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Six myths about vaccination – and why they’re wrong

Recently released government figures show levels of childhood vaccination have fallen to dangerously low levels in some areas of Australia, resulting in some corners of the media claiming re-ignition of…

Vaccines are one of the most effective public health measures ever introduced. Image from shutterstock.com

Recently released government figures show levels of childhood vaccination have fallen to dangerously low levels in some areas of Australia, resulting in some corners of the media claiming re-ignition of “the vaccine debate”.

You can check how your postcode rates here.

Well, scientifically, there’s no debate. In combination with clean water and sanitation, vaccines are one of the most effective public health measures ever introduced, saving millions of lives every year.

Those who claim there is a “debate” will cite a series of canards designed to scare people away from vaccinating, but, if you’re not familiar with their claims, you could easily be convinced by anti-vaccine rhetoric.

So what is true and what is not?

Let’s address just a few of the common vaccine myths and explain why they’re wrong.

1. Vaccines cause autism

The myth that vaccines are somehow linked to autism is an unsinkable rubber duck. Initiated in 1998 following the publication of the now notorious Lancet paper, (not-a-Dr) Andrew Wakefield was the first to suggest that the measles mumps rubella (MMR) vaccine might be linked to autism.

What he didn’t reveal was that he had multiple conflicts of interest including that he was being paid by lawyers assembling a class action against the manufacturers of MMR, and that he himself had submitted an application for a patent for a single measles vaccine.

It eventually unravelled for Wakefield when the paper was retracted in 2010. He was struck from the medical register for behaviour classified as “dishonest, unethical and callous” and the British Medical Journal accused him of deliberate fraud.

But once the idea was floated, scientists were compelled to investigate, particularly when it stood to impact public health so dramatically. One of the most powerful pieces of evidence to show that there is no link between vaccines and autism comes from Japan where the MMR was replaced with single vaccines mid-1993. Guess what happened? Autism continued to rise.

We currently don’t know what causes autism. But we do know what doesn’t: vaccines. Image from shutterstock.com

After this door closed, anti-vaxers shifted the blame to thiomersal, a mercury-containing component (not be confused with the scary type that accumulates in the body). Small amounts of thiomersal were used as a preservative in some vaccines, but this never included MMR.

Thiomersal or ethyl-mercury was removed from all scheduled childhood vaccines in 2000, so if it were contributing to rising cases of autism, you would expect a dramatic drop following its removal. Instead, like the MMR in Japan, the opposite happened, and autism continues to rise.

Further evidence comes from a recently published exhaustive review examining 12,000 research articles covering eight different vaccines which also concluded there was no link between vaccines and autism.

Yet the myth persists and probably for several reasons, one being that the time of diagnosis for autism coincides with kids receiving several vaccinations and also, we currently don’t know what causes autism. But we do know what doesn’t, and that’s vaccines.

2. Smallpox and polio have disappeared so there’s no need to vaccinate anymore

It’s precisely because of vaccines that diseases such as smallpox have disappeared.

India recently experienced two years without a single case of polio because of a concerted vaccination campaign.

Australia was declared measles-free in 2005 by the World Health Organization (WHO) – before we stopped being so vigilant about vaccinating and outbreaks began to reappear.

The impact of vaccine complacency can be observed in the current measles epidemic in Wales where there are now over 800 cases and one death, and many people presenting are of the age who missed out on MMR vaccination following the Wakefield scare.

In many ways, vaccines are a victim of their own success, leading us to forget just how debilitating preventable diseases can be – not seeing kids in calipers or hospital wards full of iron lungs means we forget just how serious these diseases can be.

3. More vaccinated people get the disease than the unvaccinated

Although this sounds counter-intuitive, it’s actually true, but it doesn’t mean that vaccines don’t work as anti-vaxers will conflate. Remember that no vaccine is 100% effective and vaccines are not a force field. So while it’s still possible to get the disease you’ve been vaccinated against, disease severity and duration will be reduced.

Those who are vaccinated have fewer complications than people who aren’t. Image from shutterstock.com

With pertussis (whooping cough), for example, severe complications such as pneumonia and encephalitis (brain inflammation) occur almost exclusively in the unvaccinated.

