Vaccine Hesitancy

Pertussis (Whooping Cough): Resurgence of a Deadly Disease

A recent article in the journal Pediatrics reported a surge in cases of pertussis, commonly known as whooping cough. Unfortunately the article is only available to subscribers to the journal. Here is a link to a description of that article in a medical news service called Medscape. Pertussis is a bad disease. See below.

History of pertussis

Pertussis is caused by a bacterium, Bordatella Pertussis. Prior to the advent of pertussis vaccines, pertussis was one of the leading US causes of death of children under 5 years of age. There were over 200,00 cases and 9000 childhood deaths in the US from pertussis every year (a rate of 4.5 deaths per thousand children). Pertussis was especially lethal in infants, and was probably the leading cause of death in this age group. Worldwide, pertussis prior to vaccines was just as bad as in the US or worse. Worldwide there were 24.1 million cases and 160,700 deaths in children under five every year.

Epidemiology of pertussis

In un-immunized people pertussis is extremely infectious, almost as much as measles. One infected person on average infects 12-18 other people. In adolescents and adults pertussis is unlikely to cause death or hospitalization, but it is an extremely unpleasant disease. Older children and adults have paroxysms of coughing, followed by a loud, wheezing inspiration (the whoop of whooping cough). These symptoms can last for weeks or months. The coughing is sometimes so severe that people break ribs or develop hernias. Treatment with antibiotics is used to prevent transmission. Antibiotics are also given to contacts to prevent them from getting infected. Antibiotics do not have any effect on the length or severity of the disease. Those who have symptomatic pertussis just have to wait for it to go away. Here is an audio file of a child with pertussis. You should listen to it realize what a severe disease pertussis is. Let me warn you that it is distressing to listen to.

Pertussis vaccines

Whole cell pertussis vaccines

Whole cell pertussis vaccine combined with vaccines for tetanus and diphtheria was widely introduced and given to infants and children in the 1940’s. This was a highly effective vaccine. It not only prevented disease, but also prevented colonization and therefore stopped transmission of pertussis. It reduced the cases of pertussis by 75%. Unfortunately, the whole cell vaccine had rare but concerning side effects.These iincluded persistent crying, febrile seizures and hypotonic-hypoeresponive episodes (HHE). Children with HHE had sudden onset of reduced muscle tone, decreased responsiveness to verbal or other stimuli, and change in skin color (pallor or cyanosis) that occurred shortly after vaccination. These adverse events, though temporary were obviously distressing to parents. There were also rare cases of encephalopathy (Inflammation of the brain) that caused permanent disability. These cases were so rare that it was impossible to know whether these permanent disabilities were caused by the vaccine, or were simply associated but not causal. Controversy over whether the vaccine had any role in these cases continues even today.

Acellular pertussis vaccine

Because of the rare but distressing side effects of whole cell pertussis vaccine, a new vaccine was developed that had components of the pertussis bacterium, but not whole cells. This was called the acellular vaccine. This acellular vaccine had far fewer and milder adverse reactions than the whole cell vaccine. The combination vaccine is abbreviated DTaP (diptheria-tetanus-acellular pertussis). This is the vaccine used for children today. Unfortunately the acellular pertussis vaccine is less effective than the previous whole cell vaccine. It does prevent children from getting ill with pertussis, but it does not prevent colonization of the nose and throat. Children who are colonized in this way are not sick, but they are infectious and can pass on the virus to other children and adults. This keeps the bordatella pertussis bacteria circulating in communities.

Waning Immunity

Neither the whole cell nor the acellular vaccine provides lifetime immunity, unlike the Measles-Mumps-Rubella vaccines, which do provide lifetime immunity. Even people who have pertussis do not get lifetime immunity. Immunity from vaccines and infection wane over time. It appears that the acellular pertussis vaccine gives good protection from getting sick from pertussis for about 4 years, and starts to wane after that. The result is that we still see pertussis even in fully immunized children and adults starting about 5 years after the last routine immunization, which occurs at between 4 and 6 years of age. A booster TDaP is also recommended at around 12 years of age. This means that the most vulnerable children, that is children 5 or under are protected from getting ill from pertussis. Infants below 2 months of age (too early for vaccination) are protected by the recommendation that all pregnant women get a booster TDaP vaccine in the third trimester of every pregnancy. Anyone who is going to have extended contact with an infant under 2 months should also get a booster TDaP.

Risk of resurgence of severe pertussis

Bordatella pertussis continues to circulate in communities because of colonization of immunized children. Resistance to vaccinating children with DTap can quickly cause a resurgence of pertussis in infants and young children. This would be disastrous and is already happening. In 2024, there were 35,435 documented cases of pertussis across the U.S., including 655 in Colorado. That was a huge jump over the 7063 cases in all of 2023. Large states, including New York and California, logged high numbers of pertussis infections in 2024. So did some less-populated states like Idaho, Washington and Oregon, each of which reported more than 1,000 cases of pertussis. There were 10 deaths from pertussis in 2024. Cases are on track to be even higher in 2025.

Research on new pertussis vaccines

The search is on for a new pertussis vaccine that prevents colonization but that also does not cause the distressing side effects that happened with the whole cell pertussis vaccine. The best candidate at the moment is a live vaccine that has been genetically modified to eliminate the toxins produced by the bacterium. If and when approved this vaccine will be administered nasally. In rhesus monkeys it prevented colonization with bordatella pertussis and had no significant side effects. It is currently in phase 3 trials in humans.

Bottom Line

Pertussis is a serious disease and is life threatening to infants and young children. The severity and duration of pertussis are not affected by antibiotics that are given to limit the spread of the disease. The only effective treatment of pertussis is prevention through immunization. Acellular pertussis vaccine is much safer but also less effective than the old whole cell vaccine. It allows bordatella pertussis to continue to circulate in communities. Resistance to immunization of children has led to a marked increase in serious pertussis infections in 2024 with 10 deaths reported. Pertussis cases are on track to be even higher in 2025. A promising new attenuated live pertussis vaccine is in phase 3 trials and may soon be approved assuming research funding is not withheld by the Trump administration.

