FACT CHECK: Correcting Anti-Vaccine Testimony

No current federal or constitutional law requires states to offer religious or personal belief exemptions from school vaccine requirements. In fact, U.S. Supreme Court decisions, including Jacobson v. Massachusetts and Zucht v. King, have made it clear that states possess the authority to require vaccination as a condition for school entry. Prince v. Commonwealth of Massachusetts established that religious freedom does not extend to those actions that endanger others: “The right to practice religion freely does not include the liberty to expose the community or the child to communicable disease or the latter to ill health or death.”

Other court rulings have clarified that the right to religious freedom is not infringed by requiring schoolchildren to be vaccinated and that citizens are not granted a First Amendment right to religious exemption from laws requiring vaccination for school attendance: “The constitutional right to freely practice one’s religion does not provide an exemption for parents seeking to avoid compulsory immunization for their school-aged children.”

California, West Virginia, and Mississippi do not allow any philosophical or religious exemptions. In 2011 the Supreme Court affirmed West Virginia’s law by refusing to take up a case against it.

It’s also worth noting that no major religion has explicit, doctrinal objections to vaccinations. A 2013 study found that only two religious groups ― Christian Scientists and the Dutch Reformed Church ― have demonstrated a precedent of widely rejecting vaccinations, but even these are not explicitly laid out in their doctrine. Vaccination is endorsed by top Jewish and Islamic scholars, and by the Vatican. Religious authorities have meticulously studied how vaccines are made and what is in them, and still have ruled that they do not violate Jewish, Islamic or Catholic law.

Let’s look at benefit versus risk with factual evidence.  Vaccines have eradicated or brought under control seven major human diseases—smallpox, diphtheria, tetanus, yellow fever, whooping cough, polio, and measles. It’s been estimated that the elimination of smallpox has saved 40 million lives. Deaths from polio worldwide have dropped by 99% since 1988, and more than 16 million people have been saved from paralysis, according to the World Health Organization. In contrast, severe adverse reactions resulting from vaccination are extremely rare. For vaccines with the most reported adverse reactions, the rate is about 1 in 1 million vaccinations.

While the chance of severe adverse reaction or death resulting from the MMR vaccine is less than 1 in 1 million, the risk to unvaccinated children is far greater: About 1 in 1,000 unvaccinated children who contract measles will suffer a serious outcome, such as encephalopathy or death. Measles, considered eliminated in the U.S. in 2000, is now resurging in outbreaks that have spread to 22 states, and the number of cases in 2019 is on pace to triple last year’s count.

Maine’s pertussis rate is 8 times the national average, and we have outbreaks underway in several towns. Pertussis can be deadly to babies: of those that are hospitalized with pertussis, 1 out of every 100 will die (see what a baby with whooping cough looks and sounds like). Since the introduction of the safer DTaP vaccine in 1999, rates of severe adverse reaction have fallen dramatically. The chances of a child having a severe allergic response today is about 1 in 1 million.

There is NO causal link between vaccines and autism, even among children who have an increased risk for autism. The cause of this pernicious and dangerous rumor was a single 1998 study of just 12 children. The study was later proven to be fraudulent, retracted from the journal that published it, and the author stripped of his medical license. Opposing that discredited theory are several large scale, long-term, peer-reviewed studies. The largest was published this year, studying 657,461 children born in Denmark from 1999 through 2010.

There are no “poisons” in vaccines.

• Formaldehyde: Some required childhood vaccines contain formaldehyde to inactivate or detoxify viruses. Formaldehyde is already a naturally occuring substance in our bodies, and the amounts used in vaccines are not harmful.
• Mercury: No required childhood vaccine contains mercury. Thimerosal, an organic compound preservative containing ethyl mercury, was used to prevent bacterial and fungal contamination of vaccines beginning in the 1930s. Today, it is only found in multi-dose vials of influenza vaccines. Ethyl mercury does not accumulate in our bodies, unlike the forms of mercury used in thermometers or found in fish. 
• Aluminum: Some required childhood vaccines contain aluminum salts, which activate the immune response. Aluminum adjuvant containing vaccines have a demonstrated safety profile of over six decades of use and have only uncommonly been associated with severe local reactions. The more common source of exposure to aluminum is from eating food or drinking water.