So since the majority of the population is vaccinated, it follows that most people who get a particular disease will be vaccinated, but critically, they will suffer fewer complications and long-term effects than those who are completely unprotected.

4. My unvaccinated child should be of no concern to your vaccinated one

Vaccination is not just a personal issue, it’s a community responsibility, largely because of a concept known as “community immunity”. This describes a level of vaccination that prevents epidemics or outbreaks from taking hold and spreading.

Some people question the validity of this concept, sometimes referred to as herd immunity, but the impact of it breaking down can be easily observed in places where vaccination levels fall dangerously low – take the current measles outbreak in Wales, for example.

The other important factor about community immunity is it protects those who, for whatever reason, can’t be vaccinated or are not fully vaccinated. This includes very young children, immunocompromised people (such as cancer sufferers) and elderly people.

5. Vaccines contain toxins

A cursory search of Google for vaccine ingredients pulls up a mishmash of scary-sounding ingredients that to the uninitiated can sound like “franken-science”.

Some of these claims are patently untrue (there is no anti-freeze in vaccines), or are simple scaremongering (aborted foetuses – in the 1960s some cells were extracted from a foetus to establish a cell line that is still used in labs today). Some of the claimed chemicals (and remember everything is made of chemicals) are present, but are at such low levels as to never reach toxicity.

A pear has 600 times more formaldehyde than a vaccine. Image from shutterstock.com

The simple thing to remember is the poison is in the dose – in high enough doses even water can kill you. And there’s 600 times more formaldehyde in a pear than a vaccine.

Also, if you ever read the claim that “vaccines are injected directly into the blood stream” (they’re not), be sceptical of any other claims made.

6. Vaccines will overwhelm kids’ undeveloped immune systems

The concept of “too many too soon” was recently examined in a detailed analysis of the US childhood immunisation schedule by The Institute of Medicine. Experts specifically looked for evidence that vaccination was linked to “autoimmune diseases, asthma, hypersensitivity, seizures, child developmental disorders, learning or developmental disorders, or attention deficit or disruptive disorders”, including autism. The researchers confirmed that the childhood vaccination schedule was safe.

The amount of immune challenges that children fight every day (between 2,000 to 6,000) in the environment is significantly greater than the number of antigens or reactive particles in all their vaccinations combined (about 150 for the entire vaccination schedule).

So the next time you hear these myths about vaccination, hopefully you’ll have some evidence up your sleeve to debunk them.

Join the conversation

52 Comments sorted by

Comments on this article are now closed.

  1. Phil Dolan

    Viticulturist

    It doesn't seem possible that parents would believe such stuff and not get their kids vaccinated. But then, there's all those climate change deniers too.

    What a weird mob we are.

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    1. John Campbell

      farmer

      In reply to Phil Dolan

      Yes the anti-science anti-any-government pro business mob know that all wisdom sanity and ethics belongs to them.

      You would wonder why people with the merest intelligence should think it as worth arguing with such enlightened people?

      I once thought that sort of insanity belonged in the USA but sadly that have successfully exported it here together with MacDonalds, obesity spin, their language and crap TV

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  2. Laurie Willberg

    Journalist

    Anybody who takes the time to actually read the complaint against Dr. Wakefield will find that it revolved around his taking cultures from children at a non-medical event, but with the full consent of their parents. It is this issue that was found to be "unethical". Due to other issues with MMR vaccine he still considers a single measles vaccine to be safer than the combination (not to mention the rubella portion has been found to be virtually useless).
    UK officials had already decided not to make…

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    1. Tyson Adams

      Scientist and author

      In reply to Laurie Willberg

      Okay, now that you have defended Wakefield, for what is undoubtedly one of the most fraudulent scare campaigns of all time and his lack of medical ethics, it is time for you to defend James Holmes.

      You must really hate science and medicine to want to defend Wakefield. In which case, may I suggest that you stop using science, you know, like the internet.

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    2. Ben Heard

      Director, ThinkClimate Consulting

      In reply to Laurie Willberg

      As per Philip Starkey, that really is very, very funny.

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    1. John Perry

      Teacher

      In reply to Giles Pickford

      I have no doubt that your anecdote is true. Unfortunately, both sides of this debate use emotive anecdotes to press their point.