Assault on Science

I recently read a very interesting book called Science Under Siege. The authors are Peter Hotez, pediatrician and vaccine researcher at Texas Children’s Hospital in Houston, Texas and Michael Mann, the prominent climate researcher who found strong evidence for manmade global warming. It is an excellent book and I highly recommend reading it. Public confidence in science has significantly declined since the pandemic, but the majority of polls continue to show strong support for science (see this link to the Pew Research Center). On the other hand, there is a well funded, sophisticated effort to discredit science and scientists. Many people do not understand how science is done, how it is funded, and its contributions to society. In this post I will write about all of those things, as well as the people and groups who are funding the assault on science and scientists.

What is the Scientific Method?

The scientific method is a systematic way to advance knowledge. Here are the steps of the scientific method: This excellent formulation is copied from a webpage from American Journal Experts.

  1. Define a question: Constructing a clear and precise problem statement that identifies the main question or goal of the investigation is the first step. The wording must lend itself to experimentation by posing a question that is both testable and measurable.
  2. Gather information and resources: Researching the topic in question to find out what is already known and what types of related questions others are asking is the next step in this process. This background information is vital to gaining a full understanding of the subject and in determining the best design for experiments. 
  3. Form a hypothesis: Composing a concise statement that identifies specific variables and potential results, which can then be tested, is a crucial step that must be completed before any experimentation. An imperfection in the composition of a hypothesis can result in weaknesses to the entire design of an experiment.
  4. Perform the experiments: Testing the hypothesis by performing replicable experiments and collecting resultant data is another fundamental step of the scientific method. By controlling some elements of an experiment while purposely manipulating others, cause and effect relationships are established.
  5. Analyze the data: Interpreting the experimental process and results by recognizing trends in the data is a necessary step for comprehending its meaning and supporting the conclusions. Drawing inferences through this systematic process lends substantive evidence for either supporting or rejecting the hypothesis.
  6. Report the results: Sharing the outcomes of an experiment, through an essay, presentation, graphic, or journal article, is often regarded as a final step in this process. Detailing the project’s design, methods, and results not only promotes transparency and replicability but also adds to the body of knowledge for future research.
  7. Retest the hypothesis: Repeating experiments to see if a hypothesis holds up in all cases is a step that is manifested through varying scenarios. Sometimes a researcher immediately checks their own work or replicates it at a future time, or another researcher will repeat the experiments to further test the hypothesis.

This is clearly not an easy process. There must be transparency at every step so that other researchers can evaluate the methods and repeat the experiments to be sure they get the same results.

How are scientific findings published?

Once results are obtained from a scientific study, a paper describing the results is prepared by the authors. There are usually several authors for any scientific paper. The principal investigator prepares the initial draft and sends it to his/her colleagues. There are usually many drafts and modifications before a final paper is ready to submit. The final paper as agreed upon by the authors is submitted to a peer reviewed scientific journal. The paper is first reviewed by the editor of the journal. If the editor feels there is significant problem with the paper or if he/she thinks it is not appropriate for readers of the journal then the editor can reject the paper. If the paper passes editorial review, then it is sent to at least 3 scientists in the same field for evaluation. These are called peer reviewers. Each reviewer writes a review of the paper, which are sent to the editors of the journal and to the authors of the paper. The reviewers often suggest modifications to the paper. The journal editor may reject the paper based on the reviewers comments, may suggest that modifications be made and the paper be resubmitted, or much more rarely may accept the paper for publication based on positive reviews from the peer reviewers.

As I can attest from my own numerous scientific publications, the acceptance of a paper by a peer reviewed journal is a long and rigorous process. I have also had papers rejected by the editor and after review by peer reviewers.

Very rarely, investigators publish papers based on fraudulent data. This is usually discovered eventually and the editors then publicly retract the paper. This happened to Andrew Wakefield with his publications about a connection between MMR vaccine and autism in the medical journal the Lancet. All of these papers were found to be based on fraudulent data and were retracted. He actually lost his medical license in the UK because of this. Subsequent large very well designed studies showed no connection between vaccines and autism. This is an example of how the scientific method advances knowledge.

Double blind randomized controlled trials

This kind of trial is the gold standard of scientific research. Subjects for the research are recruited and are randomly assigned to either the experimental group or the control group. Great care is taken to be sure that the selection for either group is completely random. The size of the two groups has to be large enough to ensure that any factors that might bias the results should be balanced out in the two groups by the random selection. The intervention being tested (usually a medicine or other treatment) is given to the experimental group and an identical placebo (inactive) pill or intervention is given to the control group. The investigators administering the treatment don’t know whether they are administering the experimental treatment or the placebo, and they also don’t know which people are in the experimental or the control group. That’s why this kind of trial is called “double blind.” The code for which patients got the experimental treatment and which got the placebo treatment is not broken until the end of the trial. Double blind randomized controlled trials give the most reliable bias free results, but they are very expensive to conduct. There are other kinds of trials as well, because not every research question lends itself to a randomized controlled trial. Almost all well designed research is expensive to conduct. In the next section I will write about how research is funded.

How research is funded

Most research is conducted at academic institutions. Funding for research has to cover the salaries of the researchers and their staff, and the research infrastructure of the institution. All of that is very expensive. Almost all research is funded by grants, either federal (National Institutes of Health (NIH) or National Science Foundation (NSF) or private foundations. Most large grants are federal.

Grant application process

Some grants are designed for application by institutions themselves but most grants are applied for by research scientists. Application for a scientific grant is a major involved process. There is a 12 page limit for the main application for an NIH grant, but supplementary documents required like budgets and investigator bio sketches can run to 150 pages. Each federal grant application is evaluated by a study section composed of eminent scientists in the field. Funding is only available for a small number of grants so most grant applications are rejected. If the study section gives the grant a good score the grant may be awarded to the institution or the investigator. Even if the grant is awarded to the investigator, the grant money is administered by the institution. It never goes directly to the investigator. A percentage of each grant is used by the institution to pay for its research infrastructure. The rest is used by the institution to pay the investigator’s salary and to pay for the costs of the research. Private foundations each have their own rules for grant applications, but they are also difficult to get. Grants from private foundations are usually, but not always smaller than federal grants.

