This article about ICAN and its anti-vaccine rhetoric about informed consent was written by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), who is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy, and the law.
Professor Reiss writes extensively in law journals about vaccination’s social and legal policies. Additionally, Reiss is also a 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 diseases. She is also a member of the Vaccines Working Group on Ethics and Policy.
In a misleading “White Paper,” the anti-vaccine organization, Del Bigtree‘s Informed Consent Action Network (ICAN) argued that “eliminating vaccine exemptions and curtailing criticism is unethical and un-American” because, they argue, it invalidates vaccination informed consent. The initial statement is wrong, and the arguments brought to support it are wrong. This article corrects the record.
ICAN anti-vaccine informed consent statement
The initial statement of the anti-vaccine group ICAN — “. . . eliminating vaccine exemptions and curtailing criticism is unethical and un-American. . .” — is wrong, and here are the facts:
- School mandates reduce the risk of outbreaks in schools and improve the safety of children and the community. Stronger mandates lead to fewer outbreaks (pdf). Parents misled by anti-vaccine misinformation do not have a protected right to make school less safe for other people’s children.
- Parents reserve the right to consent or refuse vaccines, but choices have consequences. An epilepsy patient refusing to take anti-seizure medication may be denied a driving license (which in many states would limit access to jobs, shopping, and more). The consequence of a parent’s choice not to protect their own children from diseases may be limits on their ability to send the child to school and risk others.
- The First Amendment prevents the government from curtailing speech, and the government has not acted to curtail anti-vaccine speech even to the extent allowed under the First Amendment.
- Private corporations can choose to act to limit the spread of anti-vaccine misinformation because anti-vaccine activists are not owed a platform. Setting the terms of using the platform is part of the freedom of speech of private corporations, also protected under American Law.
- Limiting the spread of anti-vaccine misinformation promotes – rather than undermines – informed consent. Misinforming people makes it harder for them to make informed choices.
ICAN’s arguments are incorrect
- As opposed to what anti-vaccine ICAN says, the pharmaceutical industry has strong incentives to assure vaccine safety. Here are a few key points:
- Vaccines are not licensed or recommended unless they meet a high level of safety. The FDA’s regulations for approving vaccines are difficult and do a good job at protecting us from harm.
- A vaccine shown unsafe can be taken off the market.
- While there are limits on pharmaceutical companies’ liability, they are not absolute. Ironically, the same people writing the White Paper claiming companies are immune from vaccines harms are litigating at least one case against a pharmaceutical company for vaccine harm.
- There is no barrier to using other tools available against pharmaceutical companies in the context of vaccines, such as criminal liability and other civil penalties mentioned in the White Paper. The authors cannot point to such examples not because the tools cannot be used, but because there was no basis to use them.
- There is no conflict built into handling alleged vaccine injuries. In fact, the handling of vaccine injury cases is done by separate units from those government agencies that license or recommend vaccines. It is also done through the Court of Federal Claims. It is a collaboration between a specific unit in the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) and is separate from the agencies handling vaccine safety. Further, attorneys’ fees and expert costs are covered (unlike in regular courts), and a GAO report found that attorney fees have increased in past years, so petitioners have access to representation covered by the state (pdf). The program provides extensive latitude for petitioners to provide documentation of their claims. In spite of the program’s comparatively low requirements, the rate of compensation is around one per million, most in settlements that do not show causation, reflecting the scientific evidence that vaccines are safe.
- HHS scientists have published multiple studies examining vaccine safety, and some of them have pointed to risks. When risks are there, studies raise them. Studies do not raise risks that are not there, nor should they.
- The anti-vaccine ICAN uses a 2000 report to claim members of the committee making vaccine recommendations – the Advisory Committee on Immunization Practices (ACIP) – have conflicts of interest. Since then, conflicts of interest rules have been tightened, and the claim is out of date. ICAN does not point to any recent evidence of conflicts of interest.
- HHS has engaged in extensive activities related to vaccine safety in the past decades. ICAN’s claim that HHS did not engage in such activities misrepresents a Freedom of Information Act (FOIA) settlement as showing otherwise when its focus was on administrative reports, not safety activity.
- Pediatric vaccines undergo years of testing and are subject to appropriate and thorough clinical trials. As pointed out by HHS, whether an inert placebo is required depends on the specific situation. The expert consensus is that vaccine testing is exemplary. The National Academy of Medicine recently explained that vaccines are tested more, not less, than other products.
- Adverse events listed in package inserts are not a good substitute for scientific evidence showing causation. ICAN suggests lists in inserts show just that. While the Code of Federal Regulations was changed in 2006 to require that only adverse events “for which there is some basis to believe there is a causal relationship between the drug and the occurrence of the adverse event” be listed many inserts written before that date make it clear they list events without regard to causality and using those lists to show causation is incorrect.
