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Cover story articleAnti-vaccination movement

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Fears about vaccines were excusable when they were new, but present concerns are groundless.
Needles are scary


Icon vax.svg
Pricks against pricks
If you really, genuinely believe that 99% of doctors in this country are dishonest, then you need to see a doctor, ironically.
—Jimmy Kimmel on anti-vaxxers[1]

The anti-vaccination movement is a loosely organized conspiracy theorist subculture which blames the medical practice of vaccinations for a wide range of health problems. The movement, to a large majority led by people with no medical or scientific qualifications (or, ironically, stripped credentials), is based largely on spuriously alleged short- and long-term side effects of vaccination. Effects which are — to boot — often trivial when compared to the severity of what were once common illnesses.

Since the argument is made that vaccines are deadly poisons (and that this ought to be "considered completely proven" to anyone but a shill), yet the anti-vaccination movement fails to gain traction outside of social media, then by necessity they argue that some kind of cover-up must be taking place, that the vaccines serve an agenda completely different from disease prevention,[2] or that the anti-vaccination "whistleblowers" are being kept down by some sort of shadowy power. This, of course, makes perfect sense.

It is important to realize that the notion of a scaremongering opposition to vaccines is antiquated rather than novel, and that the iteration of this movement that we're stuck with today is not responding to any current, new (or real) danger. The original anti-vaccination movement sprung up very soon right after the first vaccine had been invented by Edward Jenner[wp] in 1798. "Vacca", being latin for "cow", is what gave the new invention, the vaccine, its name - and as early as in 1802, just four years later, forerunners to the modern anti-vaccination movement literally claimed that getting the smallpox inoculation would turn you into a cow.[3] While vaccines have since improved from Jenner's primitive proof-of-concept to the modern medical science we reap the benefits of today, the anti-vaccination movement hasn't smartened up noticeably from the level held by their predecessors in the days of Jenner.

In recent times, there has been much debate in the press and in the doctor's office regarding what possible side-effects vaccines cause and whether these outweigh the risks of leaving a population without a vaccination schedule. Vaccines have been alleged to cause all manner of illnesses; autism is a prominent example, as its direct causes are still fairly mysterious and probably very wide-ranging, with no single cause or lifestyle risk-factor being identified. Some prominent Americans have spoken out vociferously about the supposed danger of vaccines.[4]

The mechanisms for claimed health problems are rejected or have not been explained by current scientific research. Vaccine-preventable diseases have been a major cause of illness, death, and disability throughout human history. The advent of the modern vaccine era has changed this significantly; most North Americans and Europeans have little memory of a pre-vaccine era where diseases such as mumps and measles — to say nothing of smallpox or polio — were common and often deadly.

In the United States, many state laws support an individual (or parental) right to choose whether to be vaccinated against any disease. Forty-eight states allow religious exemptions for compulsory vaccination as of 2014, and twenty states allow exemptions on philosophical or personal objections to vaccination.[5]

John D. Grabenstein wrote an extensive analysis on parents' religious exemptions for vaccines versus what a wide-range of religions actually say. His analysis found that there were "few canonical bases for declining immunization, with Christian Scientists a notable exception." Parents claims for religious exemption were usually based on fears rather than specific religious tenets.[6][7]


[edit] Premise to anti-vaccination

There's a small, but still sizeable group of people who are choosing not to vaccinate their children. Here in LA, there are schools in which 20% of the students aren't vaccinated, because parents here are more scared of gluten than they are of smallpox! And, as a result, we now have measels again.

I know if you're one of these anti-vaccine people you probably aren't going to take medical advice from talkshow hosts — I don't expect you to, I wouldn't either — but I would expect you to take medical advice from almost every doctor in the world. See, the thing about doctors is they didn't learn about the human body from their friend's Facebook page. They went to medical school, where they studied all sorts of amazing things, like how to magically prevent children from contracting horrible diseases by giving them little shots. You know these little shots of Botox? Which is Botulinum toxin[wp], by the way? You get in your face to make your head look smooth and your eyes look crazy? A little shot, like that, and "poof!" — polio is gone.

But some people did not buy into that, because they did a Google search, and Jenny McCarthy popped up. And she had clothes on, so they listened to what she had to say, and decided not to vaccinate their kids. And by the way, this would all be OK if your kids were the only ones affected — they're your kids. But they're not, because unvaccinated kids put all children in danger, especially babies who are too young to get the vaccination shot... But of course, that's according to doctors, so - you know, take that with a grain of salt.
—Jimmy Kimmel, A Message for the Anti-Vaccine Movement[8]

There are many ideas which are not supported by reviewed and accepted scientific evidence that vaccines are inherently harmful. For example, it is claimed that specific vaccines such as MMR (mumps, measles and rubella), or specific ingredients like thiomersal are causative factors leading to disease. Some claims are more vague, based on the feeling that vaccines are "unnatural," that they are somehow "useless," or that the diseases they prevent "aren't that bad anyway." Anti-vaccination campaigners often use the language of being for "freedom" in whether to be vaccinated, such as with MMR, where the campaign was the "choice" to take a non-combined vaccine. These beliefs often stem from other ideological positions; for instance, vaccination programs are seen as excessive government interference, or as an implementation of socialized medicine, although it's hardly just a conservative thing, as a look around The Huffington Post will tell you, and New Age woo is another reason some oppose vaccines. Similarly, those against "artificial" interference will also shun vaccination regardless of efficacy. It could be argued that these ideologies are the root causes of anti-vaccination positions, and bias which specific concern an individual will be attracted to.

There are, of course, well developed published data on the complication rates of vaccines and these data play an essential role in the approval process vaccines must pass in order to be licensed for sale, and recommended for use.[9] When faced with this, anti-vaccination activists often argue that the reporting system is not robust enough, resulting in these figures being misleading. The reality is that unexpected side-effects can occur, just as a parachute may fail to open, but the regulatory process ensures that such events are rare and within a risk boundary that means vaccination is statistically safer than non-vaccination.

For vaccination recommendations by governments or advisory institutions (ie. the World Heath Organization) to change to an anti-vaccination stance, it must be fully demonstrated that the harms caused directly by the vaccine are greater than the harms caused by withholding the vaccine from circulation. This needs to be demonstrated at a population level, with solid and significant statistics.

