Vaccines are one of humankind’s best achievements, and we should all be shouting about it

science-fiction-1819026_960_720Imagine aliens finally get around to visiting our planet…

“About two hundred years ago,” explains the alien scientific advisor – let’s call him Spuck – “humans developed a way to prevent disease which they call vaccination. It’s really quite fascinating. They use a needle to place a tiny quantity of a fluid into the muscle under the skin of their arm or leg. The substances are then absorbed into their bodies and cause their highly-evolved immune systems to generate an immune response without, and this is really quite ingenious, Captain, their having to contact the actual diseases or suffer the symptoms. This simple procedure has saved millions of lives worldwide, and saved many millions more from having to suffer less fatal, but none the less still deeply unpleasant, consequences of serious illnesses.”

“Sounds great, Spuck,” says the Captain – let’s call him Birk – “is there a downside?”

“Not really, Captain. Side effects are rare and extremely minor compared to the seriousness of the illnesses themselves.”

“Fantastic. Why are you telling me all this? I’ve got some green-skinned action I’d like to get back to, if you know what I mean.”

“Well, it’s interesting that you should mention unusual skin tones, Captain. A leader has recently come to power who, amongst other things, has expressed concerns about vaccination.

“Valid concerns?”

“The scientific evidence suggests not, sir.”

“Sounds like an idiot, Spuck.”

“I couldn’t possibly comment, sir.”

“Huh. Sounds like he could definitely be detrimental to the future of their race, and besides, I’m bored. Let’s go and shoot some stuff in direct contravention of the Cardinal Directive. Set blazers to ki- I mean, stun. Beam me down, Dottie!”

***

Vaccination. It’s a hot topic at the moment, and one which is so important that I think anyone who has anything to do with science communication ought to be talking about it. I’m not a medical doctor, or an immunologist, or even a biochemist (for more qualified input on the subject, I refer you here, here and here), but I AM capable of recognising scientific consensus and of separating good-quality evidence-based information from conspiracy theory dross.

Vaccination is awesome.

Awesome is a word that is somewhat overused. But I mean it literally. As in, inspires awe. We should stop, for a moment, and just look at how bloody amazing vaccination is. Thanks to these simple, near-painless, injections – most of which we receive as young children and therefore don’t even remember – we are largely protected from the horrors of….

  • Poliosymptoms and complications include fever, vomiting, headache, back pain, joint pain and stiffness, permanent muscle weakness, permanent paralysis and death.
  • Mumpssymptoms and complications include fever, headache, meningitis, painful testicular swelling in males and ovarian inflammation in females, both of which can  result in permanent infertility, pancreatic inflammation and, occasionally, hearing loss. Death from mumps is rare, but does occur in about 1 in 10,000 cases.
  • Tuberculosis – symptoms and complications include fever, loss of appetite, severe fatigue, chest pain, coughing up of blood, scarring of the lungs, internal bleeding and death (death is considerably more likely if the patient does not have access to medical care).
  • Measlessymptoms and complications include fever, painful skin rash, diarrhoea, vomiting, ear infection which can result in deafness, eye infection which can result in blindness, laryngitis, pneumonia, bronchitis, liver infection, encephalitis, and increased likelihood of re-contracting diseases previously survived (measles essentially “wipes” your immune system). Oh yes, and death. As many as 1% of measles patients will die from the disease.

… and umpteen other, horrible diseases, the majority of which most people reading this will have never experienced. Because of vaccination.

Measles rash

A child with a measles rash. The disease can cause serious complications, including immune suppression.

The risks of vaccination are tiny. The most common complications are redness and swelling around the injection site and/or slight temperature which is easily treated with an antipyretic such as paracetamol or ibuprofen. Very occasionally people suffer a serious allergic reaction, but this inevitably happens quickly after the injection is given. Since vaccinations are usually administered in a medical setting, any allergic reaction that does occur can be quickly managed. There have been a few other genuine cases of serious, adverse reactions to vaccines, but problems are still very rare (the swine flu-narcolepsy link, for example, affected 1 in 55,000) and specific to particular vaccines, and the vaccine in question has been quickly investigated.

