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The unofficial vaccine educators: are CDC funded non-profits sufficiently independent?

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5104 (Published 07 November 2017) Cite this as: BMJ 2017;359:j5104

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Re: The unofficial vaccine educators: are CDC funded non-profits sufficiently independent?

Rational doubt will continue to be raised about the measles-containing vaccine MMR until a safety study with the statistical power to detect permanent injury from the vaccine in 1 in 10,000 vaccinated subjects is produced.

Gotzsche writes below “the reason that so few people die or get seriously injured from measles is that most of the population is vaccinated.” However, it is a documented fact that before the vaccine was introduced in the United States, measles was fatal in 1 in 10,000 cases.[1,2] Consequently, to prove the vaccine causes less permanent injury than measles infection, vaccine safety studies must have the statistical power to detect permanent injury in as little as 1 in 10,000 vaccinated children.

Gotzsche also claims “measles infection increases the risk of dying from other infections,” which “persists for the next 2-3 years.” He supports that assertion by citing a study by Mina et al. that states, “Other studies (12, 38, 39) have failed to detect long-term immunologic sequelae of measles.”[3] Furthermore, Mina et al. also caution that the results of the study “should be viewed with the caveat that the increased relative risk of mortality after intensive measles exposure was measured in children exposed before 6 months of age.”3 Because less than 5% of all measles cases occur in infants less than 1 year of age,[4] and that age group is among the most vulnerable to serious complications from measles, there is reasonable doubt about the validity of projecting the immune suppressing effects of measles on infants exposed before 6 months of age to the remaining greater than 95% of all measles cases.

In addition, mortality statistics recorded in the United States between 1953 and 1973 suggest that the “increased relative risk of mortality” found by Mina et al. in young infants did not result in a significant change in absolute risk of child mortality. In 1953, 10 years before the introduction of the vaccine, about 33,500 children of age 1–14 died from a population of about 42 million (about 1 in 1,250).[5,6] By 1963, the year the vaccine was introduced, the child mortality rate had declined by 24% to 33,100 deaths from a population of 54.7 million (about 1 in 1,650).[7,8] In 1973, 10 years after the introduction of the vaccine, the child mortality rate continued to drop, but not as rapidly, declining by 16% to 26,800 deaths from a population of 52.6 million (about 1 in 1,960).[9,10] Clearly, the prevaccine decline in overall childhood mortality eclipsed the postvaccine decline. Consequently, there are reasonable doubts about the plausibility of Mina et al.’s claim that “MV infections could have been implicated in as many as half of all childhood deaths from infectious disease.”

Gotzsche concludes, “hardly any practising doctors, let alone new parents, remember how terrible those diseases once were.” However, there is an abundance of historical records describing how measles was perceived in the United States before the introduction of the mass vaccination program. Perhaps the most compelling account is that of Alexander Langmuir, chief epidemiologist of the CDC during the introduction of the measles mass vaccination program, “In the United States measles is a disease whose importance is not to be measured by total days disability or number of deaths.”

The purpose of this comment is not to determine whether a case fatality rate of 1 in 10,000 is the sign of a “benign disease,” rather, the purpose of this comment is to bring attention to the fact that measles vaccine safety studies do not have the statistical power to detect permanent injury occurring in 1 in 10,000 vaccinated children. This is an important problem that justifies reasonable doubts.

References
1. Langmuir AD, Henderson DA, Serfling RE, Sherman IL. The importance of measles as a health problem. Am J Public Health Nations Health. 1962 Feb;52(2)Suppl:3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522578/.

2. Barkin RM. Measles mortality: a retrospective look at the vaccine era. Am J Epidemiol. 1975 Oct;102(4):347. https://www.ncbi.nlm.nih.gov/pubmed/1180255.

3. Mina MJ, Metcalf CJ, de Swart RL, et al. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science. 2015 May 8;348(6235):694-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823017/.

4. Engelhardt SJ, Halsey NA, Eddins DL, Hinman AR. Measles mortality in the United States 1971-1975. Am J Public Health. 1980 Nov; 70(11): 1166-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1619577/.

5. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1953, volume II—mortality data. Washington: U.S. Government Printing Office; 1955. 164 p. https://www.cdc.gov/nchs/data/vsus/VSUS_1953_2.pdf.

6. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1953, volume I—introduction and summary tables; tables for Alaska, Hawaii, Puerto Rico, and Virgin Islands; marriage, divorce, natality, fetal mortality and infant mortality data. Washington: U.S. Government Printing Office; 1955. XXIX p. https://www.cdc.gov/nchs/data/vsus/vsus_1953_1.pdf.

7. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1963, volume II—mortality, part A. Washington: U.S. Government Printing Office; 1965. 1-86 p. https://www.cdc.gov/nchs/data/vsus/mort63_2a.pdf.

8. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1963, volume I—natality. Washington: U.S. Government Printing Office; 1964. 4-15 p. https://www.nber.org/vital-stats-books/nat63_1.CV.pdf.

9. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1973, volume II—mortality, part A. Rockville, Maryland: U.S. Government Printing Office; 1977. 1-184 p. https://www.cdc.gov/nchs/data/vsus/mort73_2a.pdf.

10. U.S. Department of Health, Education, and Welfare. Vital statistics of the United States 1973, volume I—natality. Rockville, Maryland: U.S. Government Printing Office; 1977. 4-20 p. https://www.cdc.gov/nchs/data/vsus/nat73_1.pdf.

Competing interests: No competing interests

27 June 2019
Shira Miller
President
Physicians for Informed Consent
California, USA