Paul Offit On The Anti-Vaccine Movement

In his new book, vaccine researcher Paul Offit contends that some parents' decisions not to vaccinate their kids are harming others. Offit discusses the anti-vaccine movement, and weighs in on a new report calling a 1998 study linking autism and vaccines an "elaborate fraud."

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IRA FLATOW, host:

You're listening to SCIENCE FRIDAY from NPR. I'm Ira Flatow. Up next this hour: vaccinations.

A new report this week has once again put vaccine safety in the headlines. The new report, the British Medical Journal has called that seminal 1998 study linking vaccines to autism, called it, quote, an elaborate fraud.

The study has long been discredited, long before this latest report, but the doubt it planted in the minds of some parents is still simmering, and it has led many parents to choose not to vaccinate their children against infectious diseases like measles and mumps that are very contagious and very preventable. Those diseases are on the rise in some places.

With this new report, will it change anybody's mind? A few years ago, 2008, we did a program looking at vaccinations with Paul Offit as a guest, and during that interview, a caller named Chantal(ph) said no amount of research, none of it, done by government or pharmaceutical companies, could change her mind about vaccinating her children. Here's a snippet from that interview.

FLATOW: Chantal, is there anything that Dr. Offit could tell you to change your mind?

CHANTAL: Absolutely not.

FLATOW: So even if his studies are correct, and you admit or go back and research what he's saying to be true?

CHANTAL: I do not put any faith into anything that my government tells me.

FLATOW: That was Chantal, back in an interview back in 2008. Dr. Paul Offit is here with us. Welcome back to SCIENCE FRIDAY.

Dr. PAUL OFFIT (Chief, Division of Infectious Diseases, Director, Vaccine Education Center, Children's Hospital of Philadelphia): Thanks, Ira.

FLATOW: Do you remember that?

Dr. OFFIT: I do. I remember it all too well.

FLATOW: Dr. Offit is chief of the Division of Infectious Diseases and the director of the Vaccine Education Center at Children's Hospital of Philadelphia. He's also a professor of vaccinology at the University of Pennsylvania School of Medicine, has a new book out, "Deadly Choices: How the Anti-Vaccine Movement Threatens Us All." He joins us from WHYY in Philadelphia.

Why do individual objections to her having her children vaccinated, for example, why does that threaten everybody?

Dr. OFFIT: Well because first of all, vaccines aren't 100 percent effective. So even if you're vaccinated, you might not be protected. Secondly, there are many people in this country who can't be vaccinated. They depend on those around them to be vaccinated.

And, you know, what we're seeing now is there's clearly been an erosion in immunization rates, as you're seeing outbreaks, as you said, of measles, mumps, whooping cough, even a particular type of bacterial meningitis, which is protected - which is preventable.

So it's been hard to watch this erosion. And remember, if you - it's interesting. There was a study done, actually, in the Netherlands that looked at a measles outbreak between 1999 and 2000. It involved about 4,000 people.

And what they found, and this may be counterintuitive, but when you think about it, it's not, you were actually better off having not received the measles vaccine and living in a highly vaccinated community than having received the measles vaccine and living in a relatively unvaccinated community, because no vaccine is 100 percent effective, and if you're more likely to be exposed, you're more likely to get sick.

FLATOW: 1-800-989-8255 is our number. Paul Offit is here. I know lots of people still would like to question Paul Offit about the studies. There's still - are you surprised that there are still people very skeptical about vaccination?

Dr. OFFIT: No, I think it's an influence of a lot of things. One is we do ask our citizens to get a lot of vaccines. I mean, children can receive as many as 26 inoculations in the first few years of life and five shots at one time. That's hard to watch.

Two is I think, you know, people don't really understand, necessarily, what is in that fluid that their children are being injected with. I think vaccination is to some extent a violent act.

You know, you pin the child down, you're inoculating them against their will, and that in combination with the fact that vaccines have been enormously successful is parents really - young parents today not only didn't - don't see these diseases now, they didn't grow up with these diseases. So for them, vaccination is largely a matter of faith.

I think that's kind of the perfect storm for these fears.

FLATOW: How do you answer critics? And I think the most vocal critics are saying that you've gotten rich on the vaccine research because you have a vested interest in it.

Dr. OFFIT: I mean, I'm the - I participated with a team at Children's Hospital of Philadelphia to develop the rotavirus vaccine. It's the thing, at least professionally, of which I'm most proud. I mean, this is a vaccine that we, you know, we were able to construct at Children's Hospital of Philadelphia that has the capacity to save 2,000 lives a day and is doing that.