Like Birk, if you’ve had nothing to do with the anti-vaccination community, you may be thinking this all sounds good. Benefits massive, risks tiny. Fab. Let’s go.

However, the anti-vaccination crowd – a real, and not entirely new, thing – will tell you that this is all lies. They will tell you this loudly, and at length, and repeatedly. They believe that vaccinations cause every health problem from acne to zygomycosis, but particularly the neurodevelopmental condition known as autism.

Vaccines do not cause autism. At all. As Spuck said, the scientific evidence is clear. It’s absolutely ice-from-a-moutain-stream-in-the-middle-of-nowhere crystal clear. Just for one example, a meta analysis published in the journal Vaccine in 2014 looked at studies involving over a million children. The data revealed no relationship between vaccination and autism. None. Nada.

Vaccines, you see, do not cause autism. And actually, it’s about time we stopped wasting precious resources proving that over and over and over and over again and instead focused on what does cause autism, because that would be a question worth answering.

Infection rates dropped enormously in the US after the measles vaccination was introduced.

Infection rates dropped enormously in the US after the measles vaccination was introduced.

Anti-vaxxers will often repeatedly talk about mercury in vaccines. There’s mercury in vaccines, they’ll say, and that’s nasty stuff, so even if we haven’t proved it yet, they must be causing something bad. One problem there: there isn’t any mercury in vaccines. There’s a preservative called thimerosal (or thiomersal) in some flu vaccines – which are not the ones usually given to children – but thimerosal is no more mercury than salt is chlorine.

The anti-vax crowd get whackier after this. Some of them will tell you that vaccinations don’t, in fact, protect against against disease at all – despite huge evidence to the contrary (see also here), not to mention the simple fact that many of our grandparents and even parents remember these diseases, and their complications, as horribly commonplace.

Anti-vaxxers often state that deaths from these diseases were dropping before the vaccines were introduced. This is true. Deaths did drop, because medical science was developing rapidly. A measles patient receiving medical care is, indeed, less likely to die than one left to her own devices. If I may say so, duh.

What vaccines did is to massively reduce infection rates. But just to state the obvious: if people don’t catch a disease, they also can’t die from it.

In short, if an anti-vaxxer shows you a graph, it’s smart to check to the axes labels.

After that they get really loony, and some of them will even tell you things such as smallpox wasn’t eradicated, it was just renamed acne. Or polio has been reclassified as Guillain-Barré syndrome. These ideas are so utterly ridiculous they don’t even deserve rebuke.

This has started up again in the last few days, particularly in the UK, because of the nasty deposit of conspiracy crap that is the film Vaxxed. It’s available online, but I shall not be linking to it here.

The film claims to reveal a massive cover-up at the Centre for Disease Control (the CDC) in America, and evidence that vaccines are generally evil and cause all manner of heinous negative health outcomes. Very little of it is true, and where a tiny nugget of true fact has been included it’s been so beaten and manipulated as to have lost all of its original meaning. There’s an excellent piece about it on Skeptical Raptor website, which I recommend reading before you google the term “vaxxed”. Consider it a sort of inoculation against the nonsense, if you like (hoho).

A Guardian article from 2010 reports on Wakefield.

A Guardian article from 2010 (click for link).

The main brain behind the film is Mr Andrew Wakefield, a former British doctor who was struck off the General Medical Council in 2010, when the GMC said he had acted “dishonestly and irresponsibly.” Wakefield was, it turned out, trying to patent his own measles vaccine. In an effort to further his own aims, he set out to discredit the widely-used MMR (measles, mumps and rubella vaccine) by fabricating results and, in particular, suggesting a link between the MMR and autism. He denied all this, of course, but a libel judge disagreed.

