Intended for healthcare professionals

Rapid response to:


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

Rapid Response:

Response 4 to Allan S. Cunningham. Unlimited tolerance of vaccines?

Cunningham writes: “In my May 8 response to Joel Harrison I should have responded specifically to his discussion of our immune system and its seemingly unlimited capacity to respond to vaccines. Offit’s articles are interesting, and they continue to be quoted in defense of our dense immunization schedule, but they are theoretical and do not prove that the benefits of the schedule outweigh the risks. Only trials of the type proposed by Fine, Aaby and Shann responses to Higgins.”

No one has claimed our immune system has an “unlimited capacity” to respond to vaccines. Offit explained its enormous capacity, on daily average we are exposed to up to 6,000 potentially dangerous microbes, so the 17 current vaccines, not given all at once, and increasing them by a few would not challenge our immune systems. (Harrison, 2019a)

Fine (2007) writes: “It has long been known that vaccines can have effects other than reducing the risk of the disease against which they are targeted. Perhaps most obvious are the adverse reactions that, ALBEIT RARELY, can occur as a consequence of vaccination.”

Fine (2009) states: “Routine vaccination programmes have led to substantial declines in the incidence of most of the target diseases. In these circumstances, vaccine effects beyond those on the target diseases may become evident. . . Trials of such ‘non-specific’ effects are difficult if not impossible to organise."

Aaby (2012) writes: “Recent randomised trials have shown that live vaccines such as measles and BCG enhance general resistance, preventing other infections as well as the target infection.” Aaby goes on to discuss how adding additional vaccines may affect the non-specific benefits of a particular vaccine and gender differences.

Saadatian-Elahi (2016) states: “The heterologous or non-specific effects (NSEs) of vaccines, at times defined as ‘‘off-target effects” suggest that they can affect the immune response to organisms other than their pathogen-specific intended purpose. These NSEs have been the subject of clinical, immunological and epidemiological studies and are increasingly recognized as an important biological process by a growing group of immunologists and epidemiologists.

Studies are ongoing, including various post-approval surveillance strategies (Harrison, 2019b). Cunningham ignores this. And he ignores the benefits/cost ratio, how many kids and adults avoid suffering, hospitalizations, disabilities, and death because of the advent of vaccines vs the RARE serious adverse events. We don’t live in a perfect world, would he sacrifice the many for the tragic few?

Cunningham writes: “There is at least one fatality caused by multiple vaccinations.

The article says: “A combination of vaccines that included smallpox and
anthrax might have contributed to the death of a young Army reservist . . . According to DoD's online Smallpox Vaccination Safety Summary, Lacy's case is the first case
in the current immunization program in which investigation indicated that the vaccine might
have caused death. An important conclusion of both expert groups is that nothing was discovered that indicates our screening programs could have prevented the illness and ultimate death of Specialist Lacy, who had an underlying undiagnosed disorder.” (Roos, 2003).

So, “might” is translated into certainty. For sake of argument, let’s accept the combination of vaccines as having tragically caused her death. Cunningham continues to ignore the risks from the vaccine-preventable diseases. Smallpox is actually a vaccine with serious risks, previously, 1-2 deaths per million; but we now know about autoimmune diseases and wouldn’t vaccinate them, though we might miss a few; however, if someone were to get hold of smallpox virus, unleash it on a civilian population that has not received smallpox vaccine for 50 years, there would be deaths in the millions. If one compares the risks, as tragic as her death was, if she had an underlying undiagnosed autoimmune disorder, then had she been exposed to any of the vaccine-preventable diseases, the outcome could also have been fatal. It would be extremely costly to screen every person in the US military for every possible immune disorder. Cunningham would sacrifice the vast majority for a possible minuscule number.

Cunningham writes: “Kawasaki disease first appeared in the 1960s and its frequency has marched upward right along with the expansion of the immunization schedule . . . This mysterious immune disorder has been associated with several vaccines in trials and case reports.” The paper he cites (Uehara 2012) doesn’t mention vaccines, though does state: “some evidence indicates that children with illnesses similar to KD may have been identified since the late 19th century. Those cases may have been misdiagnosed as other childhood conditions.” See also Lin (2017).

Abrams (2015) found: “Childhood vaccinations’ studied did not increase the risk of Kawasaki disease; conversely, vaccination was associated with a transient decrease in Kawasaki disease incidence.” See also: Bonetto (2016); Esposito (2016); Wormsbecker (2019).

Cunningham writes: “In spite of official pronouncements, vaccines have never been exonerated as potential causes of SIDS.”

