Examining NVIC’s “If you Vaccinate, Ask 8”

When you go to NVIC’s home page, the image you see is this:

8-questions

 

Clicking on the Ask 8 questions link gives you this:

Ask-8-

 

As you can see, the document opens with a sentence mentioning the amount paid to those injured by vaccines since 1986, suggesting that for the awardees, the risks were “100%”. The document highlights vaccines risks, and encourages parents to “become fully informed about the risks and complications of diseases and vaccines and speak with one or more trusted health care professionals before making a vaccination decision.” It then provides a list of eight questions to ask providers.

 

The next passage alerts parents to “vaccine reaction symptoms” to be alert to:

Vaccine-reaction-symptoms

 

The list includes crossing of the eyes, twitching, onset of chronic ear or respiratory infection and more. The article does warn that not all these symptoms will have been caused by vaccine but says you cannot rule causation by vaccine out and that it’s important for the doctor to write them down and report them to the Vaccine Adverse Event Reporting System (VAERS).

 

The article introduces VAERS and says that “it is estimated that less than 10 percent, perhaps less than one percent of all vaccine-related health problems are ever reported” and encourages parents to report the reaction to VAERS themselves if their doctors won’t, and to also report to NVIC’s “Vaccine Reaction Registry.”

 

Is the article accurate?

 

Amounts paid by NVICP and the claim that for those people the risks were “100%”:

 

The opening claim in the document is doubly problematic.

First, it’s true that  since 1989, when the National Vaccine Injury Compensation Program Started operating, as of October 21, 2014 $3,001,251,232.08 have been awarded to individuals and their attorneys. But just stating that number provides an incomplete, misleading picture. For one thing, the number includes over 175 million dollars in attorney fees, including over $64 million for those whose claims were dismissed. More importantly, the total amount is high because each individual disabling injury can cost millions. If you examine the number of cases, in over 25 years NVICP compensated 3764 cases, or an average of 150.56 per year. This is on a background of many millions of vaccine doses administered (an average of 4 million babies a year, most of which are vaccinated multiple times, and on top of that adult vaccination – for influenza, for other diseases, in the military, in medical and nursing school). A calculation done here found the rate of claims to vaccines to be less than 0.003%.

 

Second, the fact that someone was vaccine injured does not make their risk “100%”. When we assess the risk that something will happen, we calculate the probability of that event, how common it is, how likely to happen. For example, in the vaccine context, the CDC’s Pink Book states that for MMR, 5%-15% of recipients will have a fever following vaccinations, and 5% will develop a rash (p. 189). So a vaccinee’s risk of getting a fever is 5-15%. But in reality, the risk does or does not happen. That does not affect the level of risk. You can be very unlucky and suffer from a rare risk, or very lucky and avoid a substantial risk.

For example, from MMR, thrombocytopenia, low platelet count, happens in one out of 30,000 cases, or at a rate of 0.003%. In other words, it’s very rare, but it does happen. You may have been unlucky and been the one to whom it happened. That’s sad (though this specific side effect usually resolves without incident) and painful. But it does not change fact that the risk is very, very rare – and it does not make your risk 100% (again, as the Pink Book points out, these cases are usually temporary).

 

The Eight Questions:

There is nothing fundamentally wrong with the questions themselves, though they are probably excessive in what they demand from parents. The list is missing, however, questions about the consequences of not vaccinating. Like the whole piece it seems to start from a perspective that the default is not vaccinating, and that any deviation – the choice to vaccinate – should only be done after careful consideration. No similar consideration is recommended before the choice is made not to vaccinate. For example, parents are not asked to consider what they would do if their child contracts a preventable disease. Or infects a child too young to be vaccinated or a child with a medical condition that prevents vaccinating. Or to consider whether they have discussed the choice not to vaccinate with a trustworthy medical professional that can answer their questions.

 

Since the scientific consensus is that the small risks of vaccinating are far outweighed by the benefits of vaccinating, first and foremost for the individual child but also for the larger society, not leading the parents to consider the problems of the choice not to vaccinate is pretty glaring.

 

The Article’s Discussion of Vaccine Reactions

The most problematic part of the article is the discussion of vaccine reactions. In short, the list includes genuine vaccine reactions that do not cause long-term harms, genuine vaccine reactions that are extremely rare, problems that science shows are not caused by vaccines, and behaviors that are common and normal for infants or children. The way the list presents “vaccine reactions” may make almost any parent think their child had a vaccine reaction – often with no basis in fact – and implies vaccines are much more dangerous than the data shows.