      I expressed doubts about the safety of vaccinations to the maternity health care nurse when our first was a baby, and her response was "take a look around Fairfield cemetery and look at the gravestones of the children who died around 100 years ago and that might change your mind."

      Say what? Weren't you just telling me that the anti-vax crowd use anecdotes to prove their point?!?!

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    2. John Campbell

      farmer

      In reply to John Perry

      What on earth happened to the education revolution? How come so few people are unable to see through simple logic errors.

      For instance argument by analogy is always invalid and appeals to emotion has nothing to do with either logic or truth.

      Clearly we need to train our kids not to think that "anyone's opinion is as good as anyone else's" but to see through bullshit when it is presented to them. Perhaps then most wouldn't be quite so gullible and fooled by any and every scare campaign.

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    3. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to John Campbell

      I just read an interesting article in New Scientist (3 Nov. 2012) on Political Instincts.

      If your abode has more object related to order - stamps, calendars, cleaning products, etc then you are most likely conservative.

      If your abode is messier and has more objects relating to open-mindedness such as travel books, art supplies and diverse music collections, then you are most likely 'liberal' (ie of the left/progressive).

      The conservatives tend to want "cognitive closure" - turning uncertainties…

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  3. Stephen S Holden

    Associate Professor, Marketing at Bond University

    If '3' is true ("most people who get a particular disease will be vaccinated, but critically, they will suffer fewer complications and long-term effects than those who are completely unprotected"), why is '4' (individual choice) a problem?

    Strictly, '4' - personal choice - is not a myth! Individual rights present a conflict with the social good promoted by public health professionals but they ain't a myth. Most of us think there is a place to draw a line where individual right dominates social good. The tricky thing is deciding on where to place the line - and getting everyone to agree on it.

    Claiming expertise and public interest is unfortunately not sufficient. If it were, ex-Dr Andrew Wakefield, a trusted, respected health professional publishing in The Lancet no less would still be allowed to preach what he presumably believes today.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Stephen S Holden

      "Claiming expertise and public interest is unfortunately not sufficient. If it were, ex-Dr Andrew Wakefield, a trusted, respected health professional publishing in The Lancet no less would still be allowed to preach what he presumably believes today."

      Not sure I understand this sentence - are you saying that a person convicted of scientific fraud should still be respected and trusted for that work? Please clarify.

      Myth number 4 is a frequently repeated anti-vax canard: " If you believe that vaccines work, and your child is vaccinated, why are you worried about mine?"

      Well, that's an easy one. Vaccines - like almost everything in life, are not 100% effective. Less than 100% does not mean 0% though - many have >90% sero-conversion rates. Herd immunity is important for those who are unable to sero-convert for whatever reason, and babies too young to be vaccinated. Stop the circulating organisms, protect the vulnerable.

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    2. John Campbell

      farmer

      In reply to Sue Ieraci

      I was going to write something similar but I too couldn't really get the gist of what Steve was trying to say.

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  4. Sharon Potocnik

    HR Officer

    I am not against vaccination, I was vaccinated, my daughter was vaccinated and I have not voiced any concerns about my grandson being vaccinated. But from a neutral standpoint it seems to me that the government and proponents of vaccination do themselves a disservice by failing to acknowledge and put into perspective negative reactions to vaccinations. Population wide correlations of vaccination types and autism rates does nothing to allay fears of someone (who knows someone) who went into the immunisation room with a seemingly healthy baby and days later have a permanently damaged child. Is there a central reputable body to investigate these claims? It may turn out to be as useful as a body to investigate UFO sightings, but at least its existence would put some consistently collected data behind the arguments.

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    1. John Perry

      Teacher

      In reply to Sharon Potocnik

      Thank you for your reasoned comment.

      When I asked my GP about this, his response was "I have no problem with the science behind vaccination. It's the politics of it I have a problem with."

      I would add that I have a problem with the arrogance of it. On both sides. Why this is such a polarising issue when it is CHILDREN we are talking about infuriates me.

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    2. Ben Heard

      Director, ThinkClimate Consulting

      In reply to Sharon Potocnik

      I'm not clear how these things are put into perspective other than an article such as that above, and the research underpinning it.

      In my opinion, vaccination proponents rightly remain just a little bit above the most emotive aspects of the discussion. It's a slippery slope, and takes the discussion to somewhere that evidence means progressively less and less.

