THE VACCINATION
DEBATE: Sorting Through the
Bias and Fear
Edwin Hofmann-Smith, PhD, ND
Natural Childbirth and Family Clinic
10360 NE Wasco, Portland, OR 97220
503 252 8125
Public Health Point of View
 Vaccination protects the individual AND OTHERS,
potentially eliminates epidemics
 Measles: 1/1000 death rate (pneumonia, encephalitis,
nerve damage, etc.)
 Cost of doctors, hospitals, etc. greater than cost of
vaccines
 Risks of vaccination less than risk of disease
 One of the “greatest achievements of medicine/public
health”. Smallpox, polio, diphtheria, measles, rubella,
mumps, tetanus, all practically eliminated
Public health perspective
 Pregnant mom picked up pertussis, her
newborn got it, spent next five weeks in
NICU, permanent lung damage
 Child picks up measles in Switzerland,
exposes plane full of people, many
quarantined, some cases, no epidemic
Individual family’s perspective
 Risk of disease may be minimal (since there
are no epidemics)
 Risk of vaccination is underestimated by
officialdom
 Don’t trust the vaccine authorities
 Can control exposure (hep B, HPV)
 Our situation isn’t typical, we eat healthy, use
homeopathy,
BIAS
 A preference or an inclination,
especially one that inhibits impartial
judgment
 Helps us understand why there is such
a wide divergence of opinions
 For instance, did you believe the
cigarette manufacturers when they say
smoking doesn’t cause cancer?
BIAS: vaccine manufacturers
 Obvious, everybody knows this
 There are safeguards regarding conflict of
interest, but revolving door is reality
 Like military-industrial complex
 Donate much money to political campaigns,
lobbyists, media
 Regulators get captured by regulatees. (It’s
an axiom.)
BIAS: media
 Advertising dollars are extremely
persuasive
 When was the last time you heard of a
media outlet go against both
government and advertisers?
BIAS: CDC/Federal Government
 Vaccines for Children Program: Federal
government supplies vaccines for free if
clinic agrees to vaccinate according to
the standard schedule
 Tends to keep pediatricians in lock-step
BIAS: Vaccine Injury
Compensation Program
 Vaccine injury table - compensation only for
accepted injuries with specific timing after
vaccination
 Large cost to program if additional injury
added to table
 Adversarial program - litigant must prove
causation
 Poling case - autism and seizures,
“mitochondrial defect”
BIAS: scientific method
 Hard to prove causation for adverse
effects
 Hard to prove causation if effect is
delayed, infrequent, subtle, not
obviously related to disease
 Publication bias
 Funding bias
 Adverse effects research is a tough road
BIAS: Public health officers
 Vaccination is one of the “greatest
achievements of medicine”
 Federal grants to states’ public health
departments based on vaccination rates
 Keeps public health departments
motivated to push vaccination
BIAS: pediatric community
 Don’t want to think that what they do
every day could be harming (some) kids
 Vaccinations are an integral part of
practice, keep numbers up
 Vaccine objectors are seen as
uninformed “conspiracy theorists”
 “Don’t worry, they’re completely
harmless”
VACCINE APPROVAL
 Try to balance cost of development with
safety
 Very brief followup in safety trials
 Autoimmune and other adverse effects
may take weeks to months to develop.
 Generally look for immediate adverse
effects, then rely on post-marketing
surveillance
Vaccine adverse events
reporting system
 Reporting is required for serious effects
 Anyone can report
 Rate of reporting is between 1 and 10%
Vaccine safety datalink
 Some managed care organizations
report data on adverse effects, etc.
 First hard evidence of an adverse effect
from mercury (thimerasol)
 Quickly advised removal of thimerosal
“SAFE”
 “The U.S. Food and Drug Administration
defines a safe product as ‘one that has
acceptable risks, given the magnitude
of the benefit expected in a specific
population and within the context of
alternatives available.’ Determining what
degree of risk is 'acceptable' is a
particular challenge for regulators and
policy-makers” (and parents)
BIAS: Fear
 Unknown contaminants
 Stories of adverse effects have “legs”, not
even necessarily true
 Internet sites - no peer review, have “ax to
grind”
 Consequences are huge: lifetime of care for
disabled child
 Personal knowledge of vaccine-injured child
Mechanisms of adverse effects
 Autoimmunity
 Microglial activation
 Unintended contamination: virus,
DNA/RNA, enzymes (hypothesized)
 Chemical toxicity: mercury/thimerosal,
aluminum, formaldehyde
ASD and Developmental
Disabilities
1/110 current rate of autism spectrum (CDC)
13% with developmental disabilities
ASD lifetime cost of care is $3.2 million
Medical care cost about 5 times more than
normal kids
 About 700,000 with ASD
 50 - 60% of their parents believe illness was
triggered by vaccination
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ASD causation
 Doctors treating ASD estimate 20-50% have
clear-cut vaccine injury. Most parents blame
vaccination.
