Know thy enemy.
What are anti-vaccine advocates using to sway the public against vaccines? This page is not exhaustive, but lists many of the vaccine conspiracies and controversies – as well as refutations – to help you educate your patients and their families on vaccine safety and efficacy. An excellent resource (if you have time) is the History of Vaccines History of Anti-Vaccination Movements.
Smallpox Vaccination: Jenner to the 19th Century
After Jenner introduced the smallpox vaccine in 1798, variolation declined. (Is the milkmaid story a myth?) This produced opposition from variolators losing money, leading to published illustrations of deformities allegedly produced by vaccination (seen here), and Benjamin Moseley likening beginning a long-lasting controversy of likening cowpox to syphilis.
At the time, even vaccine supporters were concerned about the safety and efficacy of this new procedure. When legislation introduced compulsory vaccination, the general public condemned the practice. Jenner introduced vaccination before laboratory methods of production control and failure accountability were created. Sterility was almost impossible to guarantee due to the arm-to-arm and eventual animal-to-human transfer of virus particles. Disease often accompanied vaccination due to contamination (erysipelas, tuberculosis, tetanus, and syphilis) and attracted the attention of the non-science public. Anti-vaccine doctors (Dr. Charles Creighton) asserted that the vaccine itself was the cause of syphilis.
Cases of smallpox began to occur in those who had been vaccinated earlier, leading people to question Jenner’s belief that vaccination conferred complete protection. Vaccination supporters pointed out that these cases were generally very mild and occurred years later, but determined anti-vaccine movements led to an overarching public belief that vaccination was both dangerous and ineffective.
Variolation was banned in England by the 1840 Vaccination Act due to its greater risks. The Act also introduced free voluntary vaccination for infants. Thereafter, Parliament passed many acts to enact and enforce compulsory vaccination:
- 1853: Compulsory vaccination introduced, with fines for non-compliance and imprisonment for non-payment
- 1867: Extends the age requirement to 14 years, introduced repeated fines for repeated refusal for the same child
- 1871: Requiring Poor Law Guardians to prosecute those who were not vaccinating.
Requiring the Guardians to act against vaccine refusers led to Guardian imprisonment, public demonstrations and protests, and the organization of societies and publications denouncing compulsory vaccination. A mass rally was attended in Leicester in 1885 by over 20,000 protesters.
The Royal Commission on Vaccination was appointed in 1889. The recommendations of the commission were incorporated into the 1898 Vaccination Act, which still required compulsory vaccination but allowed a conscientious objection exemption. Although this made some happy, there were still opponents lobbying for the repeal of the legally enforceable Acts. In 1900, the Labour Party General Election Manifesto called for no compulsory vaccination, and when the National Health Service was introduced in 1948, the compulsory vaccination requirement was dropped with almost no opposition.
In America, President Thomas Jefferson took pains to study what would become the cold chain, and encouraged new ways to transport the vaccine material through the hot southern states to decrease ineffective batches. Vaccinating a large portion of the population of the colonies led to the containment of smallpox outbreaks by the latter half of the 19th century. This led to a decline in vaccination rates, and the appearance of anti-vaccinators claiming there was no need for vaccination at all.
Vaccination in the US was regulated by individual states, in which there followed the same progression as had England: compulsion, opposition, and repeal.
- 1879: founding of the Anti-Vaccination Society of America
- 1882: founding of the New England Anti-Compulsory Vaccination League
- 1885: founding of the Anti-Vaccination League of New York City
The vaccine controversy reached the US Supreme Court in 1905, and in Jacobson v. Massachusetts, the court ruled that states have the authority to require vaccination against smallpox during a smallpox epidemic. John Pitcairn, Jr. (founder, Pittsburgh Plate Glass Company, now PPG Industries) was a major leader of the American anti-vaccine movement, delivering addresses to the Pennsylvania General Assembly criticizing vaccination, sponsoring the National Anti-Vaccination Conference, and becoming the first president of the Anti-Vaccination League of America.
