– It was a mistake for which the medical and publishing community is beating their breasts to this day. It turned out that the review process that allowed this work to be published was, euphemistically speaking, imperfect. Later, when other scientists evaluated this work, they found many methodological errors that the author had made. As a result, Wakefield was proven not only to write untruths, but also to manipulate – explains Dr. n. med. Aneta Nitsch-Osuch, epidemiologist and pediatrician from the Department of Family Medicine at the Medical University of Warsaw.
- In 1998, Andrew Wakefield (with a group of other authors) published an article in the respected scientific journal “The Lancet” arguing that the combination of MMR vaccine given to children may increase the likelihood of autism in them
- Years later, Wakefield was proven to have falsified the research results. The author was deprived of the right to practice as a doctor, and the article itself was finally removed from the journal in 2010
- Yet the belief that vaccines cause disease continues to fuel the anti-vaccine movement to this day. Movements that are getting louder during the COVID-19 pandemic
- The interview is an excerpt from the book “Virologists talk about the fight against the plague” in which Mira Suchodolska talks with Polish scientists and doctors professionally dealing with the COVID-19 pandemic. The book was published by the Czerwone i Czarne publishing house
- You can read more about the coronavirus epidemic on the TvoiLokony home page
Mira Suchodolska: Let’s talk about the anti-vaccine movement. Ordinary people who do not have sufficient knowledge to understand all these dependencies in the natural world have the right to be afraid, distrust and err. Often, however, they are led astray by their authorities who have had a scientific career behind them. What was that gentleman’s name, Andrew Wakefield?
dr hab n.med. Aneta Nitsch-Osuch: Yes, a British physician who contributed to the spread of anti-vaccine ideas. But before I talk about it, I would like to refer to a certain shift in attitudes towards immunization that has been described by the Brighton Collaboration experts. This is a group of experts that has set itself the goal of promoting vaccination. They pointed out that attitudes towards vaccination in modern societies resemble a sine wave.
How does it look like? Well, when there is an infectious disease that we fear, we observe it every day, just like we now experience the COVID-19 pandemic, everyone is breathlessly waiting for the appearance of a vaccine, an effective remedy for the disease. Then the acceptance of possible undesirable post-vaccination reactions is very high. Finally, the vaccine shows up, it is used in millions of people, the disease is gone. And the fear of her disappears. We forget about the disease, about the panic that accompanies it, but we start looking at vaccines in more detail. And the earlier acceptance for possible undesirable side effects decreases dramatically.
The result is the reluctance to perform vaccinations, and fewer and fewer people decide to vaccinate themselves and their loved ones. Previously developed herd immunity is declining. There are fewer people vaccinated and immune to the disease, so the contagious disease appears again. This is what we experienced with whooping cough and measles, for example. They are coming back, so the acceptance for vaccinations again, unfortunately for a short time, increases.
We epidemiologists observe this every day. For example, remember 2014, when the measles outbreak began in Europe and the United States. The interest in vaccinations has grown so much that there are no vaccinations in pharmacies and wholesalers. More specifically, one so-called MMR against measles, mumps, rubella. It is this combination vaccine that is the most controversial. And it was Andrew Wakefield, a British former doctor who was still alive, who in the nineties accused him of a cause-and-effect relationship with the occurrence of autism in children.
- The MMR vaccine causes autism?
But his article, which became the anti-vaccine bible, published The Lancet, arguably the most respected medical journal.
It was a mistake for which the medical and publishing community still beats its breasts. It turned out that the review process that allowed this work to be published was, euphemistically speaking, imperfect. Later, when other scientists evaluated this work, they found many methodological errors that the author had made. As a result, Wakefield was proved not only to write untruths, but also to manipulate. For which, rightly, he suffered the worst punishment for a doctor: he was deprived of the right to practice. And this article was eventually removed from the magazine. Which does not change the fact that it can still be found in the deep resources of the Internet. What’s good about this is that the peer-review process has been sealed before being published in reputable journals. Except Wakefield’s publication was in 1998, but it took some time to prove the fraud – a report on a study that turned his claims to shame came out in 2014.
- Author of a study on the MMR vaccine – no license to practice
The procedures have been improved, the system has been sealed, but the man is still active nonetheless. In 2019, he appeared in Poland at a demonstration by members of the STOP NOP anti-vaccine organization. People say: the guy didn’t suck it all off his finger. There must be something going on.