 MMR is worst one
 Can be multiple illness/antibiotics
 Gut flora probably involved in some
 Some have bizarre immunological abnormality
 Family history: autoimmune, neurological
Neurodevelopmental Disorders:
Etiology
 Mercury? - rates not dropping
 Aluminum - not much research
 Autoimmune - auto-antibodies not
found in convincing frequency, no delay
in some cases
 Gut connection
 Microglial activation
Hannah Poling case
 Multiple ear infections (food allergy,
antibiotics, immune dysfunction?)
 Tympanostomy tubes
 At 19 months, “We need to catch her
up on her vaccinations”. Got 9 vaccines.
 Prompt and profound decline
 Mitochondrial defect
Mitochondrial dysfunction
 Mitochondria as cellular “batteries”
 They generate free radicals, also soak
up free radicals by antioxidants
 Free radicals damage the mitochondria
 Genetic mitochondrial dysfunction?
Unlikely.
 Nitric oxide generates free radicals
Microglial/excitotoxin
hypothesis for ASD
 Proposed in 2003 by Russell Blaylock, MD
 Microglia and astrocytes become activated
when the systemic immune system becomes
activated
 Secrete inflammatory chemicals (cytokines),
excitotoxins (glutamate and quinolinic acid),
free radicals and lipid peroxidation products
(damage mitochondria)
 Similar to nitric oxide mechanism of CFS, etc.
Can get stuck “on”
Nitric oxide and chronic disease
 The proven mechanism of chronic fatigue
syndrome, multiple chemical sensitivities,
post-traumatic stress disorder, gulf war
syndrome, etc. (Martin Pall)
 Over production of nitric oxide (eg. in
inflammation) leads to damaging free
radicals, etc. and can lead to positive
feedback loop.
 Overproduction can be local. Autism has
damage notably in cerebellum and frontal
cortex.
Vitamin D hypothesis
 Vitamin D has effects on about 10% of
human genes
 Rise in autism parallels recommendation
of sun avoidance
 More prevalent in dark-skinned, etc.
 Pregnant women should get 4000 IU
per day, babies 800IU/day
Aluminum toxicity
 The calculated body burden of aluminum
from vaccinations exceeds that from dietary
sources, however, it is below the minimal risk
level equivalent curve after the brief period
following injection.
 In young children, vaccines with aluminium
hydroxide caused significantly more erythema
and induration than plain vaccines (odds ratio
1·87) and significantly fewer reactions of all
types (0·21)
Aluminum toxicity
 Impairs mercury excretion
 Impairs glutathione synthesis
 Maximum dose per vaccine (850 mcg)
not based on safety studies
 Vaccines with aluminum: DTaP, Hib,
Prevnar, Hep B, Hep A, HPV
US Recommended Vaccines
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Hep B (3 doses); Polio (4 doses)
DTaP (5 doses); Rotavirus (3 doses)
Hib (3 or 4 doses); Pneumococcus (4 doses)
Varicella (2 doses); MMR (2 doses)
Hepatitis A (2 doses)
Total doses - 28
Total vaccines 42
Japanese schedule 2004
 Polio: 3 shots starting around 3 months
 DTaP: 3 shots starting around 3 months
 Measles, rubella: age 1
 Japanese encephalitis: 4 shots
 BCG: 3 shots starting at 4 mo.
 Total doses - 14
 Total vaccines - 21
Timing
 Immune system not mature till 1 year
of age
 Maternal antibodies protect against
disease in the infant and inhibit
antibody response, last about 6 months
 Breast feeding protects against some
diseases like Hib and PC
Hepatitis B
 Childhood infection: usually asymptomatic but 2590% risk of chronicity
 Chronic infection: liver cancer, cirrhosis
 Common in Asia, Africa, Eastern Europe, Pacific
Islanders, Central America, and the Carribean
 Transmitted by contact with blood, semen and
vaginal secretions
Vaccination added
in 1991
Chronic
Acute
Hepatitis B vaccine
 Risk of autoimmunity
 Extremely low risk of disease - very
weak justification for vaccination
 Not recommended
Pertussis (whooping cough)
 Increasing d/t lower vaccination rates
 Newborns not protected (lack of
maternal antibody)
 Ordinary cough for a week then
paroxysmal
 Serious in babies: pneumonia, seizures,
pulmonary hypertension
Pertussis vaccine
 Start 3 - 6 months depending on exposure,
etc.