You know, the people sort of who - and this is really more the professional anti-vaccine people. I think because they don't have science on their side, where they can say look, here's data that shows that vaccines cause autism, they choose rather to take an ad hominem attack, which is, you know, which is first of all, wrong; and two, logically worthless.

FLATOW: I had a question in email. When people find out you were coming on, and they remember that - your past and your championship of vaccinations, and some people still don't believe it, as I said before.

Jim Keith(ph) sent me an email and said: Ask Offit the question: Why do they not study the unvaccinated to determine the incidence of autism?

Dr. OFFIT: Well, it's interesting how this hypothesis continues to morph. I mean, initially when Wakefield published his paper in the Lancet, the hypothesis was that the combination measles, mumps, rubella, or MMR, vaccine caused autism. That is a testable hypothesis, and it's been studied now with about 14 different studies, and you're not at greater risk of autism if you get that vaccine or if you didn't.

Then it sort of morphed to thimerosal, this ethyl-mercury-containing preservative in vaccines, that caused autism. That was studied, and basically that notion sort of went away, especially since we largely took thimerosal out of any vaccine a young baby could have received, and the incidence of autism didn't budge.

And now we've sort of gone to this more diffuse kind of too many vaccines given too soon. Actually, there was a study done by Michael Smith and Charles Woods where they looked at children very carefully who received sort of all the vaccines as recommended by the CDC and American Academy of Pediatrics and compared them to children who received really just a couple of vaccines in the first few years of life and then prospectively subjected those children to, you know - and this was more than 1,000 children, you know, to neurodevelopmental or psychiatric tests to see whether there was any difference in autism or other neurodevelopmental delays, and there weren't.

But it doesn't even make sense that vaccines would cause autism, given what we know about autism.

FLATOW: Tell us what herd immunity is. It's one of the main points in your book.

Dr. OFFIT: Right. It's - you know, even if you're unvaccinated, remember there are people who can't be vaccinated. If you're surrounded by a highly vaccinated population, you're much, much less likely to get infected.

I can use as an example our hospital. Our hospital takes care of a vulnerable population of children, many of whom have cancer, many of whom are receiving transplants. I mean, they depend on those around them to be vaccinated, which is why we ensure that anybody who walks on that floor, and not only just health care workers but anybody who really works at Children's Hospital of Philadelphia, gets an influenza vaccine because we care about herd immunity.

FLATOW: 1-800-989-8255 if you'd like to talk with us. I'm talking with Paul Offit, author of the new book "Deadly Choices: How the Anti-Vaccine Movement Threatens Us All."

You write that some pediatricians will not see kids who are not vaccinated. Is that a good solution to the problem?

Dr. OFFIT: I don't know what's a good solution to that problem. And I feel tremendous sympathy for the clinician who's in private practice. On the one hand, and my wife sort of expressed this, she's a general practitioner, a pediatrician, you know, she'll say, you know, parents will come into her office and say I don't want to get vaccines, including, for example, the Haemophilus influenzae Type B vaccine, which is a vaccine that prevents what was, at one point, a very common cause of bacterial meningitis.

And, you know, we've had three cases or three deaths, actually, from this particular bacterial form of meningitis in the Philadelphia area just in the last couple years.

And, you know, for her, it's like, you know, let me love your child. Please don't put me in a position where I have to practice substandard care, which can result in harm, which can hurt your child. Please don't ask me to do that.

And I certainly understand the sentiment. On the other hand, if you don't see that child, you know, where does that child go? Do they go to a chiropractor who doesn't vaccinate?

I think it's hard because then you lose any chance to really immunize the child.

FLATOW: Leslie(ph) in Oakland, hi, welcome to SCIENCE FRIDAY.

LESLIE (Caller): Hi, thank you very much for having me. My name's Leslie. I'm calling from Oakland. I wanted to make a statement regarding the doctor's artificial, I believe, polarization of the issue.

I think he's cherry-picking when he cites this one study that has been widely discredited when there are literally dozens of studies whose methodologies have been impeccable and have not been discredited.

FLATOW: Let me get a - Dr. Offit?

Dr. OFFIT: If she's referring to the Wakefield publication as being a study that was discredited, first one should say that nothing was studied. That wasn't a study. That was merely a series of eight children who had received the MMR vaccine who then within a month developed symptoms of autism, and Dr. Wakefield postulated that the vaccine had caused intestinal damage, which then allowed for brain-damaging proteins to enter the body and cause autism.

