VAERS a Few Things We Need to Discuss

I've been remiss. There's a topic that I've written about in passing, but I have yet to devote an entire post to it. In all this time writing about different vaccines, studies about vaccines and anti-vaccine claims, there's a subject about which I have neglected to write more about than a paragraph here or there. I'm speaking, of course, about the Vaccine Adverse Event Reporting System, or VAERS. The handful of times I have written anything about VAERS (here, here, here and here), it's mainly been a very brief overview of what it is and how anti-vaccine activists like to abuse it (except that last link, which included a study using VAERS data).

So I thought I should rectify that situation. What prompted this was an exchange on Twitter with a doctor by the name of Jim Meehan, who tried to argue that the HPV vaccine is confirmed to have caused deaths...144 of them, to be precise. His reasoning is that there are 144 reports of death associated with HPV vaccine in the VAERS database. Therefore, he thinks HPV causes death:

He also tried to dismiss me and others by claiming we had financial conflicts of interest on the topic. Actually, he's rather fond of attacking the people he's arguing against, like suggesting that because they don't agree with him, they would probably also deny the Holocaust. (On further perusing his Twitter feed, he appears to be a full-on anti-vaccinationist himself, citing Robert Kennedy Jr.'s nonsense, "too many, too soon", "unvaccinated are healthier" and so on. And on even more perusing, I find that Dr. Meehan admits to being anti-vaccine:

If only I'd known that when I first saw this guy. Would've saved me a lot of time and explains a lot of his behavior. Perhaps at some point in the future I'll need to revisit this fellow.)

In the meantime, though, I thought it might be helpful to talk a little bit about VAERS: what it is, how it's supposed to be used and how it's abused.

An Honest Flu Ad

Click to enlarge.

Last week, the National Vaccine (mis-)Information Center ran an ad in a New Hampshire newspaper designed to make people fear the flu vaccine. I wrote about why the NVIC ad is misleading, as did Moms Who Vax and Epidemiological. In short, the NVIC ad played to the myth that the flu vaccine makes you sick (it doesn't) and promoted the idea that the vaccine doesn't work (it does). It also played on fears of adverse reactions to the vaccine ("know the risks"), but did not so much as hint at the benefits.

At any rate, I though I'd put together a somewhat more honest ad. Here's my take on the NVIC ad. Please feel free to share this, unaltered, far and wide. I also have a higher resolution version of it that should be good to print. E-mail me (contact info's in the sidebar) if you would like a copy.

NVIC? Know the Omissions (Part 2)

Those of you who read this blog regularly know some of the common tactics that anti-vaccine activists use. They're fond of the Pharma Shill Gambit, in which they accuse those with whom they disagree as being paid by pharmaceutical companies. This allows them to blissfully dismiss anything their detractors have to say. If you're paid by pharma, after all, you're hopelessly biased and nothing you say can be taken as true or honest. Of course, it doesn't matter whether you actually get paid by pharma or not. Facts don't tend to matter much to those using the pharma shill gambit.

That brings us to another tactic: dishonest or misleading rhetoric. The less, shall we say, sophisticated anti-vaccine activists aren't all that subtle about it. They will brazenly state as truth claims that are easily shown to be wrong (e.g., the false claim that MMR has the preservative thimerosal in it, or that vaccines contain antifreeze; they don't). The more skilled among the anti-vaccine movement, however, use insinuation. They imply certain claims using language that, on the surface, is technically true or could be classified as opinion, but the unstated claim is at best misleading and at worst dangerously wrong.

The National Vaccine Information Center (a more Orwellian-named organization would be hard to find) falls into that latter category, for the most part. Take, for instance, their latest ad, placed in a local New Hampshire newspaper:

The New California Personal Belief Exemption Form Unveiled

The anti-vaccine movement is a study in contradictions. They want fewer vaccines, but advocate for actions that ensure vaccines that could be taken off the schedule aren't. They want studies done, and even get involved in their design, but then reject them when the studies produce results they don't like. And they clamor for informed consent, but then raise a stink when efforts are made at improving education and helping parents make informed choices.

That was the case last year when, in March 2012, a bill was introduced in California (AB2109) that would require parents who want to opt out of required school immunizations for their children to get information about the "benefits and risks of the immunization and the health risks of the communicable diseases listed in Section 120335 to the person and to the community" from an authorized health care provider (which was rather broadly defined). These efforts at ensuring parents make informed choices were so objectionable, that anti-vaccine pro-informed choice activists vehemently opposed the bill. Yes, in the twisted world of people like NVIC's Barbara Loe Fisher, a doctor largely responsible for a measles outbreak or certain reality-challenged celebrities, a bill that requires parents be informed tramples on parents' rights to be informed. Yeah, I don't get it either, but supposedly it makes sense to them.

At any rate, AB2109 was signed into law by Gov. Jerry Brown on September 30, 2012, but with a catch. As I wrote at the time, Gov. Brown issued a signing statement with it, stating that he would direct the Department of Public Health to allow for religious exemptions to the whole getting informed piece of the legislation, despite the fact that California does not have any religious exemptions to vaccinations. As I noted at the time, there were significant problems with this, both legal and practical.

Well, the California Department of Public Health has announced the new form and made it available here (PDF).

Measles, Cows and an "Oh crap!" Moment

In the history of the battle against diseases, there are only two that have been completely eliminated from the wild. Smallpox had been with us for millennia, but it wasn't until sometime around the 17th century that moderately successful attempts at preventing the disease were practiced in the form of variolation, or inoculation with pus from an infected individual. This practice, though effective, carried significant risks, such as actually causing the disease or infection with some additional disease, like syphilis. Then along came Edward Jenner, who discovered that those infected with cowpox appeared to be immune to the more dangerous smallpox. He developed the first rudimentary vaccine in the late 18th and early 19th centuries. As medical knowledge advanced, the vaccine was refined and improved, reducing (though not eliminating) the risk of adverse effects and improving its effectiveness through booster doses. In 1967, a worldwide campaign was begun to eliminate the disease from the wild, with the last known wild case of smallpox occurring in Somalia in 1977, making it the first disease eliminated through human efforts.

The second disease that we have managed to eradicate from the wild is rinderpest, a morbillivirus closely related to human measles virus. Rinderpest was once a scourge of cattle. As with smallpox, innoculation was an early attempt to control the disease. Unlike smallpox, inoculation never really caught on, partially due to lower efficacy. Jenner's successes with vaccination using cowpox led to unsuccessful attempts to use cowpox to prevent rinderpest. Vaccines using the rinderpest virus were developed in the early 1900s, yet despite the development of effective vaccines, control efforts often took the form of wholesale slaughter of livestock when outbreaks occurred. Regional efforts at eradication of the disease began in the 1920s, but coordinated global efforts wouldn't come about for several decades. Ultimately, widespread vaccination efforts led to the last confirmed case in 2001 in Kenya. Vaccination continued for several more years, as experts suspected the virus could still be circulating among wild animal populations. In 2011, with no other cases appearing, the World Organization for Animal Health declared the disease eradicated.

We know that in the right circumstances (like when a disease is limited to a single species), and with enough effort, we can eradicate diseases. But what if a disease jumps species?