Sweden has largely been spared of the creeping vaccine rejectionist propaganda that has plagued the United States and Great Brittan for decades. However, the anti-vaccine forces are stirring under the surface and have acquired a larger internet presence than ever before, especially after the vaccination program against the pandemic H1N1/09 virus. The growing movement is centered around conspiracy-mongering websites like vaken.se that has bought into almost every conspiracy theory imaginable about 9/11, water fluoridation, vaccines, global warming and genetically modified foods. Another important hub of the Swedish anti-vaccine movement is Annika Dahlqvist, who is a medical doctor promoting diet as protection against infectious diseases. For her pseudoscientific claims, she was awarded denialist of the year (“Årets förvillare”) by a Swedish skeptic society (called “Föreningen för vetenskap och folkbildning”) in 2009. A third central figure is blogger Linda Karlström (an economist), who has recently started a new anti-vaccine group blog under the domain vaccin.me. She has teamed up with others and they spend most of their time shamelessly parroting the anti-vaccine falsehoods put forward people like Mike Adams, Lawrence B. Palevsky and Jackie Swartz, a anthroposophist doctor at a Swedish CAM clinic called Vidarekliniken. Karlström’s group is collecting anecdotal stories from anti-vaccine parents who believe their children have gotten hurt by vaccines. According to their website, they intend to gather 1000 reports before they attempt at class-action lawsuit.
Luckily, they do not have free reign. Responsible science journalists, scientists, public health professionals as well as the skeptic society of Sweden are combating their falsehoods, both online and offline.
Let us take a detailed look at what passes for evidential arguments at Karlström’s blog. The blog post that I am refuting is written in Swedish, but I will translate the claims being made to the best of my ability. Feel free to use online translation services to check the translation. The user Marina Ahlm (a nurse currently trying to become a “medicinal foot therapist” according to the website bio) posted an entry absurdly entitled Herd immunity cannot be achieved through vaccination: even vaccinated people carry viruses and bacteria that can be found here. As we shall see, it is filled by distortions, scientific falsehoods, half-truths and plain old nonsense.
Measles vaccination has been a scientific success!
—> According to the WHO (2011), the measles mortality has been reduced by as much as 78% between 2000 and 2008 mostly due to the benefits of large-scale immunization program. In the vast majority of regions, this figure is at 90% (between 2000 and 2010).
—> After the introduction of the measles vaccine in 1963, the incidence of measles fell dramatically, from almost 500000 cases per year to almost none in comparison. Even though small and sporadic peaks and valleys due to natural fluctuations, the huge reduction is real (CDC, 2011). To be sure, the fact that B follows A does not mean that A causes B, but when you have a strong correlation plus a mechanism that is supported by many different lines of evidence, the reasonable position is to tentatively accept the efficacy of the measles vaccine.
—> Ahlm makes the flawed argument that since, apparently, it is practically difficult to evaluate the efficacy of a second dose of measles vaccine, this means that the measles vaccine has been a failure and that WHO only offers excuses. However, practical problems evaluating the efficacy of a second dose of measles vaccines compared to getting one cannot undermine the enormous mountain for the efficacy of the measles vaccine. As far as we know, a single dose may potentially offer the bulk of the protection.
—> In fact, the WHO does not offer excuses, but points out the real reasons why we have seen some resurgence of measles in certain areas of the world: vaccine efforts are sometimes not sustained partly because of the actions of vaccine rejectionists (like Ahlm): “However, global immunization experts warn of a resurgence in measles deaths if vaccination efforts are not sustained. Experts fear the combined effect of decreased political and financial commitment could result in an estimated 1.7 million measles-related deaths between 2010-13, with more than half a million deaths in 2013 alone” (WHO, 2011a).
The pertussis vaccine and the illusion of perfect solutions
—> Previously, the pertussis vaccine that was used was made from inactivated, whole cell bacteria. This worked reasonably well, with an efficacy of 70-90%. However, it had some extremely rare adverse effects with 0-10.5 people in 1000000 developed acute encephalopathy (CDC, 1997), although scientists where not sure that it caused permanent brain damage, they made scientists produce a better and safer acellular vaccine just in case.
—> To carry out a rational analysis of risk, the side effects of the current DTaP vaccine has to be compared to the effects of pertussis. According to the CDC (2011), pertussis causes pneumonia for 1 in 8, encephalitis for 1 in 20 and death for 1 in 1500 individuals. Clearly, the risks of the disease outweigh the risk of the vaccine.
—> The anti-vaccine blogger Marina Ahlm, citing Kretzschmar (2010), makes the claim that pertussis probably will not be eradicated with the current vaccine because the protection afforded by the pertussis vaccine vanes after many years and that smaller outbreaks will still occur. This is a clear example of the so called perfect solution fallacy. The current pertussis vaccine is rejected because it does not offer a perfect solution. This is a flawed argument, since hardly any form of medical product offers a perfect solution and an effective and safe vaccine, although imperfect, is much better than no vaccine at all. Before the vaccine, pertussis would kill about 8000 children per year (Offit, 2005), not to mention causing many more cases of pneumonia and encephalopathy.
