Cover story articleAnti-vaccination movement

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

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Not just a river in Egypt
The anti-vaccination movement (or vaccine hysteria) is an irrational trend of mistrust of vaccination that is almost as old as the technique itself. The movement (more mockingly referred to as "anti-vaxxers") blames vaccines, or their ingredients, for a range of maladies whose mechanisms are rejected or have not been explained by current scientific research. Some of these maladies can often be childhood illnesses in order to increase the emotive factor of the argument. The ubiquity of vaccination often makes it an easy target for blame.

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 more recent times, there has been much debate in the press and in the doctor's office regarding vaccine safety — namely what possible side-effect 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.[1]

Forty-eight US states allowed religious exemptions for compulsory vaccination as of 2014. In contrast only twenty states allow exemptions to children whose parents have philosophical or personal belief objections to vaccination.[2]

Contents

[edit] Origins of vaccination

A Song Dynasty (960–1279) chancellor of China, Wang Dan (957–1017), 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. O-mei (E Mei) spread knowledge about inoculation. [3] The first clear and credible reference to smallpox inoculation in China comes from Wan Quan's (1499–1582) Douzhen xinfa (痘疹心法, Philosophy on Poxes) of 1549, which states that some women unexpectedly menstruate during the procedure, yet his text did not give details on techniques of inoculation. [4]

Inoculation was reportedly not widely practiced in China until the reign of the Longqing Emperor (r. 1567–1572). 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] Premise

Anti-vaccination rhetoric is usually presented in lots of scary, little "facts." Notice also the gigantic, oversized depiction of the needle.

There are many ideas, not supported by any accepted 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 is, of course, well developed published data on the complication rates of vaccines and this data plays an essential role of the approval process vaccines must pass in order to be licensed for sale, and recommended for use.[5] 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.

This particular pseudoscientific belief is unlikely to go away soon, despite the evidence attesting to the efficacy and safety of vaccines. It has several important factors that make it a very durable belief:

  1. It involves harm to children.
  2. It involves science that most people do not understand.
  3. It involves using a painful method (a needle) to inject a foreign substance into our bodies. Some of them even have remnants of inactive viruses!
  4. It is frightening.
  5. It seems on its face to "make sense," especially to make sense of an otherwise unexplainable tragedy.

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.

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

[edit] Known side effects

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

The current impact of vaccines on health is very simply stated here. 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.[6]

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.[6] 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.[7] Most deaths occur as a result of pneumonia or encephalitis.[8]

After the introduction of polio vaccination, cases in the United States decreased from almost 30,000 in 1955 — many of which lead to paralysis or death — to 910 cases by 1962. New cases of polio in the U.S. are now a thing of the past.[6] 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.

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.[6][9] Unfortunately, these sorts of consequences from vaccine denial isn'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.[10]

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. For example, the CDC compiles rates of risk from disease vs. risk from vaccination.[11] For the MMR (measles, mumps, rubella) vaccine, these are the data:

Complication rates (per case of disease) Complication rates (per injection given)

Measles:

  • Pneumonia: 6 in 100
  • Encephalitis: 1 in 1,000
  • Death: 2 in 1,000

MMR Vaccination:

  • Encephalitis or severe allergic reaction: 1 in 1,000,000
Rubella:
  • Congenital Rubella Syndrome: 1 in 4 (if woman becomes infected early in pregnancy)
Further to Measles & Rubella data reported by the CDC, mumps infection can also have serious sequelae, including the following:[12]

Mumps:

[edit] Negative effects of currently used vaccines

Most commonly used vaccines have a risk of severe complications; however, the risk is very 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. Certain less-commonly used vaccines are known to have greater dangers. For instance, the smallpox vaccine, which is not in wide use, has a well-quantified complication rate. Given the fact that the risk of disease exposure is almost zero, because of the success of vaccination programs, it is no longer worth the risk to vaccinate the population at large.

[edit] Specific concerns

[edit] Thiomersal

Molecular structure of thiomersal. Note the dreaded "Hg" for mercury.

