Needling (Anti)Vaxxers About Risk (or This Isn’t Your Father’s 11/780)

What’s this I hear about people being anti-Vax? Don’t they realize that without the Vax, and its older sibling, the PDP 11, there might not have been the Internet as we know it? I mean, Unix was developed for the Vaxxen. Oh, wait, I wanted to write about a different Vax. Nevermind.

Seriously, now that we’re past that bad but obligatory pun, I’d like to talk to you about a different sort of “vax” — vaccines, and their well-publicized opposition, the “anti-vaxxers”. These folks have been in the news lately because of a recently enacted California law that requires parents to vaccinate their children except when medically-contraindicated (no exemption for belief or parent choice), and a Federal Judge upholding that law. Do a search on the Internet related to that law, and you are overwhelmed by the anti-vax opposition sites, such as this one, masquerading as an information site. Closer to home, the subject is on my mind because of a recent discussion with a relative who is in the anti-vax camp, where she asked if she was anti-science because she was skeptical of many things such as the planethood of Pluto, the accuracy of meteorologists, and science’s disbelief (until recently) about the value of the microbiome. This particular post was prompted by a “Fuck You Anti-Vaxxer” rant a different friend posted, which made me realize that a more reasoned screen was necessary.

Let’s work through this and some of the arguments together. The BLUF (Bottom Line Up Front) is that being an anti-vaxxer is not necessarily being anti-science, but it is a clear demonstration of how humans want to blame something or someone when something goes wrong, how humans have difficulty separating correlation and causality, and how bad we are at judging and assessing risk. When properly assessed, the best way that a parent can reduce risk for their child is to ensure they are vaccinated.

Science and Anti-Science

Let’s start with science. Is one anti-science if one questions scientific results and is skeptical? The answer is “no”. Science is rarely an absolute process. Proofs are often based on particular assumptions, called theorems, that apply to a particular frame of reference. Things that have been proven in the past have had to be reworked as our knowledge has grown and our frames of reference have changed. Take the lowly triangle. We know that it can be proven that the sum of the angles of a triangle is a certain value, but that breaks if you are in non-Euclidean space. When it comes to the science of the natural world, and medicine is included in that world, the bulk of our science is observational. We conduct independent studies, look at the results, and base our conclusions on those results. Studies can have flaws, and can sometimes fail. Failed studies often don’t get published, even though failures are often more interesting than successes.  Studies can also have hidden biases.

How does science address all of this? By being skeptical and being transparent. Transparency means full disclosure: disclosing who funded your study, disclosing any biases or assumptions, disclosing the full methodology and approach taken, and making the data accessible. Being skeptical means one does not believe the study until it has been repeated and repeated by someone independent. Confirmation is through a preponderance of the evidence: multiple studies from different people giving the same results.

This is often difficult in the medical field because of the ethics involved. In an ideal world, you would have a group with equal sicknesses or exposure, some portion of which you randomly exposed and do not treat, and another portion whom you treat. When the untreated subjects die and the treated subjects live, you have good results. But as humans, we cannot accept studies that intentionally injure others, and this means the studies of medicine are often quite difficult, often do not cover the full range of potential patients, and are often small or anecdotal. Further, because the human body is incredibly complicated (and because, as we’re discovering, the microbiome, which is unique to every individual and constantly changing, is also if not more complicated), reactions are not the same for every person, even the best study cannot predict all cases.

So, it is not being anti-science to be skeptical. Be skeptical. But also be willing to accept the evidence and the preponderance of evidence. If 99.999999% of people indicates that if Y occurs, then Z happens next, you should accept that.