Return to top
Early Controversies: Vaccines and Antitoxin
Diphtheria antitoxin was first a serum gathered from horses immunized against diphtheria and then injected into humans. This caused a hypersensitivity reaction (serum sickness), and prompted anti-vivisectionists to oppose vaccination. Additionally, in the early 1900s, a batch of diphtheria antitoxin from a horse was contaminated with tetanus in St. Louis, Missouri. Combined with 9 deaths from a tetanus-contaminated small pox vaccine in Camden, New Jersey, this led to the passing of the Biologics Control Act of 1902.
In 1890, tuberculin was developed. When inoculated into people who have had tuberculosis, it produces a hypersensitivity reaction (and is still used to detect those who have previously been infected). Robert Koch, who developed the molecule, used it as a vaccine, causing serious reactions and deaths in those people whose latent tuberculosis was reactivated by the tuberculin.
Return to top
The Cutter Incident (1955)
In 1955, Cutter Laboratories produced 120,000 doses of the Salk polio vaccine. Unfortunately, these doses inadvertently contained some live polio virus along with the inactivated virus. This batch of vaccine caused 40,000 cases of polio, 53 cases of paralysis, and 5 deaths. The polio outbreak spread through the vaccine recipients’ families, and led to an epidemic that resulted in an additional 113 cases of paralytic polio and another 5 deaths. It has been called one of the worst pharmaceutical disasters in US history.
Return to top
Diphtheria, Tetanus, and Pertussis Controversy
In the mid-1970s, an international controversy over the safety of DTP immunization occurred in Europe, Asia, Australia, and North America. In Europe, the opposition was in response to a report from the Great Ormond Street Hospital for Sick Children in London, detailing that 36 children suffered neurologic conditions after DTP immunization. Television documentaries, newspaper reports, and the advocacy group The Association of Parents of Vaccine Damaged Children (APVDC) garnered support and interest in the potential risks and consequences of DTP.
The Joint Commission on Vaccination and Immunization (JCVI) – an independent advisory committee in the UK – confirmed the safety of the DTP vaccination in response to decreased vaccination rates and three major pertussis epidemics. Dissenting opinions by medical professionals and an outspoken physician and vaccine opponent Gordon Stewart provided more public confusion and debate about the safety of vaccines. The JCVI finally launched the National Childhood Encephalopathy Study (NCES), which identified every child between 2 and 36 months hospitalized in the UK for neurological illness and determined whether or not DTP immunization was associated with increased risk. The results of the study indicated that the risk was very low, and this data lent support to a national pro-vaccine campaign, and denial of recognition and compensation to the APVDC when the courts determined they lacked evidence to link the DTP immunization to harm.
In the United States, the controversy began when the media began reporting on the alleged risks of DTP. A 1982 documentary, DPT: Vaccine Roulette, described alleged adverse reactions to the vaccine while minimizing the benefits. In 1991, a book called A Shot in the Dark discussed potential risks. Parents formed victim advocacy groups, but the American Academy of Pediatrics (AAP), the CDC, and other advocacy groups had a stronger counter response than in the UK. Although the controversy brought on lawsuits against vaccine manufacturers, increased vaccine prices, and the halting of some DTP production, the overall controversy affected immunization rates less than in the UK.
Return to top
Wakefield: MMR and Autism
In 1998, The Lancet published a research paper linking the combined measles, mumps and rubella (MMR) vaccine to colitis and autism spectrum disorder in 8 children. The paper and its claims were widely reported, leading to a sharp drop in UK vaccination rates and increases in the cases of measles and mumps in the UK and Ireland.
The study’s lead author, Dr. Andrew Wakefield, claimed “the onset of behavioral symptoms was associated, by the parents, with MMR vaccination in 8 of the 12 children.” The study suggested a connection between neurological symptoms (autism) and gastrointestinal issues (by way of bowel symptoms, endoscopy findings, and biopsies) was real, but did NOT prove an association between the MMR vaccine and autism. Before the paper was published, Wakefield held a press conference in which he “thought it prudent” to use single vaccines instead of the MMR triple vaccine until the triple vaccine could be ruled out as an autism trigger.
There were several problems with these findings:
- The cohort was self-referred and did not include control subjects, which left the authors unable to determine if the occurrence of autism following MMR vaccine was causal or coincidental.
