Should measles vaccination be compulsory?

John Stone says that I have misrepresented him (1). I will let other readers be the judge of that.

I stated in my letter of correction (2) that: "Your rapid responses correspondent John Stone seems to think that 95% of the measles cases in Europe last year were in children under the age of one".

To remind Mr Stone, he stated in his rapid response of 6th June (3) that: "According to an Oxford Vaccine Group web page as many as 95% of cases in Europe last year were in children too young to be vaccinated".

He quoted their website (4) as stating that: "In 2016 and 2017 there were 49 deaths from measles in Europe, and 2018 saw another 72 deaths. Some countries have reported that over 60% of measles cases have been hospitalised. There have been particularly serious outbreaks in Serbia, Ukraine, Georgia, Greece, Romania, Italy, and France. Around 95% of cases have been in babies and children under 1 year of age who were not yet vaccinated."

He goes on to say: "95% is a remarkable figure but it should be noted that this is likely a consequence of vaccination not non-vaccination."

I should point out that the substance of Mr Stone's rapid response was based upon the accuracy of this presumption, since he proceeded to use this (incorrect) number as a basis for yet another one of his repetitive criticisms of measles/MMR vaccination.

It is clear that the Oxford Vaccine Group were in fact talking about deaths from measles and not cases of measles (and their website now has removed their misleading statement). It would indeed be virtually impossible for 95% of measles cases reported in 2018 as being infants under 1 year old. Mr Stone clearly realised this, since he now tells us that the day after he wrote his rapid response dated 6th June, he checked the European notifications and saw that during March 2019 only 14% of cases were in infants under 1 year of age.

However, Mr Stone's current response to me raises more questions than it answers. If, as he now claims, he appreciated at the time of his original rapid response that the "95%" figure for measles cases under 1 year of age in 2018 was "virtually impossible", then:

Why did he not validate the figure with the original source for the data before writing his rapid response;
Why did he continue to use the incorrect statistic as an argument against vaccination in his rapid response; and
Why did he not write a further BMJ rapid response correcting his previous error (or correct it in one of his subsequent responses)?

(1) https://www.bmj.com/content/365/bmj.l2359/rr-29
(2) https://www.bmj.com/content/365/bmj.l2359/rr-28
(3) https://www.bmj.com/content/365/bmj.l2359/rr-0
(4) http://vk.ovg.ox.ac.uk/measles

Your rapid responses correspondent John Stone (1) seems to think that 95% of the measles cases in Europe last year were in children under the age of one (who of course are too young to be vaccinated), and contrives to use this as an argument against vaccination.
In fact, of the 82,596 reported measles cases in Europe in 2018, only 6,441 (7.8%) were in children under 1 year old (2).

References:
(1) Stone J. https://www.bmj.com/content/365/bmj.l2359/rr-0
(2) WHO. http://www.euro.who.int/__data/assets/pdf_file/0004/394060/2019_01_Epi_D...

First, Stone (2019) writes: “he claims I contradicted myself somewhere with the citation "Harrison 2019", and this is wholly inadequate. Stone ignores what I wrote about his contradicting himself. So I’ll repeat here:

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. . . . 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???” (Harrison, 2019b).

Stone writes: “For instance, vaccine measles immunity might not be as good as natural measles immunity and it might leave different groups vulnerable (for instance infants who are too young to be vaccinated), and it might even be that in the long term even three shots would be inadequate to maintain cover. We are continually told that 95% coverage would eliminate measles but the studies which I cited below suggest collectively that this is highly improbable. . . Where will we be in another decade with this thinner immunity when people with natural immunity no longer exist as a significant ballast?”

First, given that “natural immunity” is long gone from the overwhelming majority of Americans and Brits, this is an absurd statement. Second, even infants in the past with natural immunity, as I clearly explained, were still vulnerable, almost 20 percent even before six months of age, with increased vulnerability month by month. Yet, today, in the US, only where pockets of unvaccinated were exposed to someone coming from abroad has there been small, limited outbreaks. Given the highly contagious nature of measles, why hasn’t it spread? Because the vast majority are vaccinated. Whether an infant is protected for a period of time by his/her mother’s natural immunity or by vaccine-induced immunity, they will at some time be vulnerable. While naturally-acquired maternal immunity wanes, given that the measles vaccine is a weakened vaccine, the remaining immunity will still defeat the incoming vaccine before it can induce an immune response from the infant’s own system. However, since vaccine-induced maternal immunity wanes sooner, then the infant can be vaccinated at an earlier age.

