This blog post is longer than most, and for that I apologize (somewhat). I can guarantee that the information you’re about to read will be worth the time spent if you’re interested in learning more evidence-based facts about the issue of vaccination. Enjoy!
The concept of vaccination, using an attenuated or dead pathogen to trigger an immune response, is inherently valid (Miravalle). Overwhelmingly, research has demonstrated that vaccines have dramatically reduced the incidence of several communicable diseases. They have in some ways been the greatest advancement in public health since soap. As current events have highlighted, the execution of vaccination as a public health strategy is a very contentious subject. A slightly different approach supported by current research may offer some potential solutions. The current discussion between those who oppose vaccination and its proponents is becoming increasingly polarized and non-constructive as further attempts to force vaccination cause anti-vaccination activists to more deeply entrench in their beliefs about vaccine risks and injuries. While these beliefs are often criticized and villified in published opinions, most recently advocating legal action against non-vaccinating parents (Diamond), evaluation of current research does show some basis for those beliefs (Karussis, Rowhani-Rahbar).
Enough research has been done to show that vaccines do not directly cause autism, yet also show that if a vaccine causes an inflammatory response in a susceptible individual, neurologic problems may result secondary to the inflammatory response. Adjuvants are additives in vaccines that increase the immune response and improve the vaccine’s efficacy at triggering immunity. Research articles show the inflammatory effects of metallic vaccine adjuvants(Agmon-Levin, Esposito), increased vulnerability to neurologic and immune problems as a result of early life exposure to metallic adjuvants (Stejskal, Dorea), encephalomyelitis (CNS inflammation) from vaccination (Alicino) and vaccine triggering of underlying seizure disorders (Verbeek).
The most likely secondary causality scenario involves inflammation as an intermediary problem between vaccination and neurologic problems. Many studies have shown inflammatory reactions to vaccination (Stejskal, Dorea, Alicino, de Theije are examples). The inflammatory reaction to adjuvants, for example, is common enough that an acronym has been created and used in research: ASIA (Autoimmune/inflammatory Syndrome Induced by Adjuvants). Autism and other neurologic diseases have been shown to have an inflammatory basis in many studies (Mitchell, Anderson, Rossignol, Zerbo, McDougle, Noriega, Agmon-Levin for example).
Despite the evidence suggesting that vaccine adverse reactions do occasionally happen, there is virtually no transparency in the vaccine debate, with one side of the debate saying flatly that reactions do not occur despite research indicating otherwise and a huge government vaccine injury compensation fund that pays out millions annually to parents of vaccine injured children. On the other side of the debate are parents and activists who maintain that vaccines are dangerous and cause autism and other neurologic illness. Parents who bring a reaction to the attention of their pediatrician are often routinely ignored or find their statements summarily dismissed. This lack of acknowledgment and open discussion serves only to fuel the fires of distrust and vaccine resistance, as it is predicated on a position that is unsupported by the facts and is also quite insensitive to a parent’s experience. To the mother of a child who screams incessantly for hours after a vaccination or develops seizures followed by developmental regress, vaccine reactions are facts. When physicians completely discount these experiences, a lifetime anti-vaccination advocate is born.
Even the most controversial of all vaccine reaction issues, autism, can be included in this issue. We have writers such as Dan Diamond vehemently stating that there is no link whatsoever, whereas there is research (see Hooker) that it may occur in a manner that is not directly cause-effect. There are many studies saying that MMR vaccination does not cause autism (Uno is a good recent example) so any connection is probably not directly causal. Secondary causality is much more difficult to prove or disprove in research. The issue of vaccine injury is often dismissed under the justification that because the Wakefield paper (see footnote below) was falsified and retracted, all reactions must never occur. This reasoning is overly generalizing, as autism is but one of many neurologic problems with roots in an overly zealous inflammatory response. While there may be a genetic susceptibility in some individuals, inflammation still plays a key role. Timing of vaccination can also be optimized to reduce the chances of adverse reactions (Rowhani-Rahbar).
When considering inflammation and vaccination, there is a cogent connection—both involve the immune system. The immune system of different people is dramatically variable yet this variable is almost never assessed prior to vaccination. The purpose of vaccination is to trigger an immune response, such as the formation of antibodies to the pathogen in question. Systemic or neurologic inflammation, on the other hand, is an overactivity or misdirection of the immune system. It would not seem unreasonable then to consider that inflammation could result from an unintended response of the newly vaccinated immune system (Ye). To understand how this is possible, we need to look at what variables influence the immune system; in particular, how should we identify individuals that could be at elevated risk of an inflammatory response to vaccination? This need has been identified (Soriano) and further work is necessary. One obvious variable is the human microbiome: this population of trillions of bacteria are critical for immune system programming (Underwood, Pabst, Oh, Spasova, Valdez, Hsieh, Matthews). Most of the immune system resides in the abdomen around the gut, where it can be influenced by the gut microbial symbionts known as the microbiome. The immune system receives its “training and mission profile” in part through this mechanism. As the gut bacteria are affected very significantly by diet and antibiotics, some individuals have a very compromised and imbalanced microbiome (we call this dysbiosis) and this imbalance alters immune response.
