COMMENTARY

Vaccine Science Taken Hostage? Paul Offit Responds

Paul A. Offit, MD

Disclosures

August 14, 2018

Editorial Collaboration

Medscape &

'Vaccine Science Taken Hostage'

On August 4, 2018, Melinda Wenner Moyer published an article in the New York Times titled "Anti-Vaccine Activists Have Taken Vaccine Science Hostage." Moyer seemed poised to discuss how millions of dollars have been spent on studies showing that vaccines don't cause autism, diabetes, hyperactivity, multiple sclerosis, autoimmune diseases, and a host of other ill-founded but commonly held beliefs about the harms of vaccines; and how, despite the findings in those studies, some people have remained unconvinced that vaccines are safe. But that wasn't the case in her article. Instead, Moyer has claimed that scientists are suppressing studies showing that vaccines are harmful, and that this "conspiracy of silence" is "eroding the integrity of vaccine science."

Flu Vaccine and Spontaneous Abortion: A Nonstarter

Ironically, one of the studies Moyer highlighted, which was published in the journal Vaccine,[1] directly contradicted her claims. Moyer criticized scientists who felt that the Vaccine study shouldn't have been published because it might frighten people. In this, Moyer had misread scientists' reactions to the study. Scientists weren't concerned that the study had uncovered a rare and frightening problem—spontaneous abortion caused by influenza vaccine; they were concerned that the study was, for many reasons, critically flawed.

First, six previous, large, well-controlled studies[2,3,4,5,6,7] had shown that influenza vaccination during pregnancy didn't cause spontaneous abortion. As an outlier, the Vaccine paper should have been held to a higher standard of proof.

Second, the Vaccine study[1] found an increased risk in one year but not the next. This was an inexplicable finding that remained unexplained.

Third, the only way that the study authors could show a possible problem was to alter their original hypothesis and substratify their data—something that epidemiologists frown upon. The authors of the Vaccine paper found that the risk for spontaneous abortion was present only in patients who had also received an influenza vaccine the previous year. Again, a curious finding that remained unexplained.

Fourth, the final numbers were small: 14 in the vaccine group and four in the nonvaccine group. Small numbers derived from large databases are often misleading.

Finally, the authors offered neither biological proof nor a plausible explanation for their finding.

After the study was published, several major newspapers and Internet sites decried the danger of influenza vaccination during pregnancy, no doubt causing some pregnant women to forgo the vaccine. However, the recommendation to give an influenza vaccine during pregnancy is not made casually. Natural influenza during pregnancy dramatically increases the chance of fatal pneumonia in the mother as well as potential harms to the unborn child.

Unsupported Claims of Harm Fall Apart

Another argument against Moyer's conspiracy-of-silence claim was the choice by the British journal the Lancet to publish Andrew Wakefield's belief that the measles-mumps-rubella (MMR) vaccine had caused autism in eight children.[8] Given the incidence of autism and the rate of immunization with MMR at the time, every year about 300 children in the United Kingdom would have been expected to develop autism within a month of receiving the MMR vaccine—unless the MMR vaccine prevents autism, which it doesn't. It only prevents measles, mumps, and rubella infections. Nonetheless, in the name of transparency, the Lancet published the paper.

As a consequence of this publication, thousands of parents in the United Kingdom chose not to vaccinate their children, hundreds were hospitalized, and four were killed by measles. Carl Sagan has argued that extraordinary claims should be backed by extraordinary evidence. This was an extraordinary claim backed by no evidence. Seventeen subsequent studies in seven countries on three different continents involving hundreds of thousands of children[9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25] who did or did not receive the MMR vaccine showed that it doesn't cause autism.

The Vaccine and Lancet examples aren't unique. In 2015, a study in Science Translational Medicine[26] claimed that an adjuvanted influenza vaccine used in Europe had caused narcolepsy, a permanent disorder of wakefulness. Subsequent research showed that the adjuvanted vaccine didn't cause narcolepsy. This was yet another study that had received widespread media attention but was wrong.

No Lack of Transparency

In truth, you don't have to look very far to find hundreds of published studies claiming that vaccines cause virtually every disease known to humankind. About 6500 medical and scientific journals in the world's literature publish 4000 studies every day. Not surprisingly, the quality of these studies follows a bell-shaped curve. Some are excellent. Some are awful. Most are mediocre. Scientific studies making irreproducible claims in the name of transparency are published all the time.

The problem with the influenza vaccine–spontaneous abortion paper wasn't, as Moyer claimed, that scientists were concerned that it would frighten people; it was that the study was so poorly conducted that it added nothing to our understanding of the vaccine.

On the other hand, excellent studies showing that the oral polio vaccine could cause paralysis, or that a short-lived rotavirus vaccine named RotaShield could cause intestinal blockage, or that gelatin-containing vaccines are a rare cause of severe allergic reactions have all shined a light on real vaccine safety issues. These three observations sit on top of a mountain of studies—thousands of them—showing that vaccines have no serious side effects, either in the short- or long term.

Moyer concluded that "vaccine scientists will earn a lot more public trust, and overcome a lot more unfounded fear, if they choose transparency over censorship." In truth, they've already made that choice, which is why claims like the influenza vaccine causing spontaneous abortion, the MMR vaccine causing autism, or an adjuvanted influenza vaccine causing narcolepsy were published. In the name of transparency, we do it all the time. And we do it at our peril.

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