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Antibody positivity! The unfounded controversy on vaccines


THE COMPENDIUM

  • 167 years ago, dr. Edward Jenner invented the vaccine; this incredible scientific achievement was greatly perfected over time, becoming safe, reliable and an integral part of modern life.

  • Anti-vaccination movements have existed as long as vaccines have been made mandatory; although no more unsafe than any other medical practice, they’ve been accused of deadly side effects, infringement of personal freedoms and of being deployed for nefarious agendas.

  • Side effects in vaccines are greatly exaggerated; the reliable benefits of a vaccination overshadow these severe, but rare accidents, as reported by a great number of research articles and media publications.

  • Mandatory vaccinations are seen as just another avenue for the government to control people; in reality, they’re the quickest, most effective way of guaranteeing a child’s right to the best healthcare.

  • Science as a step-by-step process is under constant scrutiny in the age of social media and 24/7 news. Setbacks and inconclusive data are simple speed bumps in developing solid science; slow progress is not intentional, but normal.

Cows theory

At the end of the 18th century, an observation by English physician Edward Jenner changed medicine forever. He noticed that milkmaids infected by cowpox, a disease which can spread from animals to humans, were immune to smallpox, a deadly illness with closely related symptoms. It had been known since ancient times that people who contract an infectious disease and survive it would never catch it again; in China, for example, a practice called variolation, which consisted in exposing healthy patients to smallpox in the hope that they would not die and emerge immunized from the ordeal, had been practiced since at least the fifteenth century. But if pus from infected cows (and people) immunized humans without resulting in disease, Jenner reasoned, could it be that, by administering it systematically, whole populations could be immunized without creating a pandemic?

Reality turned out to be more complicated than that, but, without even being aware of the existence of antibodies, Edward Jenner correctly followed the scientific method and ended up inventing vaccination. Thanks to his scientific rigour and that of the medical community who picked up his efforts, smallpox, widely regarded as one of the deadliest diseases in history, was eventually eradicated in 1980, as certified by the World Health Organization (WHO).

The science behind vaccines has had 167 years to grow and mature, and it has become one of those medical practices we now take for granted, like using antibiotics to kill dangerous bacteria or taking an aspirin to get rid of a headache; children all around the world simply have to endure a safe, quick prick on the arm to enjoy long-lasting protection against such historical terrors as smallpox, measles or rubella.


Who’s afraid of the big, bad needle?

It's quite surprising, then, that even now a vocal minority of people challenge these facts with wild claims and unverified stories. What’s worse, their voices are getting loud enough to gather momentum and catch the ears of governing bodies and politicians, who will sooner or later be tempted to listen to these requests just to make sure they’ll get their votes.

Let’s make something immediately clear: vaccines are safe and anti-vaccination claims are unfounded. Even Wikipedia corrals anti-vax efforts into an “Alternative and pseudo-medicine” section. In addition to solid scientific foundations, constant efforts are constantly put in place to guarantee this safety; the WHO, for example, keeps its guard up by evaluating vaccines in the framework of the Global Vaccine Safety Initiative, the development of a blueprint to ensure that every country has the expertise and the resources to keep inoculations safe. Resources are available online to answer questions and provide help. Family doctors will gladly offer guidance on how to achieve safe vaccination.

What, then, prompts non-specialists to believe fiction, instead of facts?

This phenomenon is far from a modern problem; Jenner himself had to face remarkable opposition against his discovery during his own lifetime. Interestingly, the objections raised then were quite similar to those found circulating today in anti-vax circles.

We can broadly group these objections in three main categories: health concerns, personal freedom infringements, fear of the unknown.


Unfounded fears and unfair flaggings

Of these categories, health concerns are the only ones with a foot in the real world. To understand them, we need to first lay out what a vaccine is, how it works and what could make it dangerous.

The term vaccine was coined by Jenner himself; it comes from Latin, and it means “derived from cows”. That’s what a vaccine was, originally: pus from one of the pustules (bovine and human alike) spawned by a smallpox infection, forced into the body of an otherwise healthy recipient via a small incision of the skin.

We’ve come a long way from then.

It’s possible to make a dangerous microorganism harmless and inject it, giving the immune system the best chance at understanding it and preparing against an eventual infection; thanks to molecular biology, though, we can now isolate or even replicate the parts of the microorganism responsible for the disease, and build a vaccine around them. Without the microscopic attacker itself, the single elements can’t cause any harm, but they are more than enough for the immune system to prepare itself against future invasions. That’s how a vaccine works: by “simulating” an infection close enough to the real thing, that the parts of our immune system in charge of remembering past attacks will be able to learn from it. This simulation is usually so mild that the rest of the immune system barely reacts to the foreign particles. It’s like showing soldiers real weapons and tactics employed by the enemy, without subjecting them to an actual combat scenario. Preparation might not be as complete as with experience in the field, but losses are reduced to zero and the chances of winning are still extremely high.

In war like in immunology, though, things are rarely so cut and dry. Enemy tactics could suddenly change, or some of the weapons could misfire and hurt those studying them. While the former means that a response to an attack might still be successful, if not as quick or efficient, the latter can have severe consequences; that’s what is quoted by anti-vax as one of the main reasons for refusing a vaccination: side effects.