- Endoscopic and neuropsychological assessments were not blind, and data were not collected systematically or completely
- GI symptoms did not predate autism in several of the children
- Neither measles, mumps, nor rubella vaccinations have not been found to cause chronic inflammation or loss of intestinal barrier function
- Putative encephalopathic peptides traveling from the intestine to the brain have never been identified
Following the publication, multiple large epidemiological studies were undertaken to assess these claims, despite no data supporting a link between MMR vaccine and autism (Plotkin, Gerber, and Offit).
These studies suggested that the combined vaccine:
- decreased the child’s risk of catching the disease while waiting for full immunization coverage
- 2 injections would cause the child less pain and distress than 6
- extra doctors visits for more vaccines would lead to delayed and missed coverage
Additionally, Wakefield was found do have undisclosed conflicts of interest:
- He was paid to conduct the study by lawyers of parents who believed their child had been harmed by the triple MMR vaccine
- He received 55,000 pounds from solicitors seeking evidence to use against vaccine manufacturers
- He had applied for patents on a rival vaccine
Eventually, Wakefield’s co-authors withdrew their support for the study’s interpretations, and ethical considerations for the study were raised:
- Children were subjected to unnecessary invasive medical procedures (colonoscopies, lumbar punctures)
- Wakefield bought blood samples from children at his son’s birthday party
- The study acted without Institutional Review Board approval
On February 2, 2010, the Lancet “fully retracted the paper from the published record.”
Mercury in Vaccines
Mercury (methylmercury) has been found to damage the nervous system. However, the preservative used in vaccines, Thimerosal, contains 50% ethylmercury by weight. It is used in multidose vaccine preparations, but is not contained in live-virus vaccines, like MMR. In 1997, despite the absence of data suggesting harm from the amount of ethylmercury used in vaccines, the American Academy of Pediatrics and the Public Health Service recommended the immediate removal of mercury from all vaccines given to young infants.
Misinterpretation of this precautionary directive provoked concern among the public, and led to several anti-mercury advocacy groups. The signs and symptoms of autism are clearly distinct from those of mercury poisoning, so concerns about mercury as the cause of autism are biologically implausible. However, many studies have been conducted on thimerosal and vaccines. In 2004, a scientific review by the Institute of Medicine (now the National Academy of Medicine) concluded that “the evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism.”
Cases of Complex Regional Pain Syndrome (CRPS), Postural Orthostatic Tachycardia Syndrome (POTS), and Chronic Fatigue Syndrome (CFS) have emerged with human papillomavirus (HPV) vaccines. These syndromes all share similar symptoms, and have been linked to HPV vaccination by anti-vaccination groups.
Complex Regional Pain Syndrome (CRPS). Seventeen suspected CRPS cases reported after HPV vaccination led to temporary suspension of proactive recommendation of HPV vaccination in Japan. An analysis performed a database review, a temporality analysis, an observed versus expected analysis, safety reviews, and a literature review. Quantitative analyses did NOT suggest an association between CRPS and HPV-16/18 adjuvanted vaccine.
Postural Orthostatic Tachycardia Syndrome (POTS). In 2015, Denmark requested a review by the European Medicines Agency (EMA) into the safety of HPV vaccines after a publicly aired documentary called “The Vaccinated Girls – Sick and Betrayed.” The study reviewed Gardasil/Silgard, Gardasil 9, and Cervarix to determine the frequency of any adverse reactions (specifically CRPS and POTS) and determine if there is any causal link between vaccine administration and these symptoms. Several anti-vaccine bodies have risen up against these findings, however there remains no sufficient evidence to suggest an increased risk of developing CRPS following HPV vaccination. The CDC has found that events related to Gardasil 9 were most commonly fainting, dizziness, nausea, headache, fever, and injection site pain.
Chronic Fatigue Syndrome (CFS). HPV vaccination was suggested as a cause of CFS/myalgic encephalomyelitis in the Netherlands. Feiring, et al concluded that HPV vaccination was not associated with an increased risk of CFS/ME.
