On Immunity : An Inoculation (9781555973278) (21 page)

Page 105

the ways in which having access to one’s own cord blood might be advantageous later in life are still fairly limited:
Most children who receive cord blood transplants need blood from a donor, rather than their own cord blood, which may carry the very condition they are being treated for. This is one of the advantages of public cord blood banking noted by Ruben Rucoba, a pediatrician whose own infant daughter received a life-saving transplant from a public bank. In his 2010 article “Public Cord Banks Offer Many Advantages over Private Banks,” Rucoba observes that public banks participate in a national registry, so blood donated to these banks will very likely be used by someone who needs it. Blood stored in private banks is likely to go unused, as the chance that a child will need her own cord blood is somewhere around 1 in 200,000. And while public banks are required to meet stringent federal standards, private banks are not. The American Academy of Pediatrics issued a statement against private cord blood banking in 2007, expressing concerns that private banks were taking advantage of parents by selling them an un-proven, unnecessary service.

Page 106

A 2011 survey published in
Pediatrics
, “Alternative Vaccination Schedule Preferences among Parents of Young Children,” found that more than one in ten parents were using an alternative vaccination schedule. And of the parents who were following the schedule recommended by the CDC, over a quarter thought that delaying vaccination would be safer. These parents, the researchers concluded, were “at risk” for switching to an alternative schedule.

Page 106

there is no credible evidence, beyond Dr. Bob’s personal speculations, that spacing and delaying vaccinations minimizes the incidence of side effects:
After an investigation designed to address the concerns of parents, advocacy groups, and the media, among others, about the childhood immunization schedule, the Institute of Medicine released a 2013 report titled “The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies.” This report found no compelling rationale for following alternative schedules, and concluded, “The committee found no significant evidence to imply that the recommended immunization schedule is not safe. Furthermore, existing surveillance and response systems have identified known adverse events associated with vaccination. The federal research infrastructure is a strong system.”

Page 107

Tetanus is not a disease that affects infants, according to Dr. Bob:
The spores of tetanus bacteria live in the soil everywhere, and anyone, including infants, can contract tetanus from dirt introduced into a wound. In developing countries, many newborns contract tetanus through their unhealed umbilical cords. Deaths from tetanus in this country have declined over 99 percent since shortly after the vaccine became available in 1938, and neonatal tetanus has been nearly eliminated. This is owed in part to improved childbirth practices, and also to the maternal antibodies that temporarily protect babies born to women who have been vaccinated. Between 2001 and 2008, only one newborn contracted tetanus in the United States.

Page 107

Hib disease is rare:
Many people harbor the Hib bacteria in their noses and throats, but are immune to it. Before the introduction of the Hib vaccine in 1985, infection with
Haemophilus influenzae
type b was the most common cause of meningitis in this country. About 1 in every 200 children under five years old developed invasive Hib disease, and over 15,000 children suffered Hib meningitis every year.

Page 107

measles is not that bad:
In this country, one out of every twenty children who contract measles will develop pneumonia, the complication that most often leads to death. The case fatality rate for measles fluctuates depending on a number of factors including age—the disease is most fatal in children under five and adults. Between the years 1987 and 1992, about 3 in every 1,000 cases of measles in the United States resulted in death, but the case fatality rate for this country is usually estimated at about 1 in 1,000.

Page 111

Infants are exposed to an onslaught of bacteria the moment they leave the womb, even before they exit the birth canal:
There are between 2,000 and 6,000 immunological components—the proteins that evoke an immune response—in a single bacterium. The smallpox vaccine, in comparison, contains about 200 immunological components.

Page 111

a website that also compiles evidence that the Holocaust was a hoax and that anti-Semitism was invented by Zionists:
This website is whale.to, which enjoys a high ranking in Google searches for “vaccination.” It hosts, among many other curiosities, the full text of the
Protocols of the Elders of Zion
, a document pretending to be the minutes of a meeting among Jewish leaders planning to take over the world through control of the economy and the press.

