Can We Get Past the “Pro” vs. “Anti” Vaccine Debate?

It’s safe to say there is a lack of constructive dialogue about vaccines and their safety. Within a few years, this issue is now as widely polarizing as political issues like abortion, health care, and taxes. Since when is a public health issue so front and center in our daily lives and where did we get off track?

Rooted at the center of it all is a basic (and also very complex) understanding of science and the role it plays in our collective health. It’s well documented that even among well educated Americans, our knowledge of science and how it works is dangerously thin. A recent poll found that only 74% of Americans believe the Earth orbits around the sun (!!). So it’s no surprise that the conversation around vaccines, something that is quite complex, is being distilled into angry online fist fights.

Regardless of where you currently stand on the issue, some of these points may resonate with you. Please read on with an open mind as I cover a lot of ground here.

I am not a scientist by training, nor am I a physician. You should talk to your physician about your concerns around vaccine safety, not me. 

It’s common for people that are pro-vaccine to dismiss questions around pharmaceutical safety, perpetuating the skepticism. It’s very rare, but some people do have allergic reactions to some vaccines and there is an even smaller percentage of the population who can’t receive vaccines for medical reasons (certain pre-existing conditions etc).

On the flip side, those that are against or skeptical of vaccines are not fully understanding both the safety of and the regulations behind vaccines and how they differ from other product categories. In addition, there is a general lack of appreciation around the concept of protecting public health and it has been distilled into a distracted conversation about personal freedom, rather than focusing on the greater good. 

The good news is as the science around vaccines evolves, we are seeing less complications and negative reactions to vaccines. Just because there are some risks with vaccinating doesn’t mean we shouldn’t be vaccinated to prevent the spread of infectious disease.

The question for me is, how can we prevent horrific infectious disease and always strive to make vaccines safer?

Different Regulations Under the FDA

It’s easy to point fingers at the FDA for being lax or to call into question the influence of pharmaceutical companies. With that being said, we need to fully understand that the FDA carries out the regulations passed by Congress (this means the FDA doesn’t get to just decide to regulate or not regulate something, Congress needs to tell them what to do). 

Beauty products are virtually unregulated by the FDA, but this is not the case for vaccines, also under the agency’s jurisdiction. Different laws, different safety standards. See where I’m going here? 

We live in a world where food additives and dyes are linked to hyperactivity, toxic chemicals like formaldehyde are in our children’s shampoo and chemicals that harm our brain are found by the pound in our couches. It’s no wonder parents are asking different questions than they did a few years ago about vaccines. But here is the fundamental difference, those aforementioned product categories (beauty, food, couches) are governed by a different set of consumer safety laws—much less stringent than the oversight on pharmaceuticals. It’s important to note that these different consumer goods are not subject to the same rigor as vaccines, so the blanketed mistrust in the FDA isn’t fair nor helpful when thinking about protecting public health.  

Many are asking: if the government is doing very little to protect us from chemicals in our food and consumer products, why should we trust them to look out for chemicals in pharmaceuticals? I completely understand and that is why I empathize with parents asking questions about vaccine safety. But it’s important to know how the regulatory and safety testing for these two categories is fundamentally different.

Peer-Reviewed Science Matters

The term “peer-review” is the gold standard of modern day science. What it means is that a researcher needs to have his or her work reviewed by a group of peers. These peers spend a lot of time reviewing how the research was conducted, looking for failed methodologies that would skew results of the tests. This type of science helps draw important conclusions around scientific concepts, like according to NASA, 97% of climate scientists indicate global warming is happening and humans are to blame. It is also what grounds the body of literature showing how toxic chemicals in our consumer products are contributing to a rise in certain chronic diseases. Not surprising, the chemical industry’s science which shows their toxic chemicals are safe hasn’t—in most cases—been peer-reviewed. Since I use this type of science to guide my thinking on global warming and toxic chemicals, I too use it to guide my views on vaccines.

The overwhelming majority of scientists and literature has shown that vaccines have done wonders to eradicate infectious disease and are safe. According to data from the CDC, since the introduction of vaccines there has been a decrease in the morbidity of infectious diseases (many of which can lead to death) like a 99% reduction in measles, mumps, and rubella.

Doctors Should Avoid Being Dismissive When Patients Ask Questions About Safety

This is a provocative thing to say, so let me explain. Many physicians are dismissive of parents’ concerns about everyday exposures to toxic chemicals from food and products. This is primarily because medical school curriculum has very little to no training on this topic. Environmental health in medical school is focused on lead in household paint, asthma and air pollution and isn’t reflective of the body of literature showing how chemicals in our every day products can impact our health. This creates a dynamic where concerned parents, outlining the peer-reviewed science about chemicals, health trends and our everyday products, are dismissed by their physicians.