Thiomersal (also commonly known by its U.S. marketing name "Thimerosal") is a mercury-containing compound used as a preservative in many vaccines. The fact that some mercury compounds are toxic has led many to conclude that vaccines containing this compound are dangerous. Many mercury compounds, particularly those with mercury-carbon bonds, are neurotoxins, such as dimethylmercury.[13] While in large doses thiomersal can be toxic, a 2002 study indicated that the mercury levels in infants receiving a vaccine preserved by an appropriate amount of thiomersal were low; some were so low that they could not be measured. The toxicity of mercury compounds found in fish oil pills is likely to exceed that of thiomersal. By definition, this means the blood concentrations of mercury were below the EPA guidelines. (The amount of mercury in stool samples was higher than normal, although this is an indicator that the body was eliminating the thiomersal, rather than accumulating it.[14][15]) Most of the concern about thiomersal derives from analogy with methylmercury, a well characterized mercury compound, but it is unclear whether the actual pharmacology is similar to thiomersal — after all, ethanol and methanol are extremely similar molecules but have quite different effects on the body.[16] Initial studies on the pharmacokinetics indicate several differences between methylmercury and thiomersal.[17] The amount of thimerosal actually present in vaccines is quite low and, most importantly, there are large studies available that have shown no evidence of harm.[18] In 1999, the CDC and the American Academy of Pediatrics requested a voluntary removal of thiomersal from vaccines and today the preservative is mainly used only in seasonal flu vaccines. This of course has done nothing to discourage the supposed link between vaccines and autism even though the alleged cause hasn't been used as an ingredient in 15 years.

[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,[19] but there were methodological problems,[20] and most other studies failed to show a link.[21][22] The most recent CDC publication on the matter cites fifteen different studies showing no link between MS and the Hepatitis B vaccine.[23]

[edit] SIDS

The DPaT has been suspected of causing Sudden Infant Death Syndrome that causes children to stop breathing and die.[24] However, studies have not shown a connection between SIDS and DPT/DPaT vaccinations.[25] 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.[26][27] 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] Autism

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.[28] 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."[1]

The following statement, attributed to Dr Boyd Haley,[29] whom Orac has referred to as "disgraced,"[30] 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.[31][32][33][34][35][36][37][38] This contrasts with many of the papers supposedly showing a link, which are often underpowered or badly controlled.

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,"[39] 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.[40] 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.[41]

Autistic adults 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.

[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..."[42] The rest of the "evidence" is based on personal testimonials of involved parents and physicians.[43][44]

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

[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.[45] A Nigerian state government further increased the hysteria by banning all polio vaccines in February, 2004.[46] 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.[47]

[edit] Vaccinosis

"Vaccinosis" is a term invented by the alternative medicine fraternity to describe a raft of symptoms purportedly caused by vaccines — or "Chronic Vaccine Disease" as they put it. Like most made up illnesses, claims about "vaccinosis" exploit genuine symptoms (known adverse reactions to vaccines) and exaggerate them, pandering to fear and mistrust of medicine.[48]

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

[edit] Aborted fetuses

Anti-vaxers often claim aborted fetuses are used as an ingredient in vaccines. They're not.

[edit] Social impact concerns

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,[49][50] thereby depriving the right of one of its favorite pro-abstinence scare tactics.

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.[51]

[edit] Philosophical opposition

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.[52] (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[53] 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.[54]
  • (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 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] In the news today

[edit] USA

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[55]
A man gets his H1N1 shot. Beware!

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. [56]

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.[57]

Safety concerns about the HPV vaccine Cervarix were raised after a girl died after being injected with the vaccine.[58] 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.[59]

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.

[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."[60] 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,[61] 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.[62]

[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[63]. 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 [64] to as much as 7.5. [65]. 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 children [64].

As is usual with stopped clock cases, these findings did not result in widespread paradigm shift against vaccinations in medicine. Instead, the scientific method carried on and, two years later, produced a model that explains these findings. As might be expected, the cause was not any of the vaccine additives anti-vaxers malign, but the fact that a certain surface proteins of the H1N1 virus resemble hypocretin, a neurotransmitter that transmits the "wake up" signal.[66]

[edit] Conclusions

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 informed by misconceptions and lies.

[edit] See also

Anti-vaccination proponents

Related topics:

