The Panic Virus
Since Edward Jenner performed his first vaccination on James Phipps for the prevention of smallpox on May 14, 1796, vaccinations have been misunderstood and feared. Vaccination remains the best protection against 16 major diseases, according to American Academy of Pediatrics.
And yet, measles is making a comeback. Whooping cough is resurfacing. Increasingly, diseases once thought nearly eradicated are returning because parents are not vaccinating their children for multiple reasons. Education may be one of the best ways to address their concerns and remind them of what life was like without immunity to these diseases. Few people born in the last fifty years remember seeing a case of polio.
The Panic Virus – A True Story of Medicine, Science, and Fear by Seth Mnookin describes the history of the development of vaccines, public health issues such as fluoridation of public drinking water and the misguided government immunization campaign for swine flu in 1976, and the panic created when Andrew Wakefield falsely linked the MMR (measles, mumps and rubella) vaccine to autism and bowel disease.
Mnookin explains how public policies and regulations regarding vaccinations were shaped. In 1969, New York became the first state to enact a compulsory school vaccination law and by the mid-1970s, thirty-nine other states had followed suit. However, school vaccination requirements were routinely ignored. The poor were often under-immunized due to lack of access to medical care, suspicions of the motives of public healthcare workers, or both. As a result, measles cases increased just when the disease appeared poised to be eradicated. In 1970, more than twice as many infections occurred than two years earlier and by 1971, that figure increased another 65 percent.
This persistence of measles underscored the paradox of vaccines that when a disease is endemic, any potential side effects of its vaccine seem slight compared to the risks of not getting immunized. However, the more effective a given vaccine, the more the targeted disease becomes an abstraction. If few people remember anyone suffering from the disease, the vaccine may be perceived as something that is no longer necessary.
Mnookin’s book describes the development of the panic behind an anti-vaccine campaign which arose after Wakefield’s now-discredited study, incorrectly linking the MMR vaccine and autism, appeared in a 1998 issue of the medical journal Lancet. Wakefield’s false link between the MMR vaccine and autism created worries, followed by the public’s concern that thimerosal, a mercury-containing organic compound used as a preservative in vaccines since the 1930s, had a theoretical potential for neurotoxicity, along with a general fear that children were receiving too many vaccines too soon.
In 1998 the media seized the story about the MMR as a potential cause of autism, which helped launch the health scare about vaccines. Mnookin details the journey from when Wakefield first theorized that measles was a likely cause of inflammatory bowel disease (IBD) – causing stomach inflammation, to him being revealed as a profiteer in league with class-action lawyers and eventually to losing his medical license in 2010.
Mnookin also describes how the FDA Modernization Act of 1997 called for a review of all mercury-containing food and drugs. He points out that the large risks of not vaccinating children far outweighed the unknown and possibly much smaller risk, if any, of cumulative exposure to thimerosal-containing vaccines over the first 6 months. There was no data or evidence of any harm caused by the level of exposure that some children may have encountered in the immunization schedule. However, any potential risk is of concern, leading to a marked decline in the use of mercury-containing preservatives in vaccines since 1999.
Even with these actions, a misperception persists that thimerosal in vaccines caused the increased rates in autism. Mnookin points out, “Thimerosal was removed from childhood vaccines a decade ago; autism rates have not gone down since then.”
Wakefield’s discredited study may have contributed to the erosion of public confidence in vaccines and declining vaccination rates, which may explain the trend in the increase of whooping cough cases.
“Up until the 1940s, whooping cough was one of the world’s leading causes of infant mortality, but in the decades immediately following the widespread introduction of the pertussis vaccine, the total number of cases and the total number of deaths in the industrial world declined by more than 90 percent.” Mnookin explains that this trend reversed somewhat in the mid-1970s “when speculative or exaggerated reports about the dangers of the whole cell pertussis vaccine led to a sharp drop in its use.”
Declining vaccination rates for children and waning immunity for adults led to a rise in infections from just over one thousand in 1976 to more than four thousand in 1986, eight thousand in 1996, approximately ten thousand in 2002 to twelve thousand diagnoses in 2003, and jumping to twenty-five thousand in 2004.
According to the Centers for Disease Control and Prevention, in 2010, 27,550 cases of pertussis (whooping cough) were reported in the U.S., but many more go undiagnosed and unreported.
The Panic Virus – A True Story of Medicine, Science, and Fear offers personal stories to illustrate the depth of feeling from both sides of the issues. Mnookin develops the story of how well-meaning parents, pediatricians, government policy makers, and public figures were caught up in the controversy that occurred when autism was falsely linked to vaccines.
In July 2003, Archives of Pediatrics and Adolescent Medicine published a review of a dozen separate epidemiological reports on MMR, which collectively studied millions of children from five different countries born over 50 years. They concluded there was no evidence of the emergence of an epidemic of autism spectrum disorders related to the MMR vaccine.
Fear of vaccines continues to impact the general public, and declining vaccination rates have led to outbreaks of preventable diseases. Coincidentally, this week April 21-28, 2012 is Minnesota Department of Health National Infant Immunization Week to encourage parents to vaccinate and protect their children.
Mayo experts, Dr. Gregory Poland and Mayo pediatrician Robert Jacobson, M.D., explain that the number of active molecules in infant vaccines is far lower than ever before, so while vaccines are not only safe, each child is receiving a fraction of actual antigen compared to children in the past. Among other evidence, they point to a recent review of 1,200 articles by the Institute of Medicine that failed to find any autoimmune side effect from vaccines. They make the point that there is either no impact or that any relation to autoimmune conditions is not causative. Finally, they make the case that while natural immunity does protect as well, the risk of illness and death is far higher than with a vaccine.
Mnookin concludes his book with his concerns about his own son who was born as research for this book was being completed. Mnookin doesn’t worry about his son passing away from receiving the MMR vaccine. Instead he worries that his son may receive a vaccine that isn’t effective, or he’ll come in contact with someone infected with Hib (Haemophilus influenzae type B) or measles, or whooping cough before he’s old enough to have received all his shots. “I worry that he’ll end up in a pediatric ICU because some parent decided the Internet was more trustworthy than the AMA (American Medical Association) and the AAP (American Academy of Pediatrics).”
Debbie Fuehrer, LPCC
Mind Body Medicine