How SVT Debatt Botched the Vaccine Issue

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SVT Debatt is a Swedish studio debating program on public television that discuss a couple of current topics each week. Issues range from immigration and feminism to soccer violence and diet trends. Unfortunately, science experts are far and few between and extremists are often given considerably more time to spew their nonsense. This is because the format of the show consists of short back-and-forth exchanges between invited guests and other audience members that are often interrupted by the show host (who serve as a moderator), thus promoting quack one-liners while penalizing careful scientific arguments.

This became abundantly clear during the show aired on 9th April that dealt with childhood vaccines. They had invited several anti-vaccine activists that were given ample time to spread their pseudoscientific misinformation, such as promoting measles parties to intentionally give children measles and the absurd claim that vaccines are supposedly just placebo treatments.

This is a point-by-point refutation of the pseudoscientific claims delivered by anti-vaccine parents on the show.

The toxin gambit

Anti-vaccine activists on the show made liberal use of the so-called toxin gambit. This approach is based on fear-mongering about vaccine ingredients by calling them “toxins” or “body-foreign chemicals”. The substances mentioned include aluminum salts and thimerosal. However, the chemical properties of a substance depends on how the atoms are arranged. Aluminum salts have very different properties from elemental aluminum and these salts have been safely used in vaccines for almost a century:

The safety of aluminum has been established by experience during the past 70 years, with hundreds of millions of people inoculated with aluminum-containing vaccines. Adverse reactions including erythema, subcutaneous nodules, contact hypersensitivity, and granulomatous inflammation have been observed rarely.

Aluminum-containing vaccines are not the only source of aluminum exposure for infants. Because aluminum is 1 of the most abundant elements in the earth’s crust and is present in air, food, and water, all infants are exposed to aluminum in the environment. For example, breast milk contains approximately 40 μg of aluminum per liter, and infant formulas contain an average of approximately 225 μg of aluminum per liter. Vaccines contain quantities of aluminum similar to those contained in infant formulas.

In other words, adjuvants based on aluminum salts have been safely used for many decades. They are safe and adverse reactions are quite rare. Finally, children get considerably more aluminum from breast milk or infant formula during a year than from all vaccines combined.

Thimerosal is a preservative that prevents vaccines from being contamination by pathogens. This substance does contain ethyl mercury, but this is not the same as elemental or methyl mercury and does not have the horrible consequences as methyl mercury. This is similar to the difference between ethanol (can make you tipsy) and methanol (can make you go blind). Although this substance has been used almost as long as aluminum salts, it was removed from the vast majority of vaccines over a decade ago due to the precautionary principle even though there was no evidence of harm. Around half-a-dozen studies have been done on thimerosal and found it to be safe and not associated with autism:

Twenty epidemiologic studies have shown that neither thimerosal nor MMR vaccine causes autism. These studies have been performed in several countries by many different investigators who have employed a multitude of epidemiologic and statistical methods. The large size of the studied populations has afforded a level of statistical power sufficient to detect even rare associations. These studies, in concert with the biological implausibility that vaccines overwhelm a child’s immune system, have effectively dismissed the notion that vaccines cause autism.

Measles is not a “banal” or harmless childhood disease

Two of the anti-vaccine activists on the show, Linda Karlström and Ann-Charlotte Stewart, made the absurd claim that measles is a “banal” and pretty much harmless childhood disease and that the major consequence was the joy of skipping school for a week. In reality, measles is a very dangerous disease. 1 in 20 will get pneumonia which is the leading cause of measles-related deaths among children. 1 in 1000 children who get measles will get brain swelling, which can make them deaf or neurodevelopmental disabilities. Between 1-2 in 1000 children with measles will die. This is not a harmless or banal childhood disease. It can kill children and lead to other dangerous complications.

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Measles parties: intentionally giving children dangerous diseases

Karlström went on to imply that there was little problem with parents sending off their children to measles parties in order to intentionally give them the measles. According to her, natural infection is beneficial to children. However this does not make any sense whatsoever from a scientific perspective. This is because you are spreading a dangerous infectious disease around and exposing your child to it when there is an effective and safe vaccine against it.

