A Tour de Force Defense of Vaccines and Science: A Review of Peter Hotez's Vaccines Didn't Cause Rachel's Autism

Peter Hotez is a rarity in the field of infectious disease. He is, at once, a brilliant vaccine scientist, a science diplomat to the world, a media expert, and an intransigent defender of the prowess of vaccines. I have had the pleasure to interact with Dr. Hotez several times and am always energized by his enthusiasm and passion for this field.

What many people might not know about Dr. Hotez is that he has a daughter with autism which is very significant given that much of the opposition to vaccines is driven by an erroneous debunked claim linking vaccines, thimerosal and whatever has anything to do with vaccines to this condition.

To combat this campaign of misinformation by providing an evidence-based defense of vaccines, along with an extensive discussion of cutting-edge theories and recent data about autism, Dr. Hotez wrote an excellent book. Vaccines Didn’t Cause Rachel’s Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad, is to me, a tour de force in the field. I have read many book on vaccines and vaccine policies and this one stands out among all of them. Perhaps it is the way Dr. Hotez seamlessly weaves in his and his family’s experiences with Rachel’s autism. He covers the diagnosis, the daily trials and tribulations, the frustrations, and the successes.

Over 12 chapters, Dr. Hotez expertly addresses each vaccine “controversy” (“whack-a-mole”) and illustrates with data and scientific reasoning why such controversies are manufactured and, in my view, essentially arbitrary. He discusses the celebrity culture that abets the anti-vaccine movement as well as the history of the anti-vaccine movement in the US.

Vaccine programs such as GAVI are also detailed with an emphasis on how vaccination in developing countries are a crucial need and how vaccines against neglected tropical diseases are a major unmet need.

There are so many critical insights in this book that is hard to list the highlights. One aspect I took special interest in is Dr. Hotez’s interactions with the media, as this is something I do a lot of as well. Dr. Hotez hypothesizes that some of the misinformation is facilitated by the fact that scientists and physicians do not engage with the general public. as he notes:

“In a survey of 3,748 scientists, only about one-half have ever spoken with a reporter or science journalist about their research, while only 47 percent ever use social media to discuss their science. Only 24 percent have ever blogged about their science and research”

It can be no surprise then that“an overwhelming majority—81 percent—of Americans could not name a living scientist.”

Dr. Hotez also recognizes, as I came to during Ebola in 2014 that

“An added challenge is that public engagement is not usually considered a vital activity for a professor at an academic health center or university. These institutions depend on their faculty to generate revenue through clinical billing or research grants, and such public activities do not generally produce funds. Yet for someone like myself, committed to public engagement or aspiring to become a public intellectual, I have found that writing scientific papers and grant applications exclusively is seldom sufficient to persuade government leaders and policymakers to address a particular group of diseases or an approach to disease treatment and prevention”

I can’t recommend this book enough and hope it has a wide audience of physicians, parents, students, and policy makers. That the heroic Dr. Hotez is the subject of vicious primitive personal attacks is a disgusting fact he should not have to deal with and hopefully this book will help others realize what an asset he is.

Gardasil: The iPhone of Vaccines

Today while scrolling through my Facebook feed a post caught my eye because it was about Gardasil, the revolutionary vaccine that has changed the face of myriad HPV-induced cancers. The post, which I would not click on, purported to detail a case of someone receiving the vaccine and developing leukemia. Looking through the comments, one stuck out. It explicitly called into question ever trusting pharmaceutical companies. It struck me as conspiratorial, arbitrary, and so misplaced. 

I, for the life of me, do not understand why there is any animus towards Gardasil -- it really is on the level of the polio vaccine in its importance to me (I also highly regard Cervarix, the other HPV vaccine). This vaccine, constructed through really cool processes involving viral like particles (VLP), has the capacity -- if adopted at high enough levels to eradicate HPV-caused cervical, vaginal, vulvar, penile, anal, and head/neck cancers. Not many other vaccines can do that. The evidence is already beginning to amount as the vaccine, first protective against 4 chief strains of HPV and now 9, has had the time to begin to impact rates of precancerous lesions as those who received the vaccine are now entering eras in their life (post sexual debut) when these changes first appear and are diagnosed. In New Mexico, for example, this is evident even with poor uptake.

There is very close to zero safety concern with this vaccine (see here and here) which should be as routine for boys and girls as all childhood immunizations are. However, I think the strong connection with HPV acquisition and sexual activity has caused some parents to balk for whatever reason (even physicians sometimes demur when including the HPV vaccine in the list of schedule vaccines at a given visit). It's odd to me that this objection comes up when hepatitis B vaccine is targeted against another a virus that can also be sexually transmitted and it is given soon after birth.

