Vaccine Opposition, an Origin Story
Injecting doubt since Smallpox and Polio
Science saves, plain and simple. Science saves time, science saves energy, and above all, science saves lives. Scientific advancements have led to a vast array of efficiencies, improvements in energy production and usage, travel, as well as countless medical breakthroughs.
One reason for this has to do with clinical trials. Typically, a clinical trial begins with animals. Provided the study shows efficacy and the animals do well, only then will researchers move on to people. Beginning with small groups, researchers increase trial participants until a well representative portion of the population is studied.
Science also requires peer review. In this process, researchers and scientists evaluate each others work, ensuring studies are proper, ethical, and can benefit humanity at large. This dance is typically done in and through a variety of scientific journals and publications, with researchers submitting trials and findings for the broader community to evaluate, study, and in some cases attempt to reproduce or refute.
As far as medical publications go, The Lancet is among the oldest, most reputable in the world. Founded in 1823 by English Surgeon Thomas Wakley, The Lancet was named for both the surgical instrument, more commonly known today as a scalpel, and for the architectural term lancet window indicating light of wisdom. Initially distributed biweekly, it has become a weekly publication with a mission to make science widely available so that medicine can serve, transform society, and positively impact the lives of people.
In 1998, The Lancet published what would become among the most controversial studies in the field of vaccination. Led by British Physician Andrew Wakefield, The Wakefield study, as it would become commonly known, hypothesized the MMR (Measles, Mumps, Rubella) vaccine was responsible for a series of events; including intestinal inflammation, harmful proteins crossing the blood-brain barrier, and subsequently causing Autism in the inoculated children. A follow up study by Dr. Wakefield in 2002 would essentially double down on this link between measles and autism, creating an uproar amongst parents and various groups already opposed to vaccines.
Wakefield became the scientific backbone of what has come to be known as the anti-vaxxer movement, and the MMR vaccine its primary villain.
To spread a message though, you need messengers. Among the most vocal vaccine opposition came from a growing list of celebrities, talk show and radio hosts, and alternative media personalities. Jenny McCarthy became one of many; a notable television personality, fixture on talk and game shows, as well as writer of several books. McCarthy’s son was diagnosed with autism when he was two and a half years old, she attributed the diagnosis to the MMR vaccine specifically. Although McCarthy has since claimed she is not anti-vaccine, only pro safe vaccine schedule, many have since echoed her theory and position on MMR specifically and vaccines in general.
Correlation without causation
In statistics, an inability to establish a cause-and-effect relationship between two variables solely based on an observed association between them is referred to as “correlation without causation”. In this case, Autism is typically diagnosed in or around the second year of life, corresponding with a series of childhood vaccines, including MMR. Also, and more importantly, subsequent examination of The Wakefield Studies, which hypothesized links between MMR and Autism, would be called into question based on parameters broadly and Dr. Wakefield in particular.
Shortly after publication, 10 of the 12 coauthors of the original study would print a retraction; stating among other things, “no causal link was established between MMR vaccine and autism as the data were insufficient”. Epidemiological studies were conducted, published, and refuted the posited link between MMR vaccination and autism. The Lancet would go on to cite Wakefield et al. for failure to disclose financial interests, finding Wakefield was funded through lawyers retained by parents considering lawsuits against vaccine makers.
At the time, The Lancet stopped short of charging Wakefield and his colleagues for ethical violations or scientific misconduct, but by February 2010, The Lancet completely retracted the Wakefield et al. paper, admitting several elements in the paper were incorrect, contrary to the findings of the earlier investigation, as well as holding Wakefield et al. guilty of ethical violations, scientific misrepresentation, and deliberate fraud. The British Medical Journal further published a series of investigative articles exposing the fraud, which appeared to take place for financial gain.
In nearly every case of public missteps, retractions rarely carry the weight and power of the original assertion. While Wakefield has since been discredited and his studies retracted, Jenny McCarthy having walked back her staunch opposition, those who quoted or believed both continue doing so unabated. Or, they simply move on to new anti vaccine torch bearers, no shortage of which currently exist in all forms of media and government alike.
