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.
About two years ago, California’s governor, Jerry Brown, signed SB277 into law, which mandated that all school age children must have all vaccines appropriate for their age before they could enter private or public schools. The law nearly eliminated the ability to get personal belief exemptions (PBE), which allowed parents to object to vaccinations for almost any reason. The new law does allow for medical exemptions, that is, children who have some medical condition that contraindicates a vaccine may be exempted from these rules. As a result of this law, it was predicted that the California vaccine uptake for school age children would increase substantially, while reducing the incidence of vaccine preventable diseases.
Those of us who have been keen observers and supporters of SB277 were hoping for the best – that the vaccination rate in the state would show increases quickly. And it did.
Data released this week (pdf), from the California Department of Public Health, showed an exceptional increase in the percentage of California’s kindergarteners who were fully vaccinated (for their age group) – it rose from 92.8% to 95.6%. But, there’s even more astonishing data underneath that. With the advent of the new law, 97.3% of California’s kindergartners have received both MMR vaccinations, up from 94.5% in 2016 and 92.6% in 2014. The same was shown for diphtheria, tetanus and pertussis (whooping cough) vaccine – it went from 94.2% in 2015 to 96.9% in 2016. There should be cheering in the streets of California for the success of SB277.
The increase in vaccine uptake for all mandated vaccines is dramatic – not only does it show that SB277 has stemmed the overuse of personal belief exemptions that was slowly reducing California vaccine uptake, but it also has increased that uptake to levels far above historical. This graph illustrates how well the law has worked in a short period of time:
The best part of the law is that it’s increasing vaccine uptake in areas of the state where the overuse of PBEs was pushing the vaccination rate down. Most California’s counties have vaccination rates above 95%, which is considered the level at which the herd effect for measles vaccinations prevent the rapid spreading of the disease. Furthermore, only 4 relatively small counties in California have rates below 90%.
California state Senator Richard Pan (D-Sacramento), who is also a pediatrician and who was one of the primary supporters of SB277, tweeted out “Great News.” Obviously he’s ecstatic with this data on California vaccine uptake across the state.
Dr. Pan was interviewed by the Los Angeles Times, and said,
Measles certainly hasn’t gone away. We need to be sure to have our immunization levels high enough. The fact that this class and the state overall has now achieved this level is one further step to restore the community immunity we had before.
He also noted that the data shows the significant increase in very young children, kindergartners. He mentioned that there are still significant number of older children who are not vaccinated because of the lax requirements in previous vaccine laws, which made PBEs very easy to get. SB277 also requires 7th graders to be completely up-t0-date on their vaccines, so all children should eventually be caught up with their vaccines. Unfortunately, many students who have passed that 7th grade vaccination checkpoint may be insufficiently vaccinated. Or not vaccinated at all.
The University of California (UC) system has stated that it will require vaccines for all new enrollees at its 10 campuses (along with the UC Hastings College of Law which has decided to comply with the UC requirements). Like the state law, it eliminates all personal belief exemptions, but does allow medical ones. Eventually, this mandate will cover the over 230,000 students in the system.
There are reasons to cheer all of this news out of California regarding immunization rates. But that’s just one state, albeit the largest and arguably the most influential state in the country. Other than California, only two other states have laws that have eliminated personal belief exemptions for immunizations – Mississippi and West Virginia, both of which have high vaccine uptake. And the easy availability of personal belief exemptions have lead many states to have vaccination rates of the MMR vaccine that are far below the 95% target. This graphic shows which states have significant deviations from the 95% standard for MMR vaccine (thanks to BuzzFeedNews):
Sadly, it may not be possible for a lot of states to copy California’s success with vaccines. One of the worst performing states for the MMR vaccine is Colorado, and, according to BuzzFeed News,
Vaccine advocates in Colorado are envious of their counterparts in California. “We are watching California very closely, and kudos to them for getting that bill through,” Stephanie Wasserman, executive director of the Colorado Children’s Immunization Coalition, told BuzzFeed News.
She believes it would be very difficult to enact similar legislation in Colorado, which has libertarian conservatives who reject government mandates on vaccines, as well as liberal enclaves like Boulder where many parents seek out alternative health care and see vaccines as a tool of Big Pharma.
Libertarian conservatives and liberals on the same side of the fence on vaccines? The problem with both groups is that they ignore the health of children just to be “politically virtuous” about vaccines. Except they are scientifically and medically wrong.
So let’s give an ovation for hard working politicians of California, who decided that the health of the state’s children was the paramount consideration for vaccinations. Dr. Pan and many other state legislators decided that the most effective way of increasing the California vaccine uptake was to reduce the availability of personal belief exemptions. And they were right – California’s immunization rate has increased appreciably because of SB277.
The issues with the pertussis vaccine waning effectiveness has been circulating for several years. There have been a number of well-designed studies that have provided evidence of the issues with the pertussis component of the DTaP or Tdap vaccine (which also provides immunization against tetanus and diphtheria, both dangerous diseases).
According to current research, individuals who have been vaccinated against whooping cough (Bordetella pertussis), with either the DTaP (version for usually for children) or Tdap vaccine, lose protection against whooping cough in some time period after being vaccinated.
A new article, published in Pediatrics, written by Nicola P Klein et al., examined children who received the Tdap vaccine in the Kaiser Permanente Northern California (KPNC) health care plan, a vertically integrated managed care system which closely tracks patients after vaccination. Their data provide important information about the strategies for the vaccine going forward.
