Intended for healthcare professionals


US county bars unvaccinated children from public spaces amid measles emergency

BMJ 2019; 364 doi: (Published 28 March 2019) Cite this as: BMJ 2019;364:l1481

Linked opinion

Measles in America—what’s playing out in New York State is nightmarish

Response 4 to John Stone

Stone (2019b) writes: “I would point out my previous reply which was not about how I read Offit's article but how it was used to persuade people about the safety of administering multiple vaccines by Offit himself others, and with detailed documentation. When it is acknowledged, at least in some cases, that a single vaccine can carry a serious risk (smallpox, anthrax, yellow fever immediately come to mind) I am not sure that the calculation was ever anything more than a red-herring, but it was manifestly used by professionals when addressing the public to reassure them about the safety of multiple vaccine exposure - indeed Harrison still seems to think that it is reassuring - and I am simply pointing this out.”

In his previous reply, Stone (2019a) wrote: “There were several obvious things wrong with Offit’s claim that 10,000 or 100,000 vaccines administered to an infant in one go might be safe.”

Isn’t the above about how Stone read Offit’s article??? (see also: Harrison, 2016, 2019ab). Offit didn’t claim 10,000 or 100,000 vaccines could be administered safely at one time. No one in their right mind would think so. It would be physically impossible. Currently there are only 17 vaccines for infants/children, not all given at once. Makes no sense how one would go from 17 to 10,000 when no one could come up with even a small fraction of that number of microbes to develop vaccines for.

As I wrote previously, I asked a random group of people what they would think if someone claimed that they would be giving 10,000 vaccines to infants/children at one time. Every one just laughed (Harrison, 2019b). It doesn’t matter if others mention this without the context supplied by Offit. It’s not a red herring, it is explaining just how robust our immune systems are. And, yes, I do think it should be reassuring to reasonable people. But even if it weren’t reassuring to some people, it is a legitimate attempt. If I were to tell someone I can construct a steel reinforced concrete wall that will withstand heavy wrecking balls so they needn’t worry about kids, even dozens, throwing rocks at it, how does this differ?

And as I’ve also explained umpteen times, on average per day, we are exposed to up to 6,000 potentially dangerous microbes at their full strength as opposed to, currently, 17 killed or attenuated ones. This is reality.

Stone brings up smallpox, anthrax, and yellow fever.

Smallpox was eradicated from the Western Hemisphere by 1971 (CDC, 2016; College of Physicians, 2018). “Because of vaccination programs and quarantine regulations, the risk of importation of smallpox into the United States was reduced by the 1960s. As a result, routine vaccinia vaccination was discontinued in 1971 . . . Since January 1982, smallpox vaccination has not been required for international travelers” (CDC, 1991)

However, we keep a supply in case a group of terrorists obtained smallpox, releasing in several airports with connecting flights. And previously 1-2 deaths per million were caused by the vaccine; but nowadays we know about autoimmune diseases, so they would not receive it. However, with an unvaccinated population, we could see millions of deaths within a few weeks, plus 10s of millions going through hell. And we are working on a better smallpox vaccine.

Anthrax: “The vaccine is recommended for adults 18 through 65 years of age who are at risk of exposure to anthrax bacteria . . . Anthrax vaccine is also recommended for unvaccinated people of all ages who have been exposed to anthrax . . . the first vaccine dose as soon after exposure as possible.” (CDC, 2018) For a period of time we stopped using it for military because of alleged serious adverse reactions; but after careful review program was restarted (Wikipedia. Anthrax vaccine).

Yellow Fever: The last outbreak occurred in New Orleans 1905 (CDCb, 2019). “Vaccine is recommended for people aged 9 months or older and who are traveling to or living in areas at risk for yellow fever virus in Africa and South America.” (CDC, 2019a; see also Wikipedia. Yellow Fever)

So Stone mentions three vaccines that are neither obligatory nor even recommended, except the yellow fever vaccine for those traveling and anthrax for military going to areas of world where prevalent. However, all three are serious diseases, causing immense suffering, with high risks of death. Though we don’t currently vaccinate the public for them, if a real threat occurred, the risks of a few tragically suffering adverse reactions would be far outweighed by the much higher number of deaths, even if one were to discount the suffering for those who survive.

Stone ignores what I have written about the immune system and Paul Offit, both in the current RR exchange and in other articles he is aware of (e.g., Harrison, 2016) and claims that his “previous reply was not about how he read Offit's article but how it was used to persuade people about the safety of administering multiple vaccines by Offit himself” which is not true. And as I’ve pointed out earlier, Stone focuses on one thing at a time, ignoring how I have refuted a number of claims made by him in this exchange. And finally, he mentions three vaccines, none mandatory, none even recommended except yellow fever for travelers to certain areas. And he seems totally oblivious to any of this. So, in my opinion, Stone is a typical example of many antivaccinationists, who base their position on a lack of understanding of the sciences underlying vaccines, a lack of critical thinking/logic, and lack of common sense, cherry-picking/confirmation bias based on a fantasy world with little to no reality testing. As more people listen to antivaccinationists, the risks to children from vaccine-preventable diseases increases.


CDC (1991 Dec 13). Vaccinia (Smallpox) Vaccine Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR; 40(RR14): 1-10. Available at:

CDC (2016 Aug 30). History of Smallpox. Available at:

CDC (2018 Mar 21). Anthrax Vaccine - What You Need to Know. Available at:

CDC (2019a Jan 15). Yellow Fever Vaccine. Available at:

CDC (accessed 2019b May 16). Yellow Fever History Timeline. Available at:

Harrison JA (2016 Mar 18). Ignoring Context and a Lack of Common Sense: Antivaccinationists Absurdly Misusing Dr. Paul Offit’s “each infant would have the theoretical capacity to respond to about 10,000 vaccines at any one time”. Vaccinate Your Family. Available at:

Harrison JA (2019a May 7). Re: US county bars unvaccinated children from public spaces amid measles emergency. BMJ Rapid Responses. Available at:

Harrison JA (2019b May 10). Response to John Stone’s “Offit’s calculation was misleading”. BMJ Rapid Responses. Available at:

Stone J (2019 May 8). Reply to Joel Harrison - Offit's calculation was misleading. BMJ Rapid Responses. Available at:

Stone J (2019 May 15). Re: US county bars unvaccinated children from public spaces amid measles emergency. BMJ Rapid Responses. Available at:

The College of Physicians of Philadelphia (2018 Jan 17). Government Regulations. History of Vaccines. Available at:

Wikipedia. Anthrax vaccine. Available at:

Competing interests: No competing interests

18 May 2019
Joel A Harrison
Long-Retired Epidemiologist
I have NEVER worked for the FDA, NIH, CDC, any pharmaceutical company, nor ever purchased pharmaceutical stocks