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Home » Debunking RFK Jr and Hooker’s book “Vax-Unvax” – Part 8, DTaP vaccine

Debunking RFK Jr and Hooker’s book “Vax-Unvax” – Part 8, DTaP vaccine

This article, part 8, the DTaP vaccine, of a series of 8 debunkings of a new book, “Vax-Unvax: Let the Science Speak” is written by Frank Han, M.D., an academic board-certified pediatrician/ pediatric cardiologist. He splits his time between cardiac imaging (Nuclear, CT, MRI, and echocardiography), inpatient cardiology, and outpatient cardiology. He primarily cares for cardiology patients of all ages with congenital heart disease and is dedicated to educating pediatric residents and medical students.

While completing his pediatric residency at Connecticut Children’s Medical Center, Dr. Han became aware of and interested in the incursion of pseudoscience into his chosen profession and saw it explode during the COVID pandemic. He has since focused his efforts on spreading the joy of science literacy and teaching patients how to take charge of their health while navigating the tricky online world of medical information. Dr. Han has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @Han_francis. The comments expressed by Dr. Han are his own and do not necessarily represent the views or opinions of OSF Medical Center, or the University of Illinois College of Medicine.

As I did in Part 1Part 2Part 3, Part 4, Part 5, Part 6, and Part 7 of this series, I will emphasize one chapter of the book “Vax-Unvax: Let the Science Speak,” by Robert F Kennedy Jr and Brian Hooker. This chapter focused on the DTaP vaccine for diphtheria, tetanus, and pertussis (whooping cough) and its predecessor vaccine.

In Part 8, I will review how the authors focus on one particular effect of a vaccine that is no longer used in the United States, to cast doubt on the entire pediatric vaccination program. They hope you didn’t notice that the version of the vaccine that has this effect, has been retired from the United States for a very long time. In the United States, even if the vaccine effects were correct as described in this chapter and applicable to American children, they wouldn’t be relevant because the DTwP vaccine (also known as the DPT vaccine which is the predecessor to the current DTaP vaccine) has been off the market since 1996.

DTaP vaccine

Introduction to DTaP and DTwP vaccine

While several articles are cited in this book chapter, they generally focus on the concept of vaccines causing effects that aren’t isolated to the original target disease. I will therefore spend this debunking focused on the concept of “Nonspecific effects” of vaccination.

As is typically true for many allegations made in this book, the claims about the DTwP (old diphtheria, tetanus, and whole cell pertussis vaccine) and its nonspecific effects are based in a kernel of reality – but the conclusions arrived at by Kennedy and Hooker are way out in left field. An in-depth dive into all the literature on this subject can be referenced in the vaccine textbook by Dr Stanley Plotkin

What is a vaccine nonspecific effect?

The nonspecific effects of vaccines were noticed as early as the 1800s when smallpox vaccination delivered unexpected positive results in the ability to be less susceptible to unrelated illnesses, some of which were not even infectious.

The nonspecific effects of vaccines are different from common vaccine reactions such as fever/chills, and different from the cross-protection sometimes given by vaccines against related pathogens. One example of a nonspecific effect of a vaccine is the BCG vaccine (for tuberculosis), which is used as an adjuvant therapy for the treatment of bladder cancer.

Where does the evidence for a nonspecific effect come from

The two authors most heavily cited in the book chapter, Aaby and Stabell-Benn, focus on the negative nonspecific effects, specifically an increase in mortality seen in girls more than boys, and in non-live vaccines when given after live vaccines in their primary population of study, children in Guinea-Bissau.

Naturally, these studies are highly advertised by the anti-vax community, because they carry the weight of an academic university finding a possible negative consequence of a vaccine. However, the people who advertise these studies don’t thoughtfully think through their problems. The studies that advertise the nonspecific effects are mostly retrospective/ database studies, introducing several biases.

To give credit where credit is due, the World Health Organization did withdraw its recommendation for an older iteration of the MMR vaccine with a higher measles dose, specifically due to its nonspecific effects of increased mortality in girls (despite the effect being linked to DTwP with later studies). Naturally, the book authors gloss over this vaccine withdrawal as the WHO cannot do anything good in their minds.

Problems with accepting nonspecific effects at face value

One such bias is healthy vaccinee bias, meaning that healthy people are more likely to be vaccinated, and people with illnesses are more likely to postpone vaccination. Another bias not thoughtfully accounted for by the book authors is survival bias, meaning for those children who are deceased, vaccine records are less likely to be available (especially in low-income nations with more spotty documentation than in high-income nations). 

While it’s not the central focus of this chapter, there has been a large meta-analysis done on the effects of vaccines on allergies – and there is no effect of vaccines on allergies. Since this study is contrary to the central narrative of the chapter on the nonspecific effects of vaccines, it is glossed over. 

The strongest evidence for vaccine claims comes when the epidemiologic and basic science data speak to the same conclusion. Therefore, it is indeed worthwhile to examine if immunological data are backing up the central claims in this chapter. Two general immunological principles can partially explain nonspecific effects – antigen cross-reactivity and bystander activation of unrelated B/T lymphocytes.

Cross-reactivity means that something in the body is erroneously recognized as foreign because it is too similar to an infectious agent. One example of this disease process is rheumatic fever, caused by streptococcus bacteria, which can cause serious heart complications since the bacteria’s antigens are similar to ones on the mitral valve. The immune system cross-reacts with both the bacteria and the mitral valve.

Bystander activation refers to the ability of one infection to activate lymphocytes dedicated to another infection. For example, immunization with tetanus toxoid has been shown to generate protective antibodies (made by B cells) against other infections.

When one tries to search for molecular evidence backing up the claims of Aaby and Stabell-Benn, specifically for the DTwP vaccine, that evidence is very sparse and hard to come by.   In addition, the World Health Organization looked at the studies cited in this chapter and conducted its own literature review – finding that the study results are not strong enough to warrant refraining from providing DTP vaccination. 

Possible future directions for the DTaP vaccine

A type of study that would indeed bring resolution to part of this debate is a randomized controlled prospective trial, but it must be done according to ethical standards. Specifically, one could not just randomize people in a low-income, high TB prevalence country to the BCG vaccine versus no BCG vaccine as this would expose an unacceptably large group of people to TB infection.

In the meantime, the book’s authors fail to demonstrate an understanding of the clinical relevance and magnitude of the effect of the nonspecific effects of vaccines. While the debate on nonspecific effects continues, there is no debate as to the relevance of providing protection against diphtheria, pertussis, and tetanus – which decreases mortality, hospitalization, and morbidity in every population where it was studied. 

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