1 or 2 in 100 (1.6%) will have convulsions (violent, uncontrolled shaking)
Two thirds (67%) will have apnea (slowed or stopped breathing)
1 in 300 (0.4%) will have encephalopathy (disease of the brain)
1 or 2 in 100 (1.6%) will die
Whooping cough can be easily prevented by the DTaP or Tdap vaccines (which also protect against tetanus and diphtheria). The vaccines can be given to infants as early as 6 weeks to 2 months old.
As with all medical procedures, there are some adverse effects with the pertussis vaccines. Moderate adverse effects from the vaccine occur in about 1 in 10,000 (or even fewer) injections. The most severe effects, which may or may not be causally related to the vaccine since the rate is so low, are in the range of 1 out of a million doses.
Of course, these outbreaks and epidemics have lead to the “blame game” from the antivaccination cult, because they have claimed that since A) most kids are vaccinated, and B) we’re having this outbreak, then C) either the vaccines are useless or are actually the cause of the outbreak. Seriously. They blame the vaccines.
Since this outbreak will undoubtedly lead to the typical antivaccine rhetoric about the whooping cough vaccines, DTaP or Tdap (which also protect against tetanus and diphtheria), I decided to search the internet to find the most popular vaccine denialist arguments regarding pertussis vaccinations–then debunk them. Hopefully, this will be useful for those who are observing what’s going on in Reno.
According to the California Department of Public Health, infants who are too young to be fully immunized or those who are not vaccinated are most vulnerable to severe and fatal cases of pertussis. In 2014, 66 of the pertussis hospitalizations cases were children four months of age or younger. Two infants have died of pertussis in California during 2014. Continue reading “Why we vaccinate–to protect our children from pertussis”
Given the 95% vaccine uptake rate, it begs the questions of why I push so hard for vaccination–because I want to protect the lives of children, and those 5% who aren’t vaccinated are at risk of serious disease and even death. And vaccines are the safest way to protect a child–protect them from death.
Nearly 55% of the readers of this blog are not American (a couple of years ago,this blog got a regular reader from Iran, which meant that all countries were represented amongst this blog’s readers). I have been accused of being a bit American-centric, but at the same time, I was also curious about vaccine uptake worldwide. Continue reading “Worldwide vaccine uptake-2014”
One of the important hypotheses of vaccination is to make sure that all family members or others who may encounter a newborn child be vaccinated, especially since many vaccinations are not indicated for infants for a couple of months after birth–those newborns are very susceptible to vaccine preventable diseases until they themselves are vaccinated with the DTaP vaccine (which also protects against tetanus and diphtheria).
This protective “cocoon,” especially important with whooping cough (Bordetella pertussis), theoretically blocks the transmission of the disease to a newborn by creating a protective circle of vaccinated individuals around the newborn. A teenage sibling could catch the disease and accidentally infect the infant. Pertussis is bad enough for a teenager, but it can be deadly to a baby.
Whooping cough can be easily prevented by the DTaP or Tdap vaccines (which also protect against tetanus and diphtheria), which can be given to infants as early as 6 weeks to 2 months old.
According to the CDPH, infants who are too young to be fully immunized or those who are not vaccinated are most vulnerable to severe and fatal cases of pertussis. In 2014, 66 of the pertussis hospitalizations cases were children four months of age or younger. Two infants have died of pertussis in California this year.
Of the 2,649 cases so far this year, 83% have occurred in infants and children younger than 18 years of age. Of these children, 8% were younger than 6 months old, and 70% were 7 through 16 years of age. In other words, all children are susceptible to the disease.
Sonoma County–83.28 (incidence rate per 100,000 residents)
City of Berkeley–18.24
For those of you who do not live in California, these are some of the wealthiest, most educated counties in the country, let alone California. Marin County is one of the whitest, wealthiest (a median income over US$113,000), best educated, and most liberal (nearly 75% of the county voted for Barack Obama). Sonoma, Napa, Trinity, Humboldt and Tehama counties, along with the City of Berkeley, are very similar in socioeconomic makeup.
These constitute probably the largest pockets of vaccine denialism, which is demonstrated by the unusually high incidence of pertussis versus the statewide incidence rate of the disease of 6.93. This provides me, at least, with additional evidence that liberals can be as anti-science as right wing fools. Vaccines are safe. Vaccines prevent diseases like pertussis which can kill children. I’m not sure why the parents in these areas miss these basic points, But these pockets of hostility towards vaccines will be ground zero for any future epidemic in other diseases like measles or chickenpox.
As a reminder, the CDPH makes these recommendations about vaccinating against pertussis:
Pregnant women receive a pertussis vaccine booster during the third trimester of each pregnancy, even if they’ve received it before.
Infants be vaccinated against pertussis as soon as possible. The first dose is recommended at two months of age but can be given as early as 6 weeks of age during pertussis outbreaks. Children need five doses of pertussis vaccine by kindergarten (ages 4-6).
California 7th grade students receive the pertussis vaccine booster as required by state law.
Adults receive a one-time pertussis vaccine booster, especially if they are in contact with infants or if they are health care workers who may have contact with infants or pregnant women.
These two babies would not have died, if they had been vaccinated (along with anyone in close contact) against whooping cough. A simple, effective, extremely safe vaccine. Are parents’ ignorance of scientific facts an excuse for these dead babies? Not in my world, where protecting children from harm should be a primary goal of society.