Vaccines did save us

Later on in the show, Karlström deploys another classic anti-vaccine trope known as the vaccines-did-not-save-us gambit. This based on the claim that vaccines were not relevant for the decline in measles infections because the death rates due to measles were already dropping before the vaccine was made. However, vaccines generally prevents infections from occurring, but does not reduce the proportion of people who die after being infected by measles. Thus, Karlström and her anti-vaccine allies have completely misunderstood how vaccines work.

Karlström also claims that vaccine-preventable diseases declined due to better sanitation and access to clean water. It is true that sanitation reduces the spread of infectious diseases, but it was only when large-scale vaccination campaigns got started that the incidence of the disease dropped substantially. The “better sanitation” argument falls apart when we realize that “better sanitation” would first eliminate diphtheria in the late 1940s, but would wait to greatly reduce measles incidence in the early 1960s and then wait again until the early 1990s to strongly reduce incidence of Haemophilus influenzae type b. The pattern fits perfectly with large-scale vaccinations, and we know the mechanism by which this happens, so it is not merely a correlational argument.

As if the argument could become more absurd, Stewart claim that vaccines are merely placebos. The head epidemiologist at the Public Health Agency of Sweden replies that smallpox and measles would never have been controlled had vaccines just been placebos.

New vaccines are not introduced primarily based on “strong commercial interests”

Vaccines are among the most profitless medical products we have. This is because one individual will at most receive one or a couple of doses of a vaccine in their lifetimes. Contrast this with blood pressure medications or antiretroviral medication against HIV/AIDS that people have to take every day for the rest of their lives. In fact, historically, the lack of profitability was one of the major reasons many pharmaceutical companies stopped producing certain vaccines.

Vaccines have undergone randomized double-blind placebo-controlled trials

Karlström claims that no vaccine has undergone proper clinical testing. This assertion is so wrong that it can be disproved by a quick search in the Pub Med database. Typing in “vaccine double-blind randomized placebo controlled trial” in the search field produces over a thousand papers. Picking a paper at random from the first page gives us a 2015 paper published in the New England Journal of Medicine called “Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults.” Sure enough, it fulfill all the requirements: it used randomization, it was double-blind and it had a placebo control:

n a randomized, double-blind, placebo-controlled trial involving 84,496 adults 65 years of age or older, we evaluated the efficacy of 13-valent polysaccharide conjugate vaccine (PCV13) in preventing first episodes of vaccine-type strains of pneumococcal community-acquired pneumonia, nonbacteremic and noninvasive pneumococcal community-acquired pneumonia, and invasive pneumococcal disease.

What were the results?

Among older adults, PCV13 was effective in preventing vaccine-type pneumococcal, bacteremic, and nonbacteremic community-acquired pneumonia and vaccine-type invasive pneumococcal disease but not in preventing community-acquired pneumonia from any cause.

So much for the claim that vaccines are not tested using the golden standard of clinical trials. Karlström also claims that these studies are not real RCTs since they do not use a blank placebo but instead use the vaccine, but with the antigen removed. This is not a problem. In fact, it ensures that the observed effect is because of the antigen (since all other components are the same) and not due to confounding. What Karlström rejects as unscientific is actually the height of scientific responsibility.

Herd immunity is real

Karlström even goes to far as to claim that vaccines do not produce herd immunity. This claims fall flat on its face since the evidence for the existence of herd immunity is so overwhelming. For instance, the herd immunity effect was demonstrated after the introduction of the vaccine against Haemophilus influenzae type b in Finland in the late 1980. It was also clearly present after the introduction of pneumococcal vaccine when looking invasive pneumococcal diseases in the USA and against influenza in Hutterites colonies of Canada. There are plenty of more examples available in the research literature. Despite this evidence, Karlström makes a last ditch effort by claiming that vaccines cannot induce herd immunity because the person getting vaccinated sheds virus particles for weeks after vaccination. However, as explained by the experts on the program, any shedding will occur at such low dosages that it is not dangerous.

Alleged deaths from vaccines is really caused by birth defects, drowning etc.

The United States has a large system for reporting alleged adverse events of vaccines called VAERS. However, just because two things happen close to each other in time does not mean that one caused the other. Karlström claimed that the MMR vaccine has killed over a 100 people, but a lot of these deaths have been shown to be due to congenial heart disease, co-sleeping and drowning. Clearly, these are not related to the vaccine.

