The difference between being antivaccine and “pro-safe vaccine,” explained using J.B. Handley

One of the most frequent complaints leveled at pro-science advocates who defend vaccines against antivaccine misinformation and pseudoscience is that we’re way too fast to label them as “antivaccine,” that we use the term as a convenient label to demonize their views. We’re not really antivaccine, they tell us. We’re vaccine safety advocates. Really. Now, I have no doubt that this is how most of these antivaccinationists masquerading as vaccine safety activists see themselves, to the point where sometimes I find it refreshing when I encounter an antivaccine activist who proudly labels herself antivaccine. However, it doesn’t take much poking around to show that, no matter how this variety of antivaccinationists view themselves as “not antivaccine,” they really are antivaccine to the core. One way to do that is simply to listen to them or read what they write about vaccines and take them at their word with respect to their statements about various vaccine science. Every so often, I think it’s useful to do that, in order to provide an example of how it’s done, and fortunately for me an old “friend” provided me with just such an example late last week.

I’m referring to someone whom long time readers of this blog will recognize, J.B. Handley. Most people probably don’t remember that it was J.B. Handley and his wife who founded the antivaccine protest group Generation Rescue, not Jenny McCarthy, who’s been its president and public face for something like eight years now. Generation Rescue (GR) was originally founded as a “mercury militia” antivaccine group; i.e., a group based on the idea that the mercury in the thimerosal preservative that was in several childhood vaccines until early 2002 is a major cause of an “autism epidemic.” Back in those days, Handley used to show up occasionally on this blog to try to convince me of the error of my ways. Not surprisingly, he failed. Be that as it may, over time, GR’s antivaccine stance “evolved” to embrace a more “holistic” view of autism causation. Now it’s not just mercury in vaccines. It’s vaccines and “environment” (code for vaccines interacting with other things). This evolution had the distinct advantage of broadening the class of antivaccine crank to whom GR could appeal, but more importantly it opened up the door to many more forms of “autism biomed” quackery than just chelation therapy and treatments designed to remove mercury.

So what did Handley write that provides me with a “teachable moment” about why it’s not inaccurate to call people like him “antivaccine”? Unfortunately Medium still allows Handley to spew his pseudoscience every now and then. When last we left him, he was regaling us with An Angry Father’s Guide to Vaccine-Autism Science. This time around, he’s recommending The Only Vaccine Guide a New Parent Will Ever Need. He starts out by trying to inoculate himself against charges of being antivaccine:

I am a dad. And, I write this without benefitting in anyway from what is said here. I have no book to peddle, no profits to protect, and there’s no doubt that writing this will result in some amount of hate directed in my general direction for challenging a popular narrative that vaccines are only safe and effective and should be administered the same way to all children without consideration for the unique biology of each and every child. So be it.

This is, of coure, a variant of the “special flower” narrative, so beloved of antivaccine activists. Basically, the idea goes like this. Every child is unique (who could argue with that?), which means that every child will react differently to vaccines and some of those reactions will be horrible and cause autism. Consequently—or so the “reasoning” goes—one size doesn’t fit all, and we have to consider each child’s “unique” biology in deciding which vaccines to administer and when. Not surprisingly, this “special flower” narrative always involves either not vaccinating, skipping many vaccines, or, in accordance with the ever-popular other major antivaccine trope (“too many too soon”) delaying vaccination and frequently involves “pretreating” a child to be vaccinated with various supplements and quackery to lessen the chances of a catastrophic vaccine injury (cough, cough, autism, cough, cough). Of course, vaccines are administered to many millions of children every year. We know that the frequency of serious adverse reactions is very, very low, while we also know that the protective value is very high and that it’s far safer to be vaccinated than unvaccinated. Of course, the “special flower” gambit really serves only as an excuse not to vaccinate unless medical science can come up with a test (or series of tests) that can absolutely predict with 100% accuracy that no harm will come to the parent’s special flower.

Thus, it’s not surprising that, before launching into a discussion of Ten truths about vaccines most people don’t know (what is it about cranks and appeals to “Truth” with a capital T?), Handley urges parents to “do your own research.” I, too, urge parents to do their own research, but, unlike Handley, I suggest that they do their research using legitimate scientific resources, not antivaccine crank websites and Google University knowledge. Consistent with the “special flower” narrative, Handley then urges parents to “find a healthcare provider who doesn’t believe “one size fits all” when it comes to vaccines.” Hilariously, he notes that they “might be a naturopath, a D.O., or a chiropractor, just find one!” Most DOs, of course, vaccinate just like MDs. Naturopaths, of course, are quacks (and antivaccine, to boot, which is presumably why Handley likes them), as are most chiropractors.

So here are Handley’s “Truths.” Many are repetitive and overlap.