Page 111

Handley, a venture capitalist, is the cofounder of a private equity firm with over $1 billion under management as well as the cofounder of Generation Rescue, an autism advocacy organization:
Shortly after its inception in 2005, Generation Rescue publicized the theory that vaccines cause autism through a media campaign that included full-page ads in the
New York Times
and
USA Today.
Jenny McCarthy served as their spokeswoman and is now their president.

Page 112

Some parents of autistic children consider this exploitation:
A number of these parents—including Kathleen Seidel, who founded the website
neurodiversity.com
, and Camille Clark, otherwise known as Autism Diva—are profiled by Paul Offit in
Autism’s False Prophets.

Page 117

What exactly constituted the real thing, when it came to medicine, was a question of considerable complexity in the early nineteenth century. Medicine at that time was practiced by bonesetters, midwives, herbalists, and a range of other lay healers in addition to “regular” doctors, who were themselves a motley crew. There was no central licensing body for doctors, no set standards for practice, and medical degrees could be openly purchased.

As doctors struggled to establish medicine as a legitimate profession and to regulate its practice, Nadja Durbach writes in
Bodily Matters
, they appealed to the state for exclusive authority over vaccination. An association of British doctors issued a report in 1840 complaining that vaccination was being provided by “itinerating quacks, petty tradesmen of an inferior order, blacksmiths, excisemen, druggists, &c; the poor, one with another.” Vaccination was being provided, in other words, by everyone who provided medical care.

The right to perform vaccination was eventually restricted to physicians and state-licensed vaccinators, and variolation was made illegal in Britain in 1841. While this allowed for better regulation of immunization, it also reinforced fears that the state was colluding with doctors to create a profit-driven monopoly over medicine. With this legislation, Durbach observes, resistance to the professionalization and standardization of medicine also became resistance to government authority.

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The clause was rather vague, requiring only that the objector “satisfy” a magistrate that her objection was a matter of conscience:
There was some debate at the time over whether women could or should apply for conscientious exemption, as men were the legal guardians of their children and it was not appropriate for women, according to one politician, to exercise their conscience outside the home. The law itself used the word
parent
and did not exclude women, but in some places women were turned away and told that only fathers could apply. In other places, almost all applicants were women. Eventually, an ambiguous amendment was interpreted to include women. “As a result of this interpretation of the new legislation,” Nadja Durbach writes, “the first widely acknowledged conscientious objectors were not only predominantly working class but also often female.”

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We have them to thank for the fact that we can no longer be vaccinated at gunpoint:
We also owe some of the safety of our current vaccine schedule to the parents who refused vaccination during a smallpox epidemic in 1901 (more on this in the note to page 131); to the parents who appealed to Congress for better tracking of vaccine side effects in 1984 (that group of parents would become the NVIC—see the note to page 75); and to parents like John Salamone, who successfully advocated for the oral polio vaccine to be replaced with a safer inactivated polio vaccine in 1998. Advocacy for vaccine safety is not the same as antivaccine activism that aims to undermine, rather than improve, our system of vaccination. But some groups, like the NVIC, engage in both.

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And allowing oneself to remain vulnerable to disease remains a legal privilege today:
The word
privilege
is from the Latin
privilegium
, meaning “law applying to one person.” A legal exemption from vaccination is, by definition, a privilege. Vaccination is required for admission to public schools as well as many day care facilities and pre-schools in the United Sates. Every state in the country offers medical exemptions to this requirement, all but two states offer religious exemptions, and nineteen states offer philosophical exemptions, our version of the conscientious objection.

Page 122

But the exact number of people this might be—the threshold at which herd immunity is lost and the risk of disease rises dramatically for both the vaccinated and the unvaccinated—varies depending on the disease and the vaccine and the population in question:
In “’Herd Immunity’: A Rough Guide,” Paul Fine argues that we must be “wary of target thresholds for vaccination, insofar as thresholds are based on assumptions that greatly simplify the complexity of actual populations. In most circumstances, the sensible public health practice is to aim for 100% coverage, with all the doses recommended, recognizing that 100% is never achievable, hoping to reach whatever is the ‘real’ herd immunity threshold in the population concerned.”