The World Health Organization (WHO) has been reviewing the safety data from HPV vaccine administration since 2007, and considers these vaccines to be extremely safe. The Global Advisory Committee on Vaccine Safety (GACVS) assessed comprehensive literature reviews and new data looking at a possible link between Guillain-Barre Syndrome (GBS), CRPS, POTS, premature ovarian insufficiency, primary ovarian failure, and venous thromboembolism and the administration of the HPV vaccine. The committee “saw no evidence for a causal association between HPV vaccine and these conditions.”
Return to top
The Flu Vaccine in Pregnancy
In September, 2017, researchers at the CDC warned that an influenza vaccine given in the first trimester of pregnancy might have caused miscarriages. This led to an outcry, as about half of all pregnant women in the United States receive an annual flu vaccine.
Dr. Paul Offit, professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, discusses why the study should never have been published in this article. In general, these are his key points:
- The CDC’s observation was inconsistent
- The study was an outlier
- Investigators sub-stratified their data to find statistical significance
- Very small sample size
- The finding did not make biological sense
The study itself concludes with the line “This study does not and cannot establish a causal relationship between repeated influenza vaccination and spontaneous abortions.”
Return to top
Events Following Vaccination Reductions
1873 – 1874: Stolkholm (smallpox)
Religious objection, concerns about effectiveness, and discussion of individual rights led to the vaccination rate in Stockholm dropping to just over 40% (compared to about 90% in the rest of Sweden). A major smallpox epidemic began in 1873 in Stockholm, and led to a rise of vaccine uptake and an end to the epidemic.
1970s – 1980s: United Kingdom (pertussis)
In a 1974 report, a prominent public-health official ascribed 36 reactions to the pertussis vaccine, claimed the vaccine itself was only marginally effective, and questioned whether its benefits outweighed the risk of getting the disease. Extended press and television coverage caused a scare, and pertussis vaccine uptake in the UK decreased from 81% to 31%. Multiple pertussis epidemics followed, and led to the deaths of many children. Mainstream medical opinion continued to support the vaccine’s efficacy and safety, and a national reassessment of vaccine efficacy was published, restoring public confidence in the vaccine. Vaccine uptake increased to levels above 90%.
1979 – 1996: Sweden (pertussis)
Sweden suspended vaccination against whooping cough (pertussis) between 1979 and 1996. Within that time, 60% of the country’s children contracted the disease before age 10. Close medical monitoring kept the death rate due to whooping cough at about one per year.
1999 – 2000: The Netherlands (measles)
An outbreak at a religious community and school resulted in2,961 cases, 3 deaths and 68 hospitalizations. In several of the affected provinces the level of immunization was high, with the exception of the religious denominations. Of those who contracted measles, 95% were unvaccinated.
As a result of the MMR vaccine controversy, vaccination rates dropped sharply in the UK after 1996. From late 1999 until summer 2000, there was a measles outbreak in North Dublin, Ireland. At the time, the national immunization level had fallen below 80%, and in part of North Dublin, the level was around 60%. Over 300 cases, over 100 hospitalizations, and 3 pediatric deaths ensued. Many children were gravely ill and required mechanical ventilation to recover.
2001 – ?: Nigeria (polio, measles, diphtheria)
In the early 21st decade, conservative religious leaders in northern Nigeria advised their followers not to have their children vaccinated with the oral polio vaccine. The leaders were suspicious of Western medicine, which led by a governor-endorsed boycott of the vaccine in the Kano State. Immunization was suspended for several months. Subsequently, polio reappeared in formerly polio-free countries bordering Nigeria, and genetic tests showed they were the same strain as had originated in northern Nigeria. Nigeria reported over 20,000 measles cases, and nearly 600 deaths from January – March 2005. In 2006, Nigeria accounted for over half of all new polio cases worldwide. Outbreaks have continued since: at least 200 children died in a late-2007 measles outbreak in Borno State.
2005: Indiana, United States (measles)
Attributed to parents who had refused to have their children vaccinated.
2008: Romania (HPV)
2013 – ?: United States (measles)
Endemic measles was declared eliminated from the United States in the year 2000 once all internal transmission had been stopped for one year. All ensuing measles cases were found to be due to importation.