Wakefield is still pushing his message. He is not a particularly nice individual. Listen to him in this video clip, for example, where he responds to Bill Gates comment, made in 2015, that he (Gates) fears a pandemic could wipe out humanity in his lifetime. Actually, I’ll save you the trouble:

“Ho Chi Minh City, you may have seen this, an outbreak of [laughs] the plague in Ho Chi Minh City. The outbreak that they were not prepared for, they never prepared for, and that is the number of children with autism in Ho Chi Minh City has increased by nearly one hundred and sixty times over eight years. So, Bill, just for your edification, the plague that you’re talking about, the next plague, the next epidemic, it’s already here. It’s already here.”

Yes, you heard that right, according to Wakefield autism is a “plague”. Anyone reading this with an autism diagnosis? You have the plague. Nice, huh?

Andrew Wakefield describes autism as a "plague".

Andrew Wakefield describes autism as a “plague”.

For the record, the number of autism diagnoses in Ho Chi Minh has increased sharply over recent years, but this is may well be – as often turns out to be the case – largely due to to better diagnosis. Certainly there’s absolutely no suggestion that it’s linked to the introduction of a vaccine or vaccines. There might be an environmental factor – some sort of pollutant perhaps – but no one is certain at the moment. (To repeat myself: perhaps if we stopped wasting time endlessly disproving the link between vaccines and autism, we’d have a better idea.)

By the way, the woman in that video clip is Polly Tommey. She has an autistic son who’s now in his twenties. Back in 2010 she chose to try and raise awareness of autism by posing in a Wonderbra-style advert, and these days she follows the campaign trail with Wakefield, repeating the message that they “will win”. What exactly they’re going to win isn’t entirely clear. Would preventing vaccination, at the cost of many lives, really be a win?

Vaxxed was due to be shown at the Curzon cinema in Soho, London on Valentine’s Day. It was pulled after the cinema realised what the film was – they had merely leased their premises to private individuals and only realised what was going on when a number of science advocates started complaining.

In a statement, a spokesperson for Curzon Cinemas said:

“We do not wish to profit from a film that has demonstrably caused great distress.”

The heyevent.uk page on Vaxxed, explaining that the location will be "annnounced" two hours before the screening.

The heyevent.uk page on Vaxxed explains that the location will be “annnounced” two hours before the screening.

Tommey was predictably unimpressed by this outcome, which she blamed on “our little five trolls in England,” saying “Britain being who they are, being big wussy pussies, just strike it off.”

Unfortunately, the cancellation turned out to be less of a victory than it first appeared. The anti-vaxx crowd then set out to find a new venue. And this time, they kept it quiet. There are many, many places that will rent you a space to screen a film, and I’ll wager that few of them really check the nature of that film. So, the anti-vaxxers correctly reasoned, if we don’t tell people where it is, no one will be able to stop us. People who had previously bought tickets were told it would be in “Central London”, and that the venue would be revealed two hours before the show.

And so, it happened. At Regent’s University London, a private university which was, incidentally, recently identified as the most expensive place to study in the UK.

In hindsight, this might actually have been worse than a screening at an independent cinema. Dodgy film in a cinema – so what? “Official” screening at a university with Q&A sessions afterwards? Hm, sounds important and… academic. The press, naturally, made the most of it, with headlines such as “Disgraced anti‑MMR vaccine doctor Andrew Wakefield gets invitation to university in London.” Sure, the first line of the actual article says the university has been criticised, but who actually reads beyond the headlines these days? Sounds like he’s being taken seriously, doesn’t it?

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Regent’s University’s response on Twitter on February 15th

Regent’s University responded pretty quickly to say that they hadn’t known what the film was, that they didn’t endorse its views, and that they would be revetting all their clients.

This provoked lots of complaints about freedom of speech, because many people seem to be under the misapprehension that freedom of speech means that any and all organisations and venues have a duty to allow them to repeat their nonsense. This is not what freedom of speech means. Freedom of speech means you can’t be chucked in prison for saying a thing (with some exceptions). It does NOT mean that everyone has to listen to you, or that you can say your thing wherever and whenever you like, whether the place renting you the space likes it or not.

