In the vaccine debate, science is just getting its boots on

There is an old saying that a lie will be heard around the world while truth is still getting its boots on. This was brought home to me during a radio interview I did on Tuesday night in the wake of the Federal Government’s decision to remove the conscientious objection exemption for vaccination. I was astonished that in 2015, some of these pieces of misinformation are still out there, and still believed, if the passionate radio callers (and several posts in my Facebook feed) are any indication.

Here is a sample of some of the misinformation and misunderstandings I encountered on the radio show and on the internet in the past 24 hours (paraphrased slightly).

“Why should we inject our kids with polyethylene glycol/brake fluid?” We don’t. There is no ethylene glycol in our vaccines. We do have harmless traces of a completely different chemical, 2-phenoxyethanol, which is an antibacterial helping keep the vaccines sterile.

“Why are we injecting our kids with formaldehyde?” Formaldehyde is used to inactivate viruses in some vaccines. After clean-up, minute traces are left, but the amount you would get from a vaccine injection is much less that is circulating naturally in your blood. Yes, your body makes formaldehyde. If you are seriously worried about formaldehyde, don’t eat apples or pears, which contain much more formaldehyde than vaccines. For details see here and here.

“Why are we injecting our kids with mercury?” We aren’t, there has been no mercury in kids vaccines in Australia since 2000. Especially those in the vaccination schedule. Note that the amount of mercury in the Thiomersal preservative is less than what you would get from eating a can of tuna and no one seems to be advocating a fish free diet for kids.

“Why are we still giving kids small pox vaccine when small pox is extinct?” We are not. And I am astonished that anyone would think that we did, but this (paraphrased) was an actual question.

Measles vaccination conquers measles Epidemiol Rev (2002) 24 (2): 125-136. doi: 10.1093/epirev/mxf002

“But we don’t need vaccines, these diseases were going before vaccines”. Nope, see that graph? That’s the incidence of measles in the UK before and after the vaccine, note the strong correlation between the fall in measles and the vaccine coverage of the population. Similar graphs are seen for the US and Canada (see here for the most dishonest anti-vaccination graph ever).

Australia stopped collecting data on measles incidence so there is a big gap in our data, but the incidence of the disease was higher before the vaccine than after. Same goes for pertussis (we had just had an epidemic when the vaccine was introduced), diptheria and Heamophilus Influenza B (and if you want to claim it’s all hygiene and diet, the HIB vaccine was introduced in the ‘90’s where nutrition and hygiene was at modern standards). See the Australian Academy of Sciences “science of vaccination” for graphs and details.

“There have been no deaths from measles since 2000”, this is actually a false statement about US data. 2000 was the year that endemic measles was declared extinct in the US. In Australia, we haven’t has a measles death since 1995. Unsurprisingly, since vaccination has been so effective.

However, in the US the has been 8 deaths during the epidemics caused by unvaccinated people catching measles overseas and bringing it back to the US, where it spreads mostly amongst the unvaccinated. In the US, it is usually linked to the heinous meme “no measles deaths since 2000, hundreds of measles deaths from the measles vaccine”. This pernicious statement is untrue, there have been no deaths due to the measles vaccine.

“What about that study that showed vaccines cause autism”. No, just no. Andrew Wakefield’s study, since retracted for unethical conduct, was so sloppy that it was meaningless, and may even be fraudulent. This unethical study has caused thousand of people to forgo measles vaccines, with kids getting caught in epidemics that should never have happened.

UPDATE 22/04/15 see this article (Free) about a large study where they look at siblings of autistic children who were or were not given subsequent vaccinations. Vaccinated kids were slightly less likley to be autistic than unvaccinated kids.

In the debate about our response to under vaccination, it is assumed that people refusing vaccines are making rational choices, weighing up the pros and cons of vaccination versus side effects with the best available data.

The controversial Leunig cartoon that shows a mother fleeing a barrage of syringes inadvertently sums up what it is really about.

Fear.

As the talking points I’ve encountered show, people are coming up with objections that are either wildly distorted or flat out untrue but they all have one thing in common. They all directly stoke the fear that by vaccinating our children we will harm them. A rational choice is difficult to make in this environment.