—> An additional irony is that the editor’s summary of the article (Kretzschmar, 2010) clearly states that “Widespread pertussis vaccination since the 1950s has greatly reduced the incidence (the number of new cases in a population) of whooping cough”. Clearly, Ahlm did not even bother to read the article she is using as a source.
—> The same fallacious argument is made with regards to the most common vaccine against tuberculosis (BCG). Scientists are trying to develop new and better vaccines that can protect against pulmonary TB.
The vaccine against tuberculosis is generally safe and effective for the types it was developed for
—> Studying the efficacy of the BCG has some practical difficulties associated with it. Petrini (2000) writes that it depends on which strain is being used and background incidens of asymptomatic TB infection. Clearly, if the strain has shown to be ineffective in animal tests and if the person being vaccinated is already infected with TB, the protection will be much less. When clinical trails are carried out responsibly, the efficacy is around 80%. Yet again, Ahlm did not care to read the source from which she got her efficacy data, but used it out of context in her attempt to argue that the BCG vaccine is ineffective.
—> Those children that have a very rare genetic immunodeficiency can acquire a disseminated TB infection and it occurs in around 1 in a 100000 according to the Swedish counterpart of the U. S. Institute of Medicine (Statens beredning för medicinsk utvärdering, 2009). In order to prevent this, the vaccine is not given until the child is six months (not newborn), so that this hereditary immunodeficiency will be discovered. Again, Ahlm took this out of context, asserting that the BCG vaccine cause TB generally.
The polio vaccine has reduced global incidence of polio with 99%
—> Between 1988 and 2006, the global incidence of polio has fallen by over 99%. This is a huge victory of vaccination programs (CDC, 2008).
—> However, certain regions, such as India, Afghanistan, Pakistan and Nigeria are still struggling with polio, even though India has not had a single cause of wild polio for about a year (WHO, 2012). These regions presents unique challenges for the goal of eradicating polio, such as special ecological circumstances, political instability, efforts of vaccine rejectionists, lack of political will etc. As for India, the problem exists primarily in the two provinces called Uttar Pradesh and Bihar. Fine (2009) points out that these regions “have a long history as entrenched foci of major infectious diseases”.
—> Ahlm continues to use her selective understanding of the literature to artificially inflate the problems in these regions as a way to undermine the efforts for global eradication of polio. It is also important to separate infection and disease, because less than 1% of infected individuals get clinical symptoms, so her assertion that hundreds of children get vaccine-induced polio should be taken with a grain of salt. Her source for the claim is the known conspiracy-mongering radio host Alex Jones, so some skepticism is warranted.
—> Also, vaccine-associated paralytic polio mainly occurs in immunodeficient individuals (Shahmahmoodi, 2010) in areas with few individuals vaccinated against polio (Kew et. al. 2002). When the national incidence of polio is small, countries usually switch from the oral polio vaccine (weakened) to the inactivated Salk vaccine. WHO (2011b) explains that “the spread of a cVDPV shows that too many children remain under-immunized. A fully-immunized population will be protected from all strains of poliovirus, whether wild or vaccine-derived.” and that “Over the past 10 years, more than 10 billion doses of OPV have been administered to more than 2.5 billion children. As a result more than 3.5 million polio cases were prevented. During that time, 18 outbreaks of cVDPVs have occurred in 16 countries, resulting in 510 VDPV cases.” So if you had to chose between 3.5 million children or 510 being infected with polio, which option would you take?
Herd immunity protects those that are not or cannot be vaccinated
—> Herd immunity occurs when a large proportion of the population is vaccinated. This ensures that the number of individuals the average pathogen can infect drops below 1. This is because the individuals around it that it can jump to are immune to it. So it reduces spread of the pathogen and individuals that are not vaccinated are shielded by the herd, because it cripples the spread of the disease and contains it (NIAID, 2010).
—> Some risk groups, such as HIV/AIDS patients, individuals who are undergoing chemotherapy or radiation therapy, are on corticosteroids for autoimmune diseases, children who are too young to be vaccinated etc. These poor individuals are protected by having a large percentage of the population vaccinated. Needless to say, this also protects vaccine rejectionists, despite their fervent opposition to all things vaccine. Ironic, isn’t it?
—> You can still have the viruses and bacteria that you have been vaccinated against in your skin or on the epithelial cells of your nose, but the immune system prevents these from infecting you like they would have if you where not protected. This limits the degree to which you can spread it, since it will often not cause symptoms like sneezing or coughing. Who do you think you are most likely to be infected by: a person who has the virus on his body or the one who sneezes it on your face?
