Flawed Swedish Anti-Vaccine Article Rejected and Retracted

Anti-vaccine activists allegedly failed to get an opinion piece dishonestly titled “Our children should not be forcibly vaccinated” published in a major Swedish newspaper called Dagens Nyheter. The provided reason was supposedly that it did not include sufficient sources for their anti-vaccine claims. They attempted to publish it on the debate section on the website of the newspaper, but it was retracted a short while after. They will likely play the martyr card and claim that the mainstream media is oppressing them, even though the newspaper just declined publication and retracted a pseudoscientific opinion piece that promoted many scientific falsehoods.

The letter to the editor was published (webcite) a day later on the alternative news website Newsvoice that have supported many different conspiracy theories before. Although many of the claims made have been disproved thousands of times before, it is important to provide credible scientific information in a time where dangerous pseudoscientific myths are gaining ground and so this post will serve a point-by-point refutation.

It turns out that the authors of the opinion piece (Boo, Tips, Ahlm, Karlström och Zazzio) based their case on confusing mandatory with compulsory, butchering a quote from the Sweden National Board of Health and Welfare, spreading fear and uncertainty about vaccine safety and efficacy, claimed that knowledge about the prevalence of vaccine side-effects relies only on spontaneous reporting rather than active monitoring. Finally, they are betrayed by their own ignorance on why infants are vaccinated and even go so far as to propose that vaccines constitute “premeditated attempted murder”.

Mandatory vaccination is not the same as compulsory vaccination

At its core, Boo and co-authors confuses mandatory with compulsory in an effort to spread fear and doubt about vaccines. If something is mandatory, you pay a societal cost for not doing it. For instance, if you fail to show up for a mandatory lab session in a university chemistry course, you will not pass the course or you may not be able to send your child to your favorite candidate school if they require children to be vaccinated. If something is compulsory, on the other hand, it means that things something will be carried out under the threat of violence. If you fail to show up to a compulsory police interrogation, the police will come to your home or job and ask you to come with them. If you decline, you will be put in handcuffs and taken to the police station. If you resist, they will use violence against you.

Mandatory vaccination is not the same as compulsory vaccination. Compulsory vaccination was tried in e. g. the 1800s, and it arguably did not work. That is why countries like Sweden and the United States do not have compulsory vaccination.

Serious side-effects are very, very rare

The CDC has a lot of information about possible side-effects. For the MMR and DTaP vaccines, there is a 1 in 1 million risk of a severe allergic reaction. Other reported side-effects are so rare that if they are real, they cannot be reliably measured (risk much less than 1 in 1 million).

The risk from getting the disease is much worse. The risk of death for diphtheria is 5-10% and for tetanus it is about 10%. For measles it is 2%. Other complications of measles disease is brain inflammation, pneumonia, seizures and several others.

If you compare the risk with the vaccine versus the risk of the disease, the disease is much, much worse.

Scientific studies show vaccines are effective

Here is an image from Appendix E of the CDC textbook Epidemiology and Prevention of Vaccine-Preventable Diseases that shows the radical impact of vaccines:

For individual vaccine-preventable diseases, such as diphtheria, there are separate chapters in the book.

Now, pro-disease activists will claim that this is just an effect of better sanitation and water, but the decline is closely connected to start of the vaccinations and better sanitation obviously will not start with eliminating diphtheria in 1940s and wait to 1980 to severely reduce Haemophilus influenzae type B.

Follow Debunking Denialism on Facebook or Twitter for new updates.

Anti-vaccine advocates misquoting the Sweden National Board of Health and Welfare

The letter to the editor also misquotes the Sweden National Board of Health and Welfare (“Socialstyrelsen”) and it is also out of context. The quote they offer is (my translation):

Vaccines that were developed at the beginning or middle of the past century is usually not evaluated with modern requirements for placebo-controlled efficacy trials. This is the case for e. g. diphtheria, tetanus, polio, measles and, in the west, rubella.

This snippet comes from the a report called “Vaccination of children: The Swedish Vaccine Schedule” with a subtitle of “A review for health care personnel” and it can be found here (webcite). The snippet in question can be found at page 23 in the document.

Boo et. al concludes that “despite the fact that vaccines have not gone through correct scientific tests, it is assumed that it would be scientifically proven that vaccines are safe and effective”.

This is, of course, completely wrong. First, they leave out a sizable part of the real quote between the two sentences and therefore butcher the quote in question. Second, they leave out the following paragraph that puts the quote in context. Third, they give the misleading impression that the Sweden National Board of Health and Welfare somehow admits that vaccines have not undergone proper testing. Nothing could be further from the truth.

The full quote reads (the part they quoted is in bold):

Vaccines that were developed at the beginning or middle of the past century is usually not evaluated with modern requirements for placebo-controlled efficacy trial. If there already exists well-functioning vaccines, the disease has usually become so rare that it is hard for statistical reasons to carry out such as efficacy study. This is the case for e. g. diphtheria, tetanus, polio, measles and, in the west, rubella. In addition, it would be considered unethical since an established and effective treatment would be withheld from persons in the control group. When a new vaccine is made, the new vaccine must instead be tested in comparison with the vaccine that already exists and are used.