That a lie can travel around the world before truth gets its boots on is never truer than in this debate. This recent article contains talking points not covered above that are either not true or wildly distorted (Fluarix does not contain foetal bovine serum, the virus for the vaccine is grown in eggs; vaccinations are not intravenous and so on). But I’ve already spent three days and over 1,000 words to cover the standard false or misleading claims and I have to stop at some point.

All the items I talked about have been dealt with long ago. But if you do an internet search for “Australian vaccine information” three of the top five hits are vaccine denialist sites. In this age of Dr. Google sites that play on fears will trump the more sober (and boring) official sites.

My approach to vaccine refusers (the people whose decisions have been influenced by misinformation and fear, as opposed to hard core vaccine denialists) is to provide them with better and more accessible information.

This may not work as well as it might be naively imagined, a study on the best way to provide accurate vaccine information to parents who had previously failed to vaccinate their children found that although the parents understanding of vaccine safety improved, they were no more likely to have their children vaccinated. Some parents became even less likely to vaccinate their children.

Even in the light of this somewhat depressing knowledge, we should not stop trying to get truth out there. One of the difficulties in communicating vaccine facts is that these may leave a gap in peoples beliefs (accounting for their reluctance to accept the facts). An approach I’ve mentioned before is replacing the gap with an alternative narrative. Whichever approach we use, we need to keep the facts front and centre.

Remember, this is not just abstract knowledge, or “cute science facts”, but information that will keep real kids out of hospital and in some case save lives.

Truth (and science) may take time to get its boots on, but those boots were made for walking, and the journey has just begun.

Methyl Bromide and Strawberries .. Shock .. Horror .. Oh, Wait a Minute.

There was an article on the ABC site this morning which gave us this alarming headline “Pesticide banned worldwide still used to grow 70pc of Australian strawberries”. Shocking!

Except, well, there were a few teeny tiny but important details missing. Like the fact that the rest of the world is still using the “banned” pesticide too.

Methyl Bromide (the substance involved) has been withdrawn worldwide under the Montreal protocol as it is a potent greenhouse gas (not because of toxicity, as many people have assumed from the headlines). However, world wide, there are exemptions for the use of methyl bromide as a fumigant for quarantine and production purposes (QPS) and some special (critical use) exemptions, it’s not just us. In 2005 Australia, stopped the use of methyl bromide for all but the exempt QPS uses, and for a few uses for which there was no suitable alternative to methyl bromide.

Just like the rest of the world.

In 2012 around 12,000 metric tonnes of methyl bromide were used around the world for various QPS and critical exemption purposes, Australia’s agricultural use was 32 tonnes at this time (Japan’s was 216 metric tonnes and the US 923 metric tonnes for comparison). Critical use exemptions, the ones that allow the strawberry farmers to fumigate their soil, must be applied for each year.

Like everyone else in the world, Australia developed plans to phase out the remaining methyl bromide use. Since 2005, when methyl bromide use in general was phased out, Australia has been replacing methyl bromide in the critical use exemption and (to a more limited extent) QPS categories with alternatives, dropping from 112 metric tonnes in 2005 to 32 metric tonnes in 2015.

Methyl bromide is an important pesticide fumigant, and is used to kill pathogens and pests in imported produce and some produce for export. Finding alternatives is not straight forward, for example, phosphine, one of the alternative fumigants, is highly flammable, so new handing procedures are needed to combat the risk of fire.

While reducing the amount of methyl bromide entering the atmosphere is important, the significant risk to the Australian biota and agricultural production from invasive pests and pathogens has to be weighted against the fact that human produced brominated compounds represent less than 0.03% of the total halogens released into the atmosphere, and that unlike CFC’s, which last in the atmosphere for decades, methyl bromide’s half life in the atmosphere is less than a year.

Given the relatively small impact of methyl bromide, and the continuing reduction of methyl bromide (see here for a comparison of the progress and the contribution of the US vs the rest of the world), Shock! Horror! headlines about Australia’s use for strawberries are unwarranted.

In the strawberry growing industry, methyl bromide is used to destroy pathogens and pests in the soil the strawberry runners are planted in. In Queensland and Tasmania, methyl bromide has been replaced. However, for the soils in the Victorian strawberry growing areas, the alternative fumigants aren’t as effective.

