Hot subject and a very emotive one. As parents, we want to do the best for our children.

We want to keep them out of harm's way, and anything that threatens a child is liable to enrage the lioness in every mother and garners an emotional visceral and sometimes violent response, also in the fathers too.

Which is part of the challenge we have with the worldview of vaccines, a bit like the flat earth, Trump, and Jacinda having a baby, everyone has a strong view from one side or the other.

Me, I look at the risk, but I am a bit strange like that. My friends will tell you so ;) and often do!

Why am I writing this?

To bring together the research and understanding I have gained over the years to give you the opportunity to be better informed about how this affects you and more importantly how it affects your kids when it comes to deciding about their health and well being.

No, I am not either a pro-vaxxer or an anti-vaxxer, I am for making an informed choice and understand why you have chosen that choice, and get on with life.

I often hear the comment my body is a temple, and I control what goes into it. While they have eaten foods that have pesticides and other nasties in them historically and processed foods now, under the misguided impression of some current health fad.

What's the message, tone it down. Look at the facts and make a reasoned, reasonable choice.

There have been many articles over the years, the big one every anti-vaxxer refers to is the autism risk followed by the toxic chemicals and herd immunity does not work.

Autism

This article from the history of vaccines site, do vaccines cause autism, on the subject of vaccines and autism, discusses the Andrew Wakefield report, which is where the original autism link in the mass media evolved from.

How it came about, and the associated autism hysteria that followed it and subsequently the lack of both repeatability of the study and the falsification of the original report.

It has not been proven that vaccines cause autism. The anti-vaxxer message is often, "but it has not been proven not to cause autism." Yes, though your position is predicated on the fear that vaccines do because of a false report suggesting it does. Science struggles to prove a double negative, which I will talk about soon.

Mercury

The CDC link also talks about mercury; the heavy metal toxin talked about in vaccines, which it turns out is different to the one in fish that does cause neurological effects.

However, the form that was in vaccines is different, and the medical fraternity did not understand its impact on the human body, even though there is no link to neurological damage, they phased it out anyway.

Further studies have not been able to link the form of mercury in vaccines to neurological damage, and continue to hold that status.

For you on the street, not medically trained, this reads poorly. It reads that there could be a link, there could be a chance. Moreover, yes, there could be, but it has not been able to be established that it does, that is more the point to take away.

Also too, due to ethical restraints we now have, they are not going to give a bunch of people doses of a compound they think is possibly toxic on the chance that it is not, that would be stupid and reckless.

Science

Science by definition of what science is about, won't say a fact is true unless it can prove it is true. The gap is the test of robustness. Science is about defining the affirmative, not the negative; medicine works in a similar but slightly different way.

We end up with many diagnoses for conditions from the elimination of other conditions, not the diagnosis of the affirmative, resulting in the diagnosis of elimination or differential diagnosis.

Which is why you have a diagnosis of 'you have glandular fever', the test was conclusive that it is glandular fever, where on the other hand with similar symptoms, you could receive a diagnosis of 'we think it's fibromyalgia', a severe autoimmune condition that is diagnosed by eliminating all other causes and conditions.

The framing of 'you have' and 'we think' is that definition of certainty. Which makes people uneasy when it is the latter.

Especially in this modern world where everything has a determined size, shape, feel, value, you get my point. We are talking about an area of life that is sacrosanct and answers that are black and white, right or wrong, are expected, no demanded. Sorry, it does not work like that with the human body.

So back to vaccines, no they have not been proven to cause autism, and they no longer have heavy metals in them, not that the ones that were in them have been determined to cause any harm either.

Immunisation = Immunity

One of the misconceptions on vaccines and immunisations is immunisation = immunity. Unfortunately, it does not. This came back to the fundamental premise of how a vaccine works and how it is intended to create immunity.

What we know is immunisations are intended to create an immune reaction in the person receiving it. This is to have their immune system respond and build the necessary defences to ward off the disease.

By introducing the vaccine, we are introducing something that will trigger the same reaction as the real condition, without creating an infection of the real condition and subsequently the adverse symptoms.

Then the body has the defence pre-prepared to ward off the real disease if it presents itself. Resulting in either no infection and establishment of the disease in question or a significantly less severe infection that the body has a far better chance of fighting off. No vaccine is 100% effective.

This last bit seems to be a good part of the anti-vaccination message, it does not work, and it causes autism. When if fact nothing in life is black and white, it is always shades of grey. Yes, I slipped that in there, as it seems it will not go away even when it has been disproven.

Where do you sit?

So my position to an anti-vaxxer is pro-vax, and to a pro-vaxxer, its why are you undermining vaccinations when I know you immunise your kids? Frankly, it's neither.

It is the establishment of verified facts, which support deciding one way or the other. I did not say irrefutable as we get new information all the time, and sometimes, it changes our approach.