[edit] Additional causes of confusion

Because of stories like Andrew Wakefield's discredited study, wrongly linking vaccines and autism, and the news media's obsession with pictures of crying, terrified children being poked with needles, people are nervous about vaccines.
—Joe Hanson, doctor of biology and host of It's Okay To Be Smart[10]

It is an unfortunate but sad truth that uninformed parents will very often click on shiny, flashy, "attention grabbing" blog posts like this,[11] as opposed to "boring", "unexciting" peer-reviewed research articles such as this.[12]

A major cause of confusion among anti-vaxxers is the utter lack of understanding the difference between actual research and woo that someone wrote on their blog. Having little to no understanding of science or the scientific process, a parent is all-too-often more likely to trust something that entertains them even while it scares them. While this is no doubt also propagated by the media, there is a key element of human behavior at play here as well. Much of the anti-vaccine movement's successes lie more with how they present their "arguments" rather than what they're actually saying.

For example, if a television network were to create an anti-vaccine special in which they used a deep-voiced narrator, ominous music, and anecdotal cases of autism that fail to provide a causal link to vaccines, parents' minds would likely be swayed long before they cut to a commercial break following the narrator saying, "Find out what happens next when Billy gets his shot. You won't be able to believe your eyes. All this and more when we return to Vaccines: the deadly poison."

[edit] Religious fearmongering

The anti-vaccination movement also contains a significant religious element. The damage done to the lives of innocent human beings, especially the poorest and hardest stricken, by this anti-scientific movement is both remarkable and heartbreaking. As related by the late Christopher Hitchens;[13]

In the fall of 2001 I was in Calcutta with the magnificent photographer Sebastião Salgado, a Brazilian genius whose studies with the camera have made vivid the lives of migrants, war victims, and those workers who toil to extract primary products from mines and quarries and forests. On this occasion, he was acting as an envoy of UNICEF and promoting his cause as a crusader — in the positive sense of that term — against the scourge of polio. Thanks to the work of inspired and enlightened scientists like Jonas Salk, it is now possible to immunize children against this ghastly malady for a negligible cost: the few cents or pennies that it takes to administer two drops of oral vaccine to the mouth of an infant.

Advances in medicine had managed to put the fear of smallpox behind us, and it was confidently expected that another year would do the same for polio. Humanity itself had seemingly united on this proposition. In several countries, including El Salvador, warring combatants had proclaimed cease-fires in order to allow the inoculation teams to move freely. Extremely poor and backward countries had mustered the resources to get the good news to every village: no more children need be killed, or made useless and miserable, by this hideous disease.

Back home in Washington, where that year many people were still fearfully staying indoors after the trauma of 9/11, my youngest daughter was going dauntlessly door to door on Halloween, piping "Trick or Treat for UNICEF" and healing or saving, with every fistful of small change, children she would never meet. One had that rare sense of participating in an entirely positive enterprise.

The people of Bengal, and particularly the women, were enthusiastic and inventive. I remember one committee meeting, where staunch Calcutta hostesses planned without embarrassment to team up with the city's prostitutes to spread the word into the farthest corners of society. Bring your children, no questions asked, and let them swallow the two drops of fluid. Someone knew of an elephant a few miles out of town that might be hired to lead a publicity parade. Everything was going well: in one of the poorest cities and states of the world there was to be a new start.

And then we began to hear of a rumor. In some outlying places, Muslim die-hards were spreading the story that the droplets were a plot. If you took this sinister Western medicine, you would be stricken by impotence and diarrhea (a forbidding and depressing combination). This was a problem, because the drops have to be administered twice—the second time as a booster and confirmation of immunity and because it takes only a few uninoculated people to allow the disease to survive and revive, and to spread back through contact and the water supply. As with smallpox, eradication must be utter and complete.

I wondered as I left Calcutta if West Bengal would manage to meet the deadline and declare itself polio-free by the end of the next year. That would leave only pockets of Afghanistan and one or two other inaccessible regions, already devastated by religious fervor, before we could say that another ancient tyranny of illness had been decisively overthrown.

In 2005 I learned of one outcome. In northern Nigeria — a country that had previously checked in as provisionally polio-free — a group of Islamic religious figures issued a ruling, or fatwa, that declared the polio vaccine to be a conspiracy by the United States (and, amazingly, the United Nations) against the Muslim faith. The drops were designed, said these mullahs, to sterilize the true believers. Their intention and effect was genocidal. Nobody was to swallow them, or administer them to infants.

Within months, polio was back, and not just in northern Nigeria. Nigerian travelers and pilgrims had already taken it as far as Mecca, and spread it back to several other polio-free countries, including three African ones and also faraway Yemen. The entire boulder would have to be rolled back right up to the top of the mountain.

[edit] Anti-vaccination proponents

[edit] People

[edit] Groups

[edit] Conclusions

Vaccines are victims of their own success.
—Science writer Seth Mnookin, on how people have forgot what now-cured diseases were like[47]

Despite the hysteria and media coverage, the only serious medical condition ever linked to a vaccine was specific to the virus strain used in the manufacture of the vaccine. In fact, epidemiological evidence shows that vaccines prevent a huge burden of disease and death in the world. Despite this, there is still a level of concern regarding vaccines. Public education about vaccines and health must continue, and we must continue to provide everyone with the rigorous scientific education needed so that they may avoid making vital public-health related decisions based on misconceptions and lies.

[edit] The science of vaccination

A system that's based on people voluntarily using their bodies to protect other vulnerable people.
—Author Eula Biss, on how getting vaccinated is one of the most empathetic things we can do[48]

[edit] Origins of vaccination

A Song Dynasty (960–1279 CE) chancellor of China, Wang Dan (957–1017 CE), lost his eldest son to smallpox and sought a means to spare the rest of his family from the disease, so he summoned physicians, wise men, and magicians from all across the empire to convene at the capital in Kaifeng and share ideas on how to cure patients of it until a man from Mt. Emei spread knowledge about inoculation.[49] The first clear and credible reference to smallpox inoculation in China comes from Wan Quan's (1499–1582 CE) Douzhen xinfa (痘疹心法, Philosophy on Poxes) of 1549 CE, which states that some women unexpectedly menstruate during the procedure, yet his text did not give details on techniques of inoculation.[50]

Inoculation was reportedly not widely practiced in China until the reign of the Longqing Emperor (reign 1567–1572 CE). From these accounts, it is known that the Chinese banned the practice of using smallpox material from patients who actually had the full-blown disease of Variola major (considered too dangerous); instead they used proxy material of a cotton plug inserted into the nose of a person who had already been inoculated and had only a few scabs.

[edit] Known side effects

Adverse reactions to the HPV vaccine Ceravix, reported between April 2008 and 23 September 2009. Very few, and fairly mild.

To put it simply: complications are more likely to arise from illness than from vaccination.

What this means is that the benefits of vaccination outweigh the risks, by far, in every case.

Most commonly used vaccines have a statistical risk of severe complications; however, the actual risk is ridiculously low. With respect to milder complications, it's often difficult to tell if the vaccine actually was the cause as the nocebo effect can be very strong with injections.