Once the bad seed has been planted and it is sprouting, it is difficult to deal with this problem in a radical way. And it doesn’t mean that modern scientific evidence, i.e. epidemiological studies, has shown that there is no causal relationship between measles, mumps, and rubella vaccination and the prevalence of autism in children. And there are a lot of such studies, their results are generally available, such is the position of the World Health Organization or, for example, the American Academy of Pediatrics.
Nevertheless, it was the FDA, the US Food and Drug Administration, that in 2000 ordered that a preservative that contained mercury compounds be withdrawn from vaccines. It is these relationships by Wakefield that have been accused of causing autism.
Wakefield preceded the so-called Thimerosal scandal with his text.
The idea was that thiomersal, a mercury derivative contained in vaccines as a preservative, could allegedly cause psychomotor disturbances in children These were serious accusations, there was panic among people, so the FDA asked manufacturers to remove thimerosal from vaccines just in case . And that’s how it happened. But huge research was launched soon, planned on large groups to find a cause-and-effect relationship between thimerosal and autism. And not found.
It turned out that this substance was used in vaccines in a dose so low that it could not affect any disorders of psychomotor development in children. Eating farmed fish, where mercury compounds can accumulate, may have a greater impact. Moreover, thiomersal is an ethyl mercury derivative. And it is a substance that, even after a high dose, is excreted through the gastrointestinal tract, which means that it remains unaccumulated in the body for up to five to seven days.
The compound ethylmercury must be distinguished from methylmercury, which actually accumulates in the central nervous system and may cause disease symptoms. The difference is similar to that between ethyl and methyl alcohol. Ethyl alcohol in small amounts is not particularly harmful, while methyl alcohol in any amount, even in small doses, is a toxic substance.
There are milestones in the development of the anti-vaccine movement – one of them is an article by Andrew Wakefield, there was another report by one Alan Phillips, a non-physician, arguing that neither antibiotics nor vaccination have improved human health.
However, we all know that vaccine complications do happen. When and why?
As every drug has its own side effects, so does the vaccine, which is a medicinal product. We call them undesirable vaccination reactions. And this is despite the fact that such a preparation is subject to many quality control processes regarding its ingredients and their impact on organisms. At one of the meetings of scientists in the field of vaccinology, the question was asked: how many quality control processes do you think a vaccine undergoes before it reaches the doctor’s office? I replied that over a hundred. Colleagues pierced me declaring that I was one hundred and forty, two hundred, six hundred. It turned out that such a vaccine may be subject to even, caution, a thousand different types of quality control processes.
- Vaccinations – types, compulsory vaccinations, post-vaccination adverse reactions [EXPLAINED]
Vaccines are one of the best-tested preparations in terms of safety. Of course, it can happen that undesirable reactions do occur, but they are rare. Which is also described in the product characteristics. Usually, these are mild local reactions: pain at the injection site, swelling, redness. There may also be a generalized reaction, usually in the form of fever. Yes, it is not pleasant to have a fever after vaccination. Nevertheless, this too can be considered a natural response, and the fever should subside within two or three days.
Of course, it is possible to experience severe, undesirable post-vaccination reactions, such as an anaphylactic reaction, i.e. allergy to one of the vaccine components, no one can predict this. It can actually be a threat to your health and life. Then it is necessary to give the patient adrenaline. But such reactions are very rare. I would say extremely rare. Nevertheless, they do happen.
Sometimes it results from the fact that a certain group of patients has a special genetic predisposition to do so. This was the case in 2009 when teenagers living in the Nordic countries were given the pandemic flu vaccine. And in this group, the risk of narcolepsy (from excessive sleepiness to falling into catalepsy, i.e. stiffening of the whole body – editor’s note) has significantly increased. After extensive research, it turned out that there is a gene mutation in this age group that promotes the onset of narcolepsy. And the administration of this vaccine was such a trigger mechanism that triggered the entire cascade that led to the appearance of disease symptoms. But these are – as I said – extreme cases.
We are sensitive to the health of our children, so if, for example, a fever appears after vaccination, we already panic and plot various black scenarios.
It is known that some children, especially young children, may develop a fever after immunization. A complication of fever in children under the age of five is febrile convulsions. This can be predicted: if there is a tendency in the family for such seizures, or the child has already had it with an infection, they should receive anti-pyretic drugs prior to vaccination. One day before vaccination and two days after vaccination.