Are scientific results truth?

Science is a systematic way to search for truth about how the world works and how we can successfully manipulate it to get desired results. It is a mistake to put too much emphasis on the results of one study. When many studies find the same or similar results, we have increasing confidence that the results represent truth, but never absolute. Scientific results are always to some degree provisional. That does not mean they are not useful.

Benefits of science to society

Rather than enumerate the benefits, here is a link to a University of California website that explains the benefits much better than I can. As the webpage points out, the benefits of science to society are substantial.

Attacks on science and scientists

Because science is a systematic search for knowledge, the findings of some scientific studies are often inconvenient for certain groups or individuals with ideological beliefs. Some scientific findings also threaten some wealthy people whose wealth comes from industries that scientific results threaten. The fossil fuel industry, for example, has created huge wealth for companies and individuals. Climate science has clearly shown that CO2 emissions from fossil fuels is causing rapid global warming that will be catastrophic if CO2 emissions are not drastically reduced. Scientific research has also been instrumental in developing alternative energy sources such as solar, wind, and others that have become economically viable. The fossil fuel industry has invested tremendous amounts of money to attack these findings. They work at creating the idea that these well validated scientific results are controversial. They hire people with academic credentials who question that CO2 emissions are causing climate change. This kind of opposition research is rarely published in peer reviewed journals. Front groups are created as well as PACs to lobby legislators that are funded without revealing the source of those funds. This is so-called dark money, but it has been shown to come primarily from people who get their wealth from fossil fuels. Koch industries is a good example. There also is a large industry that promotes supplements, vitamins, and alternative medicines that have no basis in science. This industry attacks legitimate health research as well as proven preventive treatments, particularly vaccines for children and adults.

These attacks on science are sophisticated, coordinated, and so far unfortunately very effective. In addition prominent scientists have been subpoenaed to appear before hostile congressional committees, harassed and threatened with arrest and/or bodily harm. These things are well documented in the book by Hotez and Mann.

Bottom Line

Science is a systematic way to advance knowledge. As results are validated by multiple well designed studies we find out more about the world and how to manipulate it to our benefit. Publication of scientific results in peer reviewed journals is a difficult and rigorous process. Almost all science is done in academic institutions and is almost entirely funded by federal grants and grants from private foundations. Obtaining grant funding is also a very rigorous process. Grants are administered by institutions and grant money is never given directly to investigators.

Wealthy people who stand to lose money because of scientific findings are conducting a sophisticated, well funded campaign to attack scientific results they don’t like and to discredit, harass, and threaten legitimate scientists.

mRNA Vaccines – Truth vs Misinformation

Robert F Kennedy Jr has stopped funding for research to develop new mRNA vaccines because he says they don’t work well for respiratory diseases. He also claims that mRNA vaccines induce mutations in respiratory viruses. He says that even one mutation makes mRNA vaccines ineffective. Here is a link to his video post on X where he makes these claims. He also claims that he has consulted science experts who agree with him about mRNA vaccines.

In this post I will review the real science about mRNA vaccine technology, how mRNA vaccines differ from traditional vaccine technology and also discuss how viruses mutate and why (spoiler alert: they don’t mutate because of mRNA vaccines). Here is a link to a STAT news article that deconstructs Kennedy’s arguments: Kennedy’s case against mRNA vaccines collapses under his own evidence.

Traditional vaccines

There are two types of traditional vaccines, live vaccines and killed vaccines. Both types require growing the target virus in tissue culture. In a live vaccine, the virus is weakened so that infection does not cause the disease when injected into people with healthy immune systems. The MMR vaccine is an example of a live vaccine. It contains weakened strains of measles virus, mumps virus and rubella virus. Killed vaccines use some proteins from the virus to sensitize the immune system to kill the virus when it detects those proteins. the DPT vaccine is an example of a killed vaccine. It contains protein fragments from the diphtheria virus, pertussis (whooping cough) virus and tetanus virus. It is very labor intensive to create a vaccine using these traditional methods. To make enough weakened virus or virus protein fragments to immunize a large population takes a lot of tissue culture and a long time. It usually takes 10-15 years of research and development before new traditional vaccines are ready to use. Manufacturing those already approved vaccines is still very labor intensive.

What is mRNA?

The m in mRNA stands for messenger RNA. The genes in your DNA can’t do anything by themselves. They don’t directly make proteins. Instead they code for messenger RNA. Messenger RNA does the work of making proteins that determine hair color, eye color and all other genetic traits. Each type of messenger RNA is specific for a particular protein. Messenger RNA does not last very long in animal (or human) cells. It lasts from a few minutes to a few hours and then it disappears. The DNA makes more messenger RNA as needed.

How does an mRNA vaccine work?

The advantage of an mRNA vaccine is that the body does all the work of manufacturing the virus protein fragment. No intensive tissue culture is required. mRNA is synthesized in a laboratory. The synthesized mRNA codes for a specific virus protein. In the case of the COVID mRNA vaccine, the mRNA codes for the spike protein. When that mRNA is injected into a muscle, the muscle cells start to make many copies of the spike protein. The immune system recognizes this as a foreign protein and makes antibodies against it as well as sensitizing killer lymphocytes so that they recognize the protein too. Just like the body’s own mRNA, the injected mRNA only lasts for a few minutes to a few hours and then disappears. It never changes the DNA in the cell, because DNA makes mRNA, not the other way around.

How does mRNA vaccine speed up the vaccine development process?