In other words, the Sweden National Board of Health and Welfare is not claiming that traditional vaccines are untested, unsafe and ineffective. Quote the opposite, since they label vaccines against diphtheria, tetanus, polio, measles and rubella as “well-functioning”, in stark contrast to what the anti-vaccine advocates claim! The gist of the full quote is that if a new vaccine against e. g. diphtheria is produced, it has to be compared against an already existing vaccine, since it would be both hard and unethical to do a proper randomized controlled trials.

Anti-vaccine activists often quote scientists, scientific papers and reports out of context, but here they go ever further and butcher a quote by leaving out key content that completely changes the meaning of the paragraph. If anti-vaccine activists have to go to such lengths to butcher quotes from government reports to argue for their point, it should be a very large warming sign that something is wrong with their position.

Finally, their proposed interpretation, namely that a lack of randomized controlled trials means that traditional vaccines are untested, is empirically false. This is because a lot of traditional vaccines, such as polio vaccines, have been scientifically tested on hundreds of thousands of people before being made a part of the vaccine schedule. But since this was done in the 1950s, they for obvious reasons could not use the best possible modern study designs that are in effect 60 years later. We will look at some of these studies in the next section.

Even many traditional vaccines have solid efficacy studies

For instance, the Salk polio vaccine was tested in a field trial with more than 600 000 participants where some got the polio vaccine and some got placebo. The vaccine was found to be between 80 and 90% effective in preventing polio paralysis:

The polio vaccine field trials of 1954, sponsored by the National Foundation for Infantile Paralysis (March of Dimes), are among the largest and most publicised clinical trials ever undertaken. Across the United States, 623 972 schoolchildren were injected with vaccine or placebo, and more than a million others participated as “observed” controls. The results, announced in 1955, showed good statistical evidence that Jonas Salk’s killed virus preparation was 80-90% effective in preventing paralytic poliomyelitis.1

This trial was by no means perfect by modern standards, because over half of all trial sites did not used a placebo control (and instead relied exclusively on observed controls):

The observed control trials were essential to maintaining public support for the vaccine as the product of lay faith and investment in science.

This was because otherwise only half of the students would get the vaccine and half would get a placebo, and many parents and members of the public were keen on making sure their children were protected.

Vaccine safety research includes active monitoring, not mere reliance of spontaneous reporting

Boo claims that most drug adverse events go unreported, so therefore we cannot trust claims that vaccines are safe. This is wrong for several reasons.

First, that data was for all drugs, and not vaccines specifically. Second, pre-licensing vaccine safety research does not passively rely on spontaneous reports, but careful monitoring of vaccine recipients. Third, adverse events occurring from post-licensing vaccine does not rely on spontaneous reporting either, but active monitoring by collaborations between medical centers and the CDC in the form of the Clinical Immunization Safety Assessment (CISA) Project that “conduct clinical research on vaccine-associated health risks in certain groups of people”, as well as collaborations between CDC and that are involved in “ongoing monitoring and proactive searches of vaccine-related data.”.

It should also be pointed out that an adverse events is not necessarily caused by the medical product in question. This is because correlation does not equal causation. As we saw before, very serious vaccine side-effects are exceedingly rare.

What about outbreaks of vaccine-preventable diseases in highly vaccinated populations?

This has been examined several times earlier on Debunking Denialism, such as in the article A Swedish Vaccine Rejectionist Comes Out to Play…:

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?

Boo specifically cites the outbreak in Illinois in 1984 and claims that this shows that measles can spread in a 100% fully vaccinated population. Unfortunately, this a dangerous simplification:

If waning immunity is not a problem, 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.

Even though all high school students had at least one dose of measles vaccine, this very rare outbreak is consistent with the expected efficacy rate of measles vaccination. A single dose of measles vaccine does not provide full protection (that is why we now have several booster shots), the outbreak was not sustained and the community spread was primarily among unvaccinated children.

There is no indication whatsoever of large-scale vaccine failure above and beyond the expected levels of vaccine efficacy.

Why vaccinate infants?

Boo and her collaborators are visibly appealed by the fact that infants are given vaccines:

Our infants, the most fragile we have, that have not even had time to develop a good immune system, gets 21 vaccines (some vaccines are concentrated to one and the same shot) during the span of 18 months, in the Swedish vaccine schedule for children. Some children — the ones that have an even worse immune system than normally, can get 27 vaccines during the same time period.

The reason infants are vaccinated is because they are susceptible to vaccine-preventable diseases as long as they remain unvaccinated. Since we as a society thinks it is bad for infants to get polio, diphtheria, pertussis and so on, we offer vaccinations for infants. Also, it is not 21 different vaccines, but 9 (diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B, pneumococcal disease, measles, mumps and rubella). Anti-vaccine activists inflate the number to 21 because they count boosters as completely separate vaccines, which of course they are not.

The reason some children are offered more vaccines than these 9 is because they are at increased risk of e. g. hepatitis B and tuberculosis, or have a weakened immune system so if they get infected by e. g. chickenpox, rotavirus or influenza, their disease will be much worse.

Vaccines are not “premeditated attempted murder”

Here is were Boo goes completely off the rails, accusing the vaccine schedule of being a “forced punishment” that they want to classify as “premeditated attempted murder”, “attempted involuntary bodily harm” because of the existence of exceedingly rare severe side-effects.

Calling one of the most important public health improvements in the history of humanity “premeditated attempted murder” shows that anti-vaccine and pro-disease activists cannot possibly be taken serious and do not deserve a seat at the table.