The recent outbreak of measles in New York has intensified the debate between the supporters and opponents of the vaccination program. The people who are against vaccination here are skeptics, at least in the philosophical sense, and scientists and doctors, on the other hand, don’t understand why we are having this debate in the 21st century. To the former group, the danger outweighs the benefit and to the latter, the benefit vastly outweighs the danger. We, thus, have sort of an impasse now to the point where no further discussion seems possible. One could make come up with several explanations behind why this impasse exists, but looking over the arguments from both sides, I can’t help but feel there are some deep-rooted mistrusts as well as misunderstanding between the two groups. While I can’t do much about the former, I hope, in this essay, I can alleviate some of the misunderstandings.
Let me begin with some of the common arguments I’ve seen from the people who stand family against vaccination. One such argument goes like this: my friends or family members got sick after vaccination, so vaccination isn’t really safe. I will start with an anecdote to illustrate one of the problems with that argument. One of my friends used to visit me from Chicago when I lived on Long Island. He would visit me once in a few years and I would take him to one of my favorite restaurants, a new one each time. A few years later, he told me that his parents—who used to live in Long Island several decades ago—didn’t believe him when he praised Long Island food. I had to tell him that I took him only to the restaurants that I liked, and beyond those few, there weren’t that many great restaurants. Had I taken my friend to random places, he would most likely have been more reserved in his praise. Similarly, when someone mentions family members or friends, one is relying on a small, selected sample size to draw a conclusion which may or may not be correct.
 |
| A Heated Debate: Louis Charles Moeller |
Suppose our family members or friends who got sick after vaccination went to the same hospital and went to eat at the same nearby restaurant afterward. It’s very possible that it’s the food served by that restaurant—not the vaccination—that made them sick. And that’s just one possibility; one could come up with other possibilities as well. The only way we can rule out these external factors/possibilities is by carrying out a well-designed, controlled study or experiment. Scientists are a skeptical bunch, and they are even more skeptical when it comes to evidence that relies on personal testimonies or anecdotes.
I pointed out those flaws not to suggest that vaccination does not cause sickness. After all, like most medications we take, there have to be some side-effects to vaccination and indeed there are some well-documented side-effects. But when we reach a conclusion based on anecdotal evidence, we lose our sense of proportion as well. Most people who are vaccinated never get sick from it, but when several people around us get sick after vaccination, we may think that vaccination makes most people sick. If 10000 people get sick after vaccination, the number may seem large, but if the number represents how many got sick worldwide after vaccination, then the odds of someone getting sick from vaccination is quite low.
Like most things in life, we can’t get rid of probabilities when it comes to medicine. There will always be a drawback to any medical procedure or treatment, and we need to decide whether or not the cost outweighs the benefit. I understand it’s not always possible to look at life as a set of probabilities, but at the very least, we can try to be rational about it. Flying is statistically many magnitudes safer than driving, yet, I can’t help but feel apprehensive when I have to board a plane. I don’t think I can overcome it completely, but I have learned not to let that interfere with life. If flying is the fasted and cheapest way to go somewhere, I will always choose flying.
But why does vaccination make some people sick or why is it not 100% effective? To answer that, we need to understand how the vaccination works. Whenever a foreign substance like a virus or bacteria enters our body, it tries to get rid of that substance to keep us safe. It generates a blood protein called antibodies that are specific to that foreign substance to tag that substance and once tagged, the body’s immune system can destroy it. Scientists noticed that these antibodies remain in our body so that when it encounters the same virus or bacteria, our body can eliminate those quickly before we get sick. That’s the idea behind vaccination. Like facial recognition technology, our body can detect when we encounter the same virus or bacteria that we have been vaccinated against, and this allows it to get rid of the virus quickly. If our body can’t recognize the virus, it has to come up with ways to tag it before it can eliminate the virus. That, of course, takes time. Our body may fail to eliminate the virus before we get sick with the disease.