We now have the technology to rapidly determine all the genetic code of a new virus. That sequencing can happen within a few weeks of discovering a new virus. That genetic code allows us to determine which proteins make up the virus particle. We can then decide which viral protein is the best to stimulate immunity to the virus and synthesize an mRNA molecule that will make that protein in human muscle cells. That process is much faster than the traditional method. We had an effective mRNA COVID vaccine within a year of the beginning of the pandemic. That is an absolutely unprecedented time scale in new vaccine development.

Do mRNA vaccines induce mutation in viruses

This is what Kennedy claims and it is absolutely not true. Some viruses, like COVID and flu virus mutate frequently and some like measles virus and polio virus are stable and do not mutate or mutate rarely.. The mutation rate depends on the nature of the virus, not on the vaccine. All vaccines, not just mRNA vaccines for viruses that mutate frequently lose some efficacy over time and the vaccine has to be modified. The viruses that mutate frequently would continue to do that whether a vaccine is available or not. Vaccines do not make viruses mutate faster. Most mutations make the virus less infectious, but the occasional mutation makes the virus more infective. The mutations that are more infective become more frequent and crowd out the older versions of the virus. Measles and polio vaccines prevent infection because the measles and polio viruses stay exactly the same over time.

Safety of mRNA vaccines

The only mRNA vaccine that we have extensive experience with are the ones developed for COVID. Mild reactions were common (sore arm, fever. myalgias) more commonly with the second dose. Rare cases of myocarditis (inflammation of the heart muscle) were reported in younger people. All of these were transient and completely resolved. There is a very tiny chance of having a severe allergic reaction to the vaccine. Out of 8 billion doses administered death due to allergic reaction occurred in 14 people. That is a risk of death of 1.75 x10-9 (1.75 preceded by 9 zeros!).That risk is much, much smaller than the risk of being killed in an auto accident. The risk of death from COVID in unvaccinated people is of course much higher. mRNA vaccines are safe with a minuscule risk of severe side effects.

Why do people still get influenza or COVID even after they have been vaccinated.

Antibodies induced by flu and COVID vaccines are in the blood stream and not as much on the mucus membranes. Although vaccinated people are less likely to get infected with influenza or COVID, the protection rate from infection is less than 100%. Vaccinated people can still get infected with influenza or COVID. The vaccine induced antibodies immediately start fighting the infection. This means that vaccinated people who get infected are much less likely to get severe infections, much less likely to be hospitalized and are much more likely to have mild symptoms. You get a great deal of protection from the vaccine even if you get infected with the virus. Kennedy asserts that if you get infected with the virus, then the vaccine does not work. That is poppycock!

Research into new mRNA vaccines

Researchers can now use AI to develop universal mRNA vaccines for COVID and influenza that could develop immunity to multiple genetic variants at the same time. This technology would mean that new vaccines don’t have to be developed every year to deal with new genetic variants. This technology also might make it possible to develop vaccines for malaria and leptospirosis. It may also be possible to use this technology to develop vaccines that sensitize the immune system to destroy cancer cells.

All of the federal funding for research using this promising technology has been blocked by HHS secretary Robert F Kennedy Jr.

Bottom Line

mRNA vaccines can be developed much faster than traditional vaccines. They are safe and effective at both preventing disease and making disease much milder when infection does occur. mRNA technology has the potential to make universal flu and COVID vaccines, vaccines for malaria and leptospirosis and even vaccines to prevent cancer. It is unconscionable that federal funding for this important research has been halted.

Trump Administration Assault on Health Care and Research

The Trump administration along with its rubber stamp republican controlled congress is conducting an unprecedented assault on US health infrastructure and on medical research. In this post I will write about the details of that assault and the current and likely future effects on people in the US and around the world.

HIV Funding Cuts

Funding has been cut for current studies on HIV vaccines being carried out by Duke University, The Scripps Research Institute and Moderna’s clinical trials. These vaccines showed great promise for preventing HIV infection.

The administration has eliminated the CDC HIV prevention division

Funding for the Presidents Emergency Plan for AIDS Relief has been eliminated. This program, begun in 2003 during the George Bush administration, has delivered lifesaving treatment to 25 million people in 54 countries and had previously bipartisan support. Without this funding, thousands of people around the world, especially in African countries will die. Children born with HIV are especially vulnerable.

Center for Disease Control cuts

The CDC has historically held a strong reputation as a global leader in public health. It has been considered the “gold standard” for national health agencies. In April of this year 2400 CDC employees’ jobs were terminated, shuttering whole programs at the agency. About 460 of those employees have been rehired. The Trump administration 2026 proposed budget cuts CDC funding by 50%. Much of CDC funding goes to state health departments, so state health departments will struggle and public health programs like TB treatment, and STD treatment will be understaffed if not eliminated entirely.

Vaccines

Robert F Kennedy Jr was appointed by Trump as head of HHS. He has a long history of conspiracy theories about vaccines. He recently fired all 17 members of the CDC immunization advisory panel and appointed 8 new members, many of whom have been critical of mRNA vaccines as well as other vaccines. Vaccines recommended by the panel have to be covered by insurance. It seems likely that rare side effects of vaccines will be emphasized and that vaccination rates will continue to fall in the US. Prepare yourself for the return of measles, pertussis (whooping cough), and maybe even polio.

Cuts to Medicaid

It is clear that Federal Medicaid funding will decrease substantially, but we won’t know how much until a final budget is worked out between the House and Senate. The Senate version cuts Medicaid even more than the House version. Medicaid cuts will not only affect the health of Medicaid recipients but will have downstream severe effects on the entire US healthcare system. This will include hospitals, physicians, federally qualified health centers, certified nursing facilities, and even insured persons (because premiums will increase). There is an excellent viewpoint piece in JAMA detailing all the damage to US medical care caused by substantial cuts in Medicaid spending. Here is a link to that article. It is worth reading.

Effects of Medicaid Cuts on the Medical Care Ecosystem.