The current impact of vaccines on health is very simply stated by the CDC.[51]

Children who get measles have a 1 in 20 chance of developing a serious complication; however, serious complications from the vaccine number 1 or 2 per million, according to the Institute for Vaccine Safety at Johns Hopkins University.[52] Based on historical analysis of measles-infected vs. measles-vaccinated children, a 2015 analysis reported that it is likely that there is a long-term immuno-suppression caused by measles infection that increases the likelihood of fatality from other diseases.[53][54]

Before the introduction of measles vaccination, there were about half a million cases per year in the United States, while only 89 cases were diagnosed in 1998.[52] Historically, the mortality rate for measles in the U.S. was about 1 to 3 deaths per every 1000 cases, with young children suffering the highest mortality rates.[55] Most deaths occur as a result of pneumonia or encephalitis.[56]

After the introduction of polio vaccination, cases in the United States decreased from almost 30,000 in 1955 — many of which led to paralysis or death — to 910 cases by 1962. New cases of polio in the U.S. are now a thing of the past.[52] Of the two types of polio vaccine, the oral vaccine, while effective, is the less safe of the two. As there are no more naturally acquired cases in the U.S., the oral vaccine had become the only cause of polio (8-9 cases). Since the vaccine risk, however small, eventually exceeded the disease risk, the oral vaccine was abandoned in favor of the killed vaccine. In regions where polio is still a major problem, the oral vaccine is still a better choice, as it can enter the water supply and vaccinate others passively. In regions with high HIV rates, this may be less true, as live vaccines are usually avoided in patients with compromised immune systems.

According to Willem van Panhuis et. al. 2013, "a total of 103.1 million cases of these contagious diseases have been prevented since 1924 on the basis of median weekly prevaccine incidence rates."[57]

In Britain, there was concern in the early 70s about the pertussis vaccine, where it was blamed for several cases of encephalitis. Despite the connection never being proven outright, vaccination rates still dropped from 77% to 39%. Following this drop in immunization, the UK was hit by two large whooping cough epidemics (one in 1978, and another in 1982), both of which resulted in many deaths.[52][58] Unfortunately, these sorts of consequences from vaccine denial aren't confined to history; whooping cough also hit the American northwest, generating one of the worst outbreaks in 70 years, with a 1300% increase in cases in 2012 entirely blamed on recent hysteria over vaccines.[59]

The rates of complication from vaccines are so low that the benefit of vaccines for each individual child is higher than the risk of a poor outcome, so it is not true that the few children with adverse events are being sacrificed for the health of others. Nonetheless, in the United States there is legal recognition of the potential for adverse effects from vaccines, which are handled by the Office of Special Masters of the U.S. Court of Federal Claims ("vaccine court").[60] This court uses a no-fault compensation program based on a vaccine injury table[61] that is regularly reviewed by the Institute of Medicine.[60]

[edit] Disease vs vaccine

Measles, Mumps, and Rubella vs. the MMR vaccine
Complication rates per infection Complication rates per injection


  • Pneumonia: 60,000 per 1,000,000[62]
  • Encephalitis: 1,000 per 1,000,000[62]
  • Corneal lesions: Leading cause of blindness in developing countries.[63][64]
  • Death: 2,000 per 1,000,000[62]
  • Incidences:
  • Reported: 500,000 cases per year in the U.S. (about 0.3%), population approx 190,000,000[65]
  • Estimated: 3-4,000,000 cases per year (about 2%)[65]

MMR Vaccination:

  • Possibly vaccine-caused anaphylaxis[wp]: 0.65,[66] 1,[62] or 1.8[67] per 1,000,000 injections
  • Possibly given 5 times in a lifetime, including booster shots, high-risk populations, and persons without documentation of vaccination; usually only given 2 times
  • Congenital Rubella Syndrome: 250,000 in 1,000,000 (if woman becomes infected early in pregnancy),[62] which comes with a 7.4% risk of autism.[68][69]
  • Incidences: Rubella occurred primarily in epidemics every 6 to 9 years. During 1964-1965, there were an estimated 12.5 million rubella cases in the United States, population approx. 191 million.[70] Rubella then affected about 0.868% of the population each year, if 12.5 million cases occurred on average every 7.5 years.


  • Testicular atrophy: 140,000 per 1,000,000 males[71]
  • Miscarriage: 250,000 per 1,000,000 in the first trimester[71]
  • Meningitis: 100,000 per 1,000,000[71]
  • Incidences: Before 1967, about 186,000 mumps cases (0.0936% of population) were reported every year; many more occurred.[72]
Diphtheria, Tetanus, and Pertussis vs. the DTaP vaccine
Complication rates per infection Complication rates per injection


  • Death: 50,000 per 1,000,000[62]

DTaP vaccine:

  • Continuous crying, then full recovery: 1,000 per 1,000,000[62]
  • Convulsions or shock, then full recovery: 70 per 1,000,000[62]
  • Acute encephalopathy: 0-10.5 per 1,000,000[62]
  • Death: None proven[62]


  • Death: 200,000 per 1,000,000[62]


  • Pneumonia: 125,000 per 1,000,000[62]
  • Encephalitis: 50,000 per 1,000,000[62]
  • Death: 650 per 1,000,000[62]

[edit] The return of once-cured diseases

For generations, just about everybody in the United States got vaccinations. And as a result, diseases like measles were all but eradicated. But in 1998, a study published in a scientific journal linked vaccines with autism. Even though that study was later discredited, ever since then, a small but vocal subset of parents have refused to vaccinate their kids. Now, measles... are back! As is whooping cough, mumps, and other diseases that were nearly wiped out. Children's lives are being endangered because some parents are acting on beliefs that have no scientific evidence to support them.
Hank Green[wp], Crash Course Philosophy: Anti-Vaxxers, Conspiracy Theories & Epistemic Responsibility[73]

Another wonderful side effect, not of vaccinations but to the opposition to them, is that when herd immunity breaks, once more or less eradicated diseases (atleast in regions where vaccines were prevalent) have now been able to make a comeback. One example of this is measles, in which the cause of the return is literally the failure of people to get vaccinated due to the needless fear of vaccines.[74]

[edit] Purported reasons not to get vaccinated

[edit] Ingredients

[edit] Thiomersal

See the main article on this topic: Thiomersal

Some anti-vaxxers argue that vaccines are bad because they contain thiomersal. Usually, it is claimed that thiomersal is bad because it contains mercury. While some mercury-compounds are toxic, the concentrations of thiomersal in vaccines is so low as to be almost negligible, thiomersal's type of mercury-compound is significantly less harmful, and thiomersal has been phased out from most vaccines in developed countries.

