Dorit Rubinstein Reiss – Professor of Law at the University of California Hastings College of the Law (San Francisco, CA) – is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines (generally, but sometimes moving to other areas of medicine), social policy and the law. Her articles usually unwind the complexities of legal issues with vaccinations and legal policies, such as mandatory vaccination and exemptions, with facts and citations. I know a lot of writers out there will link to one of her articles here as a sort of primary source to tear down a bogus antivaccine message.
Professor Reiss writes extensively in law journals about the social and legal policies of vaccination–she really is a well-published expert in this area of vaccine policy, and doesn’t stand on the pulpit with a veneer of Argument from Authority, but is actually an authority. Additionally, Reiss is also member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.
I thought we would take a look at the issues specific to this new version of RFK Jr and vaccine safety – we’ll analyze his comments and then take a detailed look at the published article that forms the basis of Kennedy’s comments.
RFK Jr and vaccine safety – the article
RFK Jr’s article about vaccine safety was published in Collective Evolution, a pseudoscience-pushing website that has articles about the sun exploding soon and aliens circling the moon. No, I’m not joking, Kennedy thinks his outlandish claims about vaccines fit well next to an article about alien structures on the moon.
But let’s get to what he’s saying about the DTaP vaccine:
Now a team of Scandinavian scientists has conducted such a study and the results are alarming. That study, funded in part by the Danish government and lead by Dr. Soren Wengel Mogensen, was published in January in EBioMedicine. Mogensen and his team of scientists found that African children inoculated with the DTP (diphtheria, tetanus and pertussis) vaccine, during the early 1980s had a 5-10 times greater mortality than their unvaccinated peers.
In the primary analysis, DTP-vaccinated infants experienced mortalities five times greater than DTP-unvaccinated infants. Mortalities to vaccinated girls were 9.98 times those among females in the unvaccinated control group, while mortalities to vaccinated boys were 3.93 times the controls. Oddly, the scientists found that children receiving the oral polio vaccine simultaneously with DTP fared much better than children who did not. The OPV vaccine appeared to modify the negative effect of the DTP vaccine, reducing mortalities to 3.52 times those experienced among the control group.Overall, mortalities among vaccinated children were 10 times the control group when children received only the DTP.
The data suggest that, while the vaccine protects against infection from those three bacteria, it makes children more susceptible to dying from other causes.
If this were true, it would be one scary study. However, does this study actually make that claim? Stay tuned, we’ll get to it.
Kennedy, then, comes to this conclusion:
In 2014, The World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) conducted its own literature review of the potential non-specific effects (NSEs) of several vaccines, including DTP, and found that the majority of studies reported a detrimental effect of DTP (Higgins et al., 2014; Strategic Advisory Group of Experts of Immunization, 2014) due to its penchant for increasing susceptibility to unrelated infections. SAGE recommended further research.
Moreover, Mogensen and his colleagues observe that the studies reviewed by SAGE probably underestimated the lethal effect of the DTP vaccine because of unusually high mortality in the control groups, ”Unvaccinated children in these studies have usually been frail children too sick or malnourished to get vaccinated and the studies may therefore have underestimated the negative effect of DTP”. The Mogensen study sought to avoid this pitfall by using controls selected by birthday and by eliminating underweight children and orphans from both the study group and the control group. It included only children who were breastfed. All the infants were healthy at the time of vaccination. Nevertheless, the Mogensen authors point out that, even in their study, the unvaccinated children had slightly worse nutritional status and travelled more – biases that would tend to increase mortality. They conclude that, “The estimate from the natural experiment may therefore still be conservative.”
Evidence supports a high degree of confidence in the estimate of the effect that incidence of serious adverse events following whole cell pertussis vaccination is low. From the reviewed articles, there is no significant risk of serious adverse events following administration of wP (see Note 1).
Severe adverse events are extremely rare. TTCV using various presentations have demonstrated to be safe to use in immunocompetent individuals of various age and population groups including infants, children, adolescents, adults and pregnant women.
In other words, SAGE has never said that there’s a detrimental effect of the DTP (or DTaP) vaccine on children, adults, or anyone. In summary, SAGE has been very positive, with regards to vaccine safety and adverse events, not even close to the narrative pushed by Robert F Kennedy Jr.
But let’s take a look at this Danish study pushed by RFK Jr.
