Clear Thinking About Vaccines

Instead of trying to settle the controversy about vaccines, I want to target those who are genuinely curious, confused, or otherwise unclear about the question of whether it's a good idea to vaccinate your kids.

My method is not to offer incontrovertible facts, but instead provide a pathway to the question that might lead the reader to conclusions that feel suitably rational.

The simplest path is that is to consider what the medical field thinks about vaccines. Although medicine may seem cooly scientific, internal debates rage about the efficacy of even the most straightforward treatments. Mainstream figures in medicine make compelling arguments that the standard treatments for common conditions like heart attack and stroke are more harmful than helpful. This trial, published in the New England Journal of Medicine, found that coronary artery stenting for a large portion of heart attacks was unhelpful. This study in the same journal is one of many that question the value of mammograms, and this paper in the Annals of Internal Medicine questioned whether treated blood sugar in diabetes is helpful. Vigorous debate persists in most areas of medicine, with prominent voices attacking the special interests of pharmaceutical companies, hospitals, government, and medical practitioners themselves.

But there is an area in medicine with nearly universal agreement - the effectiveness of childhood vaccines. Societies of pediatricians, internal medicine, and (most comprehensively) public health  all recommend the standard vaccines. Prominent dissenting views are very hard to come by. The conspiracy theorist might think such uniformity of opinion represents an effort by the powerful (the government, big pharma, the medical industrial complex) to quell dissent, but it still raises the question of why vaccines? How did the powerful suppress physician dissent in this area, but not in high revenue areas like cardiovascular disease, mammography or diabetes?

One physician does stand out as a notable exception. According to many, Andrew Wakefield triggered the modern antivax scare with an article published in The Lancet in 1998 linking the measles mumps rubella vaccine to autism. He was subsequently found to have received money from parents of children with autism and to have filed a patent for an alternative MMR vaccine. His papers have been retracted, and he is widely considered to be a fraud.

This is not to say that all vaccines are considered a slam dunk. There is some minor yet legitimate squabbling about the effectiveness of vaccines like that for lyme or the old shingles vaccine. There are debates about whether the HPV vaccine should be given to boys, or whether healthcare workers should be compelled to get the flu shot. But the importance of vaccines for childhood terrors of yesteryear like diphtheria, measles, and polio are a rarity in medicine - they receive nearly unanimous support.


I will start with a few questions.

1- Is it controversial that smallpox, diphtheria, measles and polio killed and maimed hundreds of millions of people?

This question leaves almost zero room for denial. Yes, it's possible that there is a widespread, continual and successful effort to fake the history books, but to spend more than 5 seconds entertaining such a conspiracy is to step decisively into unreason.

2- Is it controversial that vaccines have eradicated or nearly eradicated smallpox, diphtheria, measles and polio?



3- Is it controversial that there could be measles, diphtheria and polio outbreaks, and subsequent deaths and morbidity, if vaccination rates drop?




4- Are the chances of a bad outcome from a vaccine, more than just some soreness or a few days of generalized malaise, more than about 1 in a million