According to Wikipedia (Sudden infant death syndrome): “A number of measures have been found to be effective in preventing SIDS including changing the sleeping position, breastfeeding, limiting soft bedding, immunizing the infant and using pacifiers.” The Goldwater (2017) article cited by Cunningham includes in Box 2 under Post-natal risks: “No or late immunisation.” Müller-Nordhorm (2015) concluded: “Increased DTP immunisation coverage is associated with decreased SIDS mortality,” which updates the Ausiello (1997) study cited by Cunningham and the Talaat (2018).study cited by him doesn’t mention SIDS. And the CDC (Vaccines and Sudden Infant Death) states: “Multiple research studies and safety reviews have looked at possible links between vaccines and SIDS. The evidence accumulated over many years do not show any links between childhood immunization and SIDS.”

Cunningham overlooks one SIGNIFICANT FACT, the cases of SIDS, despite additional vaccines, has decreased significantly since 1990 (CDC Data and Statistics).

Cunningham grasps at straws, ignores numerous vaccine safety studies, finds one possible death in someone with an undetected serious autoimmune disease, ignoring the innumerable lives protected by vaccines, accused vaccines of SIDS when as vaccines have increased, SIDS incidence has decreased, all in his continuous quest to undermine vaccines (see: Harrison, 2019a).


Aaby P, Whittle H, Benn CS (2012 Jun 14). Vaccine programmes must consider their effect on general resistance. BMJ; 344: e3769.

Abrams JY, Weintraub ES, Baggs JM et al. (2015). Childhood vaccines and Kawasaki disease, Vaccine Safety Datalink,1996-2006. Vaccine; 33: 382-387.

Ausiello CM, Urbani F, La Sala A et al. (1997 Jun). Vaccine- and Antigen-Dependent Type 1 and Type 2 Cytokine Induction after Primary Vaccination of Infants with Whole-Cell or Acellular Pertussis Vaccines. Infection and Immunity; 65(6): 2168-2174.

Bonetto C, Trotta F, Felicetti P et al. (2016). Vasculitis as an adverse event following immunization – Systematic literature review. Vaccine; 2016; 34: 6641-6651.

CDC (2018 Oct 16). Vaccines and Sudden Infant Death: Vaccines have not been shown to cause sudden infant death syndrome (SIDS). Available at: [scroll down, click on Related Scientific Articles]

CDC (2019 Apr 10). Data and Statistics. Sudden Unexpected Infant Death and Sudden Infant Death Syndrome. Available at:

Cunningham AS (2019 May 9). Unlimited tolerance of vaccines? BMJ Rapid Responses. Available at:

Esposito S, Bianchini S, Dellepiane RM, Principi N (2016). Vaccines and Kawasaki disease; 15(3): 417-424.

Fine PEM, Smith PG (2007 Jan). Editorial: ‘Non-specific effects of vaccines’ – an important analytical insight, and call for a workshop. Tropical Medicine and International Health; 12(1): 1-4. Available at:

Fine PEM, Williams TN, Aaby P et al. (2009 Sep). Epidemiological studies of the ‘non-specific effects’ of vaccines: I – data collection in observational studies. Tropical Medicine and International Health; 14(9): 969-976. Available at:

Goldwater PN (2017 Aug). Infection: the neglected paradigm in SIDS research. 102(8): 767-772. Available at:

Harrison JA (2019a May 7). Response to Stone. BMJ Rapid Responses. Available at:

Harrison JA (2019b May 9). Response to Allan S. Cunningham. BMJ Rapid Responses. Available at:

Huang (2017 Jan). Vaccination and unexplained sudden death risk in Taiwanese infants. Pharmacoepidemiology and drug safety; 26(1): 17-25. Available at:

Lin (2017 Oct 31). The global epidemiology of Kawasaki disease: Review and future perspectives. Global Cardiology Science & Practice. Available at:

Müller-Nordhorn J, Hettler-Chen CM, Keil T, Muckelbauer R (2015). Association between sudden infant death syndrome and diphtheria-tetanus-pertussis immunisation: an ecological study. BMC Pediatrics. Available at:

Roos R (2003 Nov 19). Vaccines might have contributed to death of Army reservist. CIDRAP News. Available at:

Saadatian-Elahi M, Aaby P, Shann F (2016 2016 Jul 25). Heterologous vaccine effects. Vaccine; 34: 3923-3930. Vaccine; 34(34): 3923-3930.

Talaat KR, Halsey NA, Cox AB et al. (2018 Mar). Rapid changes in serum cytokines and chemokines in response to inactivated influenza vaccination. Influenza and other respiratory viruses; 12(2): 202-210. Available at:

Uehara R, Belay ED (2012). Epidemiology of Kawasaki Disease in Asia, Europe, and the United States. Journal of Epidemiology; 22(2): 79-85.

Wikipedia. Kawasaki disease. Available at:

Wikipedia. Sudden infant death syndrome. Available at:

Wormsbecker AE, Johnson C, Bourns L et al. (2019 Jan 15). Demonstration of background rates of three conditions of interest for vaccine safety surveillance. PLOS One; 14(1). Available at:

Competing interests: No competing interests

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