In 2013, the Centers for Disease Control and Prevention (CDC) reported that the three biggest outbreaks of measles were attributed to clusters of unvaccinated people (due to philosophical or religious beliefs) in New York City, North Carolina, and Texas. These pockets of outbreak contributed to 64% of the 159 measles cases reported among 16 states that year.
In 2014, there were 667 cases of measles in 27 states.
97% of the cases in the first half of the year were confirmed due (either directly or indirectly) to importation – 49% of these were imported from the Phillippeans; the remaining cases could not determine an etiology. The story began making headlines at the end of the year when XX people contracted measles after a visit to Disneyland, in California. Of the 288 victims, 57% (165) confirmed that they were unvaccinated by choice. Only 30 (10%) were confirmed to have been vaccinated.
In 2015, a large multi-state outbreak of measles began after primary cases from Disneyland came into contact with other individuals. From January 1 to June 26, 178 people from 24 states and the District of Colombia were reported to have measles. Most cases (117, 66%) have been considered as secondary or tertiary transmission from the Disneyland outbreak. CDC analysis confirmed that the measles virus type in this outbreak (B3) was identical to the virus type that caused a large measles outbreak in the Phillippines in 2014. On July 2, 2015, the first confirmed death from measles in 12 years was reported.
In 2017, a spring-time measles outbreak occurred in Minnesota. Seventy-eight cases of measles had been confirmed as of June 16: 71 were unvaccinated, and 65 were Somali-Americans. The outbreak has been attributed to low vaccination rates among Somali-American children, which dates back to 2008. In this year, Andrew Wakefield – along with other vaccine-skeptical groups – traveled to Minneapolis to raise concerns about the MMR vaccine. Somali parents expressed concerns about disproportionately high numbers of Somali preschoolers in special education classes who were receiving services for autism spectrum disorder.
2013 – ?: Wales (measles)
In 2013, an outbreak of measles occurred in the Welsh city of Swansea from November 2012 – July 3, 2013. There were a total of 1,219 suspected measles cases in Swansea, Neath Port Talbot, Bridgend, Carmarthenshire, Ceredigion, Pembrokeshire, and Powys. During the epidemic, 664 cases were in Swansea alone. A total of 88 people were hospitalized, with 1 death. The cost of the epidemic exceeded 470,000 pounds sterling ($701,898). This has been linked to the MMR vaccine controversy. Some estimates that, while Wales had an overall vaccination rate of 94% in 1995, it had fallen to as low as 67.5% in Swansea by 2003.
United States (tetanus)
Most cases of pediatric tetanus in the US occur in unvaccinated children.
2016 – ?: Romania (measles)
As of September 2017, a measles epidemic has been ongoing throughout Europe, especially Eastern Europe. In Romania, out of approximately 9300 cases, 34 unvaccinated people have died. This epidemic was preceded by a free downloadable online book being published in 2012 by Dr. Christa Todea-Gross. This book contained misinformation about vaccination, translated into Romanian, and stimulated the growth of the anti-vaccine movement. The government of Romania officially declared a measles epidemic in September 2016, and started an information campaign to encourage parents to have their children vaccinated. By February 2017, Romania’s stockpile of MMR vaccines had been depleted. The stockpile was restored by April, but by May the death toll had risen to 25.
Return to top
Safety of Vaccines
“Thimerosal is a mercury-based preservative that has been used for decades in the United States for multi-dose vials of medicines and vaccines.” – the CDC
Mercury is a naturally occurring element, of which there are two distinct species: methylmercury and ethylmercury. Methylmercury is the type of mercury found in certain types of fish (salmon). High exposure levels of methylmercury can be toxic. Federal guidelines keep as much methylmercury out of the environment and food as possible, but everyone is exposed over a lifetime.
Thimerosal is added to multi-dose vials of vaccine during the manufacturing process to prevent the growth of bacteria and fungi that can occur when needles pierce a vial’s sanitary cap multiple times. Contamination of a vaccine could cause severe local reactions, illness, or death.