“Truth” #1: Handley resurrects the old antivaccine trope that the vaccination schedule includes 72 doses. Of course, like all antivaccinationists, Handley has to strain to make this number as large as he can. For instance, he includes the flu vaccine and DTaP, both of which are administered to the mother during pregnancy, not to the child, and of course the DTaP contains three vaccines (diptheria, tetanus, and pertussis). He also separates all the combination vaccines into their individual components for purposes of counting vaccine “doses.” But, as disingenuous as Handley’s “analysis” is, let’s just take it at face value for purposes of rebuttal. So what if there are now 72 “doses” of vaccine administered between the ages of 0 and 18 in 1962 and 24 in 1983? That just means there are more diseases that can be prevented by vaccines. Handley clearly means to imply that this many doses is somehow harmful, but the evidence runs counter to that. In particular, it’s been shown time and time again that vaccines do not cause autism.

”Truth” #2: Here, Handley claims, “Even today, other first world countries often give far fewer vaccines to children than the U.S., and avoid many altogether,” to which I again ask, “So what?” obviously, Handley means to imply that this schedule is harmful and that these vaccines are unnecessary. He fails.

”Truth” #3: Handley asserts: “Vaccines injure children, and the U.S. government has an entire division set up to compensate families for that injury.” Yes, there is a National Vaccine Injury Compensation Program that was set up in the 1980s in the wake of a wave of product liability lawsuits against vaccine manufacturers. I’ve written about it many times, in particular how its rules for evidence are more lax than normal courts. Basically, Handley sounds a lot like the Canary Party in his use of the existence of the Vaccine Court as a reason to believe that vaccines are unsafe. The Vaccine Court was set up to compensate families whose child might actually have suffered an actual vaccine injury, cases that are rare but do exist. In addition, the Vaccine Court pays the complainant’s reasonable court costs. The reason antivaccinationists don’t like the Vaccine Court lies more in the greed of trial lawyers who would like to go for big “jackpot” payoffs rather than accept the easier-to-obtain but smaller payouts and reasonable (and guaranteed) fees from the Vaccine Court.

”Truth” #4: Handley asserts: “In most states, you have a choice on whether or when you give your child vaccines.” Well, yes, but that’s just evidence that we don’t have “forced” vaccination in this country. We have school vaccine mandates, and states decide which vaccines must be given prior to school entry. Usually the vaccine mandates reiterate the CDC schedule, but not always. “Truth” #4 can only be interpreted as encouragement to push the limits in not vaccinating.

“Truth” #5: Handley asserts: “There will be a permanent supply of disease “outbreaks” because the vaccines for measles, mumps, and pertussis have serious efficacy issues.” Um, not exactly. As I’ve described more times than I can remember, the vast majority of outbreaks of vaccine-preventable diseases in this country are associated with areas of low vaccine uptake. In my state of Michigan, for instance, we had pertussis outbreaks that corresponded closely to areas in the state with low vaccine uptake. Yes, the pertussis vaccine is imperfect and immunity can wane, but it’s still quite protective. As for the measles vaccine, it’s quite effective. The efficacy of the flu vaccine does fluctuate from year to year, depending on the match between the types in the vaccine and what is circulating, but it’s still better to receive it than not.

“Truth” #6: Handley warns: “A public health technique, spearheaded by the CDC, is to create ‘Concern, Anxiety, and Worry’ like we saw during the Disneyland measles scare.” This is Handley straight up being deceptive by willfully misinterpreting a statement by a CDC official named Glen Nowak in 2004, who said:

The belief that you can inform and warn people, and get them to take appropriate actions or precautions with respect to a health threat or risk without actually making them anxious or concerned. This is not possible…This is like breaking up with your boyfriend without hurting his feelings. It can’t be done.

I interpret this as a recognition that it’s impossible to inform people of the dangers of vaccine-preventable disease and the benefits of vaccines without making them worry about vaccine-preventable disease, an observation so mind-numbingly obvious that it’s hard to believe that anyone would find it surprising. Indeed, in the same talk, Nowak mentioned AIDS, traffic fatalities, and DVTs as other examples. Handley misinterprets Nowak’s remarks as a manifesto.

“Truth” #7: Handley warns: “Doctors are not required to give you the actual package insert for vaccines that spells out the known adverse events.” This is nothing more than “argument by package insert,” a deceptive antivaccine trope because package inserts are legal documents designed to cover the posteriors of drug companies, not careful discussions of risks and benefits. Basically, if any adverse event is reported during clinical trials used to apply for FDA approval, it will make it onto the package insert, regardless of how likely the adverse event was due to vaccines. Read Skeptical Raptor’s explanation.