This creates distrust of the patient-doctor relationship, a dynamic that wasn’t there ten years ago. I encourage physicians to read about the 50+ years worth of peer-reviewed science showing concerns about toxic chemical exposures in the home, from pesticides and food additives. Being open and responsive to your patients concerns about the issue of harmful ingredients in food, products and pharmaceuticals will help maintain the respect and authority you should have as a trained physician.

Distrust Leads to Ignoring Scientific Consensus on Vaccine Safety

So when a concerned parent doesn’t get validation about some concerns around chemical exposures in their homes, they may turn to the internet to research the safety of vaccines on their own. There is a lot of misinformation about vaccine safety on the internet, which is not rooted in the peer-reviewed science we discussed above. Even more alarming, studies have found that foreign governments (Russia) have been perpetuating the “debate” around vaccine safety through social media platforms, making it very hard to control (in a good way) misinformation for concerned parents.

And this all stems from the infamous physician (who has since had his license revoked) who falsely claimed vaccines were linked to autism, which spurred a flurry of misinformed information about vaccine safety. As Dr. Leo Trasande said (one of the leading researchers on the impacts of toxic chemicals and their health effects) the autism-vaccine link has been widely debunked.

The truth is, just like with global warming, there is an overwhelming scientific consensus that vaccines work and have had a tremendous positive impact on global public health. It’s hard for us to appreciate the threats of infectious disease when we’ve had very little experience with the tragedy that comes with it. 

Mortality vs. Morbidity

Someone recently asked if children were dying from the recent measles outbreaks, because if kids aren’t dying then it doesn’t matter right? I think that’s the wrong question, we know measles is highly infectious, can lead to death and a large scale outbreak would eventually lead to deaths. Solely looking at mortality from these diseases dismisses morbidity, the lifelong impacts of these diseases on one’s quality of life.

Morbidity is very real and can be daunting and disabling; looking at infectious disease risk is incomplete without recognizing the very real complications such as: meningitis, seizures, stroke, pneumonia, long-term cognitive sequelae, kidney failure and infertility later in life.

Can we Make Vaccines Safer?

As a consumer safety advocate, I think it’s upon all of us to constantly ask how we can innovate and make drugs and products safer, there isn’t anything inherently wrong with asking that question. 

We have increased the amount of vaccines drastically over the last thirty years, talk to your doctor about which vaccines are absolutely necessary for public health prevention, your lifestyle and geographic location. While there are very few vaccines that can be skipped, some do exist (for example, ask your doctor of your infant needs the Hepatitis B vaccine based on the risk and lifestyle of a child). And finally, we must demand that pharmaceutical companies innovate and find safer ways to preserve the vaccines, in the same way we do of beauty companies. 

Doctors Don’t Make Money from Pushing Vaccines

I will be the first to admit that pharmaceutical companies have a lot of influence on decisions doctors are making. In some cases, medical device or pharmaceutical representatives can wine and dine doctors in the hopes that they will push their product. Recent laws have helped reduce the influence of medical device and pharmaceutical companies on doctor decisions, but here’s the deal: while there is “money to be made” by physicians pushing certain medicines with their patients, vaccines aren’t one of them. It’s easy to say that doctors are peddling for vaccine companies like they are for others, but there is no financial incentive for doctors to do so. Ask any Family Practice physician, I’ve asked several, and have heard the same response. They don’t turn a profit from encouraging the use of vaccines.

Herd Immunity is a Real Thing

I think a recent Washington Post article with the provocative title “Measles cases are spreading, despite high vaccination rates. What’s going on?“, does a great job describing what “herd immunity” is and why it’s important. It also tackles the question that many people raise which is: If your family is vaccinated, why do you care? The author of this article outlines why that is the wrong question, and even despite the overwhelming proof that vaccines work, sometimes people still get sick. 

It’s important for all of us to vaccinate to protect herd immunity and thereby protect vulnerable populations that are at risk like the elderly, children, those undergoing chemotherapy, and others who cannot receive vaccines. 

In conclusion, I don’t have all the answers. I have tried to lay out what I see as the barriers to robust vaccination and a fair and balanced outline of the public health benefits to keeping infectious disease rates low. There are many things I didn’t cover here, like the benefit vaccines play in our ability to travel abroad and have a global, multicultural society. 

I hope that in my small corner of the internet, I’ve contributed in a constructive way to one of the biggest public health discussions of our time.

So you may ask, with all of this, if I had children, would they be vaccinated? The answer is a resounding yes.

As a defender of public health, I would be turning my back on one of the best ways to protect public health and turning my back on the mountain of science showcasing vaccine safety and efficacy. 

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