The goal when it comes to making a vaccine, thus, is to introduce a form of disease-causing virus or bacteria to create the relevant antibodies, akin to updating database of facial recognition software. There are many ways to achieve that, for example, injecting the dead or severely weakened virus to prompt our body to create necessary antibody. The system, however, is not perfect. It’s rather common, for example, to have temporary redness or swelling around the injection site. Some people—though a small number compared to the total number of people who get vaccinated—may get mildly sick after vaccination while the body is tagging and eliminating the virus. In rare cases, a person can develop allergy shortly after vaccination, and even in rarer cases, the allergy can lead to breathing difficulties (anaphylactic reaction) within minutes after vaccination. The odds of that happening are less than one in a million! Moreover, medical professionals administering the vaccine should know what to do if a person does develop severe allergic reactions.[1]
How about the effectiveness of a vaccine? Effectiveness of vaccines varies from disease to disease. Some are more effective than others: measles vaccine is about 98% effective, whereas flu-vaccines, no so much (I will come back to it shortly). One of the reasons why vaccines are not 100% effective is because sometimes people don’t develop necessary antibodies after vaccination (similar to a glitch in database update in our facial recognition analogy). These people, thus, would get sick even after vaccination. Sometimes even having the antibodies isn’t enough. Vaccinated children, for example, could get sick from the disease if they encounter a high dose of the virus or the bacteria. If they are around people who carry the virus or bacteria, they might get sick even though they had been vaccinated. They may fail to ramp up antibody production fast enough to fend off the disease. Thus, the argument that vaccinated people should have nothing to worry about is not very convincing.
I want to go over one other argument here before I get into the emotional part of the debate. I have seen people listing some chemicals—chemicals that seem dangerous—found in vaccines to prove that vaccination isn’t safe. The chemicals that are commonly found in vaccines either ensure vaccines’ maximum effectiveness or residuals that come from vaccine production. All these chemicals come at such a low concentration that they aren’t harmful to us. It’s all about concentration/dose: drinking a few glasses of wine or beer at a bar is perfectly fine for most people, but excessive drinking can send a person to the hospital or worse, to the morgue.
As I mentioned in the beginning, I sensed people who argue against vaccination are very skeptical when it comes to scientists. Since I consider myself to be a skeptic, I can never advise people to blindly trust experts, even if the experts are scientists. A healthy dose of skepticism is a desirable trait in philosophy, politics, and science. Indeed, I don’t think science can progress without skepticism. However, skepticism without rationality is neither philosophy nor science: it simply becomes faith. Here, I want to go over one paper that is often cited by people to show that vaccines come with severe side-effects. I believe an honest criticism of this paper would clear up a lot of misunderstandings people have toward science and scientists.
In that paper, titled Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children, British gastroenterologist Andrew Wakefield and his colleagues described 8 children who showed first symptoms of autism within one month after receiving the measles-mumps-rubella (MMR) vaccine. Since the publication of the paper in 1998, the idea that vaccination can lead to autism made many people world-wide wary of vaccines. After all, if a peer-reviewed science paper uncovers something, it should be the absolute truth, shouldn’t it?
Not really. To understand why that’s the case, it might be helpful to think of any field of science as a giant jigsaw puzzle. Scientists publish thousands of articles every month to add pieces to the puzzle, but sometimes they get it wrong. Sometimes it’s unintentional, sometimes it’s deliberate. While most scientists do stick to a set of rigor and ethics so that the piece they add is the accurate one, we can’t assume all the scientists are like that. Like good and bad people, there are good and bad scientists. Being skeptical of incredible claims is helpful in these situations. As I mentioned earlier, scientists are a skeptical bunch so they would do their best to find problems with those claims and often, would repeat the same experiments to see if they get the same result. If they get a different answer and find flaws in the methodology, the piece is removed. The peer review system is designed to ensure mismatched pieces don’t get added, but it’s not a perfect system. While individual scientists may not all be perfect, but science as a whole aim for perfection. Badly placed pieces are constantly removed by scientist as our understanding of the puzzle increases.
That said, let’s try to see if we can detect flaws with the paper. The way the authors arrived at their conclusion is really not better than the way my friend concluded that food on Long Island is better than other places. The authors didn’t select the subjects randomly or didn’t have a control group—the number of autistic children in unvaccinated children, for example—to support the claim (for a detailed discussion of the various problems with the paper, read this). Subsequent studies failed to validate the claim, and the Lancet magazine eventually retracted the paper in 2010. Dr. Wakefield and his colleagues were held guilty of scientific misconduct and scientific misrepresentation. The mismatched or bad piece, thus, was removed.[2]
I have also noticed that the retraction of the paper and the subsequent investigation of the authors involved with the paper often are viewed as part of a grand conspiracy. According to this view, Dr. Westfield is a hero, a truth-teller, who is being suppressed by various politicians, big pharmaceutical companies as well as scientists and doctors. A somewhat crude explanation of why that’s the case goes like this: big pharmaceutical companies benefit when they sell vaccines, and the politicians and scientist get money from these companies if they promote vaccination programs. I don’t want to get into this too much, but I want to point out a couple of problems with this view.