[edit] Intentionally tainted vaccines

A growing number of Muslims believe that Western pharmaceutical companies have intentionally tainted the polio vaccines used in their countries. They believe that Western powers secretly use the vaccines to spread AIDS and/or infertility among Muslims. An alternative story, also applied to insulin, is that the vaccine's chain of manufacture includes live pigs or pig cells. Unfortunately, this wave of hysteria has led to a sharp decrease in polio vaccinations and an almost equally sharp increase in polio cases in Muslim countries.[75] Four state governments in the predominantly-Muslim part of Nigeria further increased the hysteria by banning all polio vaccines in 2004.[76][77] This isn't limited to the developing world; Eustace Mullins wrote an article claiming the polio vaccine was a Jewish plot to mass-poison American children.[78]

[edit] Aborted fetuses

An unfounded fear common to anti-abortion and anti-vaccination "activists" is that aborted fetuses are being used as ingredients in vaccines or that abortions are necessary to manufacture them. This is a distortion of the fact that the weakened form of the viruses in some vaccines are grown in a culture derived from a cell line taken from fetal tissue. There are no fetal cells in vaccines and the original fetuses were aborted way back in the 1960s.[79]

[edit] Gelatin derived from pigs

It is true that some vaccines do contain gelatin derived from pigs. Some religions object to the consumption of pig as food, most notably Judaism and Islam.[80] Both Jewish and Islamic scholars have ruled that the use of vaccines containing pig-derived products is not forbidden. In the case of the Islamic scholars, the gelatin in vaccines is considered sufficiently transformed from pig to not be of concern; in the case of a Jewish scholar, that the vaccines are not given orally was considered to be sufficient for it not to forbidden.[80] More importantly however, most religions have particular rules, which state that in matters of life or death, nearly all laws can be broken anyway.[note 2]

[edit] Diseases

[edit] Autism

More logical than the converse, indeed. (Source)
So you've observed that some people are born with autism. Good job, that's step one. Next, you ask a question - "What caused it?". You think that it's vaccination. Now it's time to test your theory. You know that some kids who've been vaccinated develop autism, but you haven't controlled for all the other variables, such as diet, genetics, environment, chance mutations, related disabilites or simply the higher diagnosis rate due to greater awareness. Plus, you can't explain why the 99% of people who have been vaccinated didn't develop autism. OOPS! That's a shitty theory! Go back to step one!
Maddox, How to tell if you believe in bullshit[81]

There has been much concern about a possible link between autism and vaccines, particularly the MMR (measles, mumps, and rubella) vaccine in the UK and thimerosal in some flu vaccines.[82] Part of this concern is due to a possible rise in cases of diagnosed autism over the last few decades — much of it raised by parents of autistic children, and by prominent Americans such as Jenny McCarthy... but rarely by autistic people themselves. More often than not, evidence given by those peddling a link is indirect and anecdotal. When such groups do attempt to be scientific, they primarily cite links between ethylmercury exposure and other neurological problems outside the setting of vaccine administration. For instance, according to one source, "In 1977, a Russian study found that adults exposed to much lower concentrations of ethylmercury than those given to American children still suffered brain damage years later."[4]

The following statement, attributed to Dr Boyd Haley,[83] whom Orac has referred to as "disgraced,"[84] gives anecdotal evidence of a link between ethylmercury and "brain damage":

You couldn't even construct a study that shows thimerosal is safe... It's just too darn toxic. If you inject thimerosal into an animal, its brain will sicken. If you apply it to living tissue, the cells die. If you put it in a petri dish, the culture dies. Knowing these things, it would be shocking if one could inject it into an infant without causing damage.

This statement works to increase levels of fear, but makes no mention of actual vaccines or actual patients. It certainly doesn't mention statistics or dose levels, which is important when discussing medical effects of chemicals. Pouring a dose of a chemical into a petri-dish of cells (in vitro) is not the same as exposing an actual living human (in vivo) to the chemical — for a start the body has certain defence mechanisms against chemical attack. This is why actual studies are undertaken, and many promising anti-biotics and medicines have failed because they work in vitro but not in vivo.

Several very well-done population-based studies have been conducted into the link between autism and vaccinations, although they aren't very widely reported. These hard facts tend not to resonate with the public consciousness and media as much as anecdotes and sob stories from concerned individuals and interest groups do. This has been a problem with health scares for decades, and shows no sign of going away. The particular studies have looked at actual populations in real life conditions, exposed to the actual substance in question; none have shown any connection between autism and the thimerosal preservative or the MMR vaccine. There is overwhelming evidence that the MMR and thimerosal-containing vaccines play no role in the development of autism.[85][86][87][88][89][90][91][92] This contrasts with many of the papers supposedly showing a link, which are often underpowered or badly controlled. Ironically, one epidemiological study has indicated the MMR vaccine has reduced rates of one risk factor for autism-congenital rubella syndrome.[93]

A small study by Andrew Wakefield, published in The Lancet in 1998, became infamous around 2000-2002 when the UK media caught hold of it. It hypothesized an alleged link between the measles vaccine and autism despite a small sample size of only 12 children. This eventually lead to what Guardian columnist and science writer Ben Goldacre described as "the media's MMR hoax,"[94] due to the evidence for any link being so lacking that it may as well have been entirely manufactured. The paper was partially retracted several years later but continued to be the most often cited case study for the link, despite mounting evidence (including one large study into the rates of autism in adults who wouldn't have received MMR) to the contrary. It was finally considered "thrown out" on February 2, 2010 after it was discovered that Wakefield behaved unethically. Specifically, Wakefield was found guilty of not acting in the best medical interests of the children he did research on (one child was severely injured in a colonoscopy), as well as not disclosing his previous involvements with anti-vaccination groups prior to the study and it hitting the news.[95] Further examinations show that Wakefield outright fabricated information or selectively ignored facts in his study, such as preexisting conditions in 5 of the 12 children.[96]

Autistic adults and other reasonable-minded people maintain that it is hate speech to claim that vaccines cause autism because it implies claiming ipso facto that a person is better off dead of an easily preventable disease than alive and autistic.[97][98] Anti vaxxers have also been accused of hating autistic children due to comments made by anti vaxxers characterizing autistic children as brain-damaged[99] and soulless.[100]

[edit] Multiple Sclerosis

Concern has been raised about a connection between MS and vaccines, especially the Hepatitis B vaccine. One of the several studies done on the topic showed a potential link,[101] but there were methodological problems,[102] and most other studies failed to show a link.[103][104] The most recent CDC publication on the matter cites fifteen different studies showing no link between MS and the Hepatitis B vaccine.[105]

[edit] SIDS

The DTaP vaccine has been suspected of causing Sudden Infant Death Syndrome, which causes children to stop breathing and die.[106] However, studies have not shown a connection between SIDS and DTaP vaccinations.[107]

Recent studies have identified abnormalities in the development and function of medullary serotonin (5-HT) pathways in the postmortem brain from sudden infant death syndrome (SIDS) cases, suggesting 5-HT-mediated dysregulation of the autonomic nervous system in SIDS.[108][109] This is basically stating that SIDS has a strong genetic component and is more prevalent in families that have issues with serotonin re-uptake, thus preventing the infant from shifting when their airway becomes blocked while asleep.