What is happening is more often social pressure, fear, uncertainty and doubt (FUD). Which puts people in the position of not making a conscious decision to do something and by default is an unconscious decision not to.

We often have situations where a snippet of information is thrown in our direction, and this table of whooping cough infections is a classic example of the sort of thing I am meaning. *pertussis = Whooping Cough

However, it is also missing a core part the associated information, what were the treatment outcomes for the people concerned?

What this is not showing either is the total number of kids in the population to quantify the real scale of this data.

It says 61% of those suffering from a Whooping cough were immunised, which to the anti-vaxxer is proof that immunisations do not work.

What it misses is that people immunised can still contract Whooping Cough, but it is harder to do so, and it is often a much lighter impact on health than a full-blown unvaccinated case of Whooping Cough. Which is the current point of the vaccine. More on the vaccine here on the CDC site

Now according to the data 40% of cases contracting Whooping Cough were either not immunised or didn't know, or were afraid to say because they were not immunised.

Of the other 2200 cases listed as unknown could include those that have been immunised and the parent at the doctor reporting it did not know.

Now the thing to understand, Whooping Cough is a bacteria, like strep and a whole raft of other nasties. It is not a virus that is much easier to immunise for and that immunisation is far more effective in the long term, which is why we do not get boosters for the viral ones.

Bacteria are notorious for mutating, and the immune system is not immune to the mutation if it has not seen that mutation before, but it remains active for the underlying original bacteria. Again a point anti-vaxxers use to discredit vaccines. However, life is not static; it is always changing.

The concentration of cases in the table are with situations of high exposure, so I would expect to see more vaccinated to have symptoms in these age groups. Reflective of the fact that vaccinated kids continue to go to school and mingle more than the unvaccinated kids when there is an outbreak, which also skews the data. The unvaccinated kids get sent home to isolation when there is a case or outbreak of a communicable disease.

Then we have this associated data, and it is concerning. The number of hospital admissions for those under the age of 3 months. This age group, even with the vaccine regime we have, do not have full immunity from the vaccine until about six months old. With vaccines delivered at six weeks, three months and then the last one at five months. Moreover, we know it is only 70% effective too. See the CDC link.

What's interesting to see is the impact of the vaccine regime once it gets going

• From 3 months the number of hospital admissions drop by 2/3's
• From 6 months the number of hospital admissions is 10% of what they would be for a new baby.
• The expected bump in the number of cases from the first table is expected, as kids go to daycare, kindy, and school. From age 1 to 15 we see the biggest grouping of infections.
• What we do not see with the increased rate of infections with the older kids, is a corresponding increase in hospitalisations. Reflective of the better coping immune system they have and what I would expect is the better outcome if it is a previously vaccinated person catching Whooping Cough.
• Lastly, the annual notification and hospitalisation data show both the growing population and closer living conditions in a way that is inline with population growth but not in line with closer conditions, suggesting herd immunity effect is at play.

What is also interesting is these tables were supplied to us by someone who is anti-vaccines as evidence that vaccines do not work. It is easy to pull a single data point and focus on that, without the wider perspective of the community.

Here with a 10-year-old and you have not vaccinated for Whooping Cough, you probably should with an outbreak, but the data also says that your 10-year-old is now less likely to end up in the hospital if they do catch it. Still won't be a whole lot of fun, but it is less life-threatening. The core risk is in that first six months of life.

Now the other side of that coin, if you are around pregnant mothers and new babies, then you should not only vaccinate your kids, you should get a booster too. Why? Because you want to be limiting the exposure for mum to be and baby as we know those first few months are the most devastating on babies.

There is a point that is often raised about vaccine shedding. This is where the vaccine, while the body is developing immunity, causes infection in others, and it can do. Some say newly vaccinated should stay away from people, though what is being transferred is a weakened strain of the condition and while not ideal, can create lesser infections that build immunity in others.

In some ways, it's a cheeky way of vaccinating the population with a weakened strain to prevent a full-blown epidemic. It is a side effect, not a conspiracy.

The CDC page I have referred to concurs with the NZ experience in the table above, given the unknowns will be a mixed bag of vaccinated and unvaccinated people. Again, more on this vaccine here on the CDC site

The core part of the data that is missing from what these tables represent is the medical impact on those who contracted Whooping Cough. I would expect those who had been vaccinated, while getting it, would have had milder symptoms and a faster recovery. With the opposite for those without a vaccination.

With only infection rates and hospitalisations, we do not have enough data here to support this percieved view. However, a correlation between increased infection rates and no corresponding increase in hospitalisations would point to this perception but doesn't prove it.

Research

The challenge we have for the most part with our busy lives is both anti-vaxxers and pro-vaxxers are often not informed and have not done the research in an effective way to make an informed call themselves.