 

Vaccine reactions that do not normally cause long-term harms include local reactions to the shot, persistent crying, or fever. The article does not mention that they do not cause long-term harm.

 

Very rare vaccine reactions: For example, as already mentioned, thrombocytopenia can happen from MMR – in on in 30,000 cases. The article does not mention how rare the side effect is, or that it is, more often than not, temporary. By omitting information of that kind it makes vaccines seem much more dangerous than they actually are.

 

Things not caused by vaccines: Science suggests that a number of the problems listed under the heading of “vaccine reactions” are not, in fact, caused by vaccines. For example, large scale studies found no link between vaccines and asthma (see also here and here). Some of the behaviors described – the references to loss of skills, repetitive movements and head banging – seem to be covert references to autism or regressive autism, given the way they are used by other anti-vaccine activists. But the evidence is that vaccines do not, in fact, cause autism (see here, here and here). Other problems that may cause regression – for example, Rett Syndrome – are genetic in origin, not caused by vaccines. There is no evidence – and it is not even mentioned in the professional books – that vaccines cause loss of memory, restlessness, hyperactivity or inability to concentrate. One group of researchers looked at whether thimerosal-containing vaccines are related to neuropsychological outcomes, including many of those. They examined children aged 7-10 and found no effect.

 

Presenting these problems under the heading of “vaccine reactions” is highly misleading.

 

Behavior normal in Infants and Children: Some behaviors are known to be normal in young children or infants. For example, babies under four months naturally cross their eyes occasionally.[1] Similarly, infant naturally twitch.[2] And as most parents could point out, restlessness in young children is not a vaccine injury; it’s normal. These behaviors, however, can cause concern, especially with young, inexperienced parents. Listing them under “vaccine reactions” can mislead parents into thinking they were, in fact, problematic – and blaming the vaccines for them. Hardly a service to the parents.

 

In short, the entire list can potentially frighten parents more than the evidence about vaccine risks warrants. It can also prime parents to believe that anything that went wrong after the vaccine – sometimes a long time after – was because of the vaccine, predisposing them to see vaccine injuries where they do not exist. The admonition to report any of these that happen after the vaccine to VAERS can also inflate the number of events reported to VAERS by having many reports for things not caused by vaccines. Since NVIC also routinely uses unverified VAERS reports – the numbers and content – to make claims about the numbers and types of injuries caused by vaccines (e.g. here – and for the discussion of the inaccuracies and limitations of this article and the use of VAERS in it, see here) this inflation can allow them to make vaccines appear more dangerous than they are in other contexts, too.

 

Are less than 10%, Perhaps less than 1%, of Vaccine Problems Reported to VAERS?

 

NVIC provides no sources for these estimates in this article. The only sources the bloggers on this site have seen for the 10% claim were references to NVIC’s own articles. The 1% number is taken from an article by former FDA Commissioner David Kessler, where he does claim there is substantial under-reporting of adverse events. But Kessler was not talking about vaccines; he was talking about medical adverse events generally, and in fact, distinguished vaccines from other medical adverse effects. Here is what he actually said about vaccines: “Aside from adverse events associated with specified vaccines (listed in the National Childhood Vaccine Injury Act) most reporting by health providers is voluntary.” He then suggests that this voluntary reporting means that FDA only gets a fraction of the events. In short, he is expressly leaving vaccines – to which federal reporting requirements apply, and which already had a reporting system of the type he was proposing – out of the discussion.

In other words, the claim of underreporting to the extent mentioned in NVIC is unsupported.

 

There is, in fact, some credible evidence of less drastic underreporting of adverse events from vaccines. But there is also evidence of substantial over reporting – reporting of things not related to vaccines. See also here and here.

 

In short, the article misleads readers by overestimating and misrepresenting vaccine risks and misusing the VAERS reporting system. It offers a set of questions aimed at deterring parents from protecting their children against diseases using vaccines, and reinforces that with a very misleading set of alleged vaccine reactions.

 

 

[1] Archer SM, Sondhi N, Helveston EM. Strabismus in infancy. Ophthalmology 1989; 96:133; Robert M.   Kliegman, et al., Nelson Textbook of Pediatrics 2579 (Elsevier 19th ed. 2011).

[2] Visser AM, Jaddoe VW, Arends LR, et al. Paroxysmal disorders in infancy and their risk factors in a population-based cohort: the Generation R Study. Dev Med Child Neurol 2010; 52:1014.

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