“Truth” #8: Handley claims, “Vaccines have been proven to cause auto-immunity, something now epidemic amongst U.S. children.” Apparently Mr. Handley’s definition of “proven” is a bit more expansive than mine, or that of any other scientist. For example, Handley cites an abstract presented at a meeting. (Abstracts are the easiest to get accepted, particularly if they are poster presentations.). He also cites a speculative paper. That’s hardly “proven,” particularly when weighed against the rest of the evidence.

“Truth” #9: Handley makes like the Black Knight in Monty Python and the Holy Grail: “The debate about whether or not vaccines cause Autism is far from over.” He continues:

Like tens of thousands of other parents who I have heard from, I watched my son regress from normal to Autism between the age of 12 and 20 months. His decline coincided perfectly with his vaccine schedule and he developed a myriad of physical symptoms that ultimately ended up with an Autism diagnosis. I just came across a site recently with more than 2,500 personal accounts of vaccine injury that I think is worth a look right here.

Handley’s love that “tens of thousands of other parents” that he’s heard from. One wonders where he finds time to write between all the phone calls and e-mails from tens of thousands of parents. In any case, this “Truth” involves Handley invoking a greatest hits compilation of discredited vaccine-autism arguments and conspiracies. Hannah Poling? Check. She’s there. Poul Thorsen? Yep, he’s there, complete with a citation of antivaccine “journalist” Sharyl Attkison. Handley’s own “Fourteen Studies”? Of course! The “CDC whistleblower” conspiracy theory? Do you even have to ask?

I’m only surprised Handley waited until #9 for this one. Maybe he was building up to his most “potent” arguments, because after trying his best to argue that vaccines are dangerous over the first 9 “Truths,” he now tries to argue that they don’t work.

“Truth” #10: Handley proclaims, “The impact of vaccines on infectious disease since the 1900s has been overstated.” Yes, he went there. He invoked the most supremely intellectually dishonest “argument” used by antivaccinationists, namely what I like to call the “vaccines didn’t save us” gambit. Basically, it notes that mortality from various vaccine-preventable diseases was declining before the introduction of vaccines for those diseases, which is true. Our ability to keep children who came down with such diseases alive was improving. Iron lungs, for instance, allowed far more children with polio to survive. What this gambit neglects to show is how incidence from these vaccine-preventable diseases plummeted after introduction of vaccines, just as one would expect if the vaccines were highly effective.

I started this post by asserting that there is a difference between being antivaccine, which is what J.B. Handley is, and being a vaccine safety advocate, which is what many, if not most, antivaccinationists, like Handley, claim to be, and that Handley’s article would help to show that difference. To see what I meant, all that’s necessary is to contemplate each of Handley’s “Truths” about vaccines. Each is designed to claim that either (1) vaccines are dangerous or (2) that they don’t work as claimed. To top it off, there’s a heapin’ helpin’ of conspiratorial thinking, in which it is implied (or outright stated) that the CDC and big pharma are conspiring to hide the dangers and ineffectiveness of vaccines from you using—of course!—fear mongering. I suppose it’s possible that a vaccine safety advocate could believe all these things and truly be advocating for better vaccines, but it strains credulity.

That credulity breaks when I look at the last section of Handley’s article, where he lists the 11 vaccines currently on the CDC’s recommended vaccination schedule and cannot recommend a single one. Instead, he divides them into two categories: “Do your homework,” which includes DTaP, PCV, Hib, and IPV, and “Highly questionable risk/benefit ratio,” which includes all the rest. In other words, he doesn’t consider a single one of the vaccines in the CDC schedule to have an acceptable risk-benefit ratio to recommend. In his treatment of each individual vaccine, Handley doesn’t list a single favorable article. His entry for every vaccine, even the ones on his “Do your homework” list, contains only negative articles that echo and reinforce common antivaccine tropes, such as claims that Hib might cause type I diabetes, claims that DTaP causes sudden infant death syndrome, and that MMR is associated with autism coupled with the fallacious claim that measles isn’t a dangerous disease anyway.

Handley’s article can only be described as antivaccine. It’s all negative claims about vaccines and those who make and promote them, and he can’t even find a single vaccine that he can recommend as having what to him is an acceptable risk-benefit ratio—the same as it ever was.

I frequently say that it doesn’t take much to identify self-proclaimed “vaccine safety advocates.” After all, a vaccine safety advocate would most likely view some vaccines as safe, some as not, and some as probably safe but not sufficiently proven for their likes. They would be unlikely to view all vaccines as dangerous. Thus, all you have to do to scratch and reveal the antivaccinationist is to ask a “vaccine safety advocate” if there is a single vaccine that he/she considers sufficiently safe and effective to recommend for most children. Alternatively, you can ask him/her if there is one vaccine she would give her baby if he/she were to have another child. If the answer is no, what you’re dealing with is an antivaccinationist, not a vaccine safety advocate.