- Post-vaccination fever
I am convinced that the vast majority of adverse vaccination reactions could have been avoided if the qualification for vaccination had been properly conducted. This qualification is a medical procedure: a visit to the clinic is required, the child must be examined by a doctor whose task is to rule out contraindications. And these can be temporary (infection) or permanent (for example, a defect in the immune system). If this identification of contraindications is carried out carefully, vaccinations will be safe.
This is a story told by my friend: he gives birth to a son with his wife. It’s all right, the baby is coming into the world. Suddenly, a doctor appears with a syringe, says that he will vaccinate the baby. But for what, why, why so early? A row, threats to call the police. As a result, the infant was not vaccinated and was sent home with his mother. In the next day, physiological jaundice appeared. The father went with his son to a private doctor. And the latter asked if the child had received the vaccine, because if so, the prognosis was poor: the newborn’s liver would not be able to deal with the processing of vaccine toxins and those resulting from jaundice at the same time.
These vaccines, which are given in the first XNUMX hours of life, are designed to immunize the body against tuberculosis and hepatitis B. Both diseases are dangerous and must be prevented by vaccinating children. In contrast, neonatal jaundice occurs and requires monitoring and, if necessary, appropriate treatment, usually called physiological jaundice. Vaccination in the first XNUMX hours of life has no effect on the occurrence of physiological jaundice. Vaccinations against tuberculosis and hepatitis B are performed in Poland in the first XNUMX hours of life, and this time is not accidental. It is based on strong epidemiological reasons. For example, immunization against hepatitis B in a newborn baby is expected to protect a newborn from a potentially fatal disease that can lead to cirrhosis of the liver.
Could he get infected in the hospital when he was born?
Yes, although this risk is less and less likely due to the radical improvement in sanitary conditions in Polish hospitals. And with the fact that vaccines for hepatitis B became common, which drastically averted the risk of contracting the disease. But let’s remember that in the mid-XNUMXs, so quite recently, our country was number one when it comes to the number of hepatitis B cases in Europe. Fortunately, that has changed. Fortunately, it is dramatically dangerous, especially in children.
The disease progresses quickly, and life-threatening complications occur in no time. The same is true for TB vaccination. It should also be done in the first few days of a child’s life, before the newborn leaves the hospital. A newly born person handed home is more at risk, if only because he may come into contact with a coughing neighbor who may not even know he has tuberculosis. Poland still has a higher incidence of this disease than the countries of the old European Union. Admittedly, we are close to meeting the WHO criteria and if we did, we could remove TB vaccination from the vaccination calendar in the first XNUMX hours of life. But we still lack it a bit.
And we will probably miss it for a long time, because we border Ukraine, where tuberculosis is a very serious problem.
In addition, beyond our eastern border, we are dealing with multiresistant tuberculosis, i.e. tuberculosis that does not respond to antibiotic treatment.
- Why are bacteria becoming resistant to antibiotics? Discovery of Swedish scientists
Are such vaccine harvesters – when a newborn man is given a preparation designed to act against several types of viruses – safe? Wouldn’t it be better to vaccinate a toddler for one disease every few days?
These highly combination vaccines are absolutely safe. I have already mentioned that the vaccine safety process is checked many times at all stages – production and later, when the preparation is administered to a very large number of patients. These studies show that the reactivity of the five-in-one, six-in-one highly combined vaccines is not greater than that of the single-component vaccines. Besides, combined vaccines are safer because they contain the acellular pertussis component.
Please explain for laymen …
These highly combination vaccines also prevent whooping cough disease. A there are two types of pertussis vaccines, the so-called acellular, or acellular, and whole-cell vaccines. The former are safer. They were invented in the XNUMXs and have been widely used in developed countries ever since. And in general, the reactivity of highly combination vaccines is not any greater just because they contain more ingredients. That doesn’t mean they cause more side effects than the single-ingredient ones. Their reactivity is absolutely comparable.
When can things go wrong after an immunization? A powerful weapon in the hands of anti-vaccination movements are videos disseminated on the Internet, in which mothers, holding their sick children in their arms, tell dramatic stories such as: “She was a healthy, normal girl before the vaccination, but after administering the preparation …” And here the diagnosis usually appears autism or damage to the central nervous system.
Again, a cause-and-effect relationship between vaccinations and autism spectrum disorders has never been demonstrated. On the other hand, it may happen that the vaccination was performed at a time in a child’s life when some infectious disease, such as meningitis, was hatching, which consequently led to permanent damage to the central nervous system.
