Thursday, June 27, 2013

The Impossible Demand for 100% Vaccine Safety

What would you say to someone who makes a demand for you to prove to them that all automobiles are
safe?  Do you think you could use safety data to prove that automobiles are more safe than they have ever been?  Maybe you could explain how there are new innovations like airbags, crumble zones, anti-lock brakes, or traction control systems which all work together to increase safety.

Now what if that same person cited statistics which showed that even in the year 2011 there were still over 32,000 people killed in automobile accidents in the US alone?  Does that suggest that automobiles aren't really that safe after all?

When you really think about it... how do you determine what is "safe"?

Reasonable people will understand that claims about vehicle safety based upon the number of accidents or the number of deaths in a year isn't taking in to account the big picture.  First you need to realize that there are hundreds of millions of miles traveled each and every year and there are million upon millions of drivers.  Next you need to take into account that even if a vehicle has eight airbags and has a five star crash test rating, sometimes things can and do go wrong and it may have nothing to do with the vehicle.

In the end, you would realize that 32,000 deaths may seem like a significant number, but in context of the hundreds of millions of miles driven, and the millions of unique drivers, the millions of different vehicles, the total hours spent in a vehicle throughout the year... well in the end 32,000 deaths is actually a very small number.  You might even show them statistics which prove that we haven't had less traffic fatalities since 1949 when the population and the number of miles traveled were less than half of what we have today.  You might even point out that almost as many people die from accidental poisonings in a given year (more than 33,000 deaths in 2010) than do in automobile accidents.

So perhaps logical people will agree that proving vehicles are safe is based upon certain assumptions.  Number one, you need to define the term "safe" and assume that is based upon historical averages and based upon percentages.  You also need to assume that no vehicle can ever be 100% safe, and you need to accept the fact that there will be accidents, and there will be a certain amount of deaths as a result.

With that in mind, should we ban automobiles because people die every year?  Should we change the laws to only allow them to be sold if they are 100% safe?  Should we demand that the government require automobile companies to be held personally responsible for each and every death that occurs while operating a motor vehicle?  Of course not... that sounds so silly when you put it like that doesn't it?

So with that in mind, why do anti-vaccinationists demand that we prove every vaccine is 100% safe?  Not only do they demand vaccines are 100% safe, but they aren't willing to accept the commonly held definition of the term "safe" (which in this case means involving little or no risk of mishap).

Even though there is overwhelming evidence supporting the efficacy and safety of vaccines, it is doubtful this would appease an antivaxxer because chances are there will always be cases where someone had an allergic reaction to a vaccine or a case where someone suffered a side effect, or cases where someone was fully vaccinated but still contracted the disease they were supposed to be protected against.

In addition to requiring all vaccines to be 100% safe, anti-vaccinationists are quick to point out case where someone was injured by a vaccine over 50 years ago.  They believe that the modern vaccines of today should still be blamed for any problems that existed decades ago, just as we should be blaming modern automobiles for the safety failures of the Chevrolet Corvair or the Ford Pinto.

We can all admit that vaccines have not always been perfect.  There have been cases such as the Rotashield rotavirus vaccine in 1998 and 1999 which was pulled from the market after it was determined it increased the risk of intussusception (a rare type of bowel obstruction) in infants.  There was the "Cutter Incident" back in the 1950s where a live virus was included in a polio vaccine which resulted in 10 deaths, and 200 children suffering from paralysis.

We also know that some polio vaccines were contaminated with Simian vacuolating virus 40 (SV40) which has the potential of leading to tumors.  Granted studies linking SV40 to cancer in humans have been inconclusive, this doesn't remove the negative impact these contaminated vaccines have had.

However, even with these and other failures in mind, is this enough to warrant the elimination of vaccines entirely?  Sadly if you are an antivaxxer the answer is yes.  Antivaxxers are convinced that these failures overshadow any good effects from vaccines, and they believe we would be better off without any vaccinations whatsoever.

They would have us return to the days where polio infected tens of thousands annually and killed as many as 6,000 in the US alone.

They would have us return to the days of millions upon millions of people dying from smallpox and to the time where as many as one out of every seven Russian children would die from the disease.

They would even attempt to convince us that the 18 people that died from measles every hour in 2011 (158,000 deaths total) aren't important.  They would try to claim the 71% reduction in measles deaths due to vaccination is trivial and unimportant.

Whether it be a vaccine used to prevent pertussis (whooping cough) or one which has been shown to prevent rotavirus, antivaxxers seem to believe that no vaccine is a good one, and although vaccines are overwhelmingly safe and effective, even if we could guarantee vaccines were safe 99.97% of the time and effective 99.99% of the time it still wouldn't be enough to convince those in the anti-vaccine crowd, because they will never be satisfied with anything less than 100% effectiveness and 100% safety.

So there is a choice... one one hand you could...
  • Refuse to acknowledge the safety and effectiveness of vaccines and believe they cause far more harm than good
Or alternatively you can accept reality and...
  • Acknowledge that although vaccines are not perfect, they do an incredible job of reducing and in some cases actually eliminating entirely the risk of contracting disease.  Accept that vaccines safe lives and prevent the spread of disease.  Accept that vaccines are overwhelmingly safe and that we have the historical record to show us not only how safe they are, but how effective they are as well.  Acknowledge that we no longer need to fear death from diseases such as smallpox or polio, acknowledge that vaccines are one of humankind's greatest scientific breakthroughs, and agree that vaccines (although not always 100% safe or 100% effective) are far less risky or damaging than the diseases they prevent (which can, and often do lead to death or long-term complications).
Nobody says we have to be satisfied with our current vaccines, and we can (and should) demand for better vaccines, safer vaccines, and vaccines for diseases which currently have no other cure (such as HIV).  We should always be striving for advancements and we shouldn't be afraid to challenge accepted science or to ask the difficult questions.

However there is a vast difference between wishing for vaccines to improve and wishing vaccines didn't exist.  Antivaxxers don't really care about vaccine safety.  They don't care about the millions of lives lost.  They don't care about people suffering from polio or pertussis or smallpox because they have never suffered from these diseases.  They likely aren't old enough to remember a loved one dying from what we now consider to be vaccine preventable diseases, and as such I can think of no other term to describe antivaxxers than the word selfish.

These people don't care about those who have died, and their only concern is pushing a political agenda based upon something they read about on the Internet or a reaction that their cousin's, boyfriend's, sister's, coworker's daughter's, teacher's, kid had after being vaccinated for tetanus.

Demanding improvements is reasonable, demanding 100% safety and effectiveness quite simply is the exact opposite of reasonable.  Just as we understand there is a risk every time we get into an automobile, we also understand there is a risk with each and every vaccination.  The question that should be asked is whether the level of risk is worth engaging in that particular activity, and the data overwhelmingly proves to us that driving in automobiles as well as being vaccinated is well worth the risk.