RFK Jr and vaccine safety – the study
The study, published in EBioMedicine, by Dr. Soren Wengel Mogensen et al. studied the mortality rate of children after vaccination with DTP from 1984-1987. The children received the vaccine during quarterly weigh-ins in Guinea, Africa. Here are some of the issues with the study:
It was published in a rather obscure journal. This alone does not give us an indicator of the quality of the paper, but if we really had data that showed us there was a concern with the DTaP vaccine, an important part of the childhood vaccine schedule, it should have been published in a higher quality journal, maybe one that focuses on vaccines, such as the journal Vaccine. Generally, I have found that publishing in obscure journals results from not finding a place in a major journal, mostly as a result of the weakness of the data.
The study looks at the mortality rate after the vaccine used at that time, which, as I mentioned, contained the whole-cell version of pertussis. That vaccine was pulled from the market and replaced with the acellular version. The reasons for changing the vaccines are complex, but it was partially because of the higher rate of minor adverse events with the wP version of the pertussis vaccine. On the other hand, there is no evidence that the wP version caused more deaths than the current aP version.
The study only examined 1057 children, which is a tiny number in any epidemiological study that tries to compare one group to another to examine a potential effect. Many case control studies that examine vaccine effects (either effectiveness or adverse events) use 100,000 to several million patients.
The number of deaths that was used in the study was tiny, sometimes only 1 death in a population group (like female unvaccinated children). Because they used such small numbers, unintentional bias could occur.
The deaths were not categorized. Were they auto accidents, violence, or other mortality events that absolutely have nothing to do with vaccination. With such small numbers analyzed, it’s possible that unrelated mortality could have given results that could change dramatically with just a handful of unrelated deaths. Unless you can convince me that vehicle mortality is somehow related to vaccination status.
Ironically, the study showed that there was decreased mortality with the children who received oral polio vaccine (separate from the DTP vaccine). If we accept this statistically suspect small sample as unbiased (which we can’t), the overall results are positive with a full vaccination. It kind of contradicts the RFK Jr and vaccine safety narrative.
It’s difficult for me to accept the viability of this study on just about any level. At best, at the very best, we can accept this study as an observational one which could, if not contradicted by better studies, form the basis of a hypothesis about the DTaP vaccine.
And that leads me to another critical point. Robert F Kennedy Jr cherry-picked a study that supports his beliefs about vaccine safety, the antithesis of real science (hence, Kennedy chose the pseudoscientific Collective Evolution for his article). If we look at larger studies more broadly, what can we say about the safety profile of the DTaP vaccine?
Here’s a Danish study that included over 805,000 children looking at various outcomes to getting multiple antigen vaccines, such as DTP or DTaP, came to this conclusion:
These results do not support the hypotheses that multiple-antigen vaccines or aggregated vaccine exposure increase the risk of nontargeted infectious disease hospitalization.
In plain speak, there is no data to support RFK Jr and vaccine safety issues – with respect to these vaccines, there was no difference in non-targeted (that is non-diphtheria, -pertussis or -tetanus) infections in the vaccinated vs. non vaccinated groups. This is much more robust data than the study upon which Kennedy relies for his belief set.
Acellular vaccines have fewer adverse effects than whole-cell vaccines for the primary series as well as for booster doses.
Thus, the authors found no vaccine related mortality for either vaccine, which completely and utterly contradicts Kennedy’s belief about the safety of the DTaP vaccine. If we’re going to cherry pick, let’s choose the studies that actually are well designed with good statistics and outcomes that can reject or accept a hypothesis. Kennedy’s study does neither.
Not only does RFK Jr use research that has no relevance to the modern DTaP vaccine, but also he relies on a weak, small, and poorly designed study. Furthermore, the study he uses is clearly of lower quality than other, more powerful and robust studies, which show that there is no mortality concerns with the vaccine.
Kennedy’s cherry picked study simply fails to provide us with any quality evidence that we should be concerned about the modern DTaP vaccine. None. Only in a world of pseudoscience, where a weak, one-off study has more value than better designed and populated studies, can we cherry pick bad evidence to dismiss one of the most useful vaccines in the armamentarium of diseases preventing weapons.
RFK Jr and vaccine safety? Yeah, he’s wrong. Badly wrong.
wP, or whole cell pertussis vaccine, is no longer used in the USA. We use aP, or acellular pertussis, in our DTaP vaccine. At the time of the vaccination of the children in the study, the whole cell version was used.
