Seventy years-ago, a pioneering American scientist named Pearl Kendrick combined killed, whole cell pertussis bacterium with weakened diphtheria and tetanus toxins to create the first combination diphtheria-pertussis-tetanus vaccine. It was an almost instantaneous success: In 1934, six out of every 100,000 Americans died of whooping cough. By 1948, that figure was less than one in 100,000; by 1960, there were fewer than ten cases of the disease per 100,000 residents.
In the coming decades, there were reports about complications from the whole-cell pertussis vaccine. This was not surprising: while whole-cell vaccines can be both effective and safe, their use of the actual contagion as opposed to an isolated component mean they are among the crudest of all vaccines. The whole-cell pertussis vaccine could cause febrile seizures, high fevers, and even fainting — reactions which are understandably scary for parents but which typically have no long-term effects. (My younger sister ran an extremely high fever after her first DPT injection, which she received in the late 1970s.) There were also unconfirmed reports — of brain damage, comas, even paralysis — which to this day have never been verified.
Fast-forward to April 19, 1982, when WRC-TV, the local NBC affiliate in Washington, DC, aired a special titled “Vaccine Roulette.” The report, hosted by Lea Thompson, was an example of scare-mongering at it’s worst: Throughout the hour-long show, Thompson featured heart-breaking interviews with parents who described how their children had been left in near-comatose states after receiving a vaccine that was mandatory for public-school children in the vast majority of states. These were augmented by what turned out to be inaccurate statistics, cherry-picked quotes, and risible falsehoods about some of the “experts” Thompson used to support her thesis that the “medical establishment” was “aggressively promot[ing]” a vaccine while willfully ignoring “the consequences.” It also presented parents’ recollections as fact — and, as we know from countless studies, memory is imminently fallible. Those doctors and public health officials who disagreed with Thompson, on the other hand, were subjected to hours of grilling. (One AAP official said that over the course of a five-hour interview, Thompson asked the same question, “repeatedly in slightly different ways, apparently to develop or obtain an answer that fitted with the general tone of the program.”) When Thompson, who won an Emmy for the show, was asked about her errors, she said the grousing was simply coming from “doctors [who] are miffed because they have to talk to their patients now.”
In the days after “Vaccine Roulette” aired, Thompson’s employer provided callers with the phone numbers of other people who’d also called looking for more information about negative information regarding vaccines — and in doing so, helped create the modern-day anti-vaccine movement. Among the parents who met in the days after the airing of “Vaccine Roulette” was Barbara Loe Fisher, who soon formed a group with the Orwellian moniker the National Vaccine Information Center.
At the time, Fisher was a former PR professional who’d become a full-time housewife after she’d given birth to her son Chris four years earlier. When “Vaccine Roulette” aired, it had been more than a year since Chris had started displaying symptoms of what would eventually be diagnosed as a range of developmental disorders. I wrote about Fisher’s reaction to Thompson’s broadcast in my book:
It wasn’t until she saw Thompson’s broadcast that the pieces fell into place. The reactions that Thompson described—convulsions, loss of affect, permanent brain damage—were, Fisher realized, identical to those experienced by her son. Suddenly, Fisher remembered in meticulous detail what had happened one day eighteen months earlier, when Chris had received the final dose of his DPT vaccine:
When we got home, Chris seemed quieter than usual. Several hours later I walked into his bedroom to find him sitting in a rocking chair staring straight ahead as if he couldn’t see me standing in the doorway. His face was white and his lips slightly blue, and when I called out his name, his eyes rolled back in his head, his head fell to his shoulder and it was like he had suddenly fallen asleep sitting up. I tried, but could not wake him. When I picked him up, he was like a dead weight and I carried him to his bed, where he stayed without moving for more than six hours, through dinnertime, until I called my Mom, who told me to immediately try to wake him, which I finally did with great difficulty. But he didn’t know where he was, could not speak coherently and couldn’t walk. I had to carry him to the bathroom and he fell asleep again in my arms and then slept for twelve more hours.