Medicaid Work Requirements

The vast majority of Medicaid recipients who are able to work are working.  in 2023, nearly two-thirds of adults ages 19-64 covered by Medicaid were working and nearly three in ten were not working because of caregiving responsibilities, illness or disability, or due to school attendance, reasons that counted as qualifying exemptions from the work requirements under previous policies (Understanding the Intersection of Medicaid and Work: An Update). Arkansas is the only state that has previously tried work requirements for Medicaid recipients. The documentation requirements were such that over 18,000 people lost their Medicaid insurance, despite the fact that the vast majority of them were already working. If Congress passes Medicaid work requirements, millions of people will lose Medicaid. That means more emergency room care, more untreated chronic illness and more deaths.

Reduced Subsidies for Affordable Health Care Insurance Marketplace

The premium tax credits for the ACA insurance marketplace are set to expire in 2025. The House budget bill does not extend those tax credits. Without those tax credits millions of people will lose their insurance because they will not be able to afford the increased cost.

Cuts to Research Funding

National Institutes of Health (NIH)

The Current Trump administration budget includes a 40% cut in funding for NIH! This is completely unprecedented. If that level of budget cut happens, the NIH will be unable to award any new research grants for at least 3 years!

Importance of NIH Funded Research on Health

NIH funded research has resulted in numerous health benefits in the US and the world. These include improvements in chronic disease treatment and prevention, cancer diagnosis and treatment, infant and maternal health, identification and treatment of immune diseases, and a host of other benefits. Here is a link to an NIH website documenting the health benefits of NIH funded research: Improving Health.

Long Term Effects on US Research

The quality of research in the US has long been among the very best in the world. The US has attracted talented researchers from all over the world. The NIH budget cuts along with the cancellation of existing research grants makes the US a much less attractive place for researchers. The Trump administration focus on limiting immigration also makes the US much less attractive to talented researchers from outside the US.

A recent survey of US scientists was carried out by the prestigious science journal Nature. The survey found that 75% of US scientists were considering leaving the US (The Hill).

Recruitment of US scientists by other countries

A number of countries are actively recruiting top US scientists. They are offering not only funding, but also emphasizing academic freedom (Economic Times).

Bottom Line

The cuts to HIV treatment and HIV vaccine research will result in thousands of preventable deaths from HIV. The One Big Beautiful Bill Act (that is the actual name of the budget bill) will result in millions of people losing both Medicaid and ACA insurance. It will decimate medical research as well as severely compromise the US Public Health Service (because of the CDC cuts). The lack of emphasis on vaccines by HHS will likely result in continued lower vaccination rates with return of measles, pertussis, diptheria and polio. All of this will be a health care disaster.

Feel free to share this post. Also write your congressional representative and your senators. It may not help, but it can’t hurt to do what you can to mitigate this disaster in progress.

MMR Vaccine Risks in Perspective

This post is a follow-up to my recent post about measles and MMR vaccine. The purpose of this post is to compare the risk of adverse effects from the MMR vaccine to other risks that we take with our children every day.

Annual Deaths of children under 18

In the US 37,000 children under the age of 18 die every year. In 2022, the last year for which we have complete data, 604 children were killed in automobile accidents. This figure includes those killed as passengers, walking to school or in their neighborhoods, or riding their bicycles. Here is a table from the New England Journal of Medicine showing the most common causes of death of children since 1999.

As you can see from the graph, motor vehicle deaths of children have gone down significantly since 1999, but are still the second leading cause of death in children. Firearm injuries have now surpassed motor vehicle deaths as the leading cause of death in children.

All of these risks are small, the highest being 4.5 deaths per 100,000 Children. These are risks we take with our children every day. There is a risk when they ride in your car. There is a risk when they walk in their neighborhoods. There is a risk when they ride their bicycles. There is a risk that they will be killed by a mass murderer when they go to school. The risks of adverse reactions to vaccines are actually lower than the risks that we take with our children every day. Adverse reactions to vaccines almost never kill children

Deaths of children due to MMR vaccine

There have been only two documented deaths due to MMR vaccine in the 62 years it has been available. Both of these deaths were in children with Severe Combined Immunodeficiency Syndrome (SCIDS). You may remember a movie about a child with this syndrome. It was called “The Boy in the Bubble.” These children should never have received a live virus vaccine, such as MMR.

MMR Vaccine and Autism

Robert F. Kennedy Jr, the current head of HHS, has contended that MMR vaccine causes autism. There was a paper published by Andrew Wakefield in the medical journal, the Lancet, that studied 12 children and concluded that MMR vaccine was linked to autism. It was later discovered that he had falsified his results and the paper was retracted by the Lancet. This discredited paper, plus another one by the same author are still cited by people, including our current head of HHS, as evidence that MMR vaccine causes autism.

Study by Brent and Taylor

Brent and Taylor and colleagues examined the records of 498 children with autism. Cases were identified before and after MMR vaccine became available in the UK. They compared the incidence of autism in vaccinated and unvaccinated children and found no difference.

Study by Madsden and Colleagues

Madsden and colleagues did one one of the best and most rigorous studies. The study included 537,303 children representing 2,129,864 person-years of study. Approximately 82% of children had received the MMR vaccine. The risk of autism in the group of vaccinated children was the same as that in unvaccinated children. Furthermore, there was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autism.

Other studies

Many other well designed studies have shown no association between the MMR vaccine and autism.

Bottom Line

We daily accept small risks of injury and death of our children. There are no activities involving children that are without some risk. The risks of MMR vaccine side effects (or any other vaccine) are no larger than the risks we take with our children every day. See my last post for a list of possible side effects of MMR vaccine. Severe side effects of MMR vaccine are very rare. When given appropriately to children with normal immune systems, death is not one of the risks. The one study by Andrew Wakefield that showed a connection with MMR vaccine and autism was shown to be fraudulent and was retracted. Multiple well designed studies have definitively shown that MMR vaccine does not cause autism.