Opposition to vaccines didn’t begin with Wakefield or McCarthy though, it goes all the way back to the first vaccine, the one which eradicated Smallpox.
Dr. Jenner and the first vaccination
It was another Englishman by the name of Dr. Edward Jenner who created the world’s first vaccine to treat Smallpox, a devastating disease which killed 10–20% of the population at that time.
While Smallpox ravaged communities, there existed a similar, less deadly disease known as Cowpox. Noting the common observation that milkmaids were generally immune to smallpox, Dr. Jenner believed that the pus in the blisters milkmaids received from the more benign cowpox, protected them from the deadlier smallpox.
Dr. Jenner performed his first vaccination on James Phipps, an eight year old boy on May 14th 1796. Jenner used a lancet to scrape pus from cowpox blisters on the hands of Sarah Nelmes, a milkmaid who had caught cowpox from a cow named Blossom. Jenner then took the puss laden lancet from Sarah’s skin and scratched it into both arms of Phipps. The “vaccination” subsequently produced a fever, some uneasiness, but no full-blown infection in the boy.
Upon later challenging and exposing Phipps to Smallpox, the boy was found to be immune, and would not show any symptoms of exposure or infection. By using the less virulent Cowpox to inoculate patients, Jenner would confer immunity, protecting patients from the much deadlier Smallpox.
Smallpox was just the start.
Polio, measles, chicken pox, hepatitis A and B, tetanus, diphtheria, mumps, rubella, pertussis, there are no shortage of diseases which have been largely eradicated or extremely minimized thanks to the advent and use of vaccines. Others including Influenza and pneumonia have become increasingly manageable, less debilitating, and less deadly.
None of this would stop vaccine opposition, which was present at every stage in history.
Anti Vaccination Societies
Opposition to vaccines is nothing new, during Dr. Jenner’s time, the early 1800s, portions of the population objected. The rationale for this criticism varied, and included sanitary, religious, scientific, and political reasons. Religious leaders believed the vaccine to be “unchristian” because it came from an animal. Others had a general distrust of medicine, not believing in the science of the time, with some even alleging smallpox resulted from decaying matter in the atmosphere. Finally, some objected to vaccination as a violation of personal liberty, a belief intensified as mandatory vaccine policies were implemented by governments.
By 1879, the Anti Vaccination Society of America was founded, following a visit to America by leading British anti-vaxxer William Tebb. Two other leagues, the New England Anti Compulsory Vaccination League (1882) and the Anti-vaccination League of New York City (1885) followed.
While some governments and school districts only allow religious exemptions for those who chose to abstain from vaccination, personal liberty, remains a major sticking point. The organic, all natural movement has similarly made vaccines anathema, citing a variety of ingredients within vaccines as unnatural.
Indeed there is a problem with calling or labeling something “natural”. Nature offers up plenty of toxic substances, many of which can be broken down and detoxified from the body. The takeaway here is this; ingredients in vaccines either occur naturally in the body, are found in products we interact with daily, or in a growing list of foods we consume regularly.
Another argument against vaccines has to do with side effects or adverse reaction. While localized soreness and mild fever can occur, adverse reactions including seizures, swelling of brain or spinal cord, or anaphylaxis (severe allergic reaction) are extremely rare.
Statistically, there exists a 1 in a million chance of a severe reaction, similar to getting struck by lightning. The U.S. Food and Drug Administration (FDA) established the Vaccine Adverse Event Reporting System (VAERS) as a passive surveillance system for clinical events that occur after immunization.
Victims of their success
A common saying within the research and medical community is this: Vaccines have become victims of their own success. Having largely eradicated deadly or highly contagious diseases, vaccines are almost an afterthought; until of course, they’re not.
When cases of measles or pertussis (whooping cough) spike in under-vaccinated communities, there is usually an alarm and rush to ensure susceptible individuals are vaccinated.
Pandemics can also create urgency as we’ve seen with an all hands on deck approach to create and introduce vaccines against Sars-Cov-2 to end the Covid19 pandemic. As of today, two companies Pfizer and Moderna have applied for and received FDA approval. Sandra Lindsay, an intensive care unit nurse in New York City, was the first person to receive the Pfizer vaccine in the U.S.