The diphtheria vaccine doesn’t protect directly against the bacterial infection but against the toxin produced by the diphtheria bacteria which causes the symptoms of the infection.
On April 20, 2017, Tucker Carlson from Fox News interviewed Robert F. Kennedy Jr. on his show, and they talked about vaccines. Mr. Kennedy pointed out that this is only his second interview on the topic in ten years, and blamed it on advertising dollars (which, apparently, did not prevent Mr. Carlson from hosting him). So why are RFK Jr vaccine beliefs ignored by the mainstream press?
The reality, however, is that journalists familiar with Mr. Kennedy’s past utterances on vaccines avoid him is because of his history of saying things that are blatantly wrong, and journalists who give him credence may well end up with egg on their face. This interview is a good example.
After five corrections of the blatant errors in Kennedy’s article, Salon also retracted it, explaining that critics’ exposure of further problems “further eroded any faith we had in the story’s value. We’ve grown to believe the best reader service is to delete the piece entirely.”
In the intervening years studies from all around the world looked at thimerosal in vaccines and did not find a link between it and autism. More recently see publications here and here. The global nature of these studies means that even if the CDC wanted to conspire to hide a link, it wouldn’t be able to, not without controlling the rest of the world. No serious scientific source today really thinks that the tiny amounts of thimerosal in vaccines (and as a reminder, all childhood vaccines, with the exception of multi-dose influenza, contain no, or almost no, thimerosal) causes autism or other neuropsychological problems – or any other serious, long-term harms. But Kennedy does. Because conspiracy.
RFK Jr vaccine statements are hostile, and also very, very extreme. In a famous quote, he said:
They can put anything they want in that vaccine and they have no accountability for it,[…] They get the shot, that night they have a fever of a hundred and three, they go to sleep, and three months later their brain is gone…This is a holocaust, what this is doing to our country.
Other than stating that I objectively support Dr. Summers’ statements and conclusions, I don’t have much else to say. But you and I know that an op-ed piece by a real doctor will be noticed by someone in the vaccine denier world, and they will pull out every single trope, myth, and conspiracy theory to claim that Dr. Summers is wrong and that there really is a “vaccines cause autism debate.”
I came across an article by Jeremy R Hammond in the right wing alternative news website, Personal Liberty, which attacked Dr. Summers with those aforementioned tropes, myths, and conspiracy theories. The same ones you’d see from any of your standard, run-of-the-mill vaccine denier.
Let’s take a look at Hammond’s article. Generally, I can only get through about half of an anti-vaccine article when I have to stop because I’m banging my head against the desk too much. I need to protect the neurons in my brain from further damage. But I will try to persevere in the name of science.
Robert F. Kennedy, Jr. and Robert De Niro just had a press conference to push their anti-vaccine nonsense on the public. This time, they’re offering US$100,000 to anyone who can show that mercury in vaccines are safe. Well, they can write me the check today, since there is NO mercury (really, there never was) in vaccines, so based on their lame accusations, it’s safe.
Robert F. Kennedy, Jr. and Robert De Niro just had a press conference to push their anti-vaccine bullshit on the public. This time, they’re offering US$100,000 to anyone who can show that mercury in vaccines are safe. Well, they can write me the check today, since there is NO mercury (really, there never was) in vaccines, so based on their lame accusations, it’s safe.
If you’re a regular reader of this blog, you know two things – my support for vaccines is unwavering, and my loathing of Donald Trump is unmatched by just about anyone in politics. Seriously, Trump makes me yearn for the days when George W Bush was running things. So when it comes to the future of vaccines and Donald Trump, I’ve reached a whole new level of abhorrence.
In case you’ve not kept up, let’s have a quick review of Donald Trump’s views on vaccines. They’re not good.
First, Trump has been tweeting about vaccines since 2012. He thinks that vaccines cause autism, and he’s been wrong on almost everything about them. He thinks that that children get too many vaccines, he’s wrong on that too, although if he has some medical background which he hid from the world, we’d be glad to hear what his research tells us about “too many vaccines.” He claims that doctors are wrong about vaccines. Oh really? Where’s the evidence.
I don’t know why I would ask for evidence from a man who spends almost all of his day denying evidence for most science.
