constant pool of chickenpox infected children. I swear this sounds like some surreal post-apocalyptic movie running on Netflix.
Of course, nuance is not what Wakefield is about. Fear mongering is. Yes, vaccinating against varicella (the virus that causes chickenpox) could temporarily increase the incidence of shingles in younger adults. However, vaccinated children who don’t get chickenpox, thanks to the vaccine, will never have to worry about getting shingles. These are the sorts of trade-offs that real public health officials, real physicians, and real infectious disease efforts consider while evaluating evidence that ideologues like Wakefield completely ignore.
Andrew Wakefield, Polly Tommey, Del Bigtree, and the rest of Wakefield’s crew might tell themselves they are “vaccine safety advocates,” but in reality they are clearly antivaccine, given that they keep repeating long-discredited misinformation about vaccine efficacy and safety. Unfortunately, they’ve made a vehicle, VAXXED, to peddle those same old lies as old wine in a new skin. Worse, they’re peddling them to populations that can least afford the return of the scourges of the diseases that vaccines have been effectively holding at bay.