This anomaly has got to be one of the most interesting stories in the vaccine world – the state’s vaccine uptake rates (see Note 1) for MMR (for measles, mumps and rubella), DTaP (for diphtheria, tetanus and whooping cough), and varicella (chickenpox) vaccines exceed 99.4%. This number far is far beyond the level necessary for the herd effect to protect all individuals in an area. All thanks to a lack of a Mississippi vaccine exemption for religious beliefs.
The high vaccine uptake rate breaks the irony meter for one other reason – Mississippi is one of the country’s most religious states. And the fact that the state does not allow religious exemptions for vaccination of young children seems like it is out of character for the state. Mississippi is one of only three states that disallow religious exemptions to vaccines (California and West Virginia being the other two). And the Mississippi vaccine exemption rules rely upon a simple piece of jurisprudence – parental duties trump parental rights.
As a result of this important concept, Mississippi vaccine exemption rules do not allow for a religious exemption. I know, it is difficult to wrap your mind around Mississippi in this story. But let’s find out why the state has led the way on stopping religious exemptions.
Late last year, I spent a couple of thousand words critiquing an awful anti-vaccine paper that attempted to claim that vaccinated kids were sicker than unvaccinated kids. Soon after the paper was published, a huge kerfuffle arose on Twitter, which pointed out the false conclusions, bad experimental design, and high levels of bias made by the authors. Within days of publishing the article, the journal retracted it (see Note 1).
Mawson actually has a Master’s and Doctorate in Public Health, specializing in epidemiology. You’d think he’d know better about vaccines, but I guess being a sycophant of Mr. Andrew Wakefield makes him deny his scientific background. Then, he goes out and invents a bad experimental design just to support his nonsense beliefs. And to be more endearing to Wakefield I suppose.
Now, you, my reader, are probably thinking, “OK, got it, let’s talk about GMOs.” Except, I have to drag you back in, and remind you that myths, tropes and memes in the anti-vaccine world are like zombies. They never quite die, biting one anti-vaccine cheerleader after another. Even a dead paper, like Mawson’s, will arise again somewhere.
One of the most frequent topics for posts like this is a pseudoscientific or just plain bad study that, despite being retracted, keeps rising from the grave, like the proverbial zombie. I call them, appropriately enough, zombie studies. Depending on my mood when I write posts like this, I often add imagery featuring zombies (or, if you’re into The Walking Dead, walkers).
I can’t resist a good Walking Dead metaphor.
Let’s look at this zombie/walker anti-vaccine paper. Because you just know, like the end of the zombie movie, the story drops hints for Part II. Or Part II. Or Part XXI.
How did an anti-vaccine paper get retracted twice?
The simple answer is that it was published twice in predatory journals, whose standard of publication is not much more than if the author can pay the fees to publish their paper. Mawson’s article was published for the first time in Frontiers in Public Health, a part of the Frontiers Media empire. It was published for the second time in the Journal of Translational Science, a part of OAT. Both Frontiers Media and OAT are predatory publishers according to the definitive Beall’s List of predatory publishers. A predatory publisher is an “exploitative open-access publishing business model that involves charging publication fees to authors without providing the editorial and publishing services associated with legitimate journals.”
In case you missed my articles about this before, let’s look at Frontiers Media and OAT:
Frontiers in Public Health (FPH) is not indexed in PubMed. The Journal of Translational Science (JTS) is not indexed in PubMed. PubMed is one of the most valued resources in searching for biomedical articles, even in obscure journals. Without PubMed, it is extraordinarily difficult to find the article. Of course, there’s no reason given for it’s exclusion from PubMed, but we can speculate that possibly the science is bad.
Both FPH and JTS lack an impact factor. The impact factor gives us a relative understanding of the quality of a journal – generally, the impact factor tells us approximately how many times an average article published in a journal is cited per year. A journal like Nature has an impact factor of 36, which means the average article is cited 36 times a year. Why is this important? We know that more pivotal and valuable research is cited many times and often repeated by other scientists, especially in new publications. This is how science develops solid evidence, by examining and repeating the findings of others.
As we mentioned above, both FPH and JTS are published by predatory publishers (one of the possible reasons that the journals are not indexed).
Low impact factor, predatory journals are generally dismissed by scientific researchers because the peer-review is weak. These journals are often abused by researchers whose data has been rejected by one or more of the respected journals, so they settle for these low quality versions. In the academic community, publications such as these often cannot be used as evidence of qualification for tenure.