It’s an incredibly moving story, and one that Fisher has told to congressional panels, federal committees, and state legislatures, and at national press conferences for more than twenty-five years. In all that time, she’s almost never been questioned about the specifics of her narrative—and there are parts that, if nothing else, certainly are confounding.~ Fisher, as she told an Institute of Medicine (IOM) Immunization Safety Committee in 2001, is “the daughter of a nurse, the granddaughter of a doctor, and a former writer at a teaching hospital” who viewed herself as “an especially well-educated woman when it came to science and medicine.” How was it that her only response to finding her unresponsive son displaying symptoms associated with heart attacks, strokes, and suffocation was to carry him to bed and leave him alone for six more hours? And if Chris’s reaction to his fourth DPT shot was so severe that it transformed an ebullient boy into a sluggish shell of his former self, why had he been fine after receiving the first three doses?
Shortly after the formation of Dissatisfied Parents Together, Fisher founded the National Vaccine Information Center. Since then, she’s played an essential role in organizing a movement that’s targeted the press, politicians, and the public in equal measures. The result has been a steady erosion of vaccine requirements and a steady increase in the percent of the population skeptical of vaccine efficacy.
***
The vaccine wars of the 1980′s were nowhere near as pitched or as prolonged as those of today, but the focus on the P in the DPT shot was one factor that helped spur the development and eventual adoption of an acellular pertussis vaccine, which was first introduced in the United States in the early 1990′s. (By the end of that decade, the acellular formulation was used for all five recommended doses of what is now called the DTaP vaccine.) Because of the near-impossibility of having an honest discourse about vaccine side effects, there were few conversations about whether the advantages of the acellular pertussis vaccine outweighed its disadvantages — or even what those disadvantages were.
It’s looking increasingly like we’re in the midst of learning the consequences of failing to have those tough conversations two decades ago. For the past several years, the United States has had a series of unusually robust pertussis outbreaks. (Typically, outbreaks go in multi-year cycles, with peaks and troughs. That hasn’t been happening as of late: There were 27,550 cases in 2010, and there have already been 26,146 so far this year.) One theory has been that the acellular vaccine doesn’t confer as lengthy immunity as the whole-cell vaccine did — and a new study published in The New England Journal of Medicine (abstract, PDF) provides strong evidence that that is, indeed, the case. “[O]ur evaluation of data from a large pertussis outbreak in California [in 2010],” the authors write, “showed that protection from disease after a fifth dose of DTaP among children who had received only DTaP vaccines was relatively short-lived and waned substantially each year. Our findings highlight the need to develop new pertussis-containing vaccines that will provide long-lasting immunity.”
There are those who would point out that we actually know of a pertussis-containing vaccine that provides long-lasting immunity — but the chances of returning to the whole-cell DPT vaccine are next to nil. In the future, hopefully we, as a society, will have the courage and fortitude to have these difficult discussions — but for that to happen, the media needs to use the privilege of communicating with the public responsibly and judiciously. “Vaccine Roulette” might have been good for Lea Thompson’s career, but it was awful for public health.
***
One final note: The conclusions of the NEJM study also illustraste why the current pertussis outbreaks are occurring not only in unvaccinated children but also in children and adults with waning immunity. (Contrast this with the measles outbreaks which gripped the country last year, which were almost entirely initiated and propagated by deliberately unvaccinated individuals.) As Amanda Schaffer recently pointed out in Slate, this does not mean that unvaccinated children are not presenting an increased risk for the rest of us:
Now here’s how parents who don’t give it to their kids, quite apart from those flaws, are making things worse for all of us. Unimmunized children are simply more likely to get the disease than their vaccinated peers, even with the limitations of the current formulation. And when they do, they are more apt to develop severe symptoms that last longer. This means they’re more likely to pass the disease on to others, including infants, who are at greater risk of dying. Nationally, the anti-vaxers may not be responsible for most of the cases in the spate of recent outbreaks. But that’s mainly because they make up a small fraction of the population.
In addition to making sure their children are vaccinated, parents should make sure they have their pertussis boosters up to date. My mother caught whooping cough while I was working on my book, and I can tell you with confidence that it can be a nasty, nasty disease regardless of how old you are.
~ I tried to interview Fisher several times over a period of more than a year. She refused, explaining that my association with Conde Nast — I am a contributing editor at Vanity Fair — meant that I was untrustworthy.
NOTE: Portions of this post previously appeared in the chapters “Fluoride scares and swine flu scandals” and “Vaccine Roulette” of my book The Panic Virus.
sethmnookin:
matthewherper (Matthew Herper)
bellasmommy808 (Isabella's Mommy)
carlzimmer (carlzimmer)
Say, perhaps someday we can have an “honest discourse” about the ACIP’s attempts to sweep those pesky DTP reactions under the rug by recommending pre-medicating with Tylenol beforehand and the possible consequences of making these sorts of recommendations based on one measly preliminary study.