[edit] External links

[edit] References

[edit] Footnotes

  1. 1.0 1.1 Robert F. Kennedy, Jr. "Deadly immunity", Salon.com 2005 June 16.
  2. "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.
  3. 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
  4. Needham, Joseph. (2000). Science and Civilization in China: Volume 6, Biology and Biological Technology, Part 6, Medicine. Cambridge: Cambridge University Press. Page 134.
  5. Development & Approval Process (Drugs), U.S. Food and Drug Administration (FDA). 2012 October 15.
  6. 6.0 6.1 6.2 6.3 Aaron Levin. Vaccines Today. Annals of Internal Medicine. 2000;133(8):661
  7. Engelhardt SJ, Halsey NA, Eddins DL, Hinman AR. Measles mortality in the United States 1971-1975. American Journal of Public Health. 1980 Nov;70(11):1166-9.
  8. Gindler J, Tinker S, Markowitz L, Atkinson W, Dales L, Papania MJ. Acute Measles Mortality in the United States, 1987-2002. The Journal of Infectious Diseases. 2004 May 1;189 Suppl 1:S69-77.
  9. Christopher Wanjek. Whooping Cough Makes Whopping Comeback. LiveScience. 010 August 25.
  10. Steven Salzberg. Anti-Vaccine Movement Causes The Worst Whooping Cough Epidemic In 70 Years. Forbes. 2012 July 23.
  11. Some Common Misconceptions: MISCONCEPTION #1 - Diseases had already begun to disappear before vaccines were introduced, because of better hygiene and sanitation. Centers of Disease Control and Prevention (CDC). 2011 February 18.
  12. Sanjaya N Senanayake. Mumps: a resurgent disease with protean manifestations. Medical Journal of Australia. 2008;189(8):456-459.
  13. Thimerosal in Vaccines. U.S. Food and Drug Administration (FDA). 2012 June 20.
  14. Pichichero ME, Cernichiari E, Lopreiato J, Treanor J. Mercury concentrations and metabolism in infants receiving vaccines containing thimerosal: a descriptive study. Lancet. 2002 Nov 30;360(9347):1737-41.
  15. NIAID Research on Thimerosal. National Institute of Allergy and Infectious Diseases (NIAID). 2005 April 22.
  16. Even ten milliliters of methanol will destroy your optic nerves, causing blindness, burn holes in your brain, and kill you. Ethanol is much less toxic, as any alcoholic will tell you... after their hangover subsides.
  17. Burbacher TM, Shen DD, Liberato N, Grant KS, Cernichiari E, Clarkson T. Comparison of Blood and Brain Mercury Levels in Infant Monkeys Exposed to Methylmercury or Vaccines Containing Thimerosal. Environmental Health Perspectives. 005 Aug;113(8):1015-21.
  18. Barile JP, Kuperminc GP, Weintraub ES, Mink JW, Thompson WW. Thimerosal exposure in early life and neuropsychological outcomes 7-10 years later. Journal Pediatric Psychology. 2012 Jan-Feb;37(1):106-18. Epub 2011 Jul 23.
  19. Hernán MA. Jick SS. Olek MJ. Jick H. Recombinant hepatitis B vaccine and the risk of multiple sclerosis: a prospective study. Neurology. 2004;63:772-773
  20. DeStefano F, Weintraub ES, Chen RT. Recombinant hepatitis B vaccine and the risk of multiple sclerosis: a prospective study. Neurology. 2005 Apr 12;64(7):1317; author reply 1317.
  21. Mikaeloff Y, Caridade G, Assi S, Tardieu M, Suissa S; KIDSEP study group of the French Neuropaediatric Society. Hepatitis B vaccine and risk of relapse after a first childhood episode of CNS inflammatory demyelination. Brain. 2007 Apr;130(Pt 4):1105-10. Epub 2007 Feb 1.
  22. DeStefano F, Verstraeten T, Jackson LA, et al. Vaccinations and risk of central nervous system demyelinating diseases in adults. Archives of Neurology. 2003 Apr;60(4):504-9.
  23. FAQs about Hepatitis B Vaccine (Hep B) and Multiple Sclerosis. U.S. Centers for Disease Control and Prevention (CDC). 2010 July 8.
  24. Vaccine/SIDS Sudden Infant Death Syndrome (SIDS/cot death) and Childhood Vaccines: Is There a Connection? '"Shirley's Wellness Cafe."
  25. Sudden Infant Death Syndrome (SIDS) and Vaccines. U.S. Centers for Disease Control and Prevention (CDC). 2010 March 11.
  26. Rand CM, Berry-Kravis EM, Zhou L, Fan W, Weese-Mayer DE. Sudden infant death syndrome: rare mutation in the serotonin system FEV gene. Pediatric Research. 2007 Aug;62(2):180-2.
  27. Howard LM, Kirkwood G, Latinovic R. Sudden infant death syndrome and maternal depression. Journal of Clinical Psychiatry. 2007 Aug;68(8):1279-83.
  28. Robert F. Kennedy Jr. embarrassing the Kennedy family again: "Attack on Mothers." The Huffington Post. 2007 June 19.
  29. Whale.to - Boyd Haley Ph.D. quotes (Scopie's Law in full effect).
  30. Orac. The lowest of the low: Trying to bleach autism away. Respectful Insolence. ScienceBlogs. 2012 May 25.