Vaccines are often 95+% effective and random clustering is very rarely a problem

Stewart claims that there are outbreaks of vaccine-preventable diseases in populations were the vaccination rate was 100%. As was explained in a previous article, the examples usually trotted out only had 58% vaccine coverage or some of the children infected were not vaccinated. The core message, though, is that this is not a surprise given that vaccines are not always 100% effective:

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.

Notice that community spread was among unvaccinated children and that this extremely rare event is comptible with the 2-10% expected vaccine failures.

The intellectual responsibility of public television and SVT Debatt

It may seem naively comforting to think that people who spread scientific misinformation should be given equal time compared with science-based experts. Yet this is false neutrality. You would never give equal time to people who believe in geocentrism in program about physics or to Holocaust deniers in a history program. For the exact same reason, anti-vaccine cranks should not be given equal time to scientific and medical experts. SVT Debatt has given airtime to dangerous pseudoscience and has established a potentially dangerous precedent. How many parents will stop vaccinating their children because anti-vaccine activists were given this platform to spread their nonsense?

Emil Karlsson

Debunker of pseudoscience.

7 thoughts on “How SVT Debatt Botched the Vaccine Issue

  • April 9, 2015 at 22:58
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    Thank you for calling out the false neutrality. I think it is a growing problem that too many overlook.

    • April 10, 2015 at 16:40
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      Agreed. When the scientific evidence for one thing becomes overwhelming enough, trying to remain neutral on the issue becomes disservice to society and a joke at the same time.

  • April 10, 2015 at 10:04
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    Tack för detta inlägg. Man blir ju nedstämd efter att ha sett en sådan debatt.. En debatt som slutar med att en sidan påstår att det inte finns RCT och den andra sidan påstår att jo det finns det visst det och den andra sidan säger att nej det finns det inte alls det. Jag måste säga att jag inte tycker att den vettiga sidan argumenterade på att tillräckligt bra sätt. Jag tror inte att de som är osäkra blev övertygade och kanske till och med mer osäkra på vaccination.

    • April 10, 2015 at 21:31
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      (my translation)

      I must say that I don’t think that the sensible side argued sufficiently well.

      Sure, the scientific experts certainly did not bother with countering that much of the pseudoscientific misinformation that the anti-vaccine cranks spewed. This can indeed be seen as a victory for the cranks as they stood unopposed on the vast majority of claims being made. This is because the conspiracy theorists made use of the so called Gish gallop whereby they spewed a dozen or so false claims in a minute or two. If a science-friendly opponent tries to refute those claims, it will take a lot of time (say, 15 min) to make a comprehensible case that laypeople can grasp and it is too easy to get lost in the details in this kind of brief back-and-forth exchange. If the pro-science side restricts to carefully refuting one or two claims, it will look like the rest cannot be refuted. It is also important to take into account the backfire effect, whereby correction makes people more entrenched in their pseudoscientific beliefs.

      There are really no good ways to combat the Gish gallop, but the only way to survive it is to not play the game. Instead, one could focus on a couple of core issues and emphasize them over and over: vaccines are safe and well-tested, measles is dangerous and beware of crank sources.

      So yes, I agree that this was a completely horrible television event, but the experts probably did as well as was practically possible.

  • April 10, 2015 at 11:10
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    “Karlström claimed that the MMR vaccine has killed over a 100 people”

    Detta påstående bemöts inte alls utan hon börjar prata om att de två ska träffas privat istället! Det är ju fullständig katastrof. Hur många tolkar inte detta som att vaccinationsmotståndaren har rätt?

    • April 10, 2015 at 21:44
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      (my translation)

      This claim was not countered at all and instead she started talking about how the two should meet in private instead! That is completely disastrous. How many did not interpret that as if the vaccine opponent was right?

      Yes, it is very problematic that the doctor did not disprove the “100 people killed” claimed. However, it was also an underlying issue of disproving the “doctors being arrogant and think they are better than everyone else” (as the vaccine critical reporter insinuated). From the perspective of a layperson, it could also come off as insensitive or dismissive for them to, in a rush, make pronouncements of the cause of death of those people. Though, it is by no means certain that the benefit that approach was larger than the cost.

      It is an extremely difficult balance.

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