Correlation and Causality

One area where humans have incredible difficulty is statistics, and in particular, correlation and causality. Here’s the classic example, the proof that storks bring babies:

Two things may seem to be correlated (associated) when there is actually no real connection between them. This is particularly likely with changes over time. In a delightfully clear discussion of statistical aspects, mathematician Vanessa Didelez provided an entertaining example. Over the last two centuries, bread prices in Britain and sea levels in Venice increased in tandem. This simply tells us that bread prices and sea levels both rose over time. Such obvious coincidences are easily discounted, but the fundamental distinction remains crucial: correlation is just a mutual relationship between two or more things, whereas causation is a relationship in which a particular action or event can be shown to be the direct consequence of another. Two seemingly associated things may depend on some common cause that has not been considered, a statistician’s confounding factor. Ideally, we need experiments to test for cause and effect, but that is rarely possible in human biology. Lacking experiments, we must interpret indirect evidence very cautiously.

Pioneering statistician George Udny Yule, author of the seminal 1911 textbook Introduction to the Theory of Statistics, explained confounding factors with a pleasing reference to reproduction. He noted that in Alsatian villages numbers of human newborns are correlated with numbers of storks nesting locally. It is tempting to conclude that storks do actually deliver babies, but the real explanation is far more mundane. Larger villages have more houses with chimneys for storks to build nests, and more babies are of course delivered in larger villages. The confounding factor is village size.

The key point here is that sequencing is not necessarily proof of cause. The fact that a child had a vaccine and subsequently developed an illness is not proof that the vaccine caused the illness. We want to think that it is. We want to blame something. But we don’t know all the factors. We cannot authoritatively ascribe blame.

Questions of Risk and Responsibility

Professionally, I work in the field of cybersecurity. My job, every day, is to help people with risk assessment and risk mitigation. A key point in this is teaching people how to understand risk realistically, and to understand that the goal is not risk aversion or 100% reduction of risk, but understanding risk and risk assessment.

In my discussion on Facebook, the following comments came out regarding vaccines (and I’m paraphrasing):

• Am I wrong to be skeptical of vaccines?
• I know people whose child got seriously ill after a vaccine. Why should I accept the risk?
• I’ve heard that babies are naturally immune? Why can’t I just expose my baby?
• Why is the government telling me what risks I should accept for my family?
• If the government insists on the vaccine, will the government take responsibility if something goes wrong?

I’m sure you’ve heard similar arguments. In many ways, we’ve addressed the first two. You’re not wrong to be skeptical of vaccines — in fact, if you’re concerned, go out and do the research and look at the studies. Be forewarned, however, that the Internet is not the place to do that. Many of the studies are not on the Internet, and much of what purports to be studies on the Internet is really propaganda masquerading as science. Recognize also that you require understanding of medicine, chemistry, and most importantly, statistics to properly judge and understand the results. Look for transparency: who is funding it, what are their biases, what is the skill of the scientists, are their methods proper. Many people from many organizations have done the same analysis, and have concluded that the preponderance of the evidence is that vaccines are effective — that they significantly reduce the risk of the illness and disease arising from the pathogen for which they target.

• But what about the children who get ill after vaccines?

Good question. The focus of the studies is on the efficacy of the vaccine; information on side effects and adverse events is often secondary. You should understand the difference between the two terms. Side effects are reactions that are proven — that is, there is a clear causal relationship — to be a reaction from the medicine. Adverse events are other reactions that have been reported, but that cannot be proven to be due to the medicine. Side effects are often difficult to confirm, because of the complexity of the human body, the fact that we cannot know every detail about it, that there might be hidden or unknown medical conditions, that the microbiome is unique and complex in its own right, and that random things do occur (such as random mutations) in nature. Medicine cannot currently (and likely will never be able to) predict the exact reaction to a medicine: all we can say is that for the vast vast vast vast majority, they react in a particular way, and where we have been able to identify human configurations that will create problems, they are disclosed.

Are babies immune? Great question. I’ve done some searching on the Internet, and there are a number of studies that show right after birth, babies have their mother’s immunity for a short time. Think about that closely. Their mother’s immunity. That means the mother must be immune: so the baby is immune only if the mother had been vaccinated or survive the illness. That immunity is passed down from the mother, meaning it is either in the placental blood (and doesn’t last) or comes from colostrum, the first breastmilk (which is only a week or two, and provides no benefit without breastfeeding). Further, the end period is non-specific, so it is possible to expose your baby after the immunity is gone — and you might not know — and then a major illness might erupt.