Suspicions about a link between vaccines and autism probably arose because the combined measles, mumps and rubella vaccine, or MMR, is given at thirteen or fourteen months of age. And this is the age when the first spectacular symptoms of autism begin to appear. In children who received MMR earlier and diagnosed with autism shortly thereafter, a temporal relationship between vaccination and the onset of symptoms was indicated. In contrast, the plethora of studies that have been conducted have ruled out a causal relationship.
It is actually moving when you listen to desperate parents who search for all possible causes of a terrible disease in their child. And it is very difficult for us doctors to talk to them. It is also difficult to convince viewers of such programs, because when on one side of the studio sits an unhappy mother who expresses her emotions very expressively, it is easier for them to identify with her than with a professional in the other corner of the studio who has dry facts at his disposal. So what if the substantive arguments are on the doctor’s side? In such a clash of the titans, that is, emotions and knowledge, emotions win.
MMR is not the only vaccine to be infamous and shrouded in myth.
True, another that has aroused much controversy is the vaccine against HPV, the human papillomavirus. She, in turn, was associated with the occurrence of chronic fatigue syndrome in vaccinated girls. This has also been studied, and in 2015 the WHO issued a position statement stating that the link between various diseases and HPV vaccination has not been confirmed, so it should be considered safe.
- MMR vaccine – vaccination against measles, mumps and rubella [EXPLAINED]
Let me remind you that its performance is to prevent the occurrence of cervical cancer. Although the incidence of this disease is falling in Poland, unfortunately, Poland is still at the forefront of European statistics when it comes to mortality due to it. Until recently, students from other countries came to us to see patients with advanced forms of this disease, because they simply do not have such patients.
Unfortunately, even an ordinary, seemingly “tame” vaccine against seasonal flu somehow cannot be adopted in our society – less than four percent of Poles get vaccinated. It could also be because this virus is highly variable, so dosing has to be repeated every year, and people don’t want to be pricked. I hope that the situation will improve with the appearance of an intranasal vaccine, which is convenient for administration in children and adolescents.
And why in children and adolescents and not in adults? How is it administered in the form of drops?
In the form of an aerosol, it contains live attenuated, i.e. weakened, influenza viruses, and in Poland it is registered for administration in children from two to eighteen years of age. It is very effective in relation to this age group, slightly worse in adults. They will benefit more by taking inactivated, or “killed” viruses, injected intramuscularly.
I often hear complaints: I got vaccinated but got flu anyway, so it doesn’t make sense.
Let me put it briefly: having the flu vaccine protects you from getting the flu. Dot. And it is very good that it protects, because the flu is characterized by a high risk of complications, most often from the respiratory and circulatory systems, but it is actually difficult to find a system that would not be affected by complications. Complications often lead to death, especially in risk groups. Well, let’s remember that we have about two hundred respiratory viruses, and now even two hundred and one, because we have SARS-CoV-2. And the flu vaccine will not protect us against it, just as it is not effective against rhinoviruses that cause colds or the metapneumovirus responsible for inflammation of the upper and lower respiratory tract. However, immunization against the flu virus is most important, if only because a cold does not kill us, and there are no complications after it.
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And one more thing: the flu virus exacerbates the condition of patients with chronic diseases such as cardiovascular, respiratory, metabolic (diabetes), patients with multiple sclerosis, so these risk groups should also get vaccinated against the flu season every season.
There are also stories that are popular: I got vaccinated against the flu, and after two days I became so ill that nothing worse has happened to me to this day.
It is absolutely impossible that an inactivated vaccine given into a muscle will cause you to catch the flu. It contains inactive parts of the virus. A car won’t start a race without an engine, right? What can actually happen is the occurrence of certain adverse reactions to the vaccine, such as low-grade fever and joint and muscle pain. Unfortunately, there are many anti-vaccine myths, but they have little to do with reality and modern medical knowledge.
Poland is not the only country where some people give them faith. In one of your articles, I read that a rumor broke out in Romania that HPV vaccination causes infertility. That is why the vaccination campaign among the girls was unsuccessful there.
This is an example of how gossip can destroy great vaccine promotion campaigns. The one in Romania meant that only one or two percent of the population benefited from free vaccination offered by the government. But this accident at work exposed the handicap of preparations for the vaccination campaign, because it began without proper public education. People need to be explained, constantly convinced of why vaccinations should be given, what terrible diseases we can avoid, and we can explain safety issues.