More alarming still was the Q&A session at the end of the screening of Vaxxed. I watched some of it (one for the team, you’re welcome). There was much talk of “getting the message out there”, “sowing the seeds”, “people have to hear the message x times before they’ll start to accept it” and so on. In short, if you didn’t know it was all about vaccines it would start to sound an awful lot like…. well, at best a religion, and at worst a cult.

Wakefield was also asked if he would ever get his name cleared. This was his response:

Wakefield speaking at the end of the Vaxxed screening.

Wakefield speaking at the end of the Vaxxed screening.

“Well, cleared by whom? Here’s a… it’s a really important… cleared by whom? Do I want to be part of the medical profession again? [muttering from the audience] Do I want to be exonerated by the General Medical Council? Do I want to pay them an annual retainer fee? To be part of… Do I really? Is that… that takes time and effort. What is more important? Making films like this? Or trying to clear my name? [applause]

Hang on. If he really cared about getting the science right, about doing the right thing by patients, wouldn’t getting his name cleared and being reinstated as a medical doctor be of utmost importance? If he’s right about vaccines, particularly the MMR vaccine, and if he truly wants to prove it for the good of humanity, what better way than to be exonerated?

But as he says, “that takes time and effort.” What he doesn’t add, of course, is that making films like Vaxxed, travelling around the world spreading his message and hobnobbing with Donald Trump, almost certainly makes him a lot more money than being a doctor ever did. And I’ll bet it’s more fun. Why would he go back to the long hours and hard work that being a regular old doctor entails?

Wakefield is playing an extremely unpleasant and disingenuous game. The really worrying thing is that he and other anti-vaccination campaigners might be gaining ground. Robert F. Kennedy Jr. and Robert De Niro recently announced a $100,000 “challenge” to prove the safety of thimerosal vaccines. Thimerosal has already been extensively investigated – no evidence has ever been found that its inclusion in vaccines causes neurological effects, but anyway, it’s only in a few flu vaccines. Of course, the implication is that all vaccines are unsafe and that no one can prove otherwise – and now those headlines are out there, and that seed has been planted, will people really read further into it? Or will they just decide to skip the visit to the doctor?

The consequences of that are potentially serious. A mumps outbreak was reported in Washington State a week ago, and cases of mumps and measles have also just been reported in Salt Lake County. Last autumn the Guardian reported that the proportion of under-twos receiving their first dose of the MMR vaccine had fallen for the third consecutive year, and there were several reports of measles outbreaks in the UK. Flu outbreaks are also a real concern: years of hearing the phrase “mild flu-like symptoms” have created the misconception that influenza itself is a mild disease. It is not. There have been over 100 deaths from flu in Germany this year alone. People in Germany have access to good healthcare. People are still dying.

Outbreaks put everyone at risk: vaccination is effective, but nothing is 100% effective. In the midst of a full outbreak, even the vaccinated are at risk of catching the disease, and of course, those who are too young to receive the vaccine, or who can’t have it because of a genuine allergy, or because they’re immunocompromised, will be in real trouble. Let’s not forget: measles in particular is a disease with a host of horrible complications, not to mention the potential to reduce a person’s previously acquired immunity to other diseases.

Do we really want to see measles and mumps come back? Really? Because that will ultimately be the result of all of this.

And unfortunately, Captain Birk and Mr Spuck aren’t actually there to fix this mess for us. We need to see sense ourselves.


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Elements, compounds and misleading mercury

Elemental mercury isn't the same as mercury in compounds.

Elemental mercury isn’t the same as mercury in compounds.

Today I read an interesting article about some recent research carried out at the University of Illinois where they demonstrated that the best way to convince parents to vaccinate their children might be to show them the results of the diseases the vaccines prevent. (This, by the way, contradicts some research published in 2014 which showed that this tactic didn’t work. For an excellent discussion of the two, see here.)