The goal is to vaccinate medical, front line workers first, followed by nursing home residents, the elderly, or most susceptible, then essential workers, and finally, everyone else. Vaccines will be free of charge, with the specific order of who will be vaccinated when provided by each state.
Will we have enough volunteers?
In the summer of 2019, before the current pandemic, a Harris Poll survey of 2,000 U.S adults found 45% doubted vaccine safety. The top three reasons for cited were online articles 16%, past secrets/wrongdoing by the pharmaceutical industry 16% and information from medical experts 12%.
The survey also asked Americans to choose a statement that best represented their feelings about vaccine safety and efficacy. While the vast majority, 82% chose in favor of vaccines, 8% had serious doubt, and 9% were unsure.
This was the sentiment prior to Covid19, how are people feeling now? In August 2020, Gallup found 61% of Americans willing to receive a Coronavirus vaccine; this even if the vaccine was both free and FDA approved. Americans were evenly split when surveyed again in September; with the most recent poll in November showing 58% in favor of being vaccinated.
These are important numbers to consider. According to Dr. Moncef Slaoui, the chief scientific adviser for Operation Warp Speed, it is possible the United States could reach herd immunity by May 2021. To do so would require immunizing 70–80% of the population, not 58-60%.
Here’s the good news, as we learned previously, such resistance or hesitancy is not unprecedented. When Gallup asked U.S. adults in 1954, who had heard or read about the then-new polio vaccine, “Would you like to take this new polio vaccine (to keep people from getting polio) yourself?” Just 60% said they would, while 31% said they would not.
Two promising candidates
In the fight against Covid19, nearly every bureaucratic obstacle has been removed or quickly scaled to bring a viable vaccine to market. Clinical trials quickly recruited tens of thousands in study subjects. Applications seeking FDA approval were prioritized and fast tracked, ultimately clearing both Pfizer and Moderna for immediate use. From conception to distribution, wide scale vaccines will have reached the public in less than a year, breaking the previous record of four.
Pfizer, first to market, has released the following data: Primary efficacy analysis demonstrates (vaccine) to be 95% effective against COVID-19 beginning 28 days after the first dose; 170 confirmed cases of COVID-19 were evaluated, with 162 observed in the placebo group versus 8 in the vaccine group. Vaccine was well tolerated across all populations with over 43,000 participants enrolled; no serious safety concerns observed; the only Grade 3 (medically significant but not life threatening) adverse event greater than 2% in frequency was fatigue at 3.8% and headache at 2.0%. The companies expect to produce globally up to 50 million vaccine doses in 2020 and up to 1.3 billion doses by the end of 2021.
Moderna’s vaccine reduced the risk of Covid-19 infection by 94.5%. There were 95 cases of infection among patients in the company’s 30,000-patient study. Only five cases occurred in patients who received the vaccine.
Despite these encouraging, if not mind blowing figures, some people will remain hesitant. When Gallup asked those opposed to being vaccinated, for their reasons why they would forgo the vaccine; 37% cite the rushed timeline for development, 26% want to wait to confirm the vaccine is safe, 12% don’t trust vaccines in general, 10% want to wait to see how effective the vaccine will be, and 15% had other reasons.
Unfortunately time is time, we can not fast forward or have the benefit of hindsight. Time is indeed a useful tool in verifying safety and efficacy, but for those most vulnerable, medical and essential workers, or seniors, waiting may not be a viable option.
When vaccination campaigns begin, some critical questions remain; will enough people volunteer? Can it be mandated by employers, or for travelers prior to boarding a plane or cruise? Will those forgoing vaccination be excluded from certain spaces?
As the saying goes; history tends to repeat. People are as doubtful or hesitant now as they were during Smallpox or Polio. Through public health campaigns, seeing the benefits of vaccinations first hand, more people volunteered for injections, and both diseases became an afterthought.
Hopefully, history and the overwhelming success of vaccines will be on our side, and we can add Sars-Cov-2 to the list of viruses a vaccine has been able to eradicate.