Fortunately, in developed countries, including Poland, eighty percent of the population are vaccineists. What worries us, however, is the growing percentage of people who are reluctant to vaccinate.
That is?
They are good parents, they love their children but they express many doubts. Often they will not vaccinate their child in the first XNUMX hours of life, but will decide to vaccinate it later, although this may be more difficult for organizational reasons. A person who hesitates is one who will choose preparations from this range, which we have as part of the preventive vaccination program: “I will vaccinate for this, not for that anymore” (by the way, we vaccinate against, and we have infectious diseases).
Let me give you an example from my office: a mother announced that she would not be vaccinating her child against measles, mumps and rubella because, and I quote, “you know it causes autism.” However, she decides to get a tetanus vaccine because she is afraid that her branch will get hurt in the sandbox. She knows better, that’s why she chose the vaccination for her child, which she believed was safe and needed.
The World Health Organization and experts who deal with anti-vaccine attitudes indicate that our attention as medical professionals should be especially directed to those who doubt. These are parents who have come across fake news – most often on social media – and are simply scared. They don’t know what the truth looks like, yet they want the best for their child. And if this group is given enough time and attention, the doubts can be effectively dispelled.
So we have a steady, large group of followers, a growing group of hesitants. And how many radicals are there: “they murder us with these vaccines, I will not be vaccinated against coronavirus for nothing in the world, because Gates will install some chips in our body”?
Fortunately, it’s a margin. No substantive arguments reach them. During one of the expert meetings, we discussed the example of an anti-vaccine-oriented family from Vilnius. Many children, no child has been vaccinated, blank immunization cards. A few months old baby fell ill with whooping cough and died. Parents were persuaded to vaccinate the other children, but they refused. We are often doomed to failure when we meet with outspoken opponents of vaccination.
Because that’s a kind of faith …
Well, yes, and religious beliefs are not discussed. But these radicals contribute to the increase in the incidence of vaccine-preventable infectious diseases, and therefore to the worsening of the epidemiological situation. Honestly, if I were the parent of a child who cannot be vaccinated because, for example, he has problems with immunity, and would be infected by a peer who was not vaccinated due to his parents’ anti-vaccination beliefs, I would have justified claims – both to his parents and and those who manipulated them. It is just unethical to put others at risk. We cannot be selfish and as a society focused on only seeing the tip of our nose. We must also think about others.
Yes, vaccinations are good for us because we won’t get sick. But thanks to them, we also extend a protective umbrella over the weakest who cannot be vaccinated because they are undergoing oncological treatment, for example.
There are demands to abolish the vaccination obligation. So that each time the parent can decide – yes or no. It’s a good idea?
We do not have any compulsory vaccination in Poland. Compulsion was introduced only once, during the times of Marshal Józef Piłsudski, right after World War I. It was about smallpox vaccination. Then the truly refractory could be forced, including the use of physical force, to take the vaccine. Today, vaccines are a privilege, and those that are considered mandatory are reimbursed and you do not have to pay for them. People who are notoriously avoiding vaccinations face administrative and financial penalties, but no one goes to jail for it, and no one can be forced to take the vaccinations included in the vaccination schedule.
- When the smallpox vaccine was invented, people who were vaccinated were said to grow horns
I hear the opinions of specialists that the Polish vaccination calendar, free of charge, is still very poor.
For many years, experts have indicated the need to extend the Polish immunization program. It would be wonderful if rotavirus vaccinations could be introduced into it. Fortunately, rotavirus diarrhea in Polish conditions is not a fatal disease, but it is a huge burden for the health care system, but also for parents, not to mention that it is unpleasant for a child. Introducing compulsory and free rotavirus vaccinations would quickly bring spectacular benefits. This is evidenced by the experience of other countries, where the expenditure incurred to reimburse a mass, universal vaccine very quickly, after only two years, pays off. And of course, HPV vaccination should be reimbursed from the budget and included in the vaccination program. This is what we are striving for, and maybe it will happen as part of the oncology strategy. On my dream list there is also vaccination against chickenpox, which should be done more often, not only for nursery-age children, but also for older children. And also pneumococcus and flu …
***
Dr hab. n. med. Aneta Nitsch-Osuch – epidemiologist and pediatrician, assistant professor at the Chair and Department of Family Medicine at the Medical University of Warsaw. He is a member of the Committee on Epidemiology and Bioterrorism at the Sanitary and Epidemiological Council, which is part of the early warning system in the event of bioterrorist events of great importance to public health. Educator and promoter of vaccinations.
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