None of the groups involved in this conspiracy live in a bubble. Like everyone else, they and their loved ones are susceptible to catching deadly, infectious diseases. If they all overlook science and keep on creating inane, ineffective vaccines, when something like Black Plague comes, they are in danger of dying from it as much as everyone else. I’d think their survival instinct would—if not anything else—would ensure their integrity when it comes to vaccine development. Furthermore, the first successful vaccine was developed by Edward Jenner in 1796 (against smallpox). So our knowledge in vaccination spans over two centuries. Dismissing this knowledge altogether would mean dismissing one of medicine’s greatest achievements in disease prevention. Surely we can’t say everyone involved with vaccine development or relevant laws during this long period cared for nothing but money or that they purposely withheld crucial information on severe side-effects because of money.
Here, I want to digress slightly to consider a different, but somewhat similar situation. I have often found it useful to change context when I have problems analyzing an argument because of my emotional attachments, so here, I want to do the same. Let’s talk about Long QT Syndrome, a potentially fatal heart disorder. Patients suffering from this disease can suddenly develop aberrant heartbeats, which could lead to cardiac arrests. Approximately 1 in 7000 people are affected by it in the US and about 3500 people die per year because of this disease. According to these statistics, over 40000 people in the US have this disorder. Let’s assume about half of them have a driver’s license, so we have potentially 20000 people who can develop cardiac arrests while they are driving. When that happens, their loss of consciousness can easily lead to death tolls several folds more. In the UK, patients need to disclose that information to get a Driver’s License and in some situations, they simply can’t drive. As far as I know, no such law exists in the US, but if the death tolls on the road rise to say 50000, would you want a similar law? What if the death toll is 500000? And if there is a medication that prevents cardiac arrest in half of the patients—and thus could potentially reduce the death tolls by half—would you make taking the medication mandatory for every patient if they want to drive? Coming back to vaccines now, what is the death toll you are willing to accept before you are willing to make vaccination for dangerous, infectious diseases mandatory? What would you do if you a politician or a leader of your community and your decision can have consequences on millions of lives? Would you oppose such laws even if the death toll reaches several million from a preventable infectious disease because you believe it violates your freedom?
I pose these questions not because it’s important to know answers to them; rather, I think one should carefully think over these questions before taking a stand against vaccination. As I have mentioned before, one has to always make a cost-benefit analysis when it comes to any medical procedure and treatment. For example, my wife—a scientist—got sick a few times after vaccination. She did a cost-benefit analysis for yearly flu vaccines and concluded that taking flu vaccines don’t offer her any tangible benefit. According to the Center for Disease Control, between 2005 and 2015, the effectiveness of flu vaccines ranged from 10-60%, so on average, she would catch flu over half the time despite being vaccinated. Since there is a possibility that she might get sick after vaccination, getting vaccinated against flu doesn’t make much sense to her. However, if she had a pulmonary disease were catching flu could endanger her life, I am sure she would take flu vaccines every year. Furthermore, despite getting sick, she still got vaccinated against common deadly diseases.
As I write this, there is no law that makes vaccination compulsory. This might change in the future, however, I hope before that day arrives, we all can reach some sort of agreement, some sort of consensus and understanding on vaccines. If you are against vaccination, I hope you have come to that conclusion after carefully evaluating different arguments because your decision could have deadly consequences on your or your loved ones’ lives. And if you strongly believe in vaccination, I hope you can defend your position with patience and humility. That might not overcome the impasse I mentioned in the beginning, but at the very least, it would make the world a little bit nicer.
[1] I intend to write another essay to explain how a vaccine’s effectiveness and side-effects are determined.
[2] It’s a good practice to be skeptical when we see headlines like “scientists find a cure for cancer” based on a single paper. Personally, if I am interested in the topic, I read the paper carefully to see if I can detect any obvious flaw, and if everything checks out, I conditionally accept the findings—I wait for other scientists to replicate and confirm before accepting the claims. Even then, I remain skeptical because science is rarely definitive and better theories are constantly emerging to replace the old ones.