      What is of course always important is responses that are empathetic and don't make people feel stupid for asking. But I think we need to be putting the responsibility back onto the parents, not blaming the experts.

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    3. Mike Harris

      logged in via Facebook

      In reply to Sharon Potocnik

      Sharon, it worries me that as a self proclaimed student of nutrition, you seem not to be aware of the pitfalls and dangers of confusing anecdotal evidence as proof, and the difference between correlation and causation.

      As the parent of an autistic child, I noticed a change in my son at about the same time he received vaccinations, and was desperate to link the two events. To cut a long story short - there proved to be no link backed by credible scientific evidence and research.

      I too have "no problem with the science behind vaccination". It is not arrogant to dismiss the opinion of someone who has no credible proof or evidence.

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    4. Sharon Potocnik

      HR Officer

      In reply to Mike Harris

      Mike, all I asked is "Is there or shourld there be a central body to investigate on a case by case and as they occur claims of harm?" Of course these stories are anecdotal, but unless there is a systematic way to collect and analyse these stories they will carry too much influence amongst the general public. If you are telling me that such a body exists I would be glad to hear it.

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    5. Mark Amey

      logged in via Facebook

      In reply to Sharon Potocnik

      "Is there or shourld there be a central body to investigate on a case by case and as they occur claims of harm?"

      I think you will find that every state health department has an incident monitoring/reporting system which monitors everything from surgical errors to medication side effects. There is also mandatory reporting for drug side effects, which is additional to incident reporting. These systems overlap, and investigate quite rigorously. One can also report drug/vaccine side effects to the TGA at: http://www.tga.gov.au/hp/problem-medicine.htm

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Sharon Potocnik

      Sharon - have you looked for the information you seek? There are many good sources, reflecting the fact that there has been an abundance of work and reporting about your concerns.

      You could start with "The Science of Vaccination" - an easily obtainable booklet that is very well referenced - co-written by people like Fiona Stanley.

      Then there's the Autism Science Foundation - their section on vaccination shows a lot of good studies that be-bunk that myth.

      If you want to know about side-effects or adverse reactions, there is also a wealth of material from various sources - your local GP of early childhood nurse could help source or explain it.

      In short, I don't agree that "the government and proponents of vaccination do themselves a disservice by failing to acknowledge and put into perspective negative reactions to vaccinations." That information is easy to find and very public - as are the studies that de-bunk Wakefield's work.

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    1. Fred Pribac

      logged in via email @internode.on.net

      In reply to Peter Ormonde

      Hello Peter,

      could I request that you sign up for some-or-other part-time course by distance education at a learned institution of your choice. It's not too hard to find a postgraduate course in inconsequential studies that costs virtually nothing and could be dragged out for 4 years.

      This would entitle you to write articles for TC.

      Once esconced you could simply ignore the mooted course content or research and instead focus on writing articles on topics of your choice herein.

      Those of us who appreciate your insights and quirky turns of phrase would be glad ... and the rest would be purple with self-righteous apoplexy (which in itself would be a delight to witness).

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    2. Peter Ormonde

      Farmer

      In reply to Fred Pribac

      G'day Fred.

      Thanks for the nice words.

      I did offer to ghost a column for TC a while back - but they were horrified at the thought - insisted on me grafting myself onto some sort of institution. Not without the fun of some sort of crime spree at least.

      Of course I could join the old boys club at ANU, get to eat subsidised staff room tucker and be able to describe myself as an "emeritus" on AGW denialist articles but that could be construed as dishonest by the mean spirited.

      So I've settled on being an independent freelancing thorn under the saddle of society. No institution seems suitable - not without padded walls and bars.

      Trust the plucking is going well.

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  5. Tyson Adams

    Scientist and author

    Timely article, Rachael (and editors).

    I just had one question though, on #3. I was under the impression that the numbers might be higher for those vaccinated but that this was because they were a greater proportion of the population. So the actual proportion of vaccinated vs. non-vaccinated getting the disease was, in fact, higher in the non-vaccinated. I've only read the one study on that particular factor, so it may not have been representative enough.

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    1. John Campbell

      farmer

      In reply to Tyson Adams

      I wonder also if the numbers might be greater because there is a higher degree of vaccination where the particular diseases are endemic.