Research into SIDS is progressing, and has left behind the fictional link to vaccines.

[edit] Shaken baby syndrome

A small group of people have tried to tie Shaken Baby Syndrome to childhood vaccinations. The "studies" that have been published are quite weak. Most are available only online from non-recognized sources, and are "based on personal experiences of the authors..."[110] The rest of the "evidence" is based on personal testimonials of involved parents and physicians.[111][112]

These ideas are well-debunked here (PDF warning).

[edit] "Vaccinosis"

"Vaccinosis" or "Chronic Vaccine Disease" is a term invented by the alternative medicine fraternity to describe a raft of symptoms purportedly caused by vaccines. Like many made up illnesses, claims about "vaccinosis" often exploit genuine symptoms, such as known adverse reactions to vaccines, and exaggerate them to pander to fear and mistrust of medicine.[113]

WHO defines vaccinosis thusly: "Your search for vaccinosis did not match any documents."[114] The CDC, on the other hand, define vaccinosis as: "No pages or documents were found containing 'vaccinosis'."[115]

[edit] "Overwhelming the immune system"

Under-vaccination and delayed vaccination of children is a much more common problem than completely unvaccinated children. "Overwhelming their developing immune systems" is frequently given as an excuse for parents to delay or skip some vaccines for their children.[116][117]

Because the number and frequency of childhood vaccines has increased over the years[note 3] and because many parents have never seen the horrible effects of most of these separate childhood diseases[note 4], an increasing number of parents have become vaccination-shy on behalf of their children.

A review of medical literature concluded:

Current studies do not support the hypothesis that multiple vaccines overwhelm, weaken, or "use up" the immune system. On the contrary, young infants have an enormous capacity to respond to multiple vaccines, as well as to the many other challenges present in the environment. By providing protection against a number of bacterial and viral pathogens, vaccines prevent the "weakening" of the immune system and consequent secondary bacterial infections occasionally caused by natural infection.
—P. A. Offit et al., Pediatrics Vol. 109 No. 1 January 1, 2002[118]

[edit] Complications

[edit] Breastfeeding

One theory, promoted widely across the internet, holds that CDC research showed that breastfeeding reduced the effectiveness of vaccines, and so breastfeeding should be stopped or postponed.[119] However, the study made no such conclusions.[120]

[edit] Social evils

[edit] Big Pharma

Vaccines are often touted as a major source of revenue for Big Pharma (the pharmaceutical industry). However, vaccines have much lower profit margins than alternative drugs and only make up 2-3% percent of a trillion-dollar worldwide pharmaceutical industry.[121]

Lets take a look at hepatitis, for example. Hepatitis A, B and C all currently infect over 100 million people. Vaccines are available for Hepatitis A and B, but not Hep C. Sovaldi, a drug used to cure Hep C is available, for $84,000 for Americans because reasons. Medicare alone paid over $3B for Sovaldi in 2014[122], and a grand total of $7.8 Billion in the US for just this one drug[123], and that's not including Harvoni and older drugs still in use for Hepatitis C. In 2014, the total spending on all vaccines other than flu was $6.9 billion.

If absolutely everyone in big Pharma only cared about the bottom line, they wouldn't manufacture vaccines at all.

[edit] Promiscuity

Some ideologues oppose vaccination for political or moral reasons. For example, certain conservatives oppose the use of Gardasil on young girls for fear that it will discourage them from sexual abstinence by eliminating an STD,[124][125] thereby depriving the right of one of its favorite pro-abstinence scare tactics. Though it won't placate Christian fundamentalists from promoting ineffective abstinence-only sex education programs, the CDC announced that a study has shown that Gardasil does not increase the likelihood of unsafe sex among teens.[126]

[edit] Not trusting God

A measels outbreak centered round a megachurch that the family of Texas faith healer and televangelist Kenneth Copeland runs. Church officials denied that they oppose medicine or vaccination. Still people who know the culture of the ministry claim a general sense that believers should rely on God rather than modern medicine to stay well. “To get a vaccine would have been viewed by me and my friends and my peers as an act of fear — that you doubted God would keep you safe. . . . We simply didn’t do it.” Former church member Amy Arden stated.[127]

[edit] Population control conspiracy

Another example was when strange congressman Louie Gohmert voiced his equally strange concerns about vaccination on a Family Research Council broadcast: he's convinced that liberal elites are using vaccination programs to cull the earth's human population due to concerns about the scarcity of natural resources. Apparently, the evil cabal behind such a plan are aiming for a target population of 700 million, which indicates that Gohmert may have pulled that number out of his ass arrived at that number by purely imaginary means.[128]

[edit] Government intrusion

Libertarians also oppose mandatory vaccination, believing simply that the state does not own your body, and therefore mandatory vaccines are a direct contradiction to individual liberties.[129] (Note that vaccination is most effective when everyone else is also vaccinated, meaning this is a clear case of individual choices affecting the "liberty" of others.) So-called Beltway libertarians among others usually make an exception for state-mandated vaccination out of practicality, much as they do national defense. Ronald Bailey at Reason has covered the issue[130] with an argument part moral and part pragmatic, which looks something like this:

  • (1) No vaccine is 100 percent effective.
    • (This concession isn't actually necessary, but is helpful to understanding herd immunity)
  • (2) Vaccines considerably reduce the likelihood that the vaccinee will contract the disease being vaccinated for.
    • Corollary: Taking vaccination as a baseline (which, in the developed world, it is), the unvaccinated are more likely to contract diseases for which vaccines are in widespread use than the average person.
  • (3) You are more likely to catch many of these diseases from someone who has contracted the disease than from someone who has not.
    • Pertussis comes to mind as an example.[131]
  • (4) Per (3), the more people around you have a given contagious disease, the more likely you are to contract it.
    • Corollary: People around you are more likely to contract said disease if you have it.
  • (5) Per (2), (3) and (4), the more people around you are vaccinated, the less likely you are to contract the disease for which they are vaccinated.
    • This is the case irrespective of whether you personally are vaccinated or not.
    • Corollary: If you personally are vaccinated you are less likely to contract that disease, and therefore less likely to transmit it to people around you.
      • Corollary of corollary: If you personally are unvaccinated you are more likely to contract the given disease, and therefore more likely to risk transmitting it to people around you.
    • In both directions, this is the basis of herd immunity: every individual vaccinee in a population reduces the likelihood that a case of a disease will occur at all, and every case that doesn't occur reduces the likelihood, in the rare cases where a vaccine does not work as expected for a given individual, that the individual will ever be exposed to the pathogen anyway. The success of mass smallpox vaccination illustrates the positive feedback loop[wp] at work here.
  • (7) As a consequence of the various parts of (6) and the corollary established in (2), by abstaining from vaccination the abstainer exposes people around him to a risk of disease greater than the baseline.
  • (8) Per (7), abstention from vaccination may be reasonably perceived as endangering people around you.