Then, because I am just one of those people who can’t resist poking at ulcers with my tongue (you know what I mean) I had a quick look at some of the comments regarding that article. Reassuringly, most people were weighing in on the “yeah, vaccinate!” side of the argument. But not surprisingly there was also a small group of people posting the traditional anti-vaccine arguments. And then, this appeared:

mercury ppm

This is thoroughly silly, and I’ll tell you why.

Well, it did make be go “hmmmmm”, but for the reason you might imagine.

No, you see, what I thought was: “hmmmmm, someone else who has, possibly deliberately, failed to understood the difference between elements and compounds, and how chemical bonding changes properties.”

Allow me to start at the beginning. If you went to a school in the UK (and I would hope it’s similar elsewhere in the world) you learned about elements, compounds and mixtures when you were about 13 years old – if not before. You might have forgotten it since, but I can absolutely, categorically guarantee you that lesson happened. In fact, it was probably a few lessons.

iron sulfide experiment

The much-loved reaction between iron and sulfur.

One experiment much beloved of chemistry teachers since year dot is to take a mixture of sulfur (a yellow powder) and some iron filings (grey) and show that they can be separated with a magnet. Then heat the mixture up so that the two react, with a rather beautiful red glow, to form iron sulfide. This is a blackish solid which is in theory not magnetic (but in practice almost always is) and demonstrate that now the two elements cannot be separated.

Thus we have demonstrated that elements (the iron and the sulfur) have different properties to the compound they formed (iron sulfide), and also that mixtures can be separated fairly easily, whereas breaking compounds up into their constituent elements is much harder. Lovely. Job done.

And yet… so many people seem to have been asleep that day. Or perhaps just didn’t grasp it well enough to continue to apply the principle to other things.

pouring mercury

Elemental mercury

For example, mercury. Mercury, the element (the runny, silvery stuff that you used to find in thermometers) is a heavy metal. Like most of its compatriots, such as cadmium, lead and arsenic, it’s toxic. It can be absorbed through the skin and mercury vapour can be inhaled, so containers need to be tightly sealed. The increasing awareness of the toxicity of mercury is why older readers might remember seeing it ‘in the flesh’, so to speak, at school, whereas younger ones will not – these days it’s rarely even used in thermometers for fear of breakages.

That said, it does occur naturally in the environment, particularly as the result of volcanic eruptions – and very low levels aren’t considered harmful. The dose, as they say, makes the poison. It also occurs as the result of industrial processes, particularly coal-fired power plants and gold production, and occupational exposure is a genuine concern. In particular, chronic exposure is known to cause cogitative impairment. It might the source of the ‘mad dentist’ myth. It’s almost certainly the origin of the phrase ‘mad as a hatter‘.

So in summary, don’t mess about with elemental mercury; it’s not good for your health.

However, as I took some pains to establish, elements and compounds are different things. So what about compounds which contain mercury?

The compound thiomersal

The compound thiomersal

This is where vaccines come in. There is a substance that used to be used as a preservative in (some) vaccines called thiomersal (or thimerosal, in the U.S). You may have heard its name; it comes up quite a lot. Incidentally, it hasn’t just been used in vaccines, but also in various other things including skin-test antigens and tattoo inks.

Now, to be clear, thiomersal IS potentially toxic, however it’s quickly metabolised in the body to ethyl mercury (C2H5Hg+) and thiosalicylate and, although ethyl mercury does, clearly, still contain atoms of mercury, it does not bioaccumulate. In other words, your body gets rid of it. At very low doses (such as those in vaccines) there is no good evidence that thiomersal is harmful.

Still, due to continuing public health concerns, thiomersal has been phased out of most U.S. and European vaccines. In the UK, thiomersal is no longer used in any of the vaccines routinely given to babies and young children in the NHS childhood immunisation programme. And at the moment, all routinely recommended vaccines for U.S. infants are available only as thimerosal-free formulations or contain only trace amounts of thimerosal (≤1 than micrograms mercury per dose).

