The Anti Anti-Vaccine Argument

Anti-vaccine sentiment is seemingly pervasive in our culture, and at a minimum, ardent and vocal. Somehow I have wound up on an emailing list that drops anti-vaccine commentary into my inbox on a daily basis. There is anticipatory reflection on what the addition of Jenny McCarthy to the roster at the View may mean for nationally televised vaccine opposition. Time will tell.

I can sympathize with the perspectives that underlie vaccine opposition. When bad things, such as autism, happen everyone wants a reason, and something to blame. There is the hope and belief that nature is the constant house of healing power and benevolent wisdom, kinder and gentler in its ways than science. There are the sinister implications of science in the service of conspiracy theories, the cultivation of dark mischief in veiled corners.

One may sympathize with all this, and still disagree. And disagree I do. I take a position in defense of immunization.

The anti-vaccine argument is mostly a matter of unsubstantiated ideology. In contrast, the Anti anti-vaccine argument (that would be the ‘pro vaccine’ argument for the double-negative disinclined) is robustly substantiated by epidemiology. Epidemiology should trump ideology.

Before making the case against the case against immunization, let’s consider the merits of the opposition- for there are some.

The one I find most compelling is that we have evolved in a world of other organisms, and have adapted to our interactions with them. In An Epidemic of Absence, for instance, Moises Velaszquez-Manoff meticulously and persuasively makes the case that we have incurred harms, as well as benefits, from our fairly indiscriminate assault on microbial (and macrobial) pathogens of every description.

But of course, the argument runs the other way as well: we have incurred benefits as well as harms. We’ll come to those momentarily. For now, just consider that it may be advantageous for a population of deer to have a population of wolves keeping their numbers in check- but it is scarcely advantageous for an individual deer to have long canines sinking into her jugular vein.

The strongest argument against immunization is that it represents science interfering with a natural, native balance. The notion is that our immune systems can handle the job without outside interference.

The trouble with the “just leave it to nature” platform is that the nature in question- the nature to which our immune systems are adapted- is long, long gone. It does not exist today, and it has not existed for millennia.

The biological norm for Homo sapiens is those conditions that populated the inexorable but languid eons of natural selection. We lived for most of that time in small, roving, isolated bands.

There are some very important biological implications of small, roving, isolated bands. They tend to move from one fairly pristine area to another, and thus have limited cause to worry about environmental contamination. They make for rather poor incubators of microbial pathogens on the basis of numbers alone- they provide fewer bodies in which to gain purchase. They tend not to share intimacies with large numbers of others, because large numbers of others are not accessible. And there is limited cause for crowding or co-habitation with other species, and their germs (the root cause of new flu strains emerging each year in China).

And, perhaps most importantly, small roving bands do not propagate highly virulent organisms, because being highly virulent in a small population is the fast track to extinction. The survival of all species is subtended by the survival of particular genes. In the case of microorganisms, there is an advantage up to a point in genes that make you good at getting from one person to the next, invading, and infecting. Making someone sick is advantageous, too- because while the attendant misery is incidental, coughing and sneezing are great means of transmission. A germ that makes us cough and sneeze is actually enlisting our assistance in getting a fast pass to the person 3 feet away.

But the genes that make bugs good at making us sick can, of course, go further- and make the bugs lethal. That is a bad end for both host and pathogen in a small roving, band- because when the people die, the bugs are left with nowhere to go, and they die, too. The genes that make germs good at suicide don’t tend to last very long.

All of this changed roughly 12,000 years ago at the dawn of agriculture and human civilization, and the rise of population density. In large, concentrated human populations- bugs can get away with being lethal. Small pox, bubonic plague, and influenza can kill huge numbers of us and still thrive- because there are huge numbers of us. In a population of billions, the death of millions is inconsequential- except, of course, to the millions concerned. In a population of billions of hosts, small pox, influenza, measles, mumps, rubella, and polio can wreak havoc, and flourish just the same.

What this all means is that arguments for an “au naturel” approach to our concourse with pathogens are, in a word, nonsense. A native relationship with microorganisms is an “in for a penny, in for a pound proposition.” We can’t possibly go native without going back to the conditions of our hunter-gatherer ancestry. There is nothing native about a human population in excess of 7 billion.

In modern context, the evidence in support of vaccines is overwhelming. We have eradicated smallpox, and come close to doing the same with polio. Those inclined to be blasé about these stunning public health advances are limited to the beneficiaries of them. Populations subject to the ravages of smallpox and polio fully appreciate what it means to be rid of them. That the debunking of any meaningful link between vaccination and autism falls on deaf ears does nothing to alter the epidemiologic truth. Immunization does not cause autism.

The good of immunization is readily ignored, the harm as easily exaggerated. If you get a vaccine, any vaccine, and don't get the disease the vaccine prevents -- be it pertussis, or diphtheria, or measles, or polio, or flu -- nobody notices. There is, in fact, no way to say the vaccine did anything. After all, you might not have gotten sick without it. There is nothing to report, no thanks given, no drama. It's a non-event.

This is exactly why personal observations and anecdotes, however dramatic they may be, cannot determine whether a vaccine is working. This is exactly why epidemiology should trump ideology.

Every time an adverse reaction occurs after a vaccine -- whether or not due to the vaccine -- there will be drama. There will be anger. There will be public commentary. Even if one such adverse event occurs for every 100,000 helped, the one bad outcome will draw attention; the 100,000 non-events will go unnoticed.

This, by the way, is not just true about vaccines. It's true about my field, preventive medicine, in general. When it works, there's nothing to see.

Epidemiology fixes this, by looking at outcomes in the population at large. This is why the CDC and ACIP base their vaccine recommendations on epidemiology, the study of patterns in the population as a whole. It is at the level of population that a clear benefit from many vaccines, including the flu vaccine, is evident.

It makes no more sense to rant against vaccines because you know of someone who had an adverse reaction, or think might have, than it does to advise against walking in general because you've heard about a pedestrian struck by a car. Bad things will at times happen to good people, no matter what we do or don't do. Epidemiology simply helps us choose the path of least harm, most benefit -- so they happen to fewer of us. Immunization prominently adorns just that path.

We are, for the moment at least, privileged with the liberty of debating the vaccine issue. If we were mired in an influenza pandemic and counting casualties by the day, we would quickly lose our reticence about the test tube in which a remedy was cultivated. If we were still subject to smallpox and polio, we would have far more appreciation for the opportunity to be defended against them.

I note in closing that I practice integrative medicine, side-by-side with naturopathic physicians. My clinic specializes in natural treatments. I am salaried, and do not make money based on what I do or don’t prescribe. I have no incentive to give any drug or vaccine other than the vows I have made to do the best I can for my patients. Those inclined to make unsubstantiated allegations and impugn my character will no doubt do so no matter what I say here- but they are wrong. I am on no drug company’s payroll.

I take the position I do because it is my job to protect years in life and life in years, whether the requirements thereof are popular or unpopular. I take the position I do because we are sufficiently rid, for the moment, of the great infectious scourges of history to forget how catastrophic living with them could be. I take the position I do because the massive benefits of immunization are measured in things that don’t happen- and are thus, all too often, invisible.

I take the position I do because epidemiology should trump ideology. I take the position I do because the anti-vaccine argument, full as it is of sound and passion and fury, is fueled by emotion and an absence of evidence, and is unsound. I take the position I do because whatever it may sound like to you against the fractious static of our societal anxieties, the Anti anti-vaccine argument is rooted deeply in the evidence of absent diseases, and is strong.

-fin

Dr. David L. Katz; http://www.davidkatzmd.com/

www.turnthetidefoundation.org

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