Measles

Measles (also called rubeola) is one of the most infectious diseases in the world. Infectiousness of a disease is measured by something called R0 (basic reproduction number). This is a measure of how many people will be infected by one person with the disease in an un-immunized population. For measles R0 ranges from 12-18. That means in an un-immunized population, 1 person with measles will on average infect 12 or more others. To put this in perspective The R0 for influenza is 0.9-2.1. The R0 for Ebola is 1.9. The R0 of COVID19 is 1.4-2.4. You can see that the infectivity of the measles virus is as much as ten times higher than other diseases that we consider very infectious.

Measles Vaccine

The recommended two doses of measles vaccine offers lifetime 97% protection against being infected with measles. The measles vaccine is a live vaccine. This means that it is a form of measles virus that has been weakened (attenuated) so that it will not cause infection in people with normal immune systems. It cannot be given, however to people with weak immune systems, such as people on chemotherapy for cancer. It also cannot be given to infants younger than 6 months because their immune systems are not developed enough for a live virus vaccine. 1 dose of MMR vaccine can be given to infants at least 6 months old if they are going to travel to a country where measles is still endemic. This offers some protection, but they still need two doses of the MMR vaccine after age 1. The recommended age for the first dose of the measles vaccine is 1 year. The second dose is usually given at age 5 or 6. Even the first dose gives 93% protection against being infected with measles.

People who cannot get the measles vaccine are protected by all those people who do get the vaccine. This is called herd immunity. If enough of the population has been vaccinated then there is no transmission of measles even to those people who can’t take the vaccine. Outbreaks of measles are unlikely to happen if at least 90% of the population has been vaccinated. The lower the vaccination rate below 90%, the more likely measles outbreaks will occur in unvaccinated people. In Gaines county, Texas, where the current measles outbreak started, the measles vaccination rate was 75%.

Is the measles vaccine safe?

The measles vaccine is given in combination with mumps and rubella (German measles) vaccines. Reactions are not common but some children get a sore arm and/or a mild fever. One in three thousand children will have a febrile seizure. Although a febrile seizure is very scary for parents, a febrile seizure is not life threatening and never happens again unless the child already has an underlying seizure disorder. An even smaller number of children have an allergic reaction to the MMR vaccine. An allergic reaction is a rare complication of any vaccine. About one in 40,000 children can get a low platelet count. This usually resolves on its own and rarely requires treatment.

How dangerous is measles?

Measles can cause pneumonia and encephalitis (inflammation of the brain) particularly in un-immunized children under 5. About one in five children (or adults) with measles have to be hospitalized. Up to two children per thousand cases die from complications of measles. There is a rare but always fatal inflammation of the brain that can occur up to 7 years after having had measles. It is called subacute sclerosing pan encephalitis (SSPE). When immunization rates in the US were above 90% SSPE disappeared. Unfortunately with the current US outbreaks we may see it again.

In the 10 years before the measles vaccine was available nearly all children got measles by the time they were 15 years old. It is estimated 3 to 4 million people in the United States were infected each year. Among reported measles cases each year, an estimated 175,000 developed pneumonia; 48,000 were hospitalized; 1,000 suffered encephalitis (swelling of the brain); 400 to 500 people died.

As of March 7 the current outbreak in Texas and New Mexico is up to 208 cases, 198 in Texas and 10 in New Mexico. Twenty-three children have been hospitalized. There have already been two deaths in this outbreak, one in Texas and one in New Mexico.

Recommendations

If you were born before 1957 then you have had measles and are already immune. You don’t need vaccination. If you were born after 1957 and you have never had measles vaccine, then you and your children (if they are also un-immunized) should go to your pharmacy or health department and get vaccinated immediately. The risk of measles infection is much much higher than the rare adverse effects of the MMR vaccine. If your child has already had two doses of MMR vaccine after age 1 then he/she does not need to be re-vaccinated.

From 1963 until 1967 an inactivated measles vaccine was used in the US. This vaccine did not give long lasting immunity. If you were vaccinated between those years, you should get at least one MMR booster. From 1963 to 1989 only on MMR vaccine was recommended. If you were vaccinated between those years you should get a booster MMR if you live in an area with a low vaccination rate or if you are planning international travel. After 1989 two vaccinations were recommended. If you were vaccinated after 1989 you don’t need a booster.

Treatment of Measles

Once a child gets measles, there is no treatment other than supportive therapy. There are no antiviral drugs that work against the measles. Virus. Robert F Kennedy Jr, unfortunately now head of HHS, has stated that getting measles vaccine is a personal decision. While that is technically true, nothing else prevents or treats measles. Kennedy has suggested that vitamin A and Cod liver oil can be used to treat measles. There is absolutely no evidence for this and furthermore too much vitamin A can be toxic.

Bottom Line

Measles can be a deadly disease, especially for children under 5. The MMR vaccine is safe and serious reactions are very rare. Two doses of measles vaccine after age 1 gives lifetime 97% immunity to measles. There is no anti-viral medicine that treats measles. Vitamin A and cod liver oil do not work and too much vitamin A can be toxic.

Antivaxxers – What Motivates Them?

The scientific evidence is clear that vaccines, starting with the smallpox vaccine developed by Edward Jenner in 1796 have saved millions of lives. Mild adverse reactions such as fever, sore arm and fatigue are relatively common. Serious adverse reaction to any and all vaccines in use today are extremely rare, on the order of one in a million. These serious reactions are almost always severe allergic reactions that occur immediately and can be treated successfully.

Despite the overwhelming evidence of the safety and efficacy of vaccines, there have always been people who were opposed to vaccines starting with the smallpox vaccine in the 1790’s. Recently, perhaps due to the influence of social media, there are an increasing number of people who think that vaccines are harmful and refuse them for themselves and their children. These beliefs tend to be strongly held and not very amenable to change even when they are presented with the scientific evidence.

In this post I’m going to write about the reasons antivaxxers give for refusing vaccines and explore some possible reasons that it is so hard to change these erroneous beliefs.