[edit] Social alternatives

Can you explain why better nutrition and sanitation eliminated polio in 1954-55 but waited until 1964 for measles? It's very sneaky of nutrition and sanitation to kick in only at the same year vaccines are released.
—Andrew L.[132]

Many anti-vaxxers claim that better sanitation is the true reason that rates of diseases were massively reduced around the time. This is very questionable. As noted by the quote above, not all diseases decreased at the same time or the same rate, suggesting that they were not prevented by the same changes. "Sanitation" is not a binary -- for example, modern toilets and plumbing, which hugely helps in preventing waterborne diseases such as cholera, took many decades to reach even a majority of citizens in any country. And polio has been nearly eradicated not by eliminating world poverty and lack of sanitation, but via vaccination -- so even if sanitation helps, it is clear that vaccines work.

[edit] Natural alternatives

Some anti-vaxxers, rather than holding some truly far-fetched idea about autism or other diseases being caused by vaccines, claim that natural infection is better for a child than vaccination, simply because it is natural. Very few of these same people want to give their kids large doses of all-natural cyanide, though, for reasons unexplained. That aside, there are several problems with this approach:

  • Vaccines have a much smaller likelihood of causing the symptoms of the disease, such as pneumonia (pneumococcus et al.), meningitis (Haemophilus influenzae, type b), liver cancer (hepatitis B), etc.
  • Some vaccines do a better job building immunity than a "normal" infection with the corresponding disease.[133] It is known that measles infection causes short-term immuno-suppression, and there is evidence to believe that it also causes long-term immuno-suppression.[53][54]
  • Many of the alleged means by which to infect your child are either hit-and-miss or outright scams.

[edit] Around the world

[edit] USA

A man gets his H1N1 shot. Beware!
Disease is pestilence, and pestilence is from the Devil. The devil is germs and disease, which is cancer and any of those things that can take you down. But if you trust in the Lord, these things cannot come near you.
—Dina Check, on why her daughter should be entitled to spread disease in New York public schools[134]

In August 2013, there was an outbreak of measles in the Eagle Mountain International Church based in Newark, Texas. The pastor, Terri Pearsons, was critical of vaccines (due to the mythical autism link) and because of this the majority of the church's members refused vaccination. After a member of the congregation traveled to Indonesia they brought the measles back, where it spread quickly to the congregation, staff, and day care. Every reported case (21 total in the church) came from people who refused vaccination. There were no deaths from the outbreak, and the silver-lining came in the form of Pearsons reversing stance and advocating vaccinations, as well as the church hosting vaccination clinics. [135] Another outbreak in late 2014-early 2015, which started in Disneyland, was directly linked to children who weren't vaccinated, where 15 of the original 20 patients in the outbreak had not received the MMR vaccine.[136]

In the United States it is generally held (perhaps "legally held" is a better way to phrase it) that parents have the right to have their children not be inoculated if they, the parents, so desire.

The H1N1 swine flu vaccine was a hot topic among vaccine denialists, from fears the vaccine was unsafe (stoked by reports of side effects from the old 1976 swine flu vaccine) to conspiracy theories that the vaccine was a plot to curb overpopulation.[137]

Safety concerns about the HPV vaccine Cervarix were raised after a girl died after being injected with the vaccine.[138] The story was immediately jumped on by anti-vaccination groups and was widely reported in the general and scaremongering media. It was later determined that the death was due to an undiagnosed tumour, but the same media that cried out for "more research" into the incident preferred to bury this conclusion; undoubtedly a large part of the UK population still believe the young girl died due to a direct reaction to the vaccine. Anti-vaccination blogs and organizations, of course, have cried foul on this conclusion. The Sunday Express also hyped up fears about the jab by — one can only assume deliberately — misquoting Dr Diane Harper and claiming that the vaccine was "just as deadly as the cancer." Indeed, practically every single one of the claims, which were on the front page of the newspaper, were false; ranging from what Dr Harper actually said, to her actual level of involvement in the vaccine. In true tabloid style, the corrections were well and truly buried.[139]

It got into the spotlight in the 2012 Republican Party presidential nomination as candidate Michele Bachmann claimed a woman told her her daughter had become mentally retarded after receiving the HPV vaccine while attacking her opponent Rick Perry.

Three of the Republican candidates for the 2016 Presidential race announce that childhood vaccines should be voluntary: Chris Christie, Carly Fiorina, and Rand Paul. Chris Christie was accused of "pandering to the anti-vaxxer crowd".[140][141] Dr. (!) Rand Paul doubled-down — and reiterated Bachmann's idiocy from the previous race — by saying that vaccines can cause "mental disabilities".[142]

In April 2015, California legislators proposed removing the "personal belief" exemption from childhood vaccination requirements in public schools.[143] The proposed legislation does not remove a religious exemption, so how "personal belief" can be differentiated from religion remains to be seen[6][7] if the legislation passes in this form. Discredited ex-doctor Andrew Wakefield has begun rallying the antivax troops against this proposed legislation. He is reportedly contemplating busing chiropractic students to rally at the state capital.[144] The final bill that was signed into law by Governor Jerry Brown removed both the personal and religious exemptions from vaccine requirements.[145]

Having lost the legislative fight in California, antivax activists are attempting to recall state Senator Richard Pan from office. Dr. Pan, a pediatrician, was the primary author of the mandatory vaccination legislation.[146] The activists are also attempting to get an initiative on the state ballot that would overturn the legislation.[146]

In 2016, Leontine Robinson lost a lawsuit against her former employer, Children’s Hospital in Boston. Ms. Robinson worked near children at risk at the hospital, and she had refused to get a flu shot because she is a member of the Nation of Islam, and some flu shots contain a pig-derived gelatin, which she claimed was prohibited by her religion.[80] Ms. Robinson was given an opportunity to find another position at the hospital that not near children but was unable to do so, she subsequently sued her employer after her employment was terminated. The judge in the case ruled against Ms. Robinson, stating, "Had the Hospital permitted her to forgo the vaccine but keep her patient-care job, the Hospital could have put the health of vulnerable patients at risk."[147]

