Separating the scientists from the paranoid

Those who seriously evaluate the merits of vaccination should not be grouped with anti-vaxxers

Olshansky and Hayflick noted in AIMS Public Health (2017; 4:127-138) that vaccines derived from the WI-38 cell strain had treated or averted 4.5 billion cases of poliomyelitis, measles, mumps, rubella, chicken pox, shingles, adenovirus, rabies and hepatitis A infections worldwide, saving 10.3 million lives.

The WI-38 cell strain was established in 1962 by (now) Prof Leonard Hayflick from an aborted foetus. But Hayflick’s contribution to global public health was condemned in 2005 by the Roman Catholic bioethicist (then) Bishop Elio Sgreccia, who judged that parents whose children received aborted tissue-derived vaccines colluded with evil. Sgreccia’s inventory of evil-doers included those who prepared vaccines derived from cell strains established from abortions; those who marketed them; and those who used them for health reasons.

Perhaps Sgreccia had obeyed Ignatius Loyola’s injunction — Dei sacrificium intellectus — and abandoned his intellect. How much better if the late cardinal had read Howard Jacobson’s The Dog’s Last Walk (2017), the better to reflect on “[t]he absurdity of giving principle precedence over the humanity which principle exists to serve… ” Instead, Sgreccia’s ethical contortions led him to swell the ranks of the so-called anti-vaxxers, while helping public health to become another victim of religious dogmatism. Similarly, Ahmed et al address the ‘Outbreak of vaccine-preventable diseases in Muslim majority countries’ in the Journal of Infection and Public Health (2018, 11: 153–155), citing “a celebrity singer with a huge following in Malaysia and Indonesia [who] openly declared his support for an anti-vaccination stance, posting ‘Allah is all-powerful, vaccines have no power’ on social media”.

Ahmed et al demonstrate that not all anti-vaxxers are Jesuits in thrall to Loyola’s Dei sacrificium intellectus but it is nonetheless true, as Peters et al highlight in the Journal of Hospital Infection (2018, 100: 365‒370), that “[t]he anti-vaccine movement is characterised by irrational speculations and exaggerations related to vaccine outcome”. And Hotez correctly observes in Paediatric Research (2019, 85: 912–914 ) not only that “children have a fundamental right to be vaccinated and protected against deadly infections like measles and flu. This right supersedes parental choice and freedom… ”, but also that “[t]he European Commission recently identified the anti-vaccine movement as a health security threat and is shaping proposals to fight it”.

But I was puzzled by a letter from the Editor of the South African Medical Journal (2019,109:195-196). In ‘Anti-vaxx — wilful ignorance or misunderstanding?’, Dr Bridget Farham traces the history of the anti-vaxx movement, describing how vaccine opposition remained “particularly in the USA, not helped by the so-called Cutter incident in 1955, in which 120,000 doses of the Salk polio vaccine inadvertently contained live polio virus along with the inactivated virus, causing 40,000 cases of polio, 53 cases of paralysis and five deaths”. But Farham’s next but one sentence, introduced with “now for the big one… ”, cites Wakefield’s fraudulent measles/autism paper, which (for at least one reader) serves to elide Cutter fact with Wakefield fantasy. This is important in the context of her subsequent statements that: “… public health is going to become another victim of populism. Throwing science at people who truly do not want to accept it will not work.”

Perhaps it was not Farham’s intended implication, but it is my inference that she places those who voiced justified criticism of vaccine safety standards following the Cutter incident in the same ‘populist’ category as those who endorse Wakefield’s warped vision. Further, it raises the suspicion that those who dare criticise aspects of vaccines and/or vaccination risk unfair condemnation as anti-vaxxers.

For example, are Jørgensen et al anti-vaxxers because they wrote in July 2018 “the Cochrane HPV vaccine review was incomplete and ignored important evidence of bias” in BMJ Evidence-Based Medicine (2018, 23:165–168)? Their evidence-based contribution raises valid points for debate. For example, whereas the Cochrane review included 26 randomised trials, Jørgensen et al identified 46 trials that met Cochrane inclusion criteria. In its 30-page rebuttal, Cochrane expressed its regret at such debates occurring in public: “There is already a formidable and growing anti-vaccination lobby. If the result of this controversy is reduced uptake of the vaccine among young women, this has the potential to lead to women suffering and dying unnecessarily from cervical cancer.”

On the one hand, Dr Farham claims that “[t]hrowing science” at the public won’t work if people don’t want to accept it; on the other, Cochrane appears to deplore any throwing about of disputed science, especially if it’s in public.

Writing as a member of the public, I don’t think I would necessarily be grateful if Dr Farham deigned to throw some science at me; but nor would I be gratified to know that public health policy might be based on flawed science that is being kept from us.

Some health professionals judge that certain concepts are too difficult for the public to grasp. But the public is composed of individuals, many of whom have common sense and can read without moving their lips. Vaccines are not above serious debate, and it is sceptics — as distinct from anti-vaxxers — who drive medical progress.