When you ask someone to articulate their opposition to Gardasil it is often something they are unable to give logical arguments and instead, at most, rattle off a litany of anecdotes they've heard or come across on the internet that are almost always wrong. The same type of people who claim the government has a "cure for cancer" locked up somewhere are the same type who shun an actual preventive cure for HPV-induced cancers. Consistency is not something that is the strong suit of the conspiracy-haunted mind.

Worse than anecdotal evidence, to me, is when they just arbitrarily assert that pharmaceutical companies are out to poison and kill everyone -- as if that would increase their profit or shareholder value. Such insults and attack on integrity not only insult the pharmaceutical company personnel who brought this product to market but also the scientists who meticulously devoted their lives to solving this problem (one of whom received a Nobel Prize).

In my estimation, Gardasil is technologically as important as the iPhone and it, and the individual minds that made it possible, should be lauded.

RFK Jr's Anti-Vaccine Camelot: Giving More Horsepower to The 4th Horseman of the Apocalypse

President-elect Trump's supposed appointment of Robert F. Kennedy Jr. to head a "vaccine safety" commission is alarming on many different levels for myriad reasons. (For the record, the Trump transition has not confirmed the formation of this committee but the interview RFK Jr did with Science post-meeting is pretty suggestive). 

RFK, Jr. is known, not for the Kennedy mystique, but as someone who unrelentingly spreads anti-vaccine mythology. He is most associated with his vociferous opposition to thimerosal, the innocuous mercury-based preservative used in some vaccines. Because of his last name, he is given an outsized platform to promote his irrational views, notably Rolling Stone and The Daily Show. Now that platform has metastasized and risks derailing the precarious progress the human race has made in the fight against infectious disease. 

A vaccine "safety commission" led by someone whose primary involvement in vaccines does not involve the actual study of vaccines, the administration of vaccines, or the development of vaccine is puzzling on its face. When that person's primary role with vaccines is to foment doubt on the biotechnological marvel of vaccination is even too far-fetched a scenario to call Orwellian, it is the height of absurdity. Yet, that is what we have devolved to.

But what could be the deeper purpose of this action? What does it accomplish? The president has no direct control over which vaccines groups such as the American Academy of Pediatrics recommend or which vaccines schools require as a condition of enrollment. Thus, this commission is a farce with no real jurisdiction. So the only purpose, in my estimation, of this ludicrous action is to reward and pander to the anti-vaccine movement by giving them a quasi-official standing and the explicit acknowledgment that they have a "friend" in The White House who gave one of their most prominent spokespersons an official sanction. 

Such a "commission", with the support of the President, can, however, wreak havoc. For example, I anticipate RFK Jr. will interfere with state or local vaccine campaigns (as he has done before), will spread disinformation and propaganda (as he has done before), and will amplify all sorts of anti-scientific arbitrary blathering against vaccines (as he has done before). 

The value of vaccines are self-evident given the immeasurable successes they have achieved. Vaccines have transformed childhood from a period in which friends succumbed to infections into one of idyllic joy with their protection against 16 (!!) childhood infections. Vaccines have rid the planet of smallpox under DA Henderson's able hand. Vaccines have relegated polio to just two countries. Vaccines against HPV and hepatitis B have and will seriously diminish the incidence of various cancers (cervical, vaginal, vulvar, penile, head/neck, and liver).

The doctors President Obama mentioned in his farewell address that stop "pandemics in their tracks" have achieved these pathbreaking feats almost exclusively through vaccines. Right now scientists are working on a slew of vaccines that will stop future pandemics as well as halt the spread of endemic infectious diseases in their tracks and allow civilization to progress. While the President-elect and RFK Jr. may say they are "pro-vaccine" their habitual sowing of doubts about vaccine safety and questioning the number of recommended vaccines belies their true positions.

The level of evasion required to deny the efficacy of vaccines is, to me, pathological and to reward or embrace that level of mental dysfunction is tantamount to surrendering one's own mind. The twisted illogic of RFK Jr. has caused him to liken the impact of vaccines, which have saved hundreds of millions of lives, to the Holocaust.

This attitude towards vaccines is nothing short of the return of the primitive and represents the nihilistic worship, not of technological progress and the genius of Jenner and Pasteur, but of the misery, death, and pestilence that vaccines delivered us from. A harbinger worth contemplating as these forces work to make America pestilential again.

The Panic Virus: A Book With No Expiry Date

Yesterday I finished Seth Mnookin's acclaimed book The Panic Virus: The True Story Behind the Vaccine-Autism Controversy.  I am not sure why I postponed reading this book that was published in 2012 and now wish I had it read it earlier when I was heavily engaged in defending vaccines during the Disneyland measles outbreak. 