Other fumigants are being researched, but it takes time to find something that is reasonably safe, reasonably cheap and effective. One of the potential replacements, methyl iodide, has been withdrawn from the market, so the hunt is still on for a viable replacement. It may be that we have to grow our strawberries under soil-less conditions to stop disease and pest losses.

So, like all other countries, Australia has phased out methyl bromide, except for quarantine and other critical uses for which there is no effective alternative (again, just like other countries). Since 2005 we have systematically reduced the amount of methyl bromide for these uses, and are undertaking research to reduce the amount even further.

Oh, and in case you are worried that methyl bromide contaminates the strawberries, methyl bromide breaks down in the soil, and the strawberries that grow much later do not come into contact with it. There is no toxicity issue here at all.

So, the NHMRC has found homeopathy doesn’t work. Now how do we get the message across?

The NHMRC has released its final statement on homeopathy. To no ones great surprise, the report concluded that there was no evidence that homeopathy was effective in treating any of 63 separate medical conditions.

I have already dealt with aspects of the interim report, and articles in The Conversation have already dealt with the report in general (see here and here), so I would like to look at it from a different angle; how do we effectively communicate the science behind the report?

Sure, the report is on the web, and has been mentioned in a variety of media and radio programs, but is this going to be effective? The need to effectively communicate these findings is highlighted by two separate occurrences, the recent debate over vaccination in the light of measles outbreaks overseas, and the recent CSIRO report that up to 40% of Australians are “disengaged” or actively distrust science.

After all, the target audience for this information is not the people who have been following the evidence, and are well aware that homeopathy is ineffective. To some degree the people who want to treat mild or self limiting conditions, for example insomnia, and who think that homeopathy is some form of herbal medicine are also not the target audience.

What we are worried about most is those people with serious conditions who abandon standard therapy for ineffective homeopathy (for example, trying to treat diabetes with homeopathic dilutions of uranium salts). We accept that adults should be able to choose (or reject) their therapies. But we also expect that people choose or reject therapies based on the best available evidence. What happens when people reject that evidence?

A recent paper looked at various ways to communicate with parents to increase vaccination rates. They found that parents accepted that the MMR vaccine did not cause significant side effects after the various communication strategies, but were not inclined to get their children vaccinated. One subset of parents, those who had the least favourable views on vaccination at the beginning of the study, were now LESS likely to vaccinate their children.

This is consistent with other studies (see also here) showing that when people with deeply entrenched beliefs are confronted with facts that disprove those beliefs, paradoxically they become firmer in their beliefs.

So how do we effectively communicate the science in the report? The NHMRC site has meticulous information on what they did, summaries and a FAQ, but we have to get people to read them. Most news articles and radio shows do not provide the information to find the report.

From a science communication point of view, most of the information on the NHMRC site is too technical for the general public. As an example of a good way to convey science around a contentious issue, the Australian Academy of Sciences has a great web accessible document that simply and clearly explains the science behind vaccines.

However, if you google “Vaccine Information Australia” you will see 4 of the top 10 results are vaccine denialist sites (and 3 of the top 5), and the AAS report is nowhere to be found.

As well as finding information in a format accessible to the general public, we need to consider that those most at risk of ignoring conventional medicine for homeopathy are also very likely to be in that 20% that the CSIRO found to be disengaged from or distrustful of science. As well, peoples perception of health and their health philosophy can make this a very emotionally charged issue.

We need to carefully consider how to approach this audience. In the light of the pediatrics paper, referenced above, where factual information led people to be less likely to vaccinate, merely giving people the facts is unlikely to be enough.

However, there are a variety of approaches that can be tried. Most of these have been developed in relation to politics or global warming, but the processes that are involved are similar.

In view of how homeopathy may be deeply linked with peoples world views, and showing homeopathy is no more than placebo may leave a gap in peoples beliefs (accounting for their reluctance to accept the facts), an approach such as replacing the gap with an alternative narrative may be the best approach.

Whatever the approach we use, the publication of the NHMRC report on homeopathy is the beginning of a long process of engagement, not the end of the matter.