Thimerosal breaks down into ethylmercury (which is cleared from the human body more quickly than methylmercury, and is therefore less likely to cause harm) and thiosalicylate. Both of these breakdown products are rapidly eliminated from the body.
Data from many studies show that thimerosal has a record of being very safe, and there is no evidence of harm caused by the low doses of thimerosal in vaccines. The most common side effects are redness and swelling at the injection site. Allergies – though rare – to thimerosal are possible. Thimerosal was taken out of childhood vaccines in 2001. MMR, varicella, inactivated polio (IPV), and pneumococcal conjugate vaccines have NEVER contained thimerosal. Multi-dose vaccine vials of the flu vaccine do contain thimerosal as a bactericide and fungicide, but there are thimerosal-free versions as well.
There is no associative link between thimerosal and autism spectrum disorder.
The CDC recommends that children be vaccinated against 14 diseases before they are 2 years old. This amounts to anywhere from 24 to 26 different vaccine products being injected into a toddler. Some parents are concerned that this is too much at once, or that their child’s immune system will not be able to handle the strain.
Children are given vaccines at a very young age because they are at the highest risk of getting sick and/or dying if they contract the diseases vaccines prevent. Newborn babies are immune to some diseases, due to maternal antibodies, but this immunity only lasts a few months. Most babies do not get any maternal protection against diphtheria, whooping cough, polio, tetanus, hepatitis B, or Hib.
Vaccines do not cause the disease! They contain weakened or killed versions of the germs that cause the disease. These, and other elements of the vaccine like adjuvants, stimulate the baby’s immune system. Babies are exposed to thousands of germs and other environmental antigens on a daily basis: eating food, breathing, and touching objects subjects the baby to over 100 antigens. Strep throat (20-50 antigens), the common cold (up to 10 antigens), and daily living exposes the baby to multiple antigens – the number given in a vaccine (1-69, depending on the vaccine) is negligible. A child up to date on their vaccines may be exposed to somewhat more than 300 vaccine antigens by the age of two.
Combination vaccines are two or more different vaccines that have been combined into a single shot – this reduces the number of shots a child receives in a visit, protects them against multiple diseases as fast as possible, and requires fewer office visits. Combination vaccines have been used in the United States since the 1940s, and babies will often be given more than one combination vaccine during the same doctors’ visit (usually in separate limbs).
Safety Profiles of Vaccines:
- Chickenpox (Varicella)
- Diphtheria, Tetanus, and Pertussis (DTaP, Tdap)
- Hemophilus Influenzae type B (Hib)
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Measles, Mumps, and Rubella (MMR)
- Measles, Mumps, Rubella, and Varicella (MMR-V)
When combinations of vaccines are suggested, multiple studies must be done to test the safety of the new combination vaccine. Additionally, the safety and efficacy of the multiple vaccines in combination must be the same or better than the vaccines individually. Vaccine safety is continuously monitored by the Vaccine Adverse Event Reporting System (VAERS), the Vaccine Safety Datalink (VSD), and the Clinical Immunization Safety Assessment (CISA) Project.
Pregnant women are at risk for vaccine-preventable disease-related morbidity and mortality, and adverse pregnancy outcomes, including congenital anomalies, spontaneous abortion, preterm birth, and low birth weight.
There are vaccines that are contraindicated during pregnancy (live vaccines), and those that have been proven safe (yearly flu vaccine, Tdap). Some are recommended during pregnancy and postpartum based on specific risk factors and special circumstances.
Aluminum is an adjuvant in several vaccines to improve the immune response (hepatitis A & B, DTap/Tdap, Hib, HPV, and pneumococcal vaccines). It is also present in water, air, and food. As an adjuvant, Aluminum allows for lesser quantities of the vaccine particles, and fewer doses. According to the Children’s Hospital of Philadelphia, in the first 6 months of life, a baby will receive about 4 mg of Aluminum from vaccines, 10 mg from breastmilk, 40 mg from infant formula, and/or 120 mg from soy-based formula.
Aluminum is eliminated by binding to tranferrin (90%) and citrate (10%), then eliminated through the kidneys. A small amount will be retained in the tissues of the body, but about half of any aluminum in the bloodstream is eliminated within 24 hours.