  31. Hviid A, Stellfeld M, Wohlfahrt J, Melbye M. Association between thimerosal-containing vaccine and autism. Journal of the American Medical Association. 2003 Oct 1;290(13):1763-6.
  32. Uchiyama T, Kurosawa M, Inaba Y. MMR-vaccine and regression in autism spectrum disorders: negative results presented from Japan. Journal of Autism & Developmental Disorders. 2007 Feb;37(2):210-7.
  33. Afzal MA, Ozoemena LC, O'Hare A, Kidger KA, Bentley ML, Minor PD. Absence of detectable measles virus genome sequence in blood of autistic children who have had their MMR vaccination during the routine childhood immunization schedule of UK. Journal of Medical Virology. 2006 May;78(5):623-30.
  34. Honda H, Shimizu Y, Rutter M. No effect of MMR withdrawal on the incidence of autism: a total population study. Journal of Child Psychology & Psychiatry & Allied Disciplines. 2005 Jun;46(6):572-9.
  35. Smeeth L, Cook C, Fombonne E, Heavey L, Rodrigues LC, Smith PG, Hall AJ. MMR vaccination and pervasive developmental disorders: a case-control study. Lancet. 2004 Sep 11-17;364(9438):963-9.
  36. DeStefano F, Thompson WW. MMR vaccine and autism: an update of the scientific evidence. Expert Review of Vaccines. 2004 Feb;3(1):19-22.
  37. Taylor B, Miller E, Farrington CP, Petropoulos MC, Favot-Mayaud I, Li J, Waight PA. Autism and measles,mumps,and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 1999 Jun 12;353(9169):2026-9.
  38. Kreesten Meldgaard Madsen, M.D., Anders Hviid, M.Sc., Mogens Vestergaard, M.D., Diana Schendel, Ph.D., Jan Wohlfahrt, M.Sc., Poul Thorsen, M.D., Jørn Olsen, M.D., and Mads Melbye, M.D.:A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism, The New England Journal of Medicine 2002; 347:1477-1482 November 7, 2002, DOI: 10.1056/NEJMoa021134
  39. Ben Goldacre. The media’s MMR hoax. Bad Science. 2008 August 30.
  40. Autism-vaccine study retracted. CBC News. 2010 February 2.
  41. Retracted autism study an 'elaborate fraud,' British journal finds. CNN. 2011 January 5.
  42. Harold E. Buttram, MD. Shaken Baby Syndrome or Vaccine-Induced Encephalitis? Medical Sentinel. 2001;6(3):83-89.
  43. Shaken Baby Syndrome (SBS) or Vaccine-Induced Encephalitis? Misdiagnosed Shaken Baby Syndrome. Shirley's Wellness Cafe.
  44. Yurko Project. "Free Yurko."
  45. Vaccine boycott spreads polio. News24. 2004 February 11.
  46. Nigerian Muslims Bar Polio Vaccine. CBS News. 2009 February 11.
  47. Jeffrey Shallit. Lies of Our Times. 1996.
  48. Vaccinosis, What Parents Need to Know. "Hpathy.com." 2009 August.
  49. Karen Houppert. Who's Afraid of Gardasil? The Nation. 2007 March 8.
  50. Moira Gaul. Gardasil: What Every Parent Should Know about the New HPV Vaccine. Family Research Council. 2007.
  51. Gohmert: ‘Scary’ that liberal elites would use vaccines for ‘culling the population’ of humans, The Raw Story
  52. Not as a rule, but commonly. See: http://reason.com/archives/2014/03/25/should-vaccines-be-mandatory
  53. http://reason.com/archives/2013/12/06/vaccine-free-riders-1
  54. http://www.cdc.gov/features/pertussis/
  55. Religious Liberty Confers No Right To Send Unvaccinated Kids To School, Court Rules
  56. Measles outbreak tied to Texas megachurch sickens 21. NBC. 2013 August 27.
  57. Sonya Smith. Minister Farrakhan joins the fight against H1N1 flu vaccine. Examiner.com. 2009 October 20.
  58. Cancer jab alert after girl dies. BBC News. 2009 September 29.
  59. Ben Goldacre. Jabs "as bad as the cancer." Bad Science. 2009 October 10.
  60. Nick Triggle. MMR scare doctor 'acted unethically', panel finds. BBC News. 2010 January 28.
  61. Ben Goldacre. The Wakefield MMR verdict. Bad Science. 2010 January 28.
  62. As predicted by serious scientists, a measles epidemic has broken out in South Wales, hospitalising many and causing at least one fatality.Retraction—Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet. 2010 February 2.
  63. National Institute for Health and Welfare recommends discontinuation of Pandemrix vaccinations
  64. 64.0 64.1 Persson et al,Risks of neurological and immune-related diseases, including narcolepsy, after vaccination with Pandemrix: a population- and registry-based cohort study with over 2 years of follow-up, Journal of Internal Medicine Volume 275, Issue 2, pages 172–190, February 2014
  65. Wijnans et al, The incidence of narcolepsy in Europe: Before, during, and after the influenza A(H1N1)pdm09 pandemic and vaccination campaigns, Vaccine Volume 31, Issue 8, 6 February 2013, Pages 1246–1254
  66. 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
  67. Lesley Messer. Alicia Silverstone's Son Has 'Never Had a Drop of Medicine. ABC News. 2014 April 17.
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