Clearly, neither FPH or JTS were actually interested in what Mawson had written. If they were, either or both of them would have rejected the articles in the first place. But here we are, both articles were “published” (or whatever verbiage they use), and both were retracted (or scrubbed from the internet).
Remember, this anti-vaccine paper was garbage
Just in case you’re anti-vaccine, and you think that there’s some conspiracy against “evidence” that vaccines are dangerous, get over yourself. These two journals are awful, and it’s entertaining that Mawson’s article was so bad that it fell beneath the journal’s miserable standards.
Let me remind you of how terrible this article was (before being retracted twice).
This study intended to “compare vaccinated and unvaccinated children on a broad range of health outcomes, and to determine whether an association found between vaccination and neurodevelopmental disorders (NDD), if any, remains significant after adjustment for other measured factors.” This is a good start, and if done well, it could provide us with more information about any potential links between vaccines and NDDs such as autism spectrum disorder. But this is not a well-designed study to answer that question.
The study surveyed 415 mothers of 666 children educated at home. And the paper goes downhill quickly. First of all, we are relying on data from a group, which may or may not be biased versus a random sampling, that home schools children. There are lot of reasons why parents do this, but are they representative of the population at large? Second, it relies upon the memories and, frankly, biases of the mother being surveyed – it doesn’t rely upon data in actual medical files of each of these children, which can be considered to be somewhat “scientific.”
Parents who do vaccinate may be less reluctant to visit their physician to get diagnosed for diseases, while a non-vaccinating parent may choose to ignore any health issues as minor. Thus, there may be an unintentional bias towards health care issues for vaccinated children.
The groups (vaccinated vs. unvaccinated) are not randomized which will lead to observational and confirmation bias.
Questionnaires are not the best way to gather data about medical issues – in fact, the use of questionnaires for epidemiological studies is frowned upon by many researchers. The reasons for this are many, but they include a reliance upon the memory of the participant for events that may be not be recalled correctly. In addition, there might be intentional or unintentional bias of the survey participants towards relating a condition to vaccines or ignoring one in unvaccinated kids. Better done, and frankly, more expensive, epidemiological studies rely upon medical records to reduce errors in memory and bias. This is a critical point – the best studies that show no link between vaccines and autism rely upon actual medical data for each child, not on a questionnaire which may or may not be tracking accurate information.
At best, this is observational data, which are not the type of data used to reject or accept an hypothesis. The CDC uses surveys to determine vaccination uptake, for example, but they used a non-biased methodology to gather data. They surveyed nearly 15,000 children, and were given permission to contact the health care provider to get more information.
Mawson’s study found that 39% of children surveyed were not vaccinated. Now if we accepted this data without analysis, we’d think that the vaccination rate has dropped. However, that’s not what we’ve seen in other, better-designed surveys, such as the CDC’s massive ones, which showed that vaccine uptake was between 85 and 95% depending on the vaccine and the area. With such a difference between this study and better designed ones, one would have to believe that the study with a much smaller number and an apparently biased population would be the outlier.
There was a lack of analysis of potential cofounders which might bias the results. Were there other differences between he vaccinated and non-vaccinated groups that could have biased the results one way or another?
The use of odds ratio by the researchers is curious and may have biased the results. The only reason to use OR is to inflate the difference between both groups. Real epidemiologists prefer relative risk (RR) which provides us with a much more sensitive understanding of the incidence of a condition in a vaccinated group vs. an unvaccinated group. For example, the RR for ASD from this study (if the data actually were useful, which it isn’t) is 3.1, whereas the OR is 4.2.
The over reliance on p-values is always a red flag to researchers. With so many p-values, the probability of false positives is fairly large. Because the population for the study was so small, it’s also worth nothing that the OR had relatively large error brackets, most of which crossed near unity, that is, 1.0, indicating no difference between the groups.
The authors seem to overlook or ignore the point that the vaccinated children had much lower risk of diseases like chickenpox and measles, which we know bring with them significant risks of long-term health issues. Even if we accept this poorly designed study as providing us with evidence of harm from vaccines, one would have to balance it against the benefits of avoiding vaccine preventable diseases. Of course, this study is so bad, it’s hard to accept anything useful from it.