Instead of steadfastly refusing to acknowledge and discuss vaccine reactions, wouldn’t it be more productive for physicians and scientists (and various pundits) to discuss what can be done to minimize the possibility of an adverse reaction? If parents understood what reactions have been shown to happen and what reactions have been disproven, and what can be done to minimize the risk of an adverse event, they might feel more confident in the process and participate more readily. Respecting a parent’s concerns and knowledge might provide opportunity for discussion instead of resistance. When physicians are unwilling (or too overscheduled) or unversed in discussing vaccine reactions, patients resort to the Internet, with notoriously variable results. The search parameters used and persistence of false information have even been researched (Ruiz) suggesting that search engine results are less than accurate or authoritative. What else are parents to do if they believe that they could do more to protect their child but the physician refuses to discuss the options? As an example of the dogged persistence of false information when delivered via the Internet, think about the small mammal known as a lemming. What comes to mind? Does it involve lemmings jumping off a cliff? This is a frequently used analogy and many of us think it because a Disney movie in 1958 showed lemmings jumping off a cliff into the ocean. But did that actually happen? A little known fact is that Disney purchased lemmings and dumped them out of a big truck for this scene! Lemmings, in fact, do no such thing of their own accord, yet most people believe that they do—because of decades old misinformation.
If it is possible to evaluate a child’s microbiome via a stool analysis and determine if the child is at elevated risk of inflammatory adverse vaccine reaction (Huda) why would a physician not discuss that with a concerned patient or parent? The connections between intestinal dysbiosis and immune system dysfunction are both logical and well documented (Matthews) and yet this information is seldom utilized or discussed. Risk factors can be assessed with questionnaires; genetic susceptibility could be inferred from adverse reactions to siblings for example. Signs of inflammation can include constipation, diarrhea, loose stool, or alternating between these. Chronic headaches can indicate systemic inflammation, as can depression or anxiety. Joint pain can indicate inflammation also. While any one of these does not prove inflammation, a combination of these problems may indicate systemic inflammation. Blood tests can show C-Reactive Protein (CRP) levels as another indicator of underlying inflammation. Should these evaluations show dysbiosis and inflammation, why not recommend some probiotics and a dietary change to improve immune function? Perhaps also something to reduce inflammation, such as curcumin (Prasad) could be used to stem inflammatory response. Probiotics are already being recommended as a vaccine adjuvant (Pabst) so this simple and safe intervention could help reduce the chances of a vaccine reaction as well as improving the immunity triggered by the vaccine. Doing this might be what it takes to keep the doctor “in the loop” and avoid creating another vaccine-resistant parent due to failure to discuss options. These simple steps could also prevent some adverse reactions or simply ease any fear of adverse reactions.
There are some historical statistics that are interesting when reviewing the vaccination debate, and in my opinion they point toward the need for additional recommendations to reduce infections. One example has to do with measles: the Centers for Disease Control (CDC) reported in 1920 there were 469,924 measles cases in the U.S. with 7,575 deaths. Between 1958-1962 this annual average was 503,282 measles cases—but only an average of 432 deaths. The measles vaccine was licensed in the U.S. in 1963, which begs the question of why deaths had declined by over 94% prior to vaccines being used. Could it have been the development of a more robust natural immunity conferred by infection with wild virus? There is evidence to suggest exactly that, as a study of measles in Poland compared immune status of people who acquired immunity from wild infection with immunity resulting from vaccination (Cześcik). This study showed that the immune system responds more strongly to wild infection and the resultant immunity is both stronger and longer lasting than immunity from vaccination. The researcher also stated that natural immunity appears to decline in the absence of viral stimulation that normally results from recurrent outbreaks.
Reading and watching the recent news gives the impression that if a person is vaccinated, she will be immune and not be a carrier of a disease. This is also not completely accurate, as infectious outbreaks have been documented in well-vaccinated populations (Parker, Rosen) and immunity conferred by vaccination may be far shorter-lived than is commonly believed (Cherry).
There is no substitute for living a healthy lifestyle, cultivating a diverse and balanced microbiome and thereby building the most capable immune system possible. Whether immunity is naturally acquired from infections or received from vaccinations, the immune function determines how severe the infection becomes or if there is an adverse vaccine reaction—as well as the degree of immunity that remains after either method of acquisition.
In summary, dismissing parents’ concerns or flatly denying any possibility of adverse reactions occurring are strategies that have plainly failed. Believing that vaccines are the only answer and result in the healthiest individual possible is also not sufficient or true. All of these approaches are guilty of oversimplifying how the immune system functions and what the best course of action is to assure health. Physicians and other healthcare providers owe it to the public to fully disclose the entire story, all of the facts and options, if they are to live up to their healthcare oath. The issue of “informed consent” that has been so vigorously taught and enforced in healthcare also dictates that the patient’s consent is only valid after having been informed of all the facts, including any possible risks as well as any alternatives or additional recommendations that may reduce risks. When looking at the issue of vaccination, this is simply not being done. This doesn’t reduce the importance of vaccination, but explains how it can be more effective as well as safer and less feared. The time has come for more transparency and open, honest discussion between parents and physicians. The role of the microbiome (and all the interventions that influence its integrity) in vaccine efficacy and reactions must be acknowledged (Matthews) and harnessed to identify at-risk patients and improve both the efficacy and safety of the vaccination process.
Footnote: Andrew Wakefield is a former British surgeon and researcher. He is quite possibly the most controversial and notorious character in the vaccine debate, having published in 1998 a research paper describing a link from the MMR vaccine to autism. His research was officially discredited and he was stripped of his license, as well as the research journal withdrawing his paper. There were allegations of conflict of interest and falsification of results, invalidating the paper completely. He maintains his innocence and the accuracy of his paper, as well as maintaining that he was a victim of pharmaceutical conspiracy to discredit his findings. He has been described as “the Jesus of the anti-vaccination movement.”
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