 Follow general recommendations: one shot at
a time, not when sick or if gut is unhealthy,
family history of neurological or autoimmune
diseases, silicea 200C as preventive. Don’t
repeat if reaction to first shot.
 Recommended
Diphtheria
 Bacteria cause sore throat and liberate
a toxin
 Very rare except some foreign countries
 Recommended because can’t get
pertussis vaccine without it. Available as
DTaP, Tdap, etc.
Tetanus
 Anaerobic bacterium found in soil,
manure
 Infection due to dirty wound causes
generalized muscle spasm
 Recommended: DTaP, Tdap
 Can’t get pertussis vaccine without it
Polio
 Disease eradicated from the Western
Hemisphere, Europe, etc. No risk of
disease
 Vaccine is now relatively safe but not
needed. Disease may be eradicated
world-wide in future
 Can vaccinate later before foreign travel
Haemophilus influenza type B
 Bacterium is normal flora for nose and
throat. Can become invasive and cause
meningitis, pneumonia, cellulitis,
epiglottis, etc.
 Now rare due presumably to vaccination
 Largely prevented by maternal antibody
and breast feeding
Hib: not recommended
 Have seen some neurological reactions,
but none permanent
 Risk of disease very low
Strep. pneumoniae (Prevnar)
 More than 90 separate strains exist
 Causes pneumonia, otitis media, sinusitis,
sepsis, septic arthritis, meningitis, etc.
 Vaccine is directed against the 13 worst
strains
 Now other strains are causing more disease
(serotype replacement) and Staph carriage is
increased
Prevnar: not recommended
 Risk of disease is very low in the
absence of specific risk factors like
immune dysfunction
 Breast feeding is protective
 Serotype replacement
 Vaccine is relatively reactogenic
Rotavirus
 Almost all kids get this by the time
they’re 5 years old
 Vomiting 12 to 18 hours, then usually
diarrhea
 Self limited
 37 deaths per year in US
Rotavirus vaccine
 Live virus vaccine
 Rotarix (GlaxoSmithKline) contains parts of a
pig virus that doesn’t make pigs sick
 Rota Teq (Merck) contains parts of a pig virus
that kills baby pigs
 Increase in intussusception with Rota Teq
 Not recommended
Hepatitis A
 Fecal-oral transmission
 Very common in third world, rare in US
 Usually asymptomatic in kids but more
severe in adults
 No chronic state
 Vaccine relatively safe but not
recommended unless a high risk group
Measles
 Measles: 1/1000 death rate,
neurological damage
 Virtually eliminated in US d/t vaccine
 Drop in vaccination rate associated with
many-fold increase in cases
Measles vaccine
 MMR is the most common vaccine trigger of
autism, but usually was given with other
vaccines and kid was already sick
 Recommended to support public health effort
 Give after age 2 - 3
 Give 50 - 75,000 IU vitamin A, good vitamin
D status, healthy, not with other vaccines
Mumps
 Relatively mild disease
 Self limited
 Vaccine: can’t get it without measles
and rubella
 Recommended after age 2
Rubella
 If pregnant mom contracts it in first
trimester, fetus gets it and might die or
have severe birth defects
 Our public health approach - vaccinate
all kids. Prevents epidemics. Successful.
 Essentially eradicated from US
Rubella vaccine
 15% of adolescent and adult women
will get acute arthrisis, usually transient
 Worse with wild virus infection
 Can’t get it without M and M
 Recommend: start after age 2
 Don’t re-vaccinate if seronegative as
adult
Varicella Zoster (Chickenpox)
 Epidemics among young children
 Occasional severe disease
 Susceptibles like immuno-suppressed,
chemotherapy at risk for severe disease
 Carrier state with 30% getting shingles
later
 Exposure to children with chickenpox
boosts immunity
CHICKENPOX (VARICELLA)
 Disease is usually mild but virus persists
 Asymptomatic re-activation of vaccine
virus
 Risk of shingles later in life less with
vaccine? Likely.
 Shingles vaccine necessary because less
boosting of immunity from epidemics.
 Risk of “serious” reaction to vaccine is
0.03 to 0.3%
Chickenpox vaccine program
 Best information says, shingles less
frequent and milder after vaccination
than wild disease
 Live virus, slight risk of mild disease
after shot
 Risks less after shot than from disease
 Recommend after age two or three with
usual preventive for live virus