That wasn't a study. And in fact, now we know that, in fact, even what was presented was incorrect, that some of those children were said to have autism and they didn't, that some of those children were said to have received the vaccine just before they got symptoms of autism and that that wasn't true, they'd either received it afterwards or well before. So, none of that was right.

But if you want to answer the question, the way you answer that question is that you do, you look at hundreds of thousands of children who did or didn't get MMR vaccine to see whether the incidence of autism is great in the vaccinated group.

That's been done by 14 different groups of investigators on three different continents, and the answers have been very clear and consistent and reproducible. So we can say with comfort that MMR vaccine does not cause autism.

FLATOW: Leslie, let me ask you the same question I asked of Chantal in 2008: Is there any amount of research that could be presented to you that would change your mind?

LESLIE: Oh, absolutely. This is what I'm saying, is that he's presenting a false dichotomy. There is something between the yahoos who just don't look at scientific process at all and people who blindly trust what the physicians tell them, of which there are numbers. Many, many people.

You know, getting 26 vaccines in some case before the age of two is a devastating thing for a person's immune system. I'm 49. When I would get immunized back in the '60s, I had...

FLATOW: How do you - Leslie, Leslie, Leslie...

LESLIE: ...six or seven, and I think they were great. I had polio.

FLATOW: Leslie. Leslie?

LESLIE: I had, you know, measles...

(Soundbite of laughter)

LESLIE: ...you know, you name it. I had the things that we know are really bad. Meningitis, I'm on the fence about, I don't know much about that one.

FLATOW: Leslie, Leslie, could I interrupt? You said it was devastating to get 42 immunizations. Can you tell us what evidence you have that it's devastating?

LESLIE: Twenty-six.

FLATOW: Can you tell - tell me what evidence did you...

LESLIE: And the reason that I'm saying that is because there's really a lot of evidence that the preservatives that are used - which include mercury - and the vast number of immunizations that you're requiring at such a young age that really is taking a toll on the immune system. I think that's just logic. Now, if...

FLATOW: All right. Dr. Offit, I'd like to get an answer from Dr. Offit about -let's talk about the mercury issue first. Leslie, you listening?

LESLIE: Oh, yeah, I'm here.

FLATOW: Okay. Dr. Offit, let's - can you answer that?

Dr. OFFIT: Right. So Leslie raised two issues. I'll actually do it, if you don't mind, in the order in which you raised them. The first was she raised the notion that the - it's actually 14 different vaccines which can be included in as many as 26 inoculations. But certainly, you know, if you look 100 years ago, we only got one vaccine. Today, we get 14 different vaccines. And certainly, the number 14 is greater than one.

But the critical thing is whether the number of immunological components in vaccines - which is to say that the immunological challenge in vaccines is greater today than it was 100 years ago. The answer, interestingly, is no. You know, that you actually receive about 160 immunological components, and by that, I mean bacterial protein...

LESLIE: Mm-hmm.

Dr. OFFIT: ...or bacterial polysaccharide or viral protein, as compared to the smallpox vaccine, which was the only vaccine we got 100 years ago, which contained about 200 immunological components. Secondly, the notion that vaccines would overwhelm the immune system just flies in the face of everything we know about the immune system.

You know, when you're in the womb, you're in a sterile environment. When you enter the birth canal and the world, you're not. And very quickly, you have, living on the surface of your body, trillions of bacteria, literally trillion - I'm not trying to sound like Carl Sagan. It's literally trillions. You actually have 10 to the 14th, which is 100 trillion bacteria on the surface of your body. That's actually 10 times more than you have cells in your body. To which you make an immune response.

LESLIE: An immunological virus is engineered in the laboratory. It's not naturally occurring in nature.

Dr. OFFIT: Well, I'm sorry. Let me - okay, I can address that, too. But the -you know, you - you know, a person makes grams of immunoglobulin G every day, grams of secretory immunoglobulin every day to handle that sort of natural insult. So the 106 - and remember, each bacteria has between 2,000 and 6,000 immunoglobulin components. If we were overwhelmed by vaccines, our species would not survive. Believe me, that's not a problem.

Secondly, the issue of mercury, you know the quantity of ethyl mercury that was contained in the vaccines is less than - and remember, ethyl mercury is excreted much more quickly from the body than methyl mercury. And ethyl mercury is essentially out of vaccines given to young children. It still is contained in some multi-dose preparations of the influenza vaccine.