There’s more, I’m sure. I just get tired of tearing apart these bogus articles, when it’s really hard to get over the fact that it’s been retracted twice by awful predatory publishers. Seriously, that should be the end of the story.
As the crotchety Orac wrote recently about Mawson’s article,
I’ll conclude by pointing out yet again that it is a myth that there are no studies comparing the health of vaccinated children compared to unvaccinated children. In fact, there have been several. It turns out that they don’t show what antivaxers think a vaxed/unvaxed study will show. Basically, all of the vaxed/unvaxed studies not done by antivaccine-friendly scientists or quacks have shown either no differences in the prevalence of neurodevelopmental or chronic diseases between vaccinated children and unvaccinated children or have actually found better health outcomes in the vaccinated population. Mawson concludes by arguing that further “research involving larger, independent samples and stronger research designs is needed to verify and understand these unexpected findings in order to optimize the impact of vaccines on children’s health.” Mawson’s study is so biased, flawed, and incompetently carried out and analyzed that its results can be discounted as almost certainly worthless. It doesn’t provide the rationale for “more studies.” Quite the contrary.
Yet, that’s how antivaxers are spinning it, as they always do.
Same as it ever was.
There really are plenty of good articles, published in real, indexed, high impact factor journals that show that there is little or no difference between the health of vaccinated versus unvaccinated children. We should also include that nagging point that vaccinated children don’t generally catch deadly, disabling vaccine preventable diseases.
We also have boatloads of evidence, again, published in major journals, that dismiss any link between vaccines and autism, which feels like the basis of Mawson’s junk article. So, if you want to use that rubbish anti-vaccine article as the basis of your “evidence” that vaccines are dangerous – well, you really need something more convincing. Mawson’s article was retracted twice by the detritus of predatory publishers, so it would be laughable to use it as real evidence.
But we all know that this zombie article will rise again. They eat brains, and apparently they’re looking for nutritious anti-vaxxer brains. But zombies aren’t real, except on TV and movies. So the anti-vaccine world keeps pushing zombie tales – because they think that by Part XXI, we will be bored with the zombie myth and not try to take it down. Don’t count on it.
Actually Frontiers Media noted that the study was only “provisionally accepted but not published.” That might be what they think, but the article appeared on their website, then disappeared.
Technically, we can’t tell that the article was retracted. It’s just been scrubbed from JTS’ website, as if it never existed. But the internet never forgets.
Other than California, only West Virginia and Mississippi have such strict prohibitions on these PBEs that they are effectively not allowed as a method to refuse vaccines before a child enters school. But many other states are considering vaccine legislation that could improve vaccine uptake. Unfortunately, there are also states on the other side of the equation that are considering laws that reduce restrictions on personal belief exemptions.
I thought we would could take a look at current vaccine legislation being considered by various states that could potentially increase vaccine uptake in those states. Then we’ll take a look at those states pushing legislation that might decrease vaccine uptake. This should provide real information about what’s going on with these laws, instead of the alternative facts from the vaccine deniers at NVIC.
California SB277 makes immunization mandatory for children attending schools in the state by removing personal belief exemptions for vaccination. These personal belief exemptions were abused by parents in pockets of California, causing immunization rates in some communities to fall precipitously. California SB277 should correct that abuse. The new vaccine requirements should increase the vaccination rate, as long as someone doesn’t find some loophole to abuse the system, because anti-vaccine parents tend to be a resourceful group.
Interestingly, West Virginia legislators strengthened vaccination laws in 2015 by extending vaccination requirements to preschoolers. And it created the position of state Immunization Officer, who is responsible for ruling on the validity of requested medical exemptions in an unbiased manner. Maybe California could implement such a position.
The drop in disease rates in California will be much more apparent in California, which has 9 million children in school, compared to 737 thousand in Mississippi and 382 thousand in West Virginia. Diseases like chickenpox and measles are highly infectious, so high immunization rates should block any spread of the disease
California SB277 became effective on July 1, 2016, so this is the first school year where the mandatory vaccine requirements were in place. Unfortunately, because of that prior abuse of personal belief exemptions in California, there are still communities at risk for vaccine preventable diseases.
Unfortunately, there is a loophole (I told you) in the California SB277 – the medical exemption only requires a letter from a physician, and it’s not further scrutinized as is done in West Virginia. And because there are numerous anti-vaccine doctors who ignore real science for their beliefs, there appears to be a growing cottage industry forming to make medical exemptions somewhat easily available.