• But it’s my baby. Why should the government tell me what risks I should accept?

The answer here is: if it was just your baby, we might say “go for it”. Your baby gets sick, your problem. But that’s not the case, because you don’t live isolated on an island. You live in a community, like a herd of cows.

Yes, cows. Mooooooooo. Let’s say it together, “Moooooooooooooooooooooooooooo”.

What’s important here is the “herd” term — for the government is telling you what risk to accept because of herd immunity. As you won’t trust the government, or believe Wikipedia, here’s an explanation from Nova:

The term “herd immunity” refers to a means of protecting a whole community from disease by immunizing a critical mass of its populace. Vaccination protects more than just the vaccinated person. By breaking the chain of an infection’s transmission, vaccination can also protect people who haven’t been immunized. But to work, this protection requires that a certain percentage of people in a community be vaccinated.

[…]

Human communities were once relatively small and isolated. Diseases certainly broke out, but their transmission ended wherever geography limited a populace’s mobility. But today, our chains of connection traverse the globe—reaching across oceans and over mountain ranges, pervading immense cities and remote villages—linking us all into one vast, interactive human herd. Almost no one anymore lives in isolation from such connections.

These chains of human interaction have resulted in more potent chains of disease transmission. The only thing that can break a chain of transmission is a disease-resistant link. The chicken pox vaccine offers an example of the effectiveness of disease-resistant links. After the chicken pox vaccine debuted in the United States in 1995, deaths rates from chicken pox dropped by as much as 97%. Significantly, even though the vaccine is not administered to infants, no infants died from chicken pox in the United States between 2004 and 2007. These tiniest, most vulnerable links in the chain of human connections avoided exposure thanks to herd immunity.

The government is telling you what risk to accept not to take away your rights, but to protect the rights and health of the most vulnerable, the children who cannot medically have vaccines. By requiring you to vaccinate your child, who has extremely little risk of a reaction, they are saving the lives of many many more.

• But if something goes wrong, shouldn’t the government then be responsible?

Let’s work through that hypothesis, that the government should take responsibility if a child is injured from the vaccine. First question: Do we know for sure that it was the vaccine that caused the injury? Often, that cannot be proven (for example, there is no proof to the claims about autism being caused by vaccines). But let’s assume there was some reaction that caused the injury. Could the reaction have been predicted? If it could, is the fault that of the physician for not detecting the condition, as the government provided the out if there was a medical reason not to vaccine. So, let’s now assume there was no medical condition that triggered the problem, and yet the vaccine somehow still created a problem. Would the government be at fault here? I’m not a legal expert, but I would think fault and responsibility would only exist if the problem could have been predicted, and yet the government still insisted. That’s clearly not the case here. Sometimes, accidents happen and no one particular is at fault, other than the universe for having random, unpredictable things happen. However, even at that, the government actually does provide a route for compensation: http://www.hrsa.gov/vaccinecompensation/.

Figuring Out and Assessing the Real Risk

• But I personally know someone whose child developed (insert your illness) after getting a vaccine? I love my child. Why should I take that risk?

First, it is important to understand what a vaccine is not. Vaccines are, almost always, designed to be effective against viruses. They cannot inoculate against diseases that are not communicable, or conditions such as stupidity. They are not antibiotics, and cannot prevent bacterial infections. They cannot prevent mutations, brain conditions not caused by viruses, and such. Work is ongoing to develop new vaccines, especially for scourges like HIV (to prevent acquisition of the disease, as opposed to treating it once effective), Ebola, and Zika.

Further, although at one time there was concern about preservatives in vaccines, the industry has moved to preservatives and inert ingredients that statistically — that is, for the vast majority of the population, except for a fraction of a fraction of a fraction of a percent — have no reaction. Further, you have a right to ask what all the ingredients are, and to explore a medical exemption if there is a foreknown reactivity to one of them.