- VAERS reports do not show causation, and using the numbers to claim they reflect vaccine risks while ignoring the fact that they do not show causation, is misusing them, as the VAERS page itself states. In relation to a claim that only 1% of vaccines harms are reported, “This Week in Vaccine Hesitancy: April 26, 2019” explained:
The claim is based on a report analyzing a healthcare system’s possible use of electronic records in making reports to VAERS easier. Citations and rationale for the 1% figure are not given, so it is difficult to know where the number comes from.
Of note: the report analyzed health records from 2007 to 2010. Since then, VAERS has made online reporting easier, presumably to provide more data to health officials.
Finally, VAERS is only one out of four existing systems for monitoring vaccine safety, providing abundant information on vaccine risks.
- A federal system – the Clinical Immunization Safety Assessment Project – has as one of its goals to examine special populations, including those at high risk of vaccine harm.
- Vaccines are evaluated for carcinogenicity, mutagenicity, and infertility in preclinical studies. Most of the time, the evidence is that the risks of any of these vaccines are extremely low, and there is no need for follow-up in animal studies, so following those criteria, those are not done. But that is after an earlier evaluation.
- The reason health authorities point out that vaccines do not cause autism is that extensive data shows that. Only a minority of parents of autistic children still believe the claim of a link.
- The National Academy of Medicine, addressing the issue of a vaccinated v. unvaccinated study, Concluded it was unnecessary. The Institute explained:
Recommendation 6-2: The Department of Health and Human Services should refrain from initiating randomized controlled trials of the childhood immunization schedule that compare safety outcomes in fully vaccinated children with those in unvaccinated children or those vaccinated by use of an alternative schedule.
The committee also reviewed opportunities to study groups that choose not to vaccinate their children by use of a prospective cohort study design. However, such a study would not conclusively reveal differences in health outcomes between unimmunized and fully immunized children for two main reasons. First, the sample populations often suggested for study (such as some religious populations) may be too small to adequately power such a comparative analysis, particularly for very rare adverse health outcomes. Such a study would also need to account for the many confounding variables that separate these naturally occurring unimmunized populations from the average U.S. child, including lifestyle factors and genetic variables.
The committee finds that secondary analyses of existing systems are more promising approaches to the examination of the research questions that the committee identified in future studies of the childhood immunization schedule. The Vaccine Safety Datalink (VSD) is a useful collaborative project that could conduct both postmarketing surveillance and longer-term targeted research. The ability to augment routinely collected administrative data in VSD with data from parent interviews and reviews of medical records for a selected study population is an important strength.
- Measles is a dangerous disease.
- There is no good evidence showing that measles reduces rates of cancer or heart disease.
- As the World Health Organization points out, the MMR vaccine is very safe. The balance of risks between MMR and measles clearly supports vaccinating.
- Most measles cases are in unvaccinated individuals, many of whom are children, and not the result of waning immunity.
- The pertussis vaccine is not perfect, but it reduces the risk of outbreaks and provides much better protection than not vaccinating. ICAN misrepresents at least one study which compares getting the DTaP vaccine to getting the older DTP vaccine, not to being unvaccinated, and says children who got DTaP will be more susceptible than children who got DTP to pertussis, not children who got no vaccines at all.
- For polio, the inactivated polio vaccine (IPV) also reduces the spread of the disease, if less effectively. There is no basis for claiming the vaccinated are more likely to spread it. In fact, IPV reduced polio dramatically in the United States before the introduction of the oral polio vaccine (OPV) and led to stopped transmission in other countries. OPV is more effective at reducing transmission, but IPV reduces it too, and the claim that vaccination increases the risk is incorrect.
- Transmission of chickenpox by vaccinated children is extraordinarily rare and requires the presence of open lesions. On the other hand, unvaccinated children are at much higher risk of getting the wild virus and when they do, spread it broadly. While there is no complete data on the duration of immunity from the chickenpox vaccine, existing evidence suggests that it offers long-term protection. Using children as human boosters to prevent adults from getting shingles is not only problematic ethically, the evidence is that the rise in shingles is not related to vaccinating. Using the UK as an example, each year in the UK children die from chicken pox (an average of 20 per year); it is not clear why that is a good model to follow.
- Scientific discussions of vaccine ingredients can be found here.
Anti-vaccine ICAN used fear, uncertainty, and doubt in trying to make it appear informed consent does not exist or is used to misinform parents. In fact, science and evidence dispute these claims.