Concerns about Safety of Vaccines

Autism

In 1998 Andrew Wakefield and twelve other authors authored a paper that was published in the New England Journal of Medicine suggesting that the MMR vaccine was associated with autism. The paper was eventually found to be based on fraudulent data and it was retracted. In the aftermath of the Wakefield article several large well designed studies showed no evidence of a connection between MMR or any other vaccine with autism. Nonetheless many people opposed to vaccines continue to site the discredited Wakefield paper.

Pertussis Vaccine

In the 1950’s there were some reports of children developing seizures after pertussis immunizations. An extensive review of these cases found no evidence that pertussis vaccine was the cause of the seizures. Because of public concern, the pertussis vaccine was reformulated so that it did not contain dead pertussis bacteria. This is now called acellular pertussis vaccine so that the combined diphtheria tetanus and acellular pertussis vaccine is abbreviated DTaP.

Thimerosal

In the 1960’s some people became concerned that some of the components of vaccines were toxic. The biggest concern was about a preservative called thimerosal, which contained a small amount of mercury. The vast majority of studies showed no evidence of any association between thimerosal exposure in vaccines and any adverse neurologic outcomes, but a few studies showed a slight association. Since 2001, no vaccines contain thimerosal.

Aluminum

Many vaccines contain a small amount of aluminum which serves to as an adjuvant, which means it increases the effectiveness of the vaccine. In large doses aluminum can cause neurological problems and autoimmune diseases. Some people have been concerned about the safety of aluminum in vaccines. Some people think Aluminum in vaccines causes autism. Aluminum is present in food and water in much higher doses than that present in vaccines. It is poorly absorbed and what is absorbed is quickly excreted in the urine.  An FDA analysis shows that the body burden of aluminum following injections of aluminum-containing vaccines never exceeds safe US regulatory thresholds based on orally ingested aluminum even for low birth-weight infants. As noted previously a possible link to autism has been disproved by several large well designed studies.

Formaldehyde

Some people have expressed concern that formaldehyde in vaccines is toxic for children. Formaldehyde has a long history of safe use in the manufacture of certain viral and bacterial vaccines. It is used to inactivate viruses so they don’t cause disease and to detoxify bacterial toxins, such as the toxin used to make diphtheria vaccine. Almost all the formaldehyde is removed in the manufacturing process, but tiny amounts can remain. The body actually makes more formaldehyde which it uses in DNA synthesis than the tiny amount that remains in vaccines.

Lack of Trust

Although all of these concerns about toxins in vaccines have been addressed or disproved, there are still some people who lack trust in the vaccine manufacturers, the medical system and the CDC whose Advisory Committee on Immunization Practices (ACIP) makes recommendations for vaccine administration. Because of this mistrust, no amount of evidence from these groups will convince these people that vaccines are safe.

Religious Objections to vaccines

Although no major religions are opposed to vaccines, certain religious groups refuse vaccination. One common religious objection is that certain vaccines are manufactured by growing virus in fetal fibroblast cells from an aborted fetus. These cells were originally obtained from two aborted fetuses in the 1960’s. The cells have been cultured since then, so it is not necessary to obtain any more cells from fetuses. The viruses are separated from the cells, so that vaccines contain no fetal tissue. The vaccines that are grown in fetal fibroblast cells are the live virus vaccines including measles, mumps, rubella, chicken pox, the Imovax vaccine for rabies and the Janssen vaccine for COVID-19.

Opposition to Mandates

Americans are overwhelmingly supportive of all vaccination mandates with support ranging from a high 90 percent of respondents for DTaP, polio, chickenpox, and MMR to a low of 68 percent for COVID-19. Support of the HPV vaccine is somewhat lower, but still more than 50%. A smaller number of people feel that they should not be forced to vaccinate themselves or their children through state mandates. Some of this group may be willing to receive vaccinations if they feel they have a choice.

Philosophical Objections

There is a group of people who see some benefit in having their children contract certain preventable diseases. Some parents believe that natural immunity is better for their children than is immunity acquired through vaccinations. Others express the belief that if their child contracts a preventable disease, it will be beneficial for the child in the long term, as it will help make the child’s immune system stronger as he grows into adulthood. Some parents believe that the diseases for which we vaccinate are not very prevalent so their children are at minimal risk of contracting these diseases. For this reason, they also believe that the possible negative side effects of vaccine administration outweigh the benefits of the vaccines. Many parents do not see the preventable diseases as serious or life-threatening and would prefer to not put extra chemicals into their children’s bodies. Other parents think if their children have healthy diets and lifestyles they are at a decreased risk of contracting preventable childhood diseases. They also are under the assumption that if they were to contract one of the diseases that it would be easily treatable. Although all of this sounds reasonable on the surface it is absolutely wrong. See the good reasons to administer vaccinations in one of the sections below.

Conspiracy Theorists

Some people have a worldview that it’s commonplace for groups of elites to conduct elaborate and sinister hoaxes on the public, and to do so in near-perfect secrecy. They think this is just how the world works, and to believe anything else is naïve. There is a very strong correlation’s between conspiracy thinking and vaccine resistance.

Beliefs about conspiracies are very difficult to change. Evidence presented against the conspiracy by health care professionals are seen as part of the conspiracy. Conspiracy beliefs about vaccines can include believing the pharmaceutical companies or the CDC are covering up adverse effects of vaccines including that they cause autism.

Desire for Additional Information

Some parents are concerned about what they have seen on social media about vaccines and just want more information from health professionals about the safety and reasons for vaccines. This type of vaccine hesitancy is the most amenable for change by providing honest and clear information about the safety of vaccines.

The Good Reasons to Give Recommended Vaccines

It is true that many (but not all) of the diseases preventable by vaccines were relatively mild in most children. Prior to vaccines, however, 30 per cent of children died before the age of 5 from infectious diseases that are treatable or preventable today. Parents today have never seen a child with diphtheria, whooping cough, or tetanus. These were diseases that killed children prior to the vaccines and they could recur if enough people refuse vaccines.

