Opening up vaccine policy and research

I haven't posted on the vaccine/autism question for several reasons. It is quite well covered by other science bloggers, it tends to generate more heat than light, and we didn't have anything new to say. I have on several occasions discussed it with two of the world's top experts on the health effects of mercury and one of the world's top autism experts. None of the three felt there was a vaccine-mercury connection to autism. But news that the US government was going to include vaccine critics in shaping national vaccine policy made me change my mind about posting. I won't be addressing the mercury preservative vaccine issue directly, but that controversy is the context for the new policy:

The government began an unprecedented effort Friday to give vaccine critics a say in shaping how the nation researches safety questions surrounding immunizations.

The meeting, the first of more to be set, came amid new controversy about vaccines and autism - and a fledgling theory that vaccinations might worsen a rare condition called mitochondrial dysfunction that in turn triggers certain forms of autism.

Federal health officials said the work, being planned for two years, wasn't in response to that controversy, and encompasses many more questions than autism - from rare side effects of the new shingles vaccine to how to predict who's at risk for encephalopathy sometimes triggered by other inoculations.

A government-appointed working group is charged with picking the most important safety questions for the Centers for Disease Control and Prevention to research over the next five years. What's unique is that the group also is supposed to get significant public input in setting those priorities, an effort to ease skepticism that authorities hide or discount important information about vaccines. (AP via Wired)

I'm sure there will be those in the science community who see this as a cave-in to an irrational anti-vaccine mafia composed of quacks, zealots and trial lawyers. Without passing judgement on that, I agree with Bruce Gellin, head of the National Vaccine Program Office, when he said that a crisis of trust in childhood vaccination is also a crisis of trust for public health itself. And zealotry is not only confined to the anti-vaccination crowd. Many public health officials refuse to entertain reasonable questions about vaccination:

A bigger question for some of the government's advisers Friday was what the CDC's proposed research agenda didn't include - the question of how many vaccines should be given in one visit, and if they're all really needed by age 2.

"We all have to have our kids vaccinated by the time they go into daycare or kindergarten, but ... does it all have to happen in the first two years?" asked panelist Dr. Christopher Carlson of the Fred Hutchinson Cancer Research Center, himself the father of a 9-year-old with a mild type of autism called Asperger's. "I'm not saying there's proof one way or the other. But the lack of options is a concern I think we should think about."

I'm not sure how such an examination would come out. The recent outbreak of mumps suggests we should be giving more vaccine for that disease, not less. I do know that it is past time to get other voices involved in a cooperative rather than an adversary fashion. I'm pretty clear in my own mind on the benefits of vaccination from the public health point of view but I am open to other perspectives. Maybe I'd learn something and maybe they would too.

I support the idea of getting "the public" involved providing it is done honestly and openly, not with a view to co-opting troublesome perspectives. That serves nobody's interests.

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In addition to testing children for mitochondrial disorder before vaccination, the knowledge of the paternal age effect in autism and schizophrenia must be disseminated to the public. How many 55 year old men with autistic children have said they never heard the issue of the man's age as being important. Since 1955 it has been seen in research that there is more schizophrenia in the offspring of older fathers. Now early childhood schizophrenia is called autism.

Autism is defined as a pervasive development disorder of children, characterized by impaired communication and emotional detachment.
That definition applies perfectly to the idiot captain of a US warship stationed off the coast of Somalia; that ordered the firing of a missile to kill a terrorist in a town in Somalia. If ever there existed a son of a bitch with impaired communication, that bastard captain is it.
The missile did not kill the terrorist. Instead it killed innocent civilians. Talk about emotional detachment. That asshole captain did not give a shit that he failed to kill the terroist, and that he shed innocent blood.
Perhaps an injection of cyanide into the captains arm would help the cure the bastard of his emotional detachment.
A piece of shrapnel from that missile hit the face of a 15 year old girl, just below the ear, at 3AM, causing severe damage to her teeth and mouth.
If there is a hell for autistic captains of US warships, this piece of shit should go there to putrify now.

I can understand where you're coming from, but here's the problem. Antivaccinationists are doing their very best to coopt this process and make it sound as though it's an admission of guilt on the part of the CDC. And the antivaccinationists are far louder and more emotional than those who support vaccine safety, and they have no compunction about twisting facts and science. They've skillfully manipulated the Hannah Poling case to sell an unusual case as validation of their belief unfounded in science that vaccines are responsible for the "autism epidemic" when in reality it's just another attempt to rebrand autism>/a>.

The other thing that has to be kept in mind is that it's not about the mercury. It's about the vaccines. Now that the epidemiology and science is conclusively refuting the mercury/thimerosal hypothesis of autism (as the epidemiologists to whom you spoke would no doubt tell you), with another big study due out late this spring that rumors tell me is also negative, antivaccinationists are switching tactics. They're switching over to aluminum or "toxins" in vaccines. They're also claiming it's "interactions" between these ingredients, knowing that it's totally impractical to test all of the many thousands of combinations of vaccine ingredients. The whole "Green our vaccines" program is straight out of Generation Rescue, and the claim that they are "pro-safe vaccine not antivaccine" is a carefully crafted propaganda talking point to counter the (correct) perception that they are antivaccine.

Honestly, it's hard to know if this is a good idea or not. Perhaps the government thinks it can coopt antivaccinationists to some extent by giving them a stake in the decision-making. If that's the case, good luck, because these groups, unfortunately, are pretty close to fanatical in their belief that vaccines cause autism. At the very least, they are so emotionally invested in the concept that I don't see how they would ever be persuaded that vaccines are safe. In a free society, even the cranks get a voice. The problem will come when they don't get what they want. Actually, I don't think they know what they want other than no vaccines

is this about birdflu vaccine ?

Hmm. Your reactions sound a bit like my reaction as a Mechanical Engineer to global warming alarmists. Being called a "denier" by non professionals was a shock.

In just a little while we may well have "vaccination harm deniers".

It seems like there's a broader issue of trusting the government specifically, and various high-profile "trustworthy" entities like universities and large media companies in general. And the problem is, a lot of what comes out of all three is lies, a lot of the time. Politicians and top-level political appointees and CEOs routinely lie when it looks like it will achieve their goals. Newspapers and other big media routinely don't bother to get even obvious facts straight. Much of the research in the humanities from top tier universities looks like pretty obvious politically-motivated BS.

And then, we get factual statements that really are true, like that it's a good idea to get your kids vaccinated for common childhood diseases, or that there's no way at all to make a literal reading of Genesis track even remotely to what really happened in Earth's history. But it's not too obvious how to decide which case you're in--is this one of those times where the authority figures are lying to you for their own purposes or not bothering to get the facts straight? Or is this a case where they're telling you the truth? Is this the federal authorities reassuring you (correctly) that nuclear power is quite safe, or reassuring you (incorrectly) that corn-based ethanol is going to help stop rising global CO2 production?

There are always going to be rumors and whispering campaigns and such, and I expect the internet concentrates them. But we have a culture in which prominent, powerful people in government and industry who get caught lying or deceiving the public don't pay any price for it. We largely put up with people in positions of trust being untrustworthy. And it seems like that has a big cost, which we're seeing in the vaccination issue.

By albatross (not verified) on 16 Apr 2008 #permalink

bar, nobody is claiming vaccines are 100% safe. Everything carries some degree of risk. As a mechanical engineer, you might want to recalculate your connection between global warming and vaccines.