A Swedish Vaccine Rejectionist Comes Out to Play…

…but gets badly burned by powerful radiance of science-based medicine and reason.

Note: In a response to an earlier article where I debunked a Swedish anti-vaccine crank by the name of Marina Ahlm, she posted a comment so scientifically flawed that I thought I dissect it in detail. However, my comment became so long that it was worth its own blog entry. I have reproduced my reply below. Enjoy!

I see that Marina Ahlm found her way to my refutation of her blog post. She seems very keen on commenting, as she submitted her comment multiple times. It is interesting to see that she have merely senselessly copy/pasted the comment word-for-word from other texts on the internet, often repeating the same flawed claims that she presented in the original entry at your anti-vaccine blog, rather than making arguments in her own words. she also did not respond to any of the points that I made in this blog entry. Did she even read it before commenting? If she read the comment policy of this blog before she posted (she clearly did not), she would have seen that it prohibits copy/pasting long arguments without any original input. However, I will be humble and allow this behavior. For now. Also, unlike what goes on at the anti-vaccine blog at vaccine.me, I do not randomly delete comments or edit them to undermine critics. She and her allies have been exposed.

Anyhow, I will indulge her delusional beliefs and provide a point-by-point refutation (again!). Hopefully she will learn this time around, but I doubt it. When someone is so ideologically committed as she is, it is extremely hard to make them see their error. She more or less repeat the same logical fallacies as before: confirmation bias (she artificially inflates minor setbacks and limitations with vaccines while ignoring the benefits and efficacy), perfect solution fallacy (she reject vaccines because they are not perfect) and she also tend to quote government reports and scientific articles out of context. Probably, she have not read the original documents, but merely copy/paste what other anti-vaccine cranks have written.

Why do outbreaks in vaccinated populations occur?

The reason that you sometimes have outbreaks in vaccinated populations is either because the regional proportion of vaccinated individuals fall below the level required for herd immunity, or because local pockets of unvaccinated individuals that spread it to susceptible individuals where vaccination has not been effective (vaccines are usually 95% effective, with some exceptions). These are the precise individuals that she and her anti-vaccine kind encourage to skip their vaccinations. So, ironically, her argument that vaccines are ineffective because local pockets of unvaccinated individuals become sick when the pathogen enters the community is not only logically contradictory and scientifically false, but also of her own doing. How does it feel to be responsible for the deaths of children due to disease that can easily be prevented with vaccines?

Measles outbreak in 100% vaccinated population?

Marina Ahlm claims that the CDC has reported a measles outbreak in a documented 100 percent vaccinated population and the references she provide for this claim are the following two articles:

i. CDC. (1989). Measles — Quebec. Morbidity and Mortality Weekly Report 38(18), 329-330.
ii. CDC. (1984). Measles Outbreak among Vaccinated High School Students — Illinois. Morbidity and Mortality Weekly Report. 33(24), 349-51

The problem, of course, is that she have taken these articles out of context (if she even bothered to read them to begin with). It is painfully obvious, because she cannot even get the reference correct. The title of first article is “Measles — Quebec” not just “Measles”. Let us take a look at the context and expose her dishonesty, shall we? The first article states that:

Since late December 1988, more than 1600 cases of measles have been reported in the province of Quebec, Canada. Five hundred of the cases have occurred in metropolitan Montreal. In 199 (40%) of these cases, the onset of rash occurred in April (Figure 1). Detailed information is available for 486 (97%) of the 500 Montreal cases. Of these, 104 (21%) occurred in preschoolers aged 0-4 years, 328 (67%) in school- aged persons 5-19 years of age, and 54 (11%) in adults greater than or equal to 20 years of age. Of the adults, 42 (78%) were aged 20-29 years. Of school-aged patients, 191 (58%) had histories of previous vaccinations.

Only 58%, rather than 100% (as she claimed), where vaccinated. 58% is well below the level need for herd immunity against measles, which explains the outbreak. Yet again, this was precisely caused by the actions of vaccine rejectionists like herself. Does she not see the folly in using outbreaks as a result of low vaccination rates as evidence that vaccines are ineffective?

Let us take a look at the second reference that she provided. Perhaps this may save her. Unfortunately, it does not. Her second reference states that:

The outbreak involved 16 high school students, all of whom had histories of measles vaccination after 15 months of age documented in their school health records. Of the five remaining cases, four occurred in unvaccinated preschool children, two of whom were under 15 months of age, and one case occurred in a previously vaccinated college student.

So some of the individuals infected where not vaccinated. If you continue to read the article, it reviews the evidence for long-term protection from the measles vaccine and concludes that:

If waning immunity is not a problem, this outbreak suggests that measles transmission can occur within the 2%-10% of expected vaccine failures. However, transmission was not sustained beyond 36 days in this outbreak, and community spread was principally among unvaccinated preschool children. The infrequent occurrence of measles among highly vaccinated persons suggests that this outbreak may have resulted from chance clustering of otherwise randomly distributed vaccine failures in the community. That measles transmission can occur among vaccine failures makes it even more important to ensure persons are adequately vaccinated. Had there been a substantial number of unvaccinated or inadequately vaccinated students in the high school and the community, transmission in Sangamon County probably would have been sustained.

So the explanation is that no vaccine is 100% effective and that it was due to the chance clustering of those individuals for which the vaccine did not take. This is not evidence of the vaccine failing horribly, but merely that no vaccine product is 100% effective. No one has denied this.

In conclusion, none of the sources she provided support her claim of large-scale vaccine failure.