Is there risk from a vaccine? Of course: any medicine has risk, because people are unique, and possibly allergic to components. That’s why, for example, if you are allergic to eggs, you are medically exempt from many vaccines (and why the immune-impaired can only have so-called “dead virus” vaccines). But for the vast vast majority, they are statistically safe — and they are safer than exposure to the disease itself, which can often have permanent, if not fatal, consequences (which is also why there is no vaccine for the common cold, which is not fatal, or other non-fatal conditions). Still, in today’s society of “helicopter parenting”, I can understand why a parent would be scared of giving a child a vaccine and running the risk (and then blaming themselves), as opposed to the random chance of their getting a disease through exposure and then being worse off (because, of course, it then wasn’t your fault). But think about it this way: if your child gets exposed through random chance, and then ends up paralyzed, or blind, or permanently scarred, or deaf, or infertile or with other nasty (and preventable) medical conditions the rest of their life… or they die…. and you could have prevented that by giving them the vaccine, how would you feel? How would you feel if because your child was exposed and non-symptomatic, they infected some other child who was medically unable to be vaccinated, who then permanently harmed or injured that child (such as my nephew)? Fear of vaccines arises from misunderstanding risk, misunderstanding statistics, and belief in discredited studies. No, I can’t say they are 100% safe, but life isn’t safe — and we can’t live our lives being 100% risk averse. (edited to fix a typo: virus/vaccine)

Could developmental delays be due to a vaccine? As I’ve noted above, there is not proof that the vaccines are a proximate cause. Correlation is not causation, as anyone familiar with statistics will tell you, and the supposed connection between some vaccines (such as MMR) and autism have been soundly disproven. Although one might see a conspiracy of doctors because they didn’t attribute the cause to the vaccine, consider that they took their position because there might not have been any connection. Developmental delays show up at different times in different people, and there is no proof that without the vaccine, the delay might not still have occurred. We simply just do not know — and so parents grasp to find something to blame because of a bad outcome. All I can say that, statistically, vaccines are extremely safe and have significantly lowered mortality due to diseases they were designed to prevent. (I presume you would agree that vaccines do what they were supposed to do: significantly reduce the incident of problems or mortality *due to the diseases the vaccines inoculate against* when compared to an un-vaccinated population. If you do not agree with that, again, please cite specific studies.)

We all understand the desire to find something or someone to blame. The human mind looks for a correlation, and grasps at anything they could find. They had a vaccine before, and that *must* be the cause. Never mind that the condition might not have occurred without the vaccine, or that there might have been some other factor. Never mind the fact that some people develop diseases for no discernible reason other than random cell mutation.

Society today wants to blame something or someone for everything. Alas, despite our best efforts, shit sometimes happens for no reason other than … well, we don’t always know why shit happens sometimes. That means that sometimes we need to live with that risk. We can mitigate it in some ways through insurance, but you can’t take it to zero for everyone. I’m sorry to say that, but that’s life. Tomorrow you could be walking and hit by a lighting bolt. Because of that, do you never go outside?

Do you let your child swim? Don’t you know children can drown in water? Children are more likely to drown than to be shot by guns. Children are more likely to drown than to be provably injured by vaccines. But you let your child swim anyway?

Do you ride in an automobile? Auto accidents are a major cause of death or injury — much higher than injuries provably due to vaccines. Yet you still drive your child around. How can you stand the risk?

My point is everyday, unless you live in a bubble, you expose your child to even greater risk than would come from a vaccine. You don’t think twice about that exposure, yet you worry about a vaccine — which statistically will protect your child from significant illness without having a proven statistically significant to creating problems.

Humans do not understand how to properly assess risk. We grasp at statistically insignificant minor things, while clearly ignoring demonstrated risk in everyday life. We drive. We go to work. We go swimming. We walk on the street. We get together with other people. All of these significantly have more risk than a vaccine, but we do them anyway.

[ETA: PS: One thing I forgot. The one aspect that is debatable is the particular schedule of vaccines. Not whether you should give them, but when and in what order. As you can imagine, determining the schedule is at best a guesstimate, because there is no way to study the right schedule. As such, you should feel free to discuss with your doctor the right schedule and spacing, within the time frames that your local laws permit.]