You know, the - again, it's the quantity that matters. Obviously, mercury is, at high quantities, is a neurotoxin, but we're all exposed to levels of mercury because we live on this Earth, and the Earth's crust contains mercury. So mercury is in the water we drink. It's in the breast milk that we give our children...

LESLIE: I can't accept what you're saying. It does - it just sounds like pap to me. It sounds like panacea. A two-year-old cannot accept this kind of chemical onslaught.

FLATOW: All right. Let me...

Dr. OFFIT: Of course they can.

LESLIE: You know, maybe an adult could. Maybe.

Dr. OFFIT: No, of course a child - first of all, a child does.

FLATOW: Well, let me just jump in. This is SCIENCE FRIDAY from NPR.

Leslie, doesn't look like anything he's going to tell you is going to change your mind.

LESLIE: Well, I'm not hearing anything that I - that sounds credible to me as an educated adult.

FLATOW: Ah. Okay. Thanks for calling.

LESLIE: You're welcome.

FLATOW: 1-800-989-8255 is our number. That's very similar to where we were in 2008, Dr. Offit.

Dr. OFFIT: I know. I'm having, you know, these sort of regressive nightmares.

FLATOW: And so how do deal with that? How does that make you feel, like we're not making any progress, or you're not making any progress? People don't believe in science anymore? Is science is just another matter of opinion?

Dr. OFFIT: That's a good question. I would say that when you talk to parents -and we do - we have, at our vaccine education center, meetings with sometimes between 50 and 100 parents who have chosen, actually - so it's a biased group, in a way, that - to delay or withhold or separate or space out vaccines.

The good news you'll hear - and I guess we don't get those callers. But the good news is that I would say 85 percent of those people smell the smoke. They want to know whether there's any fire to it. They are reassurable by people who, you know, who have an expertise or have experience or published expertise in the field. But there are a solid 15 percent who really believe this is just a conspiracy, a conspiracy by pharmaceutical companies, the medical establishment and the government, as Chantal had said, right: I won't believe anything the government tells me - to just sell product, and that we're there, you know, that we're just trying to hurt children, and it's unconscionable. That you can't get very far with, nor do you try for very long.

FLATOW: And the point of your book is saying that if we - if our kids are not vaccinated, it's not just affecting me as a parent who doesn't believe in this, but it's affecting a lot of other kids, also.

Dr. OFFIT: Yes. There was - you're actually starting to hear that, surprisingly, since 2008, since you and I had our last discussion. You're starting to see parents step forward. There was this thing, actually, on NPR's "This American Life" that was called "Ruining it for the Rest of Us." But it was a story about a mother who chose not to vaccinate her children. She went to Switzerland. The seven-year-old got measles, comes back to the United States, proceeds to infect a series of people, certainly expose about 900 people, but while waiting in the doctor's waiting room, exposed three children who were less than a year of age, couldn't get the measles-- or hadn't gotten the measles vaccine because they were too young. All three got measles, all three were severely infected. One of them was hospitalized and almost died.

And they had that mother on the show, who was angry. You know, she said that mother who chose not to vaccinate her child made a decision for my child that almost killed him. And that's a voice you had never heard before the -unfortunately, you're starting to hear because we're starting to see these outbreaks come back again.

FLATOW: In deference to another Ira, that Ira Glass. He's on another network. So - people think it's NPR, but it's not.

And so the future, you're hopeful for the future?

Dr. OFFIT: Definitely.

FLATOW: Yeah. You still are.

Dr. OFFIT: I think things are - I am. I just think things are starting to swing back a little bit. I, you know, you're starting to see hospitals step forward, and - I think, as our hospital stepped forward to, you know, to make sure that kids in the hospital are protected.

And I think, you know, with this outbreak of pertussis or whooping cough in California that's, you know, that's involved almost 8,000 people and killed 10 babies, I mean, you're really starting to see people get interested in making sure that they and their neighbors are getting immunized. I - unfortunately, the reason that's true is that we're seeing outbreaks that's hurting children. But - I wish that wasn't the reason, but it is.

FLATOW: All right. You can read all about Dr. Paul Offit's views in his new book "Deadly Choices: How the Anti-Vaccine Movement Threatens Us All."

Thank you, Dr. Offit, for taking time to be with us again.

Dr. OFFIT: Thank you, Ira.

FLATOW: Have a good weekend. We're going to take a break. When we come back, we're going to talk about what to do with all those high-tech toys - those big TV sets and things - and how to get to get off the cable if you don't want to be on one, in the next segment. So stay with us. We'll be right back.

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