—> Ahlm seriously misunderstands the concept of herd immunity. It is not based on the idea that a certain part of the population needs to develop and active disease and the vaccine is not required to trigger the disease. Both produce memory B cells.
—> Ahlm continues to fail basic science when she claims that herd immunity denies viruses have their own life cycles and that viruses can “die out naturally” even if there is no vaccine. She confuses life cycle with the duration of an epidemic, which shows that her ignorance of basic biology is vast. Her example is SARS, but virus behind SARS was not exterminated; the emerging epidemic was curved with stringent quarantines. It is very hard to understand exactly what her point is, but presumably it is that we have to take into account spontaneous decrease in number of cases. The answer to this objection is clear: we do. It is called “control group”.
—> Ahlm claims that outbreaks can occur despite a vaccine coverage high than 90%. This is true, but only because vaccine rejectionists tend to cluster geographically. The models for herd immunity generally assume that vaccine rejectionists or people who are non-vaccinated are distributed randomly. This is generally the case. For instance, while the national converge in the United States may be above 90%, local coverage in certain areas may fall as low as 70% in Ashland, Oreagon (PBS, 2010) or even as low as 40% in certain schools near Marina del Rey (Novella, 2009). This explains why outbreaks can happen locally, despite national high vaccine coverage. Basic math.
—> Ahlm saves the most absurdly false claim to the end when she says that “you cannot vaccinate and think that your children are protected and then feel that your children are not protected because, somehow, there are certain non-vaccinated children who carry a secret organism that no one else carries. It just does not add up.” On the contrary, it does add up, because vaccines are not 100% effective, so even if you are fully vaccinated and live in a population filled with non-vaccinated individuals, you are at risk. Furthermore, remember those individuals that cannot be vaccinated such as HIV/AIDS patients, individuals who are undergoing chemotherapy or radiation therapy, are on corticosteroids for autoimmune diseases, children who are too young to be vaccinated etc.
Conclusion
The anti-vaccine hysteric Marina Ahlm tries to inflate minor practical problems and scientific uncertainties while ignoring the broad knowledge that exists on the efficacy of vaccines. She routinely misunderstand basic scientific concepts like herd immunity and life cycle. She performs many fallacies, such as the perfect solution fallacy and quoting out of context. Her claims are highly selective and scientifically flawed in multiple respects.
References and Further Reading
CDC. (1997). Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1997 Mar 28; 46(RR-7):1-25.
CDC. (2008). Progress Toward Interruption of Wild Poliovirus Transmission — Worldwide, January 2007–April 2008. Morbidity and Mortality Weekly Report, 58(18), 489-494.
CDC. (2011). Basics and Common Questions: Some Common Misconceptions about vaccination and how to respond to them. Accessed: 2012-01-29.
Fine, P. E. M. (2009). Polio: Measuring the Protection That Matters Most. The Journal of Infectious Diseases, 200(5), 673-675.
Kew, O., Morris-Glasgow, V., Landaverde, M., Burns, C., Shaw, J., Garib, Z. a., . . . de Quadros, C. (2002). Outbreak of Poliomyelitis in Hispaniola Associated with Circulating Type 1 Vaccine-Derived Poliovirus. Science, 296(5566), 356-359.
Kretzschmar, M., Teunis, P. F. M., & Pebody, R. G. (2010). Incidence and Reproduction Numbers of Pertussis: Estimates from Serological and Social Contact Data in Five European Countries. PLoS Med, 7(6), e1000291.
NIAID. (2010). Community Immunity (“Herd” Immunity). Accessed: 2012-01-29.
Novella, S. (2009). Pockets of Vaccine Noncompliance in California. Science-Based Medicine. Accessed: 2012-01-29.
Offit, P. A. (2005). The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis. New Haven and London: Yale University Press.
PBS. (2011). Frontline: The Vaccine War. Written, produced and directed by Jon Palfreman. Accessed: 2012-01-29.
Petrini, Björn. (2000). BCG-vaccination – kontrovers och kompromiss. Läkartidningen. 97(48).
Shahmahmoodi S, Mamishi S, Aghamohammadi A, Aghazadeh N, Tabatabaie H, Goya MM, et al. (2010). Vaccine-associated paralytic poliomyelitis in immunodeficient children, Iran, 1995–2008. Emerg Infect Dis.
Statens beredning för medicinsk utvärdering. (2009). Barnvaccinationer räddar liv och är säkra. Accessed: 2012-01-29.
WHO. (2011a). Measles mortality reduction: a successful initiative. Accessed: 2012-01-29.
WHO. (2011b). What is vaccine-derived polio?. Accessed: 2012-01-29.
WHO. (2012). India records one year without polio cases. Accessed: 2012-01-29.