As for any medical procedure, vaccines too can have adverse effects, ranging from a mild fever caused by the body being overzealous in fighting the simulated infection, to the exceedingly rare high fever or intense allergic reaction. As extensive studies have proven, none of these events are frequent enough to be considered a risk factor so high to be preferable to the disease the vaccine would prevent. But in this time and age, the internet is proving to be the most crowded battlefield in the war for proven facts.

One of the resources most cited by anti-vax is an online database which flags occurrences of vaccine side effects, called VAERS. The simple fact that a website like this exists seems to be proof enough that vaccines are not as safe as doctors and scientists claim. But here’s the twist: the website itself states that “VAERS reports alone cannot be used to determine if a vaccine caused or contributed to an adverse event or illness.” The reason behind this is simple: these adverse events reports are submitted mostly by non-specialists, after something went south with a vaccination. As the website itself states, “reports to VAERS are voluntary, which means they are subject to biases. This creates specific limitations on how the data can be used scientifically.” It is absolutely terrifying to see a child suffer because of a medical procedure, and it is perfectly understandable that a parent would want to point out such risks. The problem is, as usual, that correlation is not causation (you can read more about this on Biocompendium, here). An adverse effect happening once every million vaccinations is terrible, but cannot be robustly linked to the vaccine.

Another (non) issue: vaccine additives. In addition to the component of the vaccine that comes from the infecting microorganism, it’s common practice to add extra substances to help the body create an effective “memory” of the fake infection (adjuvants), or to avoid contamination from external parasites (preservatives). Although repeatedly confirmed to be safe, these additives have gotten a bad reputation, due to some unfortunate instances of misguided non-specialist research and subsequent social firestorms.

What happened with the antifungal preservative thiomersal, which has effectively been removed from regular vaccination practices in Europe and the U.S., is the perfect example of this. Due to thiomersal being a mercury compound, non-specialists never fully trusted it, on the basis that it could induce mercury poisoning in children. Researchers never proved any link between vaccine administration and mercury poisoning, but such was the clamor and the frenzy around thiomersal in the early 2010s, that European and U.S. governments banned it from vaccine formulations. The end result was an increase in cost for routine vaccinations, since removing preservatives means that the doses need to be refrigerated; this costs additional money and reduces available storage space. In those countries where the compound was not banned, formulations have not changed, and the vaccines are still used in their completely safe, cheaper, thiomersal-containing versions.

Adverse effects are inherent in any medical procedure. It is an inescapable truth. The crucial point is, none of those routinely feared by anti-vax parents are frequent enough to overshadow the proven efficacy and protection granted by vaccines. People do not stop flying on airplanes because of the horrible, but occasional crash.


Get your needle off my haystack

If the science is clear, then, what prevents a government from making a vaccine mandatory? Technically, nothing; advocates for children’s rights, like ethicist Arthur L. Caplan, argue that not providing children with the best proven medical care, including vaccines, infringes on their right to be healthy and safe, and that should be enough to override any objection coming from the parents. This, though, might be seen as trampling individual freedom rights.

When, in 1853, the British parliament culminated years of efforts to enforce widespread adoption of vaccines with the Vaccination Acts and the Contagious Diseases Acts, which instituted fines and penalties for those who would refuse vaccination, a large part of the populace perceived this as an act of oppression. In describing the point of view of the English people at the time, historians Dorothy and Roy Porter in 1988 defined these laws as acts which “suspended what we might call the natural liberty of the individual to contract and spread infectious disease, in order to protect the health of the community as a whole.”

This reactionary view did not disappear in the almost two centuries since the Acts were passed; if anything, it spread. The argument whether a heavily interventionist government infringes on the individual liberties of its subjects, or provides firm rails on which to guide the population to its best interests, has been debated endlessly. In this specific case, though, the issue develops on an additional level: when the freedom of the few can impact the health of the many, is the government to override that freedom? Families that choose not to vaccinate their children breach the foundation of herd immunity, thus putting all children too young or for which vaccination is impossible at risk; and in the case of a virus like the novel coronavirus, it’s not just children who are in serious danger. But is the government right in enforcing vaccinations, or is it just forcefully overriding any form of choice?

From a purely scientific standpoint, this argument is moot.

Vaccines are essential for the well being of a population and there should be no doubt about their efficacy and safety. Refusal to immunize a child because of this perceived “tyranny of the state'' indicates severe socio-political issues, which need to be resolved by improving the general level of education and fostering dialogue between scientists, physicians and non-specialists. And while these issues are dealt with, lives are put at unnecessary risk.


Slow and scienc-y wins the race

Absence of effective communication between scientists and laypeople is indeed at the heart of the last of the three main objections against vaccines: mistrust.

It’s undeniable that in recent years the attitude of non-specialists against science, and specifically biology, has changed considerably. The general outlook on biology went from being curiously eyed as a source of novel information and insights into the living world, to being considered at the service of a restricted circle of individuals whose decisions look arbitrary, shady or self-serving. As far as the scientific community is concerned, things have not changed one bit. Biologists still dedicate their lives to generating knowledge and to the improvement of human life. What has changed is the access non-specialists have to such knowledge, and their ability to spread their own takes on them.

