Image by USACE European District
Maybe that title is mean. But I’m angry.
(For the record — “pro- vaccine” means “pushes vaccines on everyone and thinks people shouldn’t have a choice” not “thinks vaccines are the right choice for their family and believes ‘to each his own.'”)
I truly have nothing but contempt for this movement, who think they can limit others’ freedom because of their personal belief in vaccines. This latest bit of news shows pretty clearly how they can’t think critically, and therefore shouldn’t be allowed to make decisions for anyone else (not that they should anyway).
The pro- vaccine logic goes a little bit like this:
Vaccinate everyone as much as possible! … Some people opt out … People are getting sick because we don’t vaccinate enough! … Vaccine rates go up, more people get sick … Blame the unvaccinated! They’re not listening to us!!
There are some disease outbreaks now (mostly whooping cough). But there’s also evidence of mutating strains and vaccine failure. They refuse to consider this evidence, pretend it doesn’t exist, and scream louder at the unvaccinated crowd. That’s just brilliant. And then this happened….
The Council of Foreign Relations has been tracking outbreaks of vaccine-preventable disease since 2008. They’ve created an interactive map, showing which diseases are having outbreaks and where. Each disease has its own color, and appears in the area where it occurred. The size of the circle relates to how many cases there were (and if you hover over the circle, it will tell you exactly how many cases).
This is actually really neat, and there’s a lot we could learn from it. Assuming, that is, we engage our brains and use critical thinking skills.
In the U.S., the single most common disease was whooping cough. Why?
Overall, the kindergarteners entering in the fall of 2013 had over 95% DTaP completion rate (varying from 83 – 99.9% depending on state). We’re at the level that supposedly provides “herd immunity” but a lot of people are getting pertussis anyway. And if you look at the map, some states with very high vaccination coverage had major outbreaks.
Plus if you look at the CDC’s historical data, in 1997 the coverage rate for four doses of DTP was just 81%! That means in the last 25(ish) years, coverage has significantly increased yet so have the cases of pertussis. (There were 6,564 cases of pertussis in 1997, or about 2.7 per 100,000 people. In 2012, there were 47,277 cases, or 15.4 per 100,000 people.)
This would suggest that it’s not childhood vaccination rates that are causing the pertussis outbreak. To anyone with any critical thinking skills, something else is going on. But oh no — they have to blame those “anti-vaccine parents” anyway. It’s easier to lead the witch hunt if you can scare people with misrepresented data….
But more importantly, what is going on? There are a few possibilities:
- Adult Tdap rates are low and they are spreading pertussis, possibly unknowingly (it’s often minor in adults)
- The vaccine is failing, and people who are vaccinated are getting pertussis anyway
- Pertussis is mutating, and the strain circulating isn’t covered by the vaccine
Let’s explore those a little more.
Adult Tdap Rates Are Low
About a year ago, the Annals of Internal Medicine announced an adult vaccination schedule for the first time. This includes 1 dose of Tdap, or a dose for women with each pregnancy. Since the schedule is brand new, vaccination rates are likely to be lower. The CDC also doesn’t have a very accurate count on who has received a Tdap vs. Td (just tetanus). It’s estimated that around 60% of adults have received some form of tetanus-containing vaccine, which may or may not have contained the pertussis element.
Despite the uncertain numbers, it’s likely that adult coverage is fairly low (although getting higher, since the new recommendations have come out). We know that the vaccine lasts for around 5 (or up to 12) years, so adult rates being low could be a factor in pertussis spreading.
(However, “protection” is estimated based on antibody levels, but antibody levels don’t correlate well with protection against pertussis.)
The Vaccine is Failing
We’re told that pertussis rates “must” be high because so many people aren’t vaccinating. But what does the actual data say?
According to the CDC, the vast majority of people who are getting pertussis were fully vaccinated. According to this data, 59% had 3 or more doses of DTaP. Just 9% were completely unvaccinated. In fact, a full 73% had had at least one dose of DTaP!
Which leads me to the last point….
Pertussis Strains Circulating Aren’t Covered by the Vaccine
There are two main forms of pertussis: pertussis, and parapertussis. It is theorized that parapertussis is responsible for many of the cases that we’re seeing now. In fact, this study from Penn State shows that getting a DTaP vaccine actually increases the colonization of parapertussis, making infection more likely!
This study shows that when vaccine coverage increases, so do rates of parapertussis.
How Do We Protect Infants?
Ultimately, any or all of these things could be a factor in why pertussis cases are increasing. What’s not a factor is “parents who don’t vaccinate.” That’s far too simplistic, and basically disproven by point #2 above, as well as the overall increase in vaccination coverage over the last 15 – 20 years.
But the real question we should be asking isn’t “whose fault is this,” but “how do we protect young infants?”
That’s something that we should be asking, because young babies are at risk. This is despite high vaccination coverage. We could look at all the data available to us and decide what the best option is. Some will say vaccines (the “cocooning” that is being suggested — all adults in contact with newborns should receive Tdap) and others will say something else.
I would suggest breastfeeding, babywearing, keeping new babies out of public places where possible, especially in the first month or two. I would suggest adults acquire natural immunity to pertussis if at all possible, because they will pass this to their newborns!
Regardless — there’s a lot to learn here. There’s a lot to be discussed. It’s a good conversation to have.
And yet, people are too busy focusing on the overly simplistic (and incorrect) conclusion of, “It’s those unvaccinated peoples’ fault. We need to blame them and shame them some more, and try to scare them into vaccinating.”
I have had enough of that.
Stop trying to scare or shame people. Start asking the tough questions and having a little scientific curiosity. Start having honest discussions and respecting peoples’ input. Because these latest scare tactics lead me to believe that the people using them simply aren’t capable of this level of critical thinking. They aren’t capable of looking at actual data, or history, and drawing interesting and complex conclusions. No, they’ve made up their minds that everything is “those darn non-vaccinating parents’ fault” and they’re not open to evidence that might suggest something different.
Parents on the fence, ask more questions. Demand more answers. Don’t believe everything you read. (Including here — all my sources are linked, so feel free to read them for yourself.) Maybe then we can have a respectful discussion on an important topic, without the fear.