Next up, Trump had a meeting with vaccine denier, Robert F. Kennedy, Jr., who, despite his family’s illustrious liberal name and support of science, wanted to work for Trump to investigate the safety of vaccines. Depending on the source, Trump either asked or didn’t ask Kennedy to chair a vaccine safety commission. We’re hoping Trump didn’t, but you never know.
Then, Trump named Tom Price to head the Department of Health and Human Services (HHS), which has the ultimate responsibility for America’s vaccine program. Price is a physician, which should be a good thing at HHS. Unfortunately, Dr. Price belongs to a radical, right wing physician’s group called the Association of American Physicians and Surgeons (AAPS). If you’ve never heard of AAPS, they are a politically conservative non-profit association founded in 1943 to “fight socialized medicine and to fight the government takeover of medicine.” Along with being opposed to many public health and right to healthcare issues, they’re not big fans of vaccines and mandatory vaccinations.
Given all of this bad news, where do we stand right now with regards to the future of vaccines and Donald Trump? Well, let’s get to the good news first. Because those of us who are appalled by Donald Trump need all the good news we can get.
Before we discuss the Trump administration’s actions on vaccines, let’s make sure everyone understands that the American public is not in sync with Trump’s views on vaccines. According to the Pew Research Center, 82% of Americans support requiring students in public schools to be vaccinated against measles, mumps and rubella with the MMR vaccine. Moreover, Pew found that about 88% of Americans say that the benefits of vaccines outweigh any risks – an overwhelmingly positive finding about the public perception of vaccines.
On the topic of the future vaccines and Trump, not only is he wrong about the science, but he’s way outside of the mainstream of American’s feelings about vaccinations. Since Trump seems addicted to polls, maybe he’ll see this Pew poll and let the CDC do its job with being encumbered by an anti-science directive. One can only hope. But we’ll circle back to the CDC in a couple of paragraphs.
Also on the “good news” side of things, during the confirmation hearing for Dr. Price, he was asked whether vaccines caused autism – his answer, “I think the science in that instance is that it does not,” was reassuring. Price also said that he would “make certain that factual informing (of public health issues) is conveyed to Congress and the president and the American people.”
Sadly, his comments about vaccines were sometimes less than “full-throated” support. When asked if he believed that the CDC (which is part of HHS) schedule (pdf) for vaccinations should be followed by parents, he answered, “I think that the science and healthcare has identified a very important aspect of public health, and that is the role of vaccinations.” It’s a good answer to some question somewhere, but it did not answer the question about the CDC schedule, which Trump thinks is wrong. I hope I’m not reading between the lines, but it is troubling to read these statements.
A few other pieces of good news should brighten our day with regards to vaccines. Andrew Wakefield has not been nominated to head the CDC. Of course, Trump hasn’t chosen anyone for Director as of yet.
And on the bad side of the news, the CDC seems to be under pressure to bend to Trump’s will. The CDC cancelled a conference on climate change and public health – climate change has a huge impact on public health, and the CDC should be at the forefront of the scientific information about it. Unfortunately, with a climate change denier in the White House, the CDC probably was under pressure to cancel.
I guess the news around the CDC is mostly bad these days.
As for the vaccine investigative commission (or whatever it will be called) that is supposedly going to be headed by Robert F Kennedy, Jr? Well, other than the flurry of reports when they met in early January, there hasn’t been a stitch of news since then – thus on our scale of no news is probably better than whatever horrible news we’ll get from Trump about the future of vaccines, this averages out to pretty good news. Right now, we don’t know anything, other than Kennedy and Trump met to discuss vaccines. There’s no word from the White House whether Kennedy will be heading up this investigation, even if there’s going to be an investigation into vaccines.
Right now, we’re not sure which way the wind is blowing on Donald Trump’s influence on the future of vaccines. Will the CDC quit promoting its vaccine schedule? Will Tom Price push his views about vaccines in a positive or negative way? Will Robert F. Kennedy Jr have a major role in what we perceive about vaccines? Will Trump change his mind and do nothing?
As with almost everything this administration has done, we expect the worst and hope for the best. Unfortunately, “the worst” keeps happening. But, so far, there’s nothing but rumors and suppositions about what will happen with vaccines. And for today, we’ll take that as hopeful. But I’m not sure what’s going to happen tomorrow or next week with regards to Donald Trump and vaccines. I’m hoping that the future of vaccines looks good, but I’ve got a bad feeling about this.