Oh wait…silly me…”nothing’s safer” than Tylenol, right?
Nevermind.
http://www.cdc.gov/mmwr/preview/mmwrhtml/00000917.htm
http://archpedi.jamanetwork.com/article.aspx?articleid=514103
Hi Seth. Please badger your publishers to make the Kindle e-book available in the UK and elsewhere. Thanks!
Guy — It’s not my publisher; it’s the fact that no British publisher had the least amount of interest in the book (and I was willing to give UK rights away for practically nothing). If a publisher over there brings the book out, it’ll be available in e-book version in Europe as well.
Feh, that is Teh Stupidz. As an employee of a US company I can of course employ subterfuge to buy from Amazon US…
I’m not surprised she refused an Internet. Discussion, validation and proof play a poor second to fabrication and imagination in the anti-vaccination lobby.
I think that there is a credible alternative story line here. The DPT shot really did cause an obviously adverse reaction in infants. And pediatricians really did try to cover that up by handing out free samples of Tylenol.
In fact, my challenge of my pediatrician over this issue ultimately led to me finding a new pediatrician. Taking a substance to suppress inflammation at the same time one was deliberately trying to provoke an immune reaction was clearly not right. But even though I basically didn’t trust his advice, replacing him took almost a year to accomplish, given how insurance works.
This isn’t opposition to vaccination, it is about a failed public health system.
So busy screaming “antivaxx!” that they failed to notice that the new DPT shot would require a booster.
So busy screaming “antivaxx!” that they failed to notice that the previous pertussis epidemic in California’s Central Valley was caused because some immigrant families had never been vaccinated.
So busy screaming “antivaxx!” that they fail to provide enough funding to identify and treat pregnant women who are Hepatitis B positive.
And sometimes, the problem is the medical professionals themselves. Pertussis boosters are apparently expensive to stock. I’ve had to battle my own doctors (mainstream, hospital associated clinic type doctors) three times in three different states before finding one that would give me boosters for Pertussis and for tetanus. One actually flat out told me that because he’d never known anyone with tetanus and so he didn’t see any reason to bother with it.
And then in Fort Collins, Colorado, rather perversely, even after an outbreak of invasive meningococcal menningitis, that ultimately led to 4 deaths, local health officials declared that the vaccine, which cost $125. was too expensive to be worthwhile.
“But even though there have been two deaths from the disease in Fort Collins and two others remain hospitalized, the situation isn’t so dire that everyone should rush out to get vaccinated, said Adrienne LeBailly, director of the Larimer County Department of Public Health and Environment. ”
http://www.9news.com/news/local/story.aspx?storyid=141670
In a demonstration of the fact that the general public is not opposed to vaccines when need can sensibly be demonstrated, to this day Fort Collins has a yearly fundraiser to support a non-profit that supplies these vaccines.
IMHO, the battle against antivaxxers has been counter productive. It gives a platform to a small group of extremists, and actually fights them in a way that makes those extremists seem more sensible than they would otherwise.
Other public health centered initiatives, such as efforts to provide a “cocoon of safety” around too young to immunize infants, by insuring that parents and caregivers have been immunized are much more effective. Other first line effort would include targeting communities in which disease (such as Hepatitis B ) is endemic. It also makes little sense, in my opinion, to go off on battles to get pre teens immunized for HPV when the vaccine may in fact wear off before it is needed AND at the same time, many women are falling through the cracks of our public health system and failing to get Pap smears.
I think that “antivaxxers” make too convenient a target. It is easier to have an enemy to combat, and nice for all the problems to be due to somebody else.
I think that a focus on overall sensible application of Public Health principles, and making vaccinations more readily accessible and affordable, would go a long way towards increasing immunization rates.
“IMHO, the battle against antivaxxers has been counter productive. It gives a platform to a small group of extremists, and actually fights them in a way that makes those extremists seem more sensible than they would otherwise.”
Who are you talking about here, Gaythia? Do you have any names?
I can’t edit my previous comment submission now for a correction of Tylenol, which is not NSAID. But my (long ago) conversation with the pediatrician did center on his admission that he saw Tylenol as more for the parents, who would, if the baby were asleep, not disturb him with phone calls worried about a fussy baby from the DPT shot. And, what I wanted him to identify was how I would then identify if something were wrong. And how much of a fever would be ok, if that were a reaction, and when did he want a call.