However the lessons of the book are still highly relevant to me and to the discussions I often find myself in. For instance yesterday, coincidentally, I found myself back in the same position defending the power of vaccines (this time HPV) against an onslaught of murky anecdotes, hearsay, and outright falsehoods. On such battlefields, the weapons of logic and reason can sometimes have no effect on those impervious to rational discussion based on facts. The Panic Virus explains why such a phenomen occurs. 

The chief value of this book, to me, is not that it details the history of this spurious, erroneous, and damaging smear against one of the most important life-enhancing technologies discovered (which it does), but that it delves into how such a false notion took hold, was promoted, and enabled. Published 4 years ago, The Panic Virus is still probably the best book in its field for this very reason.

A person's receptiveness to and acceptance of ideas is not automatic and, ideally, requires careful thought as to if what is being proposed as fact integrates with the sum of one's whole knowledge. A process of rational deliberation is required for an idea to be accepted as true. As such, logical thinking -- in which contradictions cannot exist -- is essential.

What lies at the root of the irrational fear of vaccines is what I believe is pure emotionalism and a disdain for reason. As Mnookin writes:

“But when it comes to decisions around emotionally charged topics, logic often takes a back seat to what are called cognitive biases—essentially a set of unconscious mechanisms that convince us that it is our feelings about a situation and not the facts that represent the truth”

Without logic, any arbitrary assertion is given a cognitive status it does not merit and impossible discussions about proving a negative ensue. If causal scientific data is considered to be equivalent to contextless correlations, anecdotes, and Jenny McCarthy's "mommy instinct" it is clear which side gains and which loses. It is especially egregious when those arguing with such overt fallaciousness are left unchallenged and regard science as just another way of "knowing" no different from rank mysticism, to which emotionalism ultimately has to degrade to as evidence is eschewed and evaded in favor of "intuition".

The Panic Virus is a book that defends not just science, but rationality as such. In Mnookin's inspiring closing of the book he harkens for a world:

“where science is acknowledged not as an ideology but as the best tool we have for understanding the universe, and where striving for the truth is recognized as the most noble quest humankind will ever undertake.”

I do too.

One Nation Under Vaccines (I wish): My Review of Vaccine Nation

The relationship the general public has had with vaccines over the past several decades has is not simple. The trajectory of vaccination began with just a single vaccine protecting against a single disease--that of Jenner's for smallpox in the late 1700s--and now every American child is protected against 16, if up-to-date on recommended vaccines (which I hope they all become). When I was a child, I was able to be protected against only 7 of what became routine in 2015.

There are, of course, more vaccines that are not routinely administered though easily available. These include vaccines against smallpox, anthrax, rabies, yellow fever, Japanese encephalitis, typhoid, and adenovirus.

What may be puzzling to many is how diseases get specifically targeted for control via vaccination and how members of the "sweet 16" came to be. A new book by Emory historian Elena Conis entitled Vaccine Nation: America's Changing Relationship with Immunization provides a lot of context and history that is not well appreciated. 

The most important aspect of the book, to me, is the theme that as society matures and medicine progresses what is a tolerable risk changes. New contexts condition how risk is objectively evaluated by individuals. Thus when there was no measles vaccines, measles was an accepted risk. However, when a safe and effective vaccine was available the risk became unacceptable.

Not all diseases are as a straightforward as measles, but the general conceptual model is the same. In many cases, the ability to live a life devoid of a "nuisance" infection may have played a role. For example, mumps--in which complications occur at a low rate--the convenience of living a life free of mumps and the ensuing need to be cared for by parents who must stay home from work (not to mention the national security implications of having soldiers sidelined by the virus which is more severe in adults). This point is moot in the current context when the mumps vaccine is exclusively (and conveniently) bundled with measles and rubella.

Risk goes the other way as well. When smallpox was nearly eradicated from the planet, the US stopped vaccinating against it (1972) because the scientifically-established risk from the vaccine outweighed the risk of contracting the illness for the general public. Similarly, when polio was nearly eliminated from the Americas there was a switch in the US from the Sabin live vaccine to the Salk inactivated vaccine to remove the risk of vaccine-derived polio from the vaccine strain.

Professor Conis provides much vivid material surrounding the debates and decisions that played a role in the rise of such vaccines as ones against measles, mumps, rubella, hepatitis B and HPV.

She also, in a very clinical way, looks at the various facets of the anti-vaccine movement finding its roots in other social movements which espoused certain philosophies that derided the scientific method, logic, and objective evidence in favor of some other "method".

The book also usefully immerses the reader in the politics that followed the introduction of the polio vaccine in the 1950s. This political atmosphere led to a growing government role in specifically funding vaccination activities of the states through various laws that developed new programs beginning in the Eisenhower administration and culminating in the Clinton administration's Vaccines for Children program.

With this book, Professor Conis has made a great contribution to the literature on the social aspects of vaccination and as a dyed-in-the-wool unapologetic vaccine advocate I think it is required reading.

P.S. Get your flu shot