Dr. Zandvliet also states that MTHFR gene mutation is a risk factor for vaccines. But that’s simply not true, and no reliable source says that this gene mutation is a serious contraindication for vaccines.
Furthermore, her list of vaccine reactions actually may or may not be related to vaccines. The whole list is dependent upon parental memory and post hoc logical fallacies.
Finally, as Orac points out, the actual list of real contraindications for vaccines is rather limited – severe allergic reaction to the vaccine or its components, which will be obvious to anyone, is the major one. But I suppose, to get the vaccine medical exemption, people will try to make that claim. And because California relies upon the word of the physician rather than an independent, unbiased party, like West Virginia’s Immunization officer, there will be no way to dismiss this problem.
The charges against Sears cannot help but create a stultifying effect on pediatricians who have been merchandising themselves as anti-vaccine practitioners, and on those who have been considering doing so. They are all thinking things through very carefully at the moment. The upside to writing slightly spurious vaccine exemptions is to build one’s medical practice and to gain the gratitude of anti-vaccine parents. The downside is the possible loss of one’s career.
By the way, continuing a narrative that bothers me about the anti-vaccine movement, it feels like only white privileged types are going to be able to get these “for sale” medical exemptions. Dr. Sears practices in a swanky part of Southern California, and caters to wealthy parents. Of course, Dr. Zandvliet charges $120 for her “services” in providing medical exemptions. I’ve seen numerous other “ads” from physicians in the expensive areas of California saying that they’ll consider writing medical exemptions for children.
The problem with this industry is that it has a negative impact on the California SB277 – the law may not be as effective as we want, although I’ve got a feeling that a lot of people who used personal belief exemptions are not going to be bothered by trying to find a pediatrician to write an exemption, once their own physician says, “NO!”
As long as California SB277 increases the uptake rate for childhood vaccines, despite the exemption industry, the overall effect should be strongly positive. But we all await data from California on the exemption rate and vaccination rate – as I always say, it’s the evidence that matters, and hopefully we’ll get some good evidence soon.
The SB 277 vaccine exemption bill was sponsored by California Senator Richard Pan MD and by Ben Allen, of Santa Monica. The bill was introduced after a outbreak of measles in December at Disneyland sickened 136 Californians. It passed quickly through both houses of the California Legislature.
The law applies to students attending any public or private school in the state, so parents who choose not to vaccinate children for non-medical reasons would need to make other arrangements for their child’s education. Now, only valid medical exemptions, such as known allergies and other medical conditions, approved by a physician, will be allowed an exemption to vaccination.
Governor Brown also reiterated, while signing the bill, that “while requiring that school children be vaccinated, the law explicitly provides an exception when a physician believes that circumstances – in the judgment and sound discretion of the physician – so warrant.”
There is some evidence that the medical exemption has been abused by parents who do not want their children vaccinated with cooperation of like minded physicians. This does worry me, since there are pediatricians who “advertise” their services in signing these forms.
Notwithstanding my concern, this makes California one of the three toughest states for vaccinations, along with Mississippi and West Virginia. And that is good news indeed.
Overall, 48 states and DC (as well as 8 US jurisdictions, including Guam, Puerto Rico and other territories) reported 2012-13 school vaccination coverage. Approximately 94.5% of kindergartners had received their complete MMR vaccinations, an insignificant drop from the 2011-12 level of 94.8%. DTaP coverage was 95.1%, above Healthy People 2020 target of 95%. For the varicella vaccine, 93.8% of American kindergartners received both necessary doses.
The state of West Virginia (WV) has one of the toughest child vaccination regulations in the United States, not allowing any religious exemptions to vaccinations required before attending school. Only Mississippi has regulations this strict for allowable exemptions. Of course, as I have written, religious exemptions have been abused by vaccine deniers by creating “fake” religions so that parents’ antivaccination beliefs will be recognized by the state. In fact, only medical exemptions are accepted by the state (pdf), and their standards on who can meet the medical exemption are quite tough.
The Vermont Senate just passed a bill that will end the so-called “philosophical exemption” from requirements for students to receive vaccines before attending public schools. This exemption is used by the anti-vaccine lunatics to allow their children to attend schools without having the standard courses of vaccinations. Of course, these philosophical objections are almost always based on pseudoscientific beliefs rather than evidence. Continue reading “Vermont Senate passes bill to end philosophical exemptions from vaccinations”