      Incidentally I always find the arguments about toxins amusing as in general all plants contain toxins, having developed them to cope with insect attack.

      Anyone's chance of avoiding toxins is therefore zero. Interesting also is that with global warming the toxins in many plant species is likely to increase significantly.

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    2. Tyson Adams

      Scientist and author

      In reply to John Campbell

      Toxins are fantastic things. A lot of our herbicides and pesticides were discovered in plants.

      On your last point, I'm not sure if the toxins will increase or just that there will be less dilution of it due to having a more stressed plant. Do you have any links to read on that one?

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    3. Peter Ormonde

      Farmer

      In reply to Tyson Adams

      Tyson,

      There is a young woman working for CSIRO I think looking at the responses of plants - crops in particular - to increased CO2. I heard her on the Radio National Science Show maybe 18 months ago. She was suggesting that where conditions become more favourable to growth plants respond by pumping their suddenly spare resources into producing defences - like cyanide and the like. Not a lot. But could have an impact if you a living on say rice or lentils or some other staple. Or if you are a cow.

      I decided not to be so lazy and I've tracked her down: http://www.abc.net.au/radionational/programs/scienceshow/how-plants-respond-to-increasing-carbon-dioxide/3031138

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  6. Raine S Ferdinands

    Education

    Some countries have mandated that unless children have been vaccinated (proof on Birth Cert being stamped at the back with vaccination date/s) no schools will register these children. It has worked rather well.

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  7. Michael Wilbur-Ham (MWH)

    Writer (ex telecommunications engineer)

    Does anyone know where the Liberals stand on vaccination?

    Have Labor under Rudd or Gillard done anything to try to increase or to hinder our vaccination rates?

    This is one area where I have no idea of the politics, and I would like to know if this issue is consensus politics or if our votes make a difference.

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    1. Elizabeth Hart

      Independent Vaccine Investigator

      In reply to Michael Wilbur-Ham (MWH)

      For example, the Gardasil HPV vaccine was originally rejected by the Australian Pharmaceutical Benefits Advisory Committee (PBAC) in 2006, when the Howard Liberal Government was in power.
      An article by Matthew Stevens in The Australian at the time (November 2006)(1), reports the PBAC rejected Gardasil because it was “too expensive and, just maybe, not what it was cracked up to be anyway”. Apparently, Tony Abbott, then the Australian Federal Health Minister “took to the airwaves, passing on PBAC’s…

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    2. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Elizabeth Hart

      That Howard acted seemingly without looking into the evidence is worrying, but that our probable future Prime Minister reacted as he did is of much greater concern.

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  8. Elizabeth Hart

    Independent Vaccine Investigator

    Rachael Dunlop is an administrator of the Stop the AVN Facebook page. Supporters of the Stop the AVN Facebook page are opposed to the Australian Vaccination Network. However it appears people affiliated with Stop the AVN work very hard to stifle questioning of vaccination from any quarter, they are in effect gatekeepers for the vaccine industry.
    It is truly frightening the way legitimate concerns about vaccination are stifled in our so-called democratic society. As a result, more and more vaccine…

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    1. Michael Wilbur-Ham (MWH)

      Writer (ex telecommunications engineer)

      In reply to Elizabeth Hart

      I suspect that there are good questions that can be asked about the link between government and big business.

      But with all the non-science being put up against vaccination such subtle questions get lost in the battle between science and non-science.

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    2. Ben Heard

      Director, ThinkClimate Consulting

      In reply to Michael Wilbur-Ham (MWH)

      I do agree. But in terms of junk, or unnecessary, or over-prescribed medicines, vaccines would have to be the last place any responsible investigative body would start. How about the known effectiveness of exercise and dietary modification for a range of serious illnesses where drug companies would rather see prescriptions? How about the largely BS sector of homeopathy, natural medicines and supplements?

      Vaccinnes? This is primary health care with a stunning record of effectiveness. Naturally oversight is required, but as is so often the case there is furore where little is warranted, while completely garbage and corrupt arrangements are waved through as business as usual.