Two trends occurring at the same time does not prove that one causes the other. While it’s true that autism rates have climbed dramatically since the 1970s, the numbers Sen. Miramant presented are both inaccurate and obscure autism’s scientifically proven risk factors. The actual rate of autism in the U.S. has increased from 1 in 5,000 in 1975 to 1 in 59 today (1 in 37 for boys and 1 in 151 for girls). Experts say the bulk of the increase stems from a growing awareness of autism and changes to the condition’s diagnostic criteria and availability of supportive services. Autism did not appear in the DSM until 1980, despite the term being coined as early as 1943. Until that time, many people with autism were diagnosed with an intellectual disability, institutionalized, and rendered invisible. As the diagnostic criteria expanded, so did the number of cases reported. In 1991, students diagnosed with autism qualified for special education services, making a diagnosis an avenue for support instead of stigma. Since then, the definition of autism has further broadened to include Asperger’s. Research indicates that genetics are involved in the vast majority of autism cases, along with parental age and premature birth.

Again, there is NO MERCURY in any required childhood vaccine. Vaccine manufacturers have made changes to vaccines based on reporting of adverse reactions. The shift from the DTP to the DTaP vaccine is one important example that greatly increased safety. Maine requires 9 vaccinations (covering 13 diseases) for all school children, including daycare for babies and toddlers. Most of these vaccines require multiple booster shots given over the course of several years to achieve immunity. While the DTaP vaccine is less effective than the DTP vaccine, it is considered safer. 

Parents and doctors still have wide latitude in determining the best vaccination schedule for their child. Children who enter the school system in kindergarten have about 5 years to acquire 4 required vaccines.

Herd immunity is not a fringe theory. It’s established scientific fact that when a sufficiently large proportion of a population is immune to a contagious disease, the disease cannot easily spread from person to person. This roadblock protects individuals who cannot be vaccinated due to age or illness, keeping their already elevated risk of contracting a disease as low as possible. The other benefit of a large vaccinated population is that diseases are less likely to mutate and become ineffective if they cannot gain a foothold in a community. Mutations happen as a result of sustained outbreaks, and are most likely to occur in communities where vaccination rates are low. When mutation happens, even vaccinated people are at greater risk of contracting the disease. This is exactly what is currently happening with pertussis in Maine.

The vaccination rate required to achieve herd immunity depends on the disease. While experts say 80% is enough to protect against rubella and mumps, pertussis and measles spread far more easily and require a rate closer to 95%. In more than 40 of Maine’s elementary schools, the vaccination rate is below 85% (five are in Sen. Miramant’s district). Although the health and safety of our community’s children are the primary source of concern when it comes to maintaining herd immunity, we shouldn’t forget that letting it lapse also comes with a massive financial risk. When a community in Brooklyn experienced a measles outbreak in 2013, it took 87 city health employees 10,000 staff hours and $400,000 to bring the outbreak under control.

Most vaccines, when administered according to the appropriate schedule, will last a lifetime. The booster shots children recieve help ensure immunity. For some vaccines, like pertussis, an adult booster shot is recommended. Disease mutation can also happen as a result of prolonged outbreaks among unvaccinated populations. Mutations make vaccines less effective for everyone and increase the risk factor for those who cannot be vaccinated for age or health reasons.

A different liability system was set up for vaccine makers precisely because of the critical public health role they play and the vast populations they serve. Endless lawsuits (whether legitimate or frivolous) could drive up the costs of vaccines, and discourage companies from making them altogether. Injured parties without means could be too intimidated to take on a deep-pocketed pharma company. To ensure that vaccines remain affordable and available, Congress established a trust fund for damage awards, financed by a 75 cent tax on every vaccine administered. Under the no-fault system, the goal is to settle matters quickly and fairly. If petitioners don’t like the outcome, they can still take their case to the traditional civil court system. Since 1988, when the National Vaccine Injury Compensation Program began, trillions of vaccines have been administered in the US. In those 30 years, 20,000 claims have been filed and $4 billion has been awarded to about 6,400 claimants, with the small number of severely impacted people receiving the bulk of the funds.

