EDITORIAL: VACCINES AND AUTISM: THE CONTROVERSY AND THE SCIENCE
By Dr. Joel A. Harrison
March 1, 2009 (San Diego) — On February 12, the U.S. Court of Federal Claims in Washington, D.C. rendered its decision finding no link between autism and vaccines. While researchers, doctors, and public health officials feel vindicated, hoping that vaccination rates will increase, many parents of autistic children are distraught. Autism devastates families both emotionally and financially. People seek answers as to why, both to lay blame and to prevent future cases, and to obtain necessary resources. There are three interconnected issues surrounding the autism-vaccine controversy: 1) the science, 2) vaccination rates, and 3) helping families.
The Science: At first a link was claimed between a mercury-based preservative, Thimerosol, and autism. However, rates of autism continued to increase in cohorts of children receiving thimerosal-free vaccines. Proponents of the thimerosol link claimed the fetus is still being exposed to trace amounts of thimerosol from vaccines given to their mothers. It makes no sense that rates would continue to increase as levels of exposure decrease to trace levels.
The second alleged link was exacerbation of an underlying mitochondrial disorder. Mitochondria are the energy factories of our cells. For proponents of this link, the vaccines, by triggering an immune response overtax an already defective system. Our immune systems respond to literally thousands of potential threats every day, microbes and foreign substances in the air we breathe, the food and drink we consume, and especially in children the ever-present scrapes and cuts.
Vaccines are composed of killed microbes or extremely weakened ones. How can a few killed and weakened intruders over several months possibly cause harm when the child's immune system over the same period of time has responded to tens of thousands of intruders, many much more dangerous? Children with undiagnosed mitochondrial disorders are subject to the same quantity and array of intruders.
I am a member of the baby-boomer generation. Most of my generation experienced not one, but all of the childhood diseases: measles; rubella; mumps, chicken pox; and influenza, plus the ubiquitous common colds, scrapes and cuts. Any one of the childhood diseases involved a major assault on our bodies demanding maximum output from our mitochondria, not for a few hours; but for days and even weeks.
Many years ago I taught undergraduate courses aboard U.S Naval ships in the Pacific. Prior to my first deployment, I "walked" the gauntlet, receiving vaccinations for smallpox, yellow fever, plague, typhoid/paratyphoid, cholera, tetanus, pertussis, polio, measles, mumps, and rubella. That evening both deltoid muscles were sore and I briefly ran a low grade fever, nothing remotely compared with any of the experienced childhood diseases.
At no time are today's children receiving remotely as many vaccinations in such a short time period. Additionally, while the number of vaccines has increased, the total number of antigenic determinants (the foreign proteins that our immune system responds to) is less. The smallpox vaccine alone, which is no longer given, contained a significant number of antigenic determinants.
Mitochondrial disorders do not manifest themselves immediately; but most cases do become symptomatic within the first 5 - 10 years of life. It is possible that vaccinations may shift symptomatology by a few weeks; but eventually a common cold or a minor infection will elicit the disorder. In addition, imagine the devastation to these children if, instead of the vaccines, they suffered any of the full-blown childhood diseases.
Some parents feel that rejection of the link between vaccines and autism by the scientific community means abandonment. In fact, research on causes and treatments for autism is increasing. Squandering resources in continuing to disprove the connection with vaccines just slows viable lines of research.
Vaccine Rates: Unfortunately, the need for simple answers, in this case blaming autism on vaccines, has lead to ever diminishing rates of vaccinations. The diseases we vaccinate for are real and still exist in the world. They cause millions of deaths and disabilities around the world. With international flights and our porous borders they can infect American children at any time. For those skeptics, five unvaccinated Amish children came down with polio in 2005 and there have been several recent outbreaks of measles (for those who believe measles harmless, besides permanent disabilities, measles kills approximately three per 1000). If only a few parents refuse childhood vaccinations, the risks are small; but as the numbers grow, we all become at risk, both our children and adults who have been vaccinated. Vaccines have been thought to confer lifetime immunity; but, in fact, immunity subsides over time. While the risk of exposure remains small, the residual immunity still can protect us; but if an epidemic should break out, then repeated exposures could overwhelm residual immunity and childhood diseases caught as adults are usually far more severe and deadly.
Helping Families with Autistic Children: Families with autistic children, when left to their own resources, are simply overwhelmed. Lawsuits by desperate families are a gamble at best. Blaming vaccines for conditions based on unsubstantiated conjecture, misunderstood science, and compassion for the families of disabled children has resulted in families refusing to vaccinate their children and in vaccine shortages as fewer pharmaceutical companies are willing to manufacture them. If this trend keeps up, it could be catastrophic.
Suggestions:
- To ensure that all children diagnosed with autism-spectral disorder receive the best medical care we have to offer, they should be covered by Medicare just as we cover end-stage renal disease. However, coverage for these children should include no deductibles, no co-pays and no need for supplementary insurance.
- Additional funding for special education programs, and
- Special funding for counseling and other support resources, including respite care.
Besides being the right and compassionate thing to do, this is a prime example of "there but for the Grace of God go I." Autism is a devastating disorder that could happen to any family. Research efforts around the world are working to discover its cause(s) and develop treatments. The continued efforts to link autism to vaccines is leading to shortages of vaccines and parents refusing to vaccinate their children placing not only their children; but all of us at risk. We as a compassionate society need to develop programs that support these tragic families.
Recommended Reading: For those wanting to study the history and scientific issues, I highly recommend a new book by Dr. Paul A. Offit, Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure. In addition, the CDC has an excellent website on Autism including information on autism and vaccines and links to other websites which can be found at www.cdc.gov/ncbddd/autism/index.htm. Finally, for those interested in the history of vaccines, I encourage them to read a fascinating book by Arthur Allen, Vaccine: The Controversial Story of Medicine's Greatest Lifesaver.
Joel A. Harrison, PhD, MPH, a native San Diegan, is a semi-retired epidemiologist. He has worked in the areas of preventive medicine, infectious diseases, medical outcomes research, and evidence-based clinical practice guidelines. He is currently active in supporting the adoption of a single-payer health care system in the U.S. For more information on single-payer go to Physicians for a National Health Program's website at www.pnhp.org