A 2012 survey of US pediatricians and family physicians that was published in 2015 reported that one-fifth of pediatricians refused to treat children of vaccine refusers, primarily to protect other patients.[148][149]

[edit] UK

More recently, the MMR-autism link (mentioned above) hit the UK headlines after Andrew Wakefield, the lead author of a paper suggesting a link between autism and MMR, was found guilty of unethical conduct. Despite the ruling only applying to his ethical conduct in the research, which had been questioned for several years (a "conflict of interest" was raised in 2004, three years after he left the Royal Free Hospital under controversial circumstances), the UK media have taken the ruling to also mean "his work has been discredited."[150] As those who may have seen Wakefield's original research would know, a series of 12 case studies never particularly had any credit to actually be discredited,[151] and Wakefield's conclusions had been repeatedly discounted by further study long before the ethical matters were ruled upon. The Lancet — the premier medical journal that featured his research — issued a full retraction of the study in February 2010.[152]

[edit] Scandinavia

In August 2010, the Finnish National Institute of Health and Welfare recommended that use of the Pandemrix H1N1 vaccine should be discontinued, pending investigation into 15 cases of narcolepsy in recently vaccinated children and adolescents in the previous year.[153] At the same time, the European Medicines Agency and the Swedish Medical Products agency launched their own investigations to the vaccine. Far from being quashed by Big Pharma, these studies were completed in early 2011, and concluded that there was indeed an increased relative risk of developing narcolepsy in children and adolescents vaccinated with Pandemrix. A number of follow-up studies have found various relative risks, ranging from about 3 [154] to as much as 7.5.[155] Because narcolepsy is so rare to begin with, relative risks are hard to estimate, and the confidence intervals mentioned in the studies reflect this, generally giving a range of half to one and a half times the cited risk. Also because of the rarity, the actual risk amounted to some four additional cases per 100 000 people per year.[154]

As is usual with stopped clock cases, these findings did not result in widespread paradigm shift against vaccinations in medicine. Instead, the scientific method labored on to produce a model that explains these findings. A research group suggested that narcolepsy might be caused by the fact that certain surface proteins of the H1N1 virus resemble hypocretin, a neurotransmitter that transmits the "wake up" signal.[156] In June 2014, they retracted the paper after having failed to reproduce its key findings, although they continue to believe that their original hypothesis remains valid.[157] Later in the same year, a research paper comparing Pandemrix with another vaccine with the same adjuvants but different viral antigens concluded that the focus for finding the cause should be the viral antigens and not the vaccine adjuvants.[158]

[edit] Pakistan

In 2015, Pakistan arrested about 500 parents for refusing to have their children vaccinated against polio, and over 1000 arrest warrants were issued. Officials turned to these drastic means because of community opposition and Taliban threats. Sixty-four workers from polio eradication teams have been killed for doing their work since 2012.[159][160] In 2014, Pakistan had the highest number of new polio cases in the world 327 of 413 total (or 306 of 359 of wild-derived cases).[161]

In 2015, Pakstan, along with Afghanistan became the last two countries with endemic polio. In November 2015, a local polio co-ordinator was assassinated in the north-western Swabi district. On January 13, 2016, a suicide bomber killed 15 people in the vicinity of a vaccination clinic in Quetta.[162]

[edit] Australia

Australia is planning to cut welfare payments to parents of unvaccinated children starting in 2016.[163] In response, anti-vaxxers started setting up "black market" childcare facilities,[164] with predictable results.[165]

[edit] See also

[edit] External links

[edit] References

[edit] Notes

  1. In his own words: "What I've read about what they think I'm saying is not what I've said. I'm not a germ theory denier. I believe vaccinations can work. Polio is a good example. Do I think in certain situations that inoculating Third World children against malaria or diphtheria, or whatever, is right? Of course. In a situation like that, the benefits outweigh costs. But to me living in Los Angeles? To get a flu shot? No."
  2. With some notable exceptions — it's the genius of religious reasoning we're talking about here, after all.
  3. For example, there are 20 recommended vaccinations before age 2.
  4. Responses along the lines of "nobody I know has ever seen polio" are comparable to Were you there? responses by young-earth creationists — truth is not related to personal experience.