The way that medical practices are set up in this country, after months developing a very close relationship with one’s obstetrician, one starts up fresh with a pediatrician with whom one has had, for a first child only a short interview before the birth of the baby. If the birth has been a healthy one, vaccinations are really the first time a parent deals with the pediatrician at all. My solution to this pediatrician was to reject him, but not the concept of vaccinations. He did a few years later, go public with a very sad story about one of his patients who refused vaccinations all together, and did get measles.
I think that a lot could be accomplished with better communication with parents. If the pediatricians themselves do not have time for this, nurse practitioners or others could be involved. We have a shortage of family physicians in this country. One of the advantages of a family practice as opposed to a series of specialists would be that the continuity would help build long term relationships, (assuming that parents had enough freedom of choice regarding medical care to be able to connect with a compatible doctor)
We also do not have school nurses anymore, who in my childhood where involved with both tracking immunizations and organizing school based clinics to administer them.
Having personally dealt with infants who did have the old vaccine, (minus the Tylenol) I don’t think that an effort to return to that is going to be supported. I would certainly personally advise against it. Maybe researchers can go back and produce a new vaccine that is both more effective than the current one and also less likely to cause a reaction than the original version.
I think that encouraging boosters, and a lot of effort regarding the “cocoon of safety” are better strategies.
It’s all about informed consent. As parents, we were given accurate information about the vaccines we were offered, especially about the level of risk and the likely effects (which amount in most cases to a harmless mild fever easily managed with paracetamol). We chose to vaccinate. In the event most of the shots caused no reaction at all.
In fact our second child was receiving his vaccinations while the Wakefield MMR/autism stuff was at its most prominent, before the fraud became known, and my GP actually trained with Wakefield and knew him well as a rugby teammate. We still opted for the vaccinations because pertussis is deadly and the link even then looked speculative.
Excellent post. I hope your mother is fully recovered. I enjoy sharing your posts here:
http://www.facebook.com/permalink.php?story_fbid=417809281613135&id=236107336440146
As a family dealing with the serious side effects of the pertussis vaccine given to my daughter 28 years ago I can honestly say it was the worse choice I have ever made in my life. My daughter had the vaccine at 4 months. She was instantly very ill. I called the doctors office and they told me to give her tylenol. She did not get better. I called them again and they told me that her reaction was normal for this type of shot. Her temp was 106 and the soft spot on her head was swollen and purple. I thought I was going to loose her that night. In the morning I took her in without them approving the appointment. She was crippled. The doctor said “She was born like this.” I screamed. I knew that she was normal and I had pictures of her to prove it. He sent us to a neurologist who confirmed my child had brain damage from the shot. She was in and out of the hospital for 1 year and 6 months. She has seizures constantly and in clusters as an adult. Yes this is a rare complication but that does not matter when it is your child who the rare complications has afftected. Thankfully they were able to restore her body through physical therapy, but there is nothing they can do for the seizures.
At that age, a temperature like that qualifies for a call to 911. Why did you not do that?
I called 911 when my kid had seizures just a day after a doctor’s appointment where I was told he seemed to getting better.
Chris, you need to understand that Vicki Gulch’ experience at the time was general practice. And that 911 was not as generally available in the past. And what would have been the likelihood that a parent got anything other than further disrespectful dismissal?
When handed Tylenol by my pediatrician I specifically asked him as to how I was supposed to know which amount of fever or discomfort was to be considered safe. What he told me was that the Tylenol was “for the parents” so the baby would sleep through the experience, not worry the parents who in turn would not bother the doctor. He had no real answer for “where is the dividing line between safe and not safe” but clearly, he was expressing the opinion that parents who did become concerned by a fever would have been considered excessive worryworts.
All of which caused me to get a different pediatrician. And skip the Tylenol. At the time I did not recognize that this was general practice, I thought he was individually a bad doctor.
Ms. Weis:
That is not an excuse. 911 services were available thirty years ago (I used 911 over thirty years ago when a drunken stranger tried to enter my apartment). And there were pages early in the old phone books to call other emergency services. Or just drive to the local hospital’s emergency room.
I remember being told to watch for very high fevers after giving birth twenty four years ago, and 106 is considered a very high fever. I had a fever of 104 after my son’s birth over twenty four years ago, and I was seen promptly (his birth ripped me from step to stern, and it became infected). If the standard practice was to ignore 106 degree fever, then that is a good reason to change doctors!