One good example is the (understandable) interest in the progress against COVID-19.

The novel coronavirus pandemic is unprecedented in its influence on the daily lives of every single human being on the planet. The range of limitations we live with, from the ubiquitous mask to hand washing, from social distancing to travel restrictions, has taken a toll on us of a magnitude we will need years to fully appreciate.This has led to a seismic shift in the relationship between non-specialists and biology, as filtered through the intervention of the government.

If we use “coronavirus vaccine” as a trend topic on Google Trends, it becomes apparent how invested people have been in the fight against the virus, especially in the first months of lockdown. While the majority was obviously more interested in practical answers like the actual distance involved in social distancing and for how long are hands supposed to be washed, many got obsessed with the science behind these recommendations. It turns out that science’s slow and methodical way of building facts over progressively less shaky foundations is quite the burden in a world where every single step in the process gets exposed to the general public. Wavering between the suggestion of wearing or not wearing a mask, for example, was the single biggest mistake the WHO (and the CDC in the U.S.) made during the beginning of the pandemic. The possibility of a shortage of masks and the subsequent danger health professionals would have faced was the main reason behind this indecisive behavior, and a good one at that; plus, the data on the actual transmission avenues of the coronavirus was still scarce, and no scientific body would have advised to suggest for everyone to wear a mask. Various world governments, pressed by their constituents, took the matter into their own hands, further muddying the message and deepening the feeling of insecurity. Only very recently a study has clarified that masks are very important in reducing the spread of the virus. But public confidence had been deeply shaken, and it never fully recovered.

More questions arise daily, but in a research lab, questions are starting points to plan experiments; these experiments may or may not give a direct answer, and more often than not, further work is required. In the context of a pandemic reported live on social and news media, this is next to impossible. Every failure to obtain a direct answer is widely amplified, turning the usual process of doing science into a race to get the public the answer it wants to hear. What basically amounts to a misunderstanding of science proceedings turned into mistrust and suspicion on the real motives behind unclear data and the pace of progress. Is Big Pharma exploiting the pandemic to maximize vaccine sales? Are emergency measures just an excuse to further crack down on individual freedoms? Questions like these are seen at least as relevant as wondering if there actually will be a second wave, or if vaccines are being rushed to the point of putting people carelessly in danger.

In everyday life as in a crisis, a cool head and informed decisions provide a winning advantage. Science is here to help us get exactly that.



References and further reading


On the lack of association between vaccines and infant deaths

https://healthfeedback.org/claimreview/infant-deaths-did-not-decrease-during-the-pandemic-due-to-a-reduced-use-of-vaccines-vaccines-are-not-associated-with-sudden-infant-death-syndrome/


A quick read on dr. Jenner

https://web.archive.org/web/20090628230753/http://jennermuseum.com/sv/smallpox2.shtml


Wikipedia page on smallpox

https://en.wikipedia.org/wiki/Smallpox


The official Global Vaccine Safety website

https://www.who.int/vaccine_safety/initiative/en/


Wikipedia page on Vaccine hesitancy

https://en.wikipedia.org/wiki/Vaccine_hesitancy


Vaccine Safety Net, another initiative of the WHO to provide information on vaccine safety

https://www.vaccinesafetynet.org/


The Vaccine Adverse Event Reporting System (VAERS) website

https://vaers.hhs.gov/


On anti-vaccination movements and controversies throughout history

https://www.historyofvaccines.org/content/articles/history-anti-vaccination-movements


An example of media coverage on COVID-19 on the British publication The Independent

https://www.independent.co.uk/topic/anti-vaxxers?CMP=ILC-refresh


Wikipedia page on vaccines

https://en.wikipedia.org/wiki/Vaccine


On inoculation and pre-vaccine methodologies

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407399/


On adjuvants function and safety

https://www.cdc.gov/vaccinesafety/concerns/adjuvants.html


A recent study including reports on adjuvant safety

https://pubmed.ncbi.nlm.nih.gov/32124728/


On thiomersal

https://en.wikipedia.org/wiki/Thiomersal


Arthur L. Caplan's view on children's rights and vaccination

https://www.medscape.com/viewarticle/902956


On parents' worries about vaccines

https://www.health.harvard.edu/blog/why-do-parents-worry-about-vaccines-2019080217406


Dorothy and Roy Porter's essay on the British anti-vaccinationism in the nineteenth century

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1139881/pdf/medhist00062-0007.pdf


Press article on the study confirming the efficacy of face masks in containing COVID-19

https://www.sciencedaily.com/releases/2020/06/200612172200.htm


On the conflicting views on face masks during the pandemic

https://www.npr.org/sections/goatsandsoda/2020/04/10/829890635/why-there-so-many-different-guidelines-for-face-masks-for-the-public?t=1595186512803


An overview of vaccine safety findings

https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Vaccine-Studies-Examine-the-Evidence.aspx




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