[edit] Footnotes

  1. https://www.youtube.com/watch?feature=player_detailpage&v=i2mdwmpLYLY#t=136
  2. http://www.infowars.com/the-truth-behind-mass-vaccination/
  3. https://www.youtube.com/watch?feature=player_detailpage&v=3aNhzLUL2ys#t=303
  4. 4.0 4.1 Robert F. Kennedy, Jr. "Deadly immunity", Salon.com 2005 June 16.
  5. "Vaccination Exemptions", The College of Physicians of Philadelphia, undated, accessed February 8, 2013; "Exemptions from providing medical care for sick children", Children's Healthcare is a Legal Duty.
  6. 6.0 6.1 How Vaccine Skeptics Game The System With 'Religious Exemptions' by Catherine Thompson (February 11, 2015, 6:00 AM EST) Talking Points Memo
  7. 7.0 7.1 http://www.sciencedirect.com/science/article/pii/S0264410X13001898 What the World's religions teach, applied to vaccines and immune globulins] by John D. Grabenstein Vaccine (Volume 31, Issue 16, 12 April 2013, Pages 2011–2023)
  8. https://www.youtube.com/watch?feature=player_detailpage&v=QgpfNScEd3M#t=12
  9. Development & Approval Process (Drugs), U.S. Food and Drug Administration (FDA). 2012 October 15.
  10. https://www.youtube.com/watch?feature=player_detailpage&v=3aNhzLUL2ys#t=286
  11. http://vactruth.com/2013/09/26/how-pharmaceutical-hide-dangers/
  12. On-time Vaccine Receipt in the First Year Does Not Adversely Affect Neuropsychological Outcomes by Smith et al. Pediatrics Vol. 125 No. 6 June 1, 2010 pp. 1134 -1141 (doi: 10.1542/peds.2009-2489)
  13. God Is Not Great: How Religion Poisons Everything, page 43-45.
  14. Joss Whedon On #GamerGate, JURASSIC WORLD, Adam Baldwin And Speaking Out Badass Digest "I never understood. He very sweetly begged me not to vaccinate my children. He gave me books on the subject."
  15. http://www.thestar.com/entertainment/television/2012/11/02/aidan_quinn_elementary_star_says_you_have_to_learn_to_live_with_lifes_jokes.html
  16. https://www.youtube.com/watch?v=qfZMS4nCLFE
  17. http://www.thewire.com/culture/2014/05/toni-braxton-thinks-god-punished-her-for-getting-an-abortion-by-giving-her-son-autism/371518/
  18. Lesley Messer. Alicia Silverstone's Son Has 'Never Had a Drop of Medicine. ABC News. 2014 April 17.
  19. http://scienceblogs.com/insolence/2009/11/04/another-celebrity-anti-vaccine-moron-bil/
  20. https://www.sciencebasedmedicine.org/five-years-on-bill-maher-is-still-an-antivaccine-crank-and-proves-it-yet-again/
  21. Controversial comic stirring the pot by Jim Slotek (October 28, 2009 6:10:00 EDT AM) The Peterborough Examiner.
  22. http://zap2it.com/blogs/charlie-sheen-t-2008-06/
  23. https://www.davidicke.com/article/133757/80212-five-vaccines-to-never-give-a-child
  24. http://scienceblogs.com/insolence/2009/11/06/desiree-jennings-cured/
  25. Rory Carroll, "Donald Trump on vaccines: ‘It’s not helpful’, experts say", The Guardian
  26. https://www.sciencebasedmedicine.org/why-the-latest-geier-geier-paper-is-not-evidence-that-mercury-in-vaccines-causes-autism/
  27. http://www.essence.com/2009/03/31/holly-robinson-peete-on-autism-fearmonge
  28. http://www.latimes.com/business/hiltzik/la-fi-mh-jenny-mccarthy-antivaxxer-public-menace-20150127-column.html
  29. http://theconversation.com/dumb-or-dumber-jim-carreys-anti-vax-antics-expose-the-tactics-of-internet-cranks-44236
  30. http://www.huffingtonpost.com/2012/07/01/rob-schneider-links-autism-vaccines_n_1641922.html
  31. http://hatingautism.blogspot.se/2014/11/autism-omnibus-decision-to-be-reversed.html
  32. https://www.sciencebasedmedicine.org/vaccination-as-rape-meryl-dorey-and-the-australian-vaccination-network/
  33. http://www.reuters.com/article/us-cancer-hpv-idUSTRE78E5YM20110915
  34. http://time.com/3012797/vaccine-rfk-jr-thimerosal/
  35. https://www.youtube.com/watch?v=FJ7iPn39i08
  36. http://scienceblogs.com/insolence/2011/12/19/quoth-dr-suzanne-humphries-vaccines-are/
  37. McKinney on vaccines, among other batshittery]
  38. http://www.abc.net.au/news/2014-03-18/australian-vaccination-skeptics-network-banned-from-charity-sta/5327378
  39. Nigeria's Boko Haram insurgency thwarting UN war on polio: One of last polio holdouts, West Africa country 'in best position' ever to stop spread of disease
  40. http://www.smh.com.au/federal-politics/political-news/vaccinationexempt-church-revealed-as-christian-scientists-20150414-1mkmj8.html
  41. http://scienceblogs.com/insolence/2009/05/01/what-to-do-about-huffpo/
  42. http://www.greenmedinfo.com/blog/vaccine-safety-myth
  43. http://www.infowars.com/doctor-reveals-secrets-behind-the-vaccine-autism-cover-up/
  44. http://www.livingwhole.org/vaccines-dont-work-here-are-the-facts/
  45. http://www.naturalnews.com/042012_vaccine_facts_vaccine-damaged_children_CDC.html
  46. CIA Vaccination Cover in Pakistan
  47. https://www.youtube.com/watch?feature=player_detailpage&v=3aNhzLUL2ys#t=280
  48. https://www.youtube.com/watch?feature=player_detailpage&v=3aNhzLUL2ys#t=354
  49. Which was in turn credited as taught by deities from the mountain. Needham, Joseph. (2000). Science and Civilization in China: Volume 6, Biology and Biological Technology, Part 6, Medicine. Cambridge: Cambridge University Press. p.154T
  50. Needham, Joseph. (2000). Science and Civilization in China: Volume 6, Biology and Biological Technology, Part 6, Medicine. Cambridge: Cambridge University Press. Page 134.
  51. http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm
  52. 52.0 52.1 52.2 52.3 Aaron Levin. Vaccines Today. Annals of Internal Medicine. 2000;133(8):661
  53. 53.0 53.1 Study points to years-long immune system woes from measles by Eryn Brown (May 7, 2015) Los Angeles Times.
  54. 54.0 54.1 Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality by Michael J. Mina et al. Science 8 May 2015: Vol. 348 no. 6235 pp. 694-699. DOI: 10.1126/science.aaa3662
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  117. Vaccination holdouts a disparate mix of rural, populous counties by Erin Allday (March 22, 2015) San Francisco Chronicle.
  118. Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?
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  129. Not as a rule, but commonly. See: http://reason.com/archives/2014/03/25/should-vaccines-be-mandatory
  130. http://reason.com/archives/2013/12/06/vaccine-free-riders-1
  131. http://www.cdc.gov/features/pertussis/
  132. https://www.facebook.com/hatepseudoscience/photos/a.167664610048076.39182.163735987107605/424222604392274/?type=1&theater
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  150. Nick Triggle. MMR scare doctor 'acted unethically', panel finds. BBC News. 2010 January 28.
  151. Ben Goldacre. The Wakefield MMR verdict. Bad Science. 2010 January 28.
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  156. De la Herrán-Arita et al, CD4+ T Cell Autoimmunity to Hypocretin/Orexin and Cross-Reactivity to a 2009 H1N1 Influenza A Epitope in Narcolepsy, Sci Transl Med 18 December 2013 DOI: 10.1126/scitranslmed.3007762
  157. Journal retracts paper linking vaccine and narcolepsy
  158. Vaarala, O. et al., Antigenic Differences between AS03 Adjuvanted Influenza A (H1N1) Pandemic Vaccines: Implications for Pandemrix-Associated Narcolepsy Risk, DOI: 10.1371/journal.pone.0114361
  159. Pakistan arrests parents for refusing polio vaccination
  160. Over 500 Pakistani parents arrested for children's failure to get polio vaccine
  161. Global Polio Eradication Initiative: Polio this week as of 25 February 2015
  162. Bomb near Pakistan polio centre 'kills 15' January 13, 2016 BBC.
  163. 'No jab, no pay:' Australia cuts benefits for parents who don't vaccinate kids by Naomi Ng, CNN Updated 1:15 AM ET, Mon April 13, 2015
  164. Report: Anti vaccination supporters are setting up 'black market' childcare, Business Insider, November 30 2015
  165. Eighty children get chickenpox at Brunswick North West Primary, a school that calls for 'tolerance' of vaccine dodgers, The Age, December 10 2015
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