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  9. Margaret Moorhouse

    conservationist and retired psychologist

    The time has passed when the general population was aware of the long term serious health impacts on unvaccinated children. Memories of polio may linger - childhood victims from the 1950s are still to be seen, with their leg irons and other obvious disabilities. But it is only in later life the hidden damage from childhood infections (such as serious lung damage from measles viral pneumonia) shows its hand, placing the victim at much greater risk of early death from simple infections such as colds and flu. This personal benefit of vaccination needs to be better publicised, along with the public health benefit.

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  10. Fred Pribac

    logged in via email @internode.on.net

    Great contribution and perspective, thank you!

    I would love for their to be a follow up on the complex issues of the nexus between individual rights, responsibility to the community and demonstrability of efficacy of community health measures.

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  11. John Perry

    Teacher

    I'd be interested to hear about the double blind experiments with large groups (including an unvaccinated control group) that shows the real effectiveness out in the field. Does Rachael have any links to those?

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    1. Sue Ieraci

      Public hospital clinician

      In reply to John Perry

      John Perry - do you consider it ethical to do a prospective blinded study where the subjects are exposed to infectious diseases, half unknowingly unprotected?

      In general our community doesn't, so there are other ways of testing vaccine efficacy and safety:
      - Epidemiological studies - disease rates in the vax vs unvax
      - Post-hoc surveys or testing after epidemics - calculating the percentage vaxed vs unvaxed
      - Measurement of antibody levels and correlation with effective immunity (from past data).

      We commonly do the latter to check for ongoing immunity, and whether a booster is needed.

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    2. John Perry

      Teacher

      In reply to Sue Ieraci

      "... do you consider it ethical to do a prospective blinded study where the subjects are exposed to infectious diseases, half unknowingly unprotected?"

      Playing the Devil's Advocate here - would that be considered any less ethical than using the vaccine on EVERYONE, without its having been tested in a scientific manner as I originally proposed?

      I appreciate the examples you have given, but without a double blind study does that make the vaccination program "scientific"?

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  12. John Perry

    Teacher

    I'm a little bit concerned about your #2, however. I have a very good book (very scientific, not an anti-vacc treatise in the slightest) that details the history of smallpox. Fascinating reading.

    It's been a while since I read it, but it turns out that before it was eradicated in some parts of the world it got to a point where THE VACCINE DID NOT WORK. In fact, it caused serious re-infection rates and they had to stop. They went back to quarantining, isolation and treatment and the disease consequently disappeared from those regions.

    This was in the latter part of the smallpox eradication program. Yes, the vaccine quite likely assisted in the early stages, but evidently there was a point beyond which it had no effect. Medical professionals these days are quite likely loath to use the smallpox vaccine unless they absolutely have to.

    Therefore, I would have to take you to task on some aspects of #2 - vaccination DID NOT eradicate smallpox.

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    1. John Perry

      Teacher

      In reply to Sue Ieraci

      I'll search for that book at home and post the title here when I find it.

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  13. Ngoc Luan Ho Trieu

    logged in via Facebook

    "..Small amounts of thiomersal were used as a preservative in some vaccines, but this never included MMR.

    Thiomersal or ethyl-mercury was removed from all scheduled childhood vaccines in 2000, ..."
    So thiomersal was in non-MMR vaccines before 2000 and children who were vaccinated for non-MMR diseases before 2000 could have their health damaged by the vaccination!

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Ngoc Luan Ho Trieu

      "Thiomersal" was removed due to community anxiety - not evidence.

      Compounds of mercury do no behave in the same way as mercury - just like iron compounds are not iron. There has never been evidence of harm from the thiomersal in vaccines - only of fear.

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    2. John Perry

      Teacher

      In reply to Sue Ieraci

      "Thiomersal was removed due to community anxiety - not evidence."

      If they were able to remove it and the vaccine were still effective, why was it there in the first place? What other added synthetic chemicals could be removed?

      By the way, I find Rachael's comment "everything is made of chemicals" a little disingenuous. Isn't that the same type of comment climate change denialists make about CO2?

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    3. Nathan P

      In reply to John Perry

      If you had read the link about how thiomersal ought "not [to] be confused with the scary type that accumulates in the body," you would know that thiomersal is a preservative that was put into vials of multiple-dose medicines and vaccines (i.e.: where the vial is used with multiple syringes, for multiple people)

      The point of the thiomersal was to prevent any microbial contamination from the syringes, so that an infection wasn't unwittingly introduced into the vaccine recipient.

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