And all you have from Ms. Gulch is an anecdote. The plural of anecdote is not data. What you need to do is compare the fever effects of the vaccine versus that of the actual vaccine.
Now, Ms. Weis, you need to provide me the title, journal and date of the PubMed indexed study that shows a vaccine causes very high fever (and some do, rarely) more often than the actual disease (which is more common), and then you might have a valid argument.
Ooops. My comment has a very big typo:
What you need to do is compare the fever effects of the vaccine versus that of the actual disease.
Sorry about that. My son is almost twenty five years old, and I remember being given specific fever temperatures to worry about.
Though recent research reveals that giving Tylenol will suppress the effectiveness of the vaccines. I never really used the Tylenol drops because our family doctor was very sure to tell us a bit of fever was good and nothing to worry about. Though he was also sure to tell us that a high fever was very serious, especially for babies.
Here are some modern fever guidelines.
Chris,
You don’t understand my point and are, IMHO, trying to create an argument over the wrong issue.
I support vaccines and did utilize the old DPT shot because that was the best available at the time.
My point is that the pediatricians at the time apparently in a manner much more widespread than just my own case, mishandled communication with patients. Handing out free samples of Tylenol was something that was apparently fairly general practice. Doctors gave a clear message of not wanting to be bothered. Thus parents were actively discouraged from calling.
The old DPT shot left large numbers of parents at home nervously monitoring fever in newborn infants and wondering what to do and when to do it.
My conclusion was that my individual pediatrician was a jerk. I could not get my pediatrician to effectively communicate what he expected me to do if my baby had a fever. I could see that some amount of fever might be a good indication of a health immune system in action. But if 106 was indeed too much, at what point before that did he want to be called? The message from him was that by handing out the Tylenol, he anticipated that the baby would sleep, the parents would stay calm and not call, and he could spend his evening in peace and quiet without those pesky parents bothering him. This is not a setup designed to get parents to take effective action.
Neither Seth Mnookin nor I can go back in time to set up a scientific survey to see whose theory is right. Seth, above, seems to blame “antivaxxers” for the loss of usage of a more effective vaccine. I say that poor communication on the part of pediatricians led to a situation in which pediatricians lost some amount of the trust of parents. Thus, while some of us may have simply blamed individual pediatricians, others blamed the whole vaccine process.
The first time it is heard, the potential of an autism linkage does make some amount of sense. Breaking the appeal of that message requires more than jumping up and down and shouting “antivaxxer” it involves actively acknowledging the real concerns on the part of parents that drive parents in the direction of finding alternative messages more credible.
In my opinion, effective science communication needs to be done in ways that acknowledge real concerns and address them in a manner that focuses on those concerns without simply giving the “antivaxxer” crowd the publicity they so crave. In fact, I think that the way public vaccination communication was mishandled gave Andrew Wakefield and friends much more of a public stage for much longer than ought to have been the case. I think we ought to learn from this and incorporate better health and science communication techniques when similar issues come up in the future.
And also, for new parents, the autism message does not really resonate until the baby is born and vaccines are confronted directly. In my opinion, there are similar new issues of folklore that arise in the pre-birth process. Most obstetrical offices have education programs that utlize nurse practitioners and others to answer questions and concerns. Pediatric offices can (and in some cases now do) turn vaccination education into a fairly routine part of such a program.
If we want “antivaxxers” to be seen as the isolated nut cases that they really are then we ought to handle them as such and stop highlighting them.
I still say there is no excuse for not getting emergency medical services for a child with a fever of 106. That is actually high enough to cause real brain damage.
I have in front of me the 1982 edition of the American Medical Association Family Medical Guide. I bought it long before I had kids to help me know when to or not call my family doctor. On page 221, in the lower right corner of the flow chart on what to do with a child who has a fever it says if the fever is over 102 to call your physician immediately (he/she should have someone from their practice on call). I would add that a fever of 106, that would constitute an emergency.
I have had a child with seizures, I cannot imagine not calling for emergency services when you have a very ill child. Yet, some who claim vaccine injury from seizures will also reveal they never called 911, or followed up with a neurologist or there own doctor. It is very hard to get actual medical details when they have no medical records.
And it is a reminder that these stories are anecdotes, and the plural of anecdote is not data. Since my son’s last seizure was from an actual disease before there was a vaccine for it: I value scientific evidence over anecdotes.