Polio

The polio virus attacks the nervous system in children. It was a feared disease in the late 19th and early 20th century. In an outbreak in the early 1950’s. Over 2000 people died and many children had permanent paralysis. Paralysis of the respiratory system led to many children being placed in external respirators called iron lungs. Epidemics tended to occur in the summer. Parents kept children away from public gatherings like swimming pools and movie theaters. On April 12, 1955 the Salk vaccine was introduced and mass immunizations began, often in schools. Cases dropped dramatically. Several years later the Sabin oral polio vaccine was introduced. It was so effective that polio was completely eradicated in the United States. Polio vaccine is therefore no longer recommended for children in the US. Pockets of polio virus infection remain in other parts of the world. The most recent cases were in Gaza during the Israeli invasion of Gaza. Emergency vaccination of children in Gaza were carried out and the disease was brought under control.

Measles

Although measles is a relatively mild disease for most children it can be very severe and cause death for some. Before the introduction of measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every two to three years and caused an estimated 2.6 million deaths each year.

Mumps

Mumps prior to the mumps vaccine was very common and mild in most children. Complications of mumps include inflammation of the testes, ovaries and pancreas, hearing loss, meningitis, and encephalitis. These are more common in adults than in children. Mumps was one of the most common causes of aseptic meningitis and hearing loss in children in the United States prior to the introduction of the vaccine.

Rubella

Rubella (German measles) is a mild disease but if contracted by a pregnant mother can result in severe fetal deformities and sometimes still birth. The rubella vaccine prevents rubella infection.

Influenza

Influenza occurs in epidemics. One strain in 1918 caused a pandemic with millions of deaths. There are always deaths from influenza in unvaccinated people every year. Influenza vaccine is effective in preventing or reducing the severity of illness. The influenza virus develops new mutations easily, so the vaccine has to be changed every year. The flu season in the southern hemisphere occurs during our summer, so flu vaccines for the northern hemisphere are developed based on the strains found to be circulating in the southern hemisphere flu season. This process can cause some variation in the effectiveness of the flu vaccine from year to year, but it always offers some protection and reduces the severity of illness from influenza virus.

Haemophilus Influenza

Before the Haemophilus influenza vaccine, this bacteria was the leading cause of bacterial meningitis, joint infection and ear infection in children. This vaccine was introduced after I was already in practice. I treated one case of bacterial meningitis in a child and several joint infections caused by H-flu. After widespread vaccination, I never saw another case.

Varicella (Chicken Pox)

Varicella is a very infectious disease in childhood. There are a few people, especially young infants who have severe disease requiring hospitalization. In the 25 years before the varicella vaccine was available there were over 2000 deaths from varicella. Giving the vaccine at 12-15 months of age protects vulnerable infants, and older people with chronic disease.

Human Papilloma Virus

The human papilloma virus (HPV) , which is transmitted by sexual intercourse, causes cervical cancer in some infected women. The HPV vaccine, given to preadolescent girls and boys prevents 90 % of cervical cancer in women.

Respiratory Syncytial Virus (RSV)

Most children and adults with RSV have mild cold-like symptoms with cough. About 3 per cent of babies with RSV have severe disease and require hospitalization and sometimes have to be placed on a mechanical ventilator. Young infants are more at risk as well as older adults, especially those with chronic disease. There is a vaccine for both babies and adults that is very effective at preventing RSV.

Rotavirus

Rotavirus is a highly contagious virus that infects the lining of the intestines. Symptoms include: High fever, Severe and persistent vomiting, and Diarrhea. It can usually be treated at home, but can cause severe dehydration. Prior to the availability of the oral rotavirus vaccine rotavirus was a leading cause of severe diarrhea in infants and children. There were 70,000 hospitalizations a year for rotavirus and 20-60 deaths per year. The oral vaccine is very effective at preventing rotavirus infection.

Hepatitis b

Hepatitis b can be contacted through sexual intercourse or by contaminated needles. Unlike hepatitis C, there is no effective treatment for hepatitis b. Hepatitis b can cause cirrhosis of the liver as well as liver cancer. Initially the vaccine was given only to high risk people, but it turned out that we were really bad at identifying who was at risk. Hepatitis b vaccine is now given to all babies and it has essentially eliminated hepatitis b.

Pneumoccocus

Before the vaccine, every year pneumococcus caused about 700 cases of meningitis, 17,000 cases of bloodstream infections, 200 deaths and 5 million ear infections in children. The pneumococcus vaccine is very effective at preventing these infections.

Meningococcus

Meningococcus is a bacterium that can cause meningitis or blood stream infection (sepsis). When it occurs It can be treated with antibiotics if caught quickly enough but it progresses so rapidly that people are deathly ill by the time they make it to the doctor. There is now a vaccine to prevent meningococcus infection. It is recommended for all adolescents between ages 11 and 12.

Shingles

Shingles is a reactivation in adults of childhood infection with chicken pox. It is a painful blistering rash along the distribution of a nerve on one side of the body. It can occur on any part of the body. Some people have persistent pain long after the rash is gone. This is called post herpetic neuralgia. Two doses of the vaccine called Shingrix is 98% effective at protecting adults from developing shingles. It is recommended for all adults age 50 and over.

Bottom Line

People can be opposed to receiving vaccines for themselves or their children for many reasons. Some people who just want more information can often be convinced of the safety of vaccines and then agree to be vaccinated. Other reasons such as mistrust of medical and public health sources of information and conspiracy thinking are very resistant to change. Philosophical objections including the belief that getting childhood illnesses gives better immunity and the low risk of infection of vaccine preventable diseases obviates the need for vaccinations are also resistant to change. The diseases that current vaccines prevent, although often mild in most people all have caused hospitalizations and deaths in the period prior to vaccine availability. All current vaccines have been shown to be very safe and associated with only mild transient side effects. Serious reactions to vaccines are extremely rare (on the order of one in a million) and are almost all amenable to treatment.