Page 130

As the Environmental Protection Agency observed at the time, Corexit was neither the safest nor the most effective dispersant on the market—it was simply the most readily available
to BP in the wake of the spill:
Before the spill, the EPA rated Corexit as less effective and more toxic than at least twelve other products. But after the spill, the EPA conducted a test that found that Corexit mixed with Louisiana crude was no more or less toxic to marine life than other dispersants mixed with oil. One of the EPA’s own employees questioned the merit of this test, as Suzanne Goldenberg noted in an article for the
Guardian
, “BP Oil Spill: Obama Administration’s Scientists Admit Alarm over Chemicals.” And Susan Shaw, the director of the Marine Environmental Research Institute, told the
Guardian
, “It was only one test and it was very crude.” By that point, the amount of Corexit that had been used in the Gulf already constituted, as the toxicologist Ron Kendall observed, an enormous unregulated “eco-toxicological experiment.” The results of that experiment are still to be concluded.

Page 131

“In the fall of 1901, regulation was a controversial idea,” the historian Michael Willrich writes. “A few months later, it was federal law.” What happened in between was a smallpox outbreak in Camden, New Jersey:
When smallpox broke out in Camden, the Board of Education announced that children who were not vaccinated could not attend school. Thousands of schoolchildren were vaccinated over the next month, but then a sixteen-year-old boy who had recently been vaccinated came down with a case of tetanus that locked his jaw and sent his body into convulsions. And then a sixteen-year-old girl who had recently been vaccinated came down with tetanus, and an eleven-year-old boy who had recently been vaccinated died less than a day after coming down with tetanus.

Nearly all the afflicted children, an investigation would find, had received vaccine from the same manufacturer. And this manufacturer would also be linked to an outbreak of tetanus at Philadelphia Hospital. In Europe, vaccines were controlled or even produced by governments, but here anyone could make and sell a vaccine. The smallpox vaccine was sourced from cows and produced on farms, where it was prone to contamination from the dust and manure of the stables, which often contained tetanus bacilli.

As deaths from tetanus began to exceed deaths from smallpox in Camden, parents launched a school strike and refused vaccination. When isolated cases of tetanus were reported in schoolchildren who had been vaccinated in Atlantic City and Philadelphia, the Camden panic became a national crisis. With resistance to vaccination rising, Theodore Roosevelt signed the Biologics Control Act, which established a system of licensing and inspection for vaccine manufacturers. This legislation, the
New York Times
observed, “would involve a dangerous expansion of Federal authority were it not aimed to correct an evil yet more dangerous.”

The danger, as many understood it, was not just that children might be harmed by bad vaccines, but that even more children might be harmed by smallpox when their parents justifiably refused vaccination. In Camden, a total of nine children died of tetanus after vaccination, and fifteen people—none of them recently vaccinated—died of smallpox. “By the time the epidemic wound down that spring,” Willrich writes, “smallpox had indeed proved more fatal there than vaccination.”

Page 132

Vaccines are subject to ongoing surveillance though a national database:
The Vaccine Adverse Event Reporting System (VAERS) collects reports of “adverse events” (including everything from fevers and rashes to seizures and anaphylaxis) following vaccination. This system is sometimes misunderstood as a database of vaccine side effects, but it is intended to function as a passive surveillance system in which clusters or patterns of similar reports will prompt further investigation by the CDC. Anyone can make a report to VAERS, including parents and personal injury lawyers, and the database inevitably gathers reports of events unrelated to vaccination—deaths from suicides and car accidents following vaccination have been reported to VAERS, as well as one man’s transformation into the Incredible Hulk following his vaccination against influenza.