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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Glow sticks or sparklers: which is riskier?

by Unknown artist,print,(circa 1605)

Remember, remember the 5th of November… (Image by Unknown artist, circa 1605)

It’s fireworks night in the UK – the day when we celebrate a small group of terrorists nearly managing to blow up the Houses of Parliament in 1605 by, er, setting fire to stuff. No, it makes perfect sense, honestly, because…. look, it’s fun, all right?

Anyway, logical or not, Brits light fireworks on this day to mark the occasion. Fireworks, of course, are dangerous things, and there’s been more than one petition to ban their sale to members of the general public because of safety concerns. It hasn’t happened yet, but public firework displays, rather than private ones at home, are more and more popular.

Which brings me to this snippet from a letter a friend of mine recently received.

screen-shot-2016-11-04-at-21-51-33

In case you can’t read it, it says:

“NO SPARKLERS PLEASE – with so many children runni[ng] around, we believe it is too dangerous fro children to be [words missing] lighted sparklers around.
Last year we had a few incidents of children drinking the [words missing] glowsticks – please advise against this.”

Now there are some words missing here, but it’s fairly clear that sparklers are prohibited at this event, and it seems to be suggesting that children have managed to get into, and swallow, the contents of glowsticks. But they, by contrast, haven’t been banned. Indeed, parents are merely being asked to “advise” against it.

Hmmm.

Does this seem like an appropriate response? Well, let’s see…

1024px-sparklers_moving_slow_shutter_speedWhat are these things? Let’s begin with sparklers. They’re hand-held fireworks, usually made of a stiff metal wire, about 20 cm long, the end of which is dipped in a thick mixture of metallic particles, fuel and an oxidising agent. The metal particles are most commonly magnesium and/or iron. The fuel usually involves charcoal, and the oxidiser is likely to be potassium nitrate. Sometimes metal salts are also added to produce pretty colours.

Sparklers are designed to burn hot and fast. The chemical-dipped end can reach temperatures between 1000-1600 oC, but the bit you hold doesn’t have time to heat up before the firework goes out (although gloves are still recommended). The sparks, likewise, are extremely hot but burn out in seconds. This makes sparklers relatively safe, if they’re held well way from the face and body, and if the hot end isn’t touched.

If. Every year there are injuries. Sparkler injuries aren’t recorded separately from other firework injuries in the UK, but the data we do have suggest we might be looking at a few thousand A&E admissions each year, and probably a lot more minor injuries which are treated at home.

Sparklers are most dangerous once they've gone out.

Sparklers are most dangerous after they’ve gone out.

The biggest danger comes from people, usually children, picking up ‘spent’ sparklers. The burny end takes a long time to cool down, but once the sparkles are finished and it’s stopped glowing it’s impossible to judge how hot it is just by looking.

The burns caused by picking up hot sparklers are undoubtedly very, very nasty, but they’re also relatively easy to avoid. Supply buckets of cold water, and drill everyone to put their spent sparklers into the buckets as soon as they go out. Hazard minimised. Well, assuming everyone follows instructions of course, which isn’t always a given. Other risks are people getting poked with hot sparkers – which can be avoided by insisting sparkler-users stand in a line, facing the same way, with plenty of space in front of them – and people lighting several sparklers at once and getting a flare. Again, fairly easily avoided in a public setting, where you can threaten and nag everyone about safety and keep an eye on what they’re doing.

Although I do understand the instinct to simply ban the potentially-dangerous thing, and thus remove the risk, the idea does worry me a little bit. I was born in the 70s and I grew up with fire. I remember the coal truck delivering coal to us and our neighbours. I was taught how to light a match at an early age, and cautioned not to play with them (and then I did, obviously, because in those days it was usual for kids to spend hours and hours entirely unsupervised – but fortunately I emerged unscathed). Pretty much everyone kept a supply of candles in a drawer, in case the lights went out. And bonfires were a semi-regular event – this being long before garden waste collections.

These days things are very different. It’s not unusual to meet a child who, by age 11, has never lit a match. If their home oven and hob are electric, they may never have seen a flame outside of yearly birthday cake candles. But so what? You may be thinking. Aren’t fewer burns and house fires a good thing?