The National Childhood Vaccine Injury Act requires health care providers to report serious health problems following vaccination to the federal Vaccine Adverse Events Reporting System (VAERS). There are no recent definitive studies that show the rates of reporting. Because anyone can report any kind of adverse reaction, whether mild or severe, and whether they know the reaction to be a result of the vaccine or not, the system is primarily used to spot trends. Reports to the VAERS system of the adverse effects of the first rotavirus vaccine helped remove the vaccine from the schedule and replace it with a safer one.

To suggest that there haven’t been studies conducted on vaccine safety is ludicrous. An exhaustive list of them can be found on the CDC’s website. There are no less than 20 studies under the tab for 2018 alone. The Clinical Immunization Safety Assessment (CISA) project was established in 2001 to conduct and review clinical research on vaccine safety. CISA is a national network of vaccine safety experts from the CDC’s Immunization Safety Office, seven medical research centers, and other partners.

The MMR vaccine received a lot of attention from researchers precisely because of the amount of dangerous misinformation spread since the fraudulent Andrew Wakefield study from 1998, as well as from the similarly discredited and retracted “CDC coverup” conspiracy theory pedaled by William Thompson. MMR has no causal effect on autism rates, and the findings are conclusive. While there are no studies that show a link between any vaccine and autism, there are several large studies that show that there is no link.

No such study showing an increased rate of autism among newborns who received the HepB vaccine exists. The most recent study examining this issue found no causal effect, and another recent study on adverse reactions to HepB recorded in the VAERS system found no new or unexpected safety concerns.

The reason that there are no large scale, long-term, double-blind studies conducted with control groups is because it would be completely unethical. Researchers cannot purposefully withhold vaccines from tens or hundreds of thousands of children and not inform their parents whether they have been vaccinated. No research review board would allow such a study to even be proposed.

Strong oversight by government agencies and ethics committees, advocacy groups, and the press are essential to preventing conflicts of interest. But conflicts of interest do not necessarily indicate that a vaccine is unsafe. In the case of the first rotavirus vaccine, the vaccine was pulled from the schedule in 1999 after adverse reactions were flagged in the VAERS reporting system.

Studies have shown that the current vaccine schedule poses no increased risk of injury. Paul Thomas is a rising star in the anti-vaccination movement, not a medical researcher. His anecdotal claims are not supported by any peer-reviewed or published studies, and his intensive marketing of his book and “nutritional supplements” show that he has a significant financial interest in the issue. One of his patients is the unvaccinated Oregon boy who became the first tetanus patient in the state in more than 30 years. After an 8-week hospital stay that cost more than $800,000, the boy remains unvaccinated.

Parents are not lacking in sources of reputable studies on vaccine safety, or about autism. Unfortunately, they also have to combat a barrage of misinformation in the public sphere, including this public testimony. Parents who are still worried about vaccine safety should talk to their doctors, who are professionally obligated to provide accurate and up-to-date information about the risks of any medication or procedure, as well as the risks of NOT following medical advice and public health laws. If a child has known risk factors or a prior adverse reaction to a vaccine, your doctor can help you determine if a medical exemption from vaccination is warranted.

The courts have ruled time and again that restrictions on individual liberty are justified when individual decisions or actions threaten public health and safety. The US Supreme Court’s decision in Prince v. Commonwealth of Massachusetts established that First Amendment protections do not extend to actions that endanger others: “The right to practice religion freely does not include the liberty to expose the community or the child to communicable disease or the latter to ill health or death.”  As made clear from the amount of misinformation circulating in the public sphere, free speech is alive and well in America. Social media platforms, as private businesses, have the right to set their own guidelines to prevent the spread of dangerous conspiracy theories and junk science. Those who want to dive deeper into the evidence about vaccines should learn to seek out and read reputable scientific and medical journals.

Each of these cases represents a product that was determined through sound research, reporting, and oversight to pose greater harm than benefit. In the case of required childhood vaccines, decades of sound research, reporting, and oversight have demonstrated that the public health benefit of vaccines far outweighs the risk. The other issue that has been studied in depth is whether laws that require school children to be vaccinated reduce rates of disease. The evidence not only shows that these requirements work, but also that communities with high vaccination opt-out rates have higher rates of disease.

Medical exemptions are still allowed under this bill, and parents are still permitted to work with their doctors to determine a vaccine schedule that meets school entry requirements.