Let me just say that again. The evidence suggests it’s safe, but it’s been removed anyway as a precaution. If you live in the UK, it’s not in your child’s vaccines, and that includes the new nasal-spray vaccine for flu which has been rolled out over the last few years. If you live in the U.S. it’s probably not, and thimerosal (thiomersal) free versions exist. It does turn up most often in flu vaccines (hence the meme image at the start) but thiomersal-free versions of those also exist in the U.S.

So chances are it’s not in your vaccines. Not in there. Got it? Ok.

ethyl vs methyl mercury

methyl mercury (left) is not the same as ethyl mercury (right)

Now, you may have heard about mercury in seafood. It is an issue, particularly for women who are pregnant, trying to become pregnant or breastfeeding, and is the reason such women are advised not to eat shark and swordfish, and to keep their tuna consumption low. But here’s the thing: it’s a different kind of mercury. In this case, it’s methyl mercury (remember, thiomersal breaks down to ethyl mercury, which is not the same).

Methyl mercury is more toxic than ethyl mercury. Methyl mercury binds to parts of amino acids much more readily than its ethyl cousin, and it’s able to pass through the blood brain barrier and into nerve cells where it causes damage. In addition, ethyl mercury is much more quickly eliminated from the body than methyl mercury. Because of all this, methyl mercury does bioaccumulate (build up in the body), and that’s why large top-of-the-food-chain fish like shark and tuna can have significant levels of it, and why certain groups of people should be careful about eating them.

The FDA’s action level (the limit at or above which FDA will take legal action) for methyl mercury in fish is 1000 ppb (1 ppm). But remember, that’s for the much more dangerous methyl mercury, not ethyl mercury. I’ve been unable to find an equivalent figure for the UK, but I’d imagine it’s similar.

So, where does the 200 ppb mercury figure in the image at the top come from? Well the Environmental Protection Agency does indeed set a ‘maximum contaminant level goal’ for inorganic mercury of 0.002 mg/L or 2 ppb in water supplies. Methyl and ethyl mercury are not inorganic mercury; compounds that fall into this category include mercuric chloride, mercuric acetate and mercuric sulfide, which largely get into water as the result of industrial contamination.

In summary, that meme image at the start is basically comparing apples and oranges. The EPA limit isn’t relevant to vaccines, because it’s for inorganic mercury, which the substance in vaccines isn’t. While we’re about it, the levels applied to fish don’t apply either, because that’s methyl mercury, not ethyl mercury. They’re not the same thing. And all that aside, it’s highly unlikely (if you live in the UK, no chance at all) that there are 50,000 ppb of ethyl mercury in your flu vaccine anyway. AND, let’s not forget, there’s no evidence that the tiny quantities of thiomersal used in vaccines are harmful in the first place.

Phew.

You may note that I’ve studiously avoided the word ‘autism’ in this post so far. But yes, that’s the big concern; that exposure to thiomersal in vaccines could cause autism. Despite multiple, huge, studies in several countries looking for possible links between vaccines and autism, none have been found. Vaccines don’t cause autism. It’s time we stopped wasting enormous amounts of time and resources on this non-link and spent it instead on finding out what does cause it. Wouldn’t that be far more useful and interesting?

Now… if you’re hardcore anti-vaccine and you’ve read this far, and you’re about to hit the comment button and tell me that all this research is just Big Pharma covering things up so they can make money from the ‘million(/billion/trillion) dollar vaccine industry’, just wait a moment.

Stop.

Think about this: how much money could the medical industry make from people actually catching measles, mumps, polio, TB, whooping cough and all the others? Just think of all the money they could make selling antivirals and antibiotics, all the money to be made from painkillers, antipyretics, drugs to treat respiratory symptoms of one kind or another, and everything else? Believe me, it would be much, much more than they make from a single 2 ml dose of vaccine. Why ‘cover up’ research that’s, if anything, reducing their profits?

All these diseases are horrible, and some can be fatal or have genuinely life-changing consequences. That’s proven. Please vaccinate your children, and yourself.

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