Vaccine rejectionist Ahlm fails at basic math

Marina Ahlm claims that most individuals who get sick in a vaccine-preventable disease are vaccinated is a statistical artifact due to low number of unvaccinated individuals and betrays a fundamental ignorance of basic mathematics on your part.

Assume, for the sake of argument, that a school has 10000 students. Let’s say that 5 of them are unvaccinated. Let us also assume that a hypothetical vaccine is 95% efficient and that 80% of susceptible (vaccinated or unvaccinated) become ill. So that means that 4 unvaccinated individuals will become sick (0.8*5) and that 400 vaccinated people will become sick (0.8*0.05*10000). So while it is trivially true that the absolute amount of individuals who become sick will have been vaccinated (400 vs 4), the relative proportion of individuals sick tells another story. The risk of becoming infected if you are not vaccinated are 4/5 = 80%, whereas the risk of becoming infected if you are vaccinated is 400/10000 = 4%. So in this example, you have 20 times higher risk of becoming infected if you are unvaccinated than if you are vaccinated, despite the fact that the absolute number of individuals is higher in the vaccinated group than the unvaccinated group. Maybe they do not teach basic mathematics during her courses in foot therapy?

Smallpox was eradicated by vaccination!

She does not list a reference for your claims about smallpox so it is hard for me to evaluate it. However, this does not really matter. The eradication of smallpox by vaccination stands as a crowning achievement of modern medicine and your argument exposes her confirmation bias. It is estimated that smallpox killed around half a billion people through history. Poof! It is gone, thanks to vaccination. It is also intellectually disingenuous to compare a vaccine developed in the 1800s with modern vaccines. It is like comparing apples to watermelons.

Vaccine rejectionist quote a bunch of papers out of context

Marina Ahlm cites the paper by Poland and Jacobson (1994) to support her position, but this actually shows that my refutation is correct: the apparent paradox is due to a low number of unvaccinated individuals. The article actually supports vaccines, recommending a second dose of the measles vaccine.

She claims that measles vaccine “produces immune suppression which contributes to an increased susceptibility to other infections.” This is another quote out of context. It comes originally from a paper by Auwaerter et. al. (1996), but it stated that “Measles produces immune suppression which contributes to an increased susceptibility to other infections”, not the measles vaccine. Another highly embarrassing error from her part. Also, the changes that Auwaerter et. al. reported also returned to baseline after a couple of months.

Later, she refers to Cohn et. al. (1994) to support her notion of “measles vaccine failure”. However, she has clearly not even read the abstract. It says that:

The measles-specific antibody responses of seronegative adolescents and young adults were evaluated after revaccination. Of 1650 previously vaccinated healthy volunteers between the ages of 10 and 30 years, 4.4% were found to be seronegative for measles antibodies and 9.9% had equivocal titers.

This means that only 4.4% lacked antibodies against measles after a first dose. That means that, according to this article, the vaccine was effective in over 95% of individuals for producing antibodies against measles. This study checks to see if those who did not respond to a first dose would respond to a second, not to see whether or not the measles vaccine was effective.

After that, she cites Yuan (1994). However, this study does not support her claims either, since:

Revaccination significantly reduced the risk of measles among subjects who had been vaccinated before 1980. It also appeared to reduce the risk among those who had been vaccinated after 1980. The lack of a statistically significant decline in this group was likely due to low study power.

So revaccination with the measles vaccine reduced the risk of measles among the vaccinated group. How is this a failure of vaccination? The study points out that this particular strategy of giving a second dose was not that effective, but this is yet a discussion of how to improve the administration of the second dose, not a study that shows that measles vaccination has failed.

Ahlm then cites Ammari et. al. (1994). However, this study does not support your position either:

Of 1,311 employees working in patient care areas, 900 (68.6%) had sera tested for measles antibody. Fourteen (1.5%) were negative, 338 (37.6%) had low positive antibody levels, 372 (41.3%) were mid-positive, and 171 (19%) were high-positive; 5 (0.6%) showed equivocal results.

Again, only 1.5% individuals where negative (i.e. the vaccine did not induce antibodies). This does not imply that the measles vaccine was a failure.

Finally, Ahlm also cites Frasch et. al. (1991). However, this does not support your position either:

There were 30.7 reported vaccine failures per million doses of the polysaccharide vaccine compared with 9.0 per million doses of the conjugate vaccine, a 3.4-fold difference.

Based on this data, the vaccine protected 99.9969% of individuals given the vaccine. Hardly a vaccine failure.

Marina Ahlm uses severely outdated sources

Most of the sources Marina Ahlm abuses are also way out of date (late 80s and early 90s), which further enforces my conclusion that she is just shamelessly copy/pasting older sources as if it was her own. In science, this is called plagiarism and falls under scientific misconduct.

Marina Ahlm is a germ-theory denialist

I find it interesting that Ahlm list the book “Pasteur Exposed: The False Foundations of Modern Medicine” as a reference. It is a book from the 80s that actually denies the germ theory of disease, that it, it rejects the notion that germs such as bacteria and viruses can cause disease. It is a completely delusional book as pretty much all advances in modern pathology is based on the germ theory of disease. It is one of the greatest advances of science and Ahlm apparently deny it. Marina Ahlm’s ignorance amuses me.

Conclusion

Marina Ahlm copy/pasted most of the content of her comment from other places without giving credit and is therefore guilty of plagiarism. She did not respond to any of my criticisms, but continued to peddle the perfect solution fallacy, confirmation bias and quoted over half-a-dozen scientific papers out of context, even when the context could easily be found just looking at the abstract. She also apparently rejects the germ theory of disease of all things.

Marina Ahlm’s comment was an abject failure and she should not be taken seriously on anything she says about vaccines or modern medicine.