It is usually repeating the sensational news headlines without reading the articles behind, which are often poorly written by journalists who do not understand their subject matter and have a deadline to meet on a subject assigned to them.

The critical thinking of "is this plausible?" isn't engaged before they launch into print/lecture/etc.

Herd Immunity

Another favourite football in this debate is herd immunity

The scientific and mathematic modelling of herd immunity does work when there is sufficient people vaccinated. However, it falls over very quickly when the vaccination threshold is less than 80-95% depending on the infectiousness of the condition.

There is a lot of data in here, CDC site on Vaccines and Vaccines Today has a nice video on how it works What is Herd Immunity

The reasons to pursue herd immunity are more aspirational than directly impacting you and your decision to immunise or not. Though if you chose not to vaccinate, then you should get the protection from the herd if people are sufficiently immunised for this in your area.

The reasons herd immunisation is important to the medical fraternity is about protecting those who are not immunised or can't be immunised due to their age, health conditions or even the health treatment they are going through. i.e. The babies illustrated above in the hospitalisation rates.

Immune compromised people rely heavily on those around them being immunised and not being infectious too.

It is emotional

This is an emotive area; your kids are involved. So yes you should do your research and make an informed decision. Don't just do what everyone else does, question it. Understand the decision and why you are doing it.

What I would say in closing, be careful about the data you invest in and believe, it is very easy to twist the stats around and sometimes it is inadvertent, but still gives the wrong impression.

Analyse the data

I have seen a study that said kids not vaccinated had lower ear infection rates than kids that did.

They based their results on the data after some simple math, % of the population. If this was equal numbers of vaccinated and unvaccinated, ok, I will believe that. However, it was not.

The table below, the top graph is from the study, the bottom graph is the recalculated numbers based on each subset.

 

When I crunched the numbers published as subsets of the whole. I found that the unvaccinated kids had a significantly higher level of ear infections as a group when compared to the incidence rate of the unvaccinated kids. We are also talking a small number in a specific situation; that is homeschooled kids in a particular region.

Trying to prove something one way or the other from research reports is difficult. You do not have visibility of the whole research project. You cannot see the data at the source, how it was collected, how it was collated, what data got left out, how it was calculated, and finally how it was interpreted.

The only thing you can do is trust that they got it right. Moreover, this too is part of the scientific process. The repeating of the same study over and over by different teams in different locations. The body of repeated results that concur increases the accuracy and reliability of a study, which should also increase your trust in the results.

So do not go with the data on a one-off study, look for data that is associated with multiple studies done in the same way and have had similar or the same results. This will give you a better research basis to make an informed decision on the facts. Which being humans and nature, is never going to be black and white, it will always be the best guess.

What I do know, the risk of having a serious medical outcome from a condition that could be vaccinated is significantly higher than the very low risk of side effects. Which are often related to underlying conditions people did not know about.

It is your choice, and that is ok.

If you want some further reading, this list of sites was compiled by Insufferably Intolerant Science Nerd very pro-science and makes for some interesting reading.

All in one vaccination resource: https://www.historyofvaccines.org/
Vaccine studies (not complete): https://drive.google.com/drive/folders/0BwNFCLOriAMMSE5TREpQRlpxRnc
Studies on the economic burden of disease:

• https://drive.google.com/drive/folders/0BwNFCLOriAMMajRWaEozeVI3VUU
• https://www.historyofvaccines.org/
• http://www.chop.edu/centers-programs/vaccine-education-center

Links debunking incorrect claims:

• http://www.redwineandapplesauce.com/vaccine-articles-off-site/
  http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/resources-menu?OpenDocument&CATEGORY=1All+Resources-1&SUBMIT=Search
• https://www.cdc.gov/vaccines/parents/resources/index.html
• https://www.canada.ca/en/public-health/services/immunization-vaccine-awareness-materials.html
• https://www.gov.uk/government/collections/immunisation

Extensive List of Debunk Pseudoscience Studies about vaccines:

• https://theconversation.com/explainer-what-is-herd-immunity-52377
• https://www.historyofvaccines.org/content/herd-immunity-0
• http://lizditz.typepad.com/i_speak_of_dreams/2013/08/-those-lists-of-papers-that-claim-vaccines-cause-autism-part-1.html

Herd Immunity Guide: https://drive.google.com/file/d/1-PivY_PfuC3U5Z3kTfOOxq7DibQ0LuWo/view?usp=drivesdk
From Bozeman Science: https://www.youtube.com/watch?v=kLUzwT9tWxY
From Healthcare Triage: https://www.youtube.com/watch?v=ZuiHFg_nfnE
SkepticalRaptor: http://www.skepticalraptor.com/skepticalraptorblog.php/