Now, you might be asking yourself, “self, why is this feathery dinosaur getting all cranky about whether these people are called skeptics or deniers?” Because skepticism, even to the lay person, implies that the person has some legitimate beef with the science of a topic based on a thoughtful and unbiased review of said science. That is actually the furthest thing from the truth for these so-called vaccine skeptics.
President-elect Donald Trump has met with Robert F Kennedy Jr., a notorious vaccine denier, today. The two will discuss “the issues pertaining to vaccines and immunizations.” And whatever tiny spark of hope that maybe Trump was pandering to the anti-vaccine wing nuts for votes has been put out with a bucket of water.
Trump himself shares many of the Kennedy’s anti-science beliefs on vaccines, including claiming that there is a link between vaccines and autism. During a 2015 GOP primary debate, Trump said
I am totally in favor of vaccines. But I want smaller doses over a longer period of time. Same exact amount, but you take this little beautiful baby, and you pump–I mean, it looks just like it’s meant for a horse, not for a child, and we’ve had so many instances, people that work for me. … [in which] a child, a beautiful child went to have the vaccine, and came back and a week later had a tremendous fever, got very, very sick, now is autistic.
One of the things I’ve learned, while fighting the good fight on science on the internet for over 20 years, when someone says “I am totally in favor of XYZ,” they generally will follow up with how they really aren’t. Trump does the same.
Outspoken vaccine critic Robert Kennedy Jr. has accepted a position within Donald Trump’s administration as chair of a panel on vaccine safety and scientific integrity — the clearest sign yet of the president-elect’s suspicions about vaccines.
The offer, which came in a Wednesday meeting between Trump and the scion of America’s most prominent Democratic family, is likely to concern scientists and public health experts who fear the incoming administration could give legitimacy to skeptics of childhood immunizations, despite a huge body of scientific research demonstrating that vaccines are safe.
Kennedy told reporters after the meeting,
President-elect Trump has some doubts about the current vaccine policies and he has questions about it. His opinion doesn’t matter but the science does matter and we ought to be reading the science and we ought to be debating the science. And that everybody ought to be able to be assured that the vaccines that we have — he’s very pro-vaccine, as am I — but they’re as safe as they possibly can be.
Yes, Mr. Kennedy the science dos matter and you are on the absolute wrong side of science. Face it, you’re a science denier on the facts of vaccines. Moreover, science is not subject to debate – either the evidence is solid or not, and you don’t debate. You provide scientific evidence equal to, or better than, the science presented that supports my understanding of vaccines. Claiming that yourself, or Donald Trump, are “pro-vaccine” falls on deaf ears when it’s clear that you will use any lame conspiracy theory, bad science or outright lies to support your point of view about vaccines.
Robert F Kennedy Jr – you are an embarrassment to liberal ideals on science. You are an embarrassment to the legacies of your father and your uncles. You’re just an embarrassment.
Now this science denying ignoramus might chair a panel to look at vaccine safety. Maybe I should hope that Kennedy gets shamed into accepting the scientific facts. But my hopes are starting to be delusions.
The President-elect enjoyed his discussion with Robert Kennedy Jr. on a range of issues and appreciates his thoughts and ideas. The President-elect is exploring the possibility of forming a commission on Autism, which affects so many families; however no decisions have been made at this time. The President-elect looks forward to continuing the discussion about all aspects of Autism with many groups and individuals.
So Trump may or may not set up this panel and may or may not appoint Kennedy to chair it.
Robert F. Kennedy Jr. told members of his environmental group late Wednesday that he expects to temporarily leave it to chair a vaccine safety commission he has been discussing with President-elect Donald Trump and his aides for more than a month.
So, RFK Jr has been discussing this panel for much longer than it appeared when this news first broke. And it kind of supports the notion that this will happen, causing unneeded confusion about the safety and effectiveness of vaccines, which is beyond dispute. At least beyond dispute of that uninformed, unscientific group.
I am not alone at being appalled by this turn of events. Nearly every scientific, medical and skeptical writer has expressed either shock, alarm, humor, or crying. Maybe all four at once.
Kennedy no longer represents liberal democrats to me. He’s an unscientific traitor.
Despite the consternation with Trump’s views on vaccines, we really should examine what he can and cannot do. Because other than the tweeting out his opinions about vaccines, which constitutes modern politics’ bully pulpit, what powers does Trump really have to modify or eliminate vaccines. The answer is somewhat complicated.