Stone ignores or does not understand what I wrote. I suggest viewers read through my longer exchange of Rapid Responses with Stone (Tanne, 2019) as well as other articles I’ve written refuting claims by Stone (Harrison, 2016ab, 2017). I realized long ago that nothing will change his mind. As a child I read the unabridged Don Quixote by Cervantes. Then came the musical comedy Man of La Mancha. I actually saw it on stage in London in 1968 with Keith Mitchell and Joan Diener. One of my all-time favorite musicals, have seen it several times since, have a 2 record album of the complete London play and a paperback of the manuscript. There is a scene where Don Quixote’s niece and parish priest, Dr Carasco, catch up to him:

Dr Carrasco: “There are no giants. . . No knights . . . There have been no knights for 300 years.”
Don Quixote (To the padre, pittingly): “So learned, yet so misinformed.”
Dr Carrasco: “These are facts.”
Don Quixote: “Facts are the enemy of truth.” (Wasserman, 1966, pp. 39-40)

“Facts are the enemy of truth.” One of my favorite lines ever, great in a musical comedy; but not when it contradicts science, when people lacking any understanding of microbiology, immunology, epidemiology, biostatistics, nor the history of vaccine-preventable infectious diseases or current state of them in the world, ignore, twist, cherry-pick what confirms their ideological beliefs. Because of them, vaccine-preventable diseases are on the rise.

This isn’t about intelligence, it’s about knowledge and skills that take years to learn and develop. Stone believes that his personal experiences and “careful reading” is all that is necessary. I consider myself reasonably intelligent; but if someone gave me several detailed plans for building a bridge over a river, no matter how carefully I read them I don’t have training/education in structural engineering. I’m sure there are antivaccinationists far more intelligent than me; but not even understanding the basic concepts of the sciences underlying vaccines can’t be compensated for by just intelligence, otherwise, why not scrap university degrees, just give people IQ tests, and hire them. Let’s have the John Stones of the world design our bridges, etc (Harrison, 2019a). Just to be clear, people can acquire knowledge without a formal education; but it requires time and effort. Stone has given NO indication he has attempted to learn even the basics of any of the above mentioned sciences.

I doubt anything will change Stone’s mind. An entire set of psychological studies find that the vast majority of people, once they have formed an opinion, bend over backwards not to change it, even if it results in harm to them. The studies are based on cognitive-dissonance theory, that the psychological pain of experiencing dissonance arising from admitting a mistake is just too much. Of course, some people will change; but not the vast majority (Tavris, 2015).

Basically, Stone hopes that eventually he will get the last word, that I will tire of this, quite possible, so that those reading his final Rapid Response will take him at his word. Not how science works; but given BMJ continues to post his as well as other antivaxxers Rapid Responses, even when it is clear that they are ignoring previous refutations of their claims, makes one wonder about BMJ’s position on vaccines.

References:

Harrison JA (2016a 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: https://64gbq3vj11cj33l2zkxvv10k-wpengine.netdna-ssl.com/wp-content/uplo...

Harrison JA (2016b Aug 1). Andrew Wakefield Has Never Been “Exonerated”: Why Justice Mitting’s Decision in the Professor John Walker-Smith Case Does Not Apply to Wakefield. Vaccinate Your Family. Available at: https://64gbq3vj11cj33l2zkxvv10k-wpengine.netdna-ssl.com/wp-content/uplo...

Harrison JA (2017 May 10). John Stone and the “Best of Age of Autism”: Just Plain Wrong About Everything. Vaccinate Your Family. Available at: https://64gbq3vj11cj33l2zkxvv10k-wpengine.netdna-ssl.com/wp-content/uplo...

Harrison JA (2019a May 7). Response to John Stone & Elizabeth M. Hart. Available at: https://www.bmj.com/content/364/bmj.l1481/rr-13

Harrison JA (2019 May 18). Response 4 to John Stone. BMJ Rapid Responses. Available at: https://www.bmj.com/content/364/bmj.l1481/rr-31

Stone (2019 Jun 24). I would not start from here. BMJ Rapid Responses. Available at: https://www.bmj.com/content/365/bmj.l2359/rr-21

Tanne JH (2019 Mar 28). US county bars unvaccinated children from public spaces amid measles emergency. BMJ. Available at: https://www.bmj.com/content/364/bmj.l1481/rapid-responses [click on Order Ascending, Items per page 40, then Apply, read in chronological order]

Tavris C, Aronson E (2015). Mistakes Were Made (But not by me): Why we Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts (Revised New Edition). Harcourt, Inc. Check out amazon.com: https://www.amazon.com/Mistakes-Were-Made-but-Not/dp/0544574788/ref=sr_1...

Wasserman D, Darion J, Leigh M (1966). Man of La Mancha. Random House Publishers.

Stone writes: “it strikes me that public criticism of vaccine products may come a poor third in the spread of measles in comparison with failure of outreach and failure of the vaccine technology itself. In addition to the 1996 paper by Markowitz which I cited I note a number of papers pointing to failure of immunity as a result of the programme. Even with 100% coverage and three doses it seems unlikely that synthetic herd immunity is set to do anything but decline: meanwhile censuring and criminalising critics and dissenters is only distracting in a politically unpleasant way from the problem. I am personally grateful to the editor for her recent call for "civil discourse, and debate.”

“Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Also, measles virus can live for up to two hours in an airspace where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected. Infected people can spread measles to others from four days before through four days after the rash appears.” (CDC, 2018a)

Prior to the vaccine’s introduction in 1963, an average of 500,000 cases were reported, 400 to 500 died, 48,000 were hospitalized, and 1,000 suffered encephalitis, resulting in permanent disabilities for ca. 400 (CDC, 2018b; CDC, 2015). Using the average population growth of the US from 1950 thru 2010 of 1.1% per year (Pew Research Center, 2014), and the lower 400 deaths, from 1963 to 2018, total cases = 21,205,831, total hospitalizations = 3,688,540, deaths = 30,738, encephalitis = 76,845, and disabilities = 30,738. Note that 1 in 20 develop pneumonia. Measles was declared eliminated (absence of continuous disease transmission for greater than 12 months) from the United States in 2000 (CDC, 2018b). Thanks to pockets of unvaccinated, it exists once more, though high rates of vaccination has limited its spread.

Stone includes references to studies showing waning immunity (RRs are limited to 1,000 words so I can’t review them); but ignores even this past year, in a population double that of the 1950s, the US has experienced around 1,000 cases, most unvaccinated and even those with waning immunity have to be exposed to someone with the live virus coming from abroad. Stone ignores the numbers above, if there had never been a measles vaccine, and despite articles on “waning” immunity, as highly infectious as measles is, we have had few cases.

The Markowitz (1996) study cited by Stone found the following measles antibodies in children, comparing those with mothers who more than likely had measles (born before 1957) vs likely immunized (born after 1963), 6 months: 83 vs 44%; 9 months: 56 vs 23%; 12 months: 21 vs 5%. Markowitz writes: “Other studies have reported seroprevalence at 6 months of age as low as 9% in children of vaccinated women and 35% in children of naturally infected women, which are much lower than our results. Nevertheless, the trends are the same. . . This study and other studies showing increased susceptibility of children to measles and better responses to vaccine at younger ages. . . Our data indicate that, in the future, when virtually all women of child-bearing age will have vaccine-induced immunity, the recommended age for vaccination may be able to be lowered . . . without diminishing vaccine efficacy.” Even natural immunity only lasts for many up to 6 months so that without the vaccine protecting infants by herd immunity, they would be vulnerable. And the article clearly promotes vaccines.

Stone and others continue to claim they aren’t listened to, they only want a “civil discourse.” The truth is they are listened to; but listening to someone and agreeing with them is NOT the same thing and debating someone publicly gives the impression that both sides represent legitimate points of view, with the better, more “charismatic” debater often influencing the audience most. Science progresses, not by personality; but by research, including critique based on solid scientific understanding. Despite what Stone and others believe, the overwhelming scientific evidence finds the benefits of vaccines far outweigh the minuscule risks. I have in one file on my computer around 300, mainly journal articles, showing past, current, and ongoing programs to education/persuade people about vaccines (see, for instance, my exchange with Stone, Cunningham, Anand, etc. where I clearly refute claims made by them (BMJ, 2019), where in one RR Stone even contradicts himself (Harrison, 2019).

Using science and logic to refute antivaccinationists claims is NOT attacking their intelligence. Intelligence and knowledge/skills are NOT the same thing. I consider myself reasonably intelligent and well-educated; yet, if someone were to give me several plans for building a bridge over a river, no matter how carefully I studied them, I couldn’t render a valid choice because I have NEVER studied structural engineering. Stone seems to pick and choose papers, not based on understanding the strengths and limitations of various research designs and the underlying science, but if they confirm his beliefs or don’t.

I support continued efforts at education/persuasion, With modern medicine’s survival of low and very low birthweight children, autoimmune diseases, and chemotherapy for cancer, today’s population includes many with weakened immune systems. “Synthetic” herd immunity works. We live in communities where both rights and responsibilities exist. There is an old saying: “There but for the Grace of God go I.” How would Stone and others feel if an unvaccinated kid infected their loved ones, e.g., measles with resultant hospitalization or even disabiity? ”Education/persuasion is great and continues; but how do we protect the vulnerable if education/persuasion isn’t enough?

References:

CDC (2015). Pink Book. Epidemiology and Prevention of Vaccine-Preventable Diseases 13th Edition. Chapter 13. Measles. [see especially sections on Complications and Secular Trends] .Available at: https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html#secular

CDC (2018a Feb 5). Transmission of Measles. Available at: https://www.cdc.gov/measles/transmission.html

CDC (2018b Feb 5). Measles History. Available at: https://www.cdc.gov/measles/about/history.html

Tanne (2019 Mar 28). US county bars unvaccinated children from public spaces amid measles emergency. BMJ News [Click Ascending Order and 40 Items per page to follow chronologically exchange, mine included] Available at: https://www.bmj.com/content/364/bmj.l1481

Harrison JA (2019 May 18). Response 4 to John Stone. BMJ Rapid Responses. Available at: https://www.bmj.com/content/364/bmj.l1481/rr-31

Markowitz LE, Albrecht P, Rhodes P et al. (1996 Jan). Changing Levels of Measles Antibody Titers in Women and Children in the United States: Impact on Response to Vaccination. Pediatrics; 97(1) 53-58.

Pew Research Center (2014 Jan 30). Population Change in the U.S. and the World from 1950 to 2050. Available at: https://www.pewresearch.org/global/2014/01/30/chapter-4-population-chang...

Stone J (2019 Jun 5). Measles vaccination has substituted one problem for another. BMJ Rapid Response. Available at: https://www.bmj.com/content/365/bmj.l2359/rr-19