Of course they are, but people who’ve never dealt with fire tend to panic when faced with it. If the only flame you’ve ever met is a birthday cake candle, your instinct might well be to blow when faced with something bigger. This can be disastrous – it can make the fire worse, and it can spread hot embers to other nearby flammable items.

I’m personally of the opinion that children ought to be taught to handle fire safely, how to safely extinguish a small fire, when to call in the experts, and not to disintegrate into hysterics the presence of anything warmer than a cup of tea. Sparklers, I think, can be part of that. Particularly if they’re used in a well-supervised setting, with plenty of safety measures and guidance on-hand. (As opposed to, say, picking them up for the first time at university with some drunk mates, setting fire to half a dozen at once and immediately dropping them.)

Now. Onto glowsticks. They’re pretty neat, aren’t they? We’ve already established that I’m quite old, and I remember these appearing in shops for the first time, sometime in the very early 90s, and being utterly mesmerised by that eerie, cold light.

phenyl_oxalate_ester

Diphenyl oxalate (trademark name Cyalume)

They work thanks to two chemicals. Usually, these are hydrogen peroxide (H2O2 – also used to bleach hair, as a general disinfectant, and as the subject of a well-known punny joke involving two scientists in a bar) and another solution containing a phenyl oxalate ester and a fluorescent dye.

These two solutions are separated, with the hydrogen peroxide in a thin-walled, sealed glass vial which is floating in the mixture of ester and dye solution. The whole thing is then sealed in a tough, plastic coating. When you bend the glowstick the glass breaks, the chemicals mix, and a series of chemical reactions happen which ultimately produce light.

How Light Sticks work (from HowStuffWorks.com - click image for more)

How Light Sticks work (from HowStuffWorks.com – click image for more)

Which is all very well. Certainly nice and safe, you’d think. Glowsticks don’t get hot. The chemicals are all sealed in a tube. What could go wrong?

I thought that too, once. Until I gave some glowsticks to some teenagers and they, being teenagers, immediately ripped them apart. You see, it’s actually not that difficult to break the outer plastic coating, particularly on those thin glow sticks that are often used to make bracelets and necklaces. Scissors will do it easily, and teeth will also work, with a bit of determination.

How dangerous is that? Well… it’s almost impossible to get into a glowstick without activating it (the glass vial will break), so it’s less the reactants we need to worry about, more the products.

And those are? Firstly, carbon dioxide, which is no big deal. We breathe that in and out all the time. Then there’s some activated fluorescent dye. Now, these vary by colour and by manufacturer, but as a general rule they’re not something anyone should be drinking. Some fluorescent dyes are known to cause adverse reactions such as nausea and vomiting, and if someone turns out to be allergic to the dye the consequences could be serious. This is fairly unlikely, but still.

Another product of the chemical reactions is phenol, which is potentially very nasty stuff, and definitely not something anyone should be getting on their skin if they can avoid it, let alone drinking.

Inside every activated glowstick are fragments of broken glass.

Inside every activated glowstick are fragments of broken glass.

And then, of course, let’s not forget the broken glass. Inside every activated glowstick are fragments of broken glass – it’s how they’re designed to work. If you break the plastic coating, that glass is exposed. If someone drinks the solution inside a glow stick they could, potentially, swallow that glass. Do I need to spell out the fact that this would be a Bad Thing™?

The thing with hazards is that, sometimes, something that’s obviously risky actually ends up being pretty safe. Because people take care over it. They put safety precautions in place. They write risk assessments. They think.

Whereas something that everyone assumes is safe can actually be more dangerous, precisely because no one thinks about it. How many people know that glowsticks contain broken glass, for instance? Probably not the writer of that letter back there, else they might have used stronger language than “please advise against this.”

So glowsticks or sparklers? Personally, I’d have both. Light on a dark night, after all, is endlessly fascinating. But I’d make sure the sparkler users had buckets of water, cordons and someone to supervise. And glowstick users also ought to be supervised (at least by their parents), warned in the strongest terms not to attempt to break the plastic, and all efforts should be made to ensure that the pretty glowy things don’t fall into the hands of a child still young enough to immediately stuff everything into his or her mouth.

The most important thing about managing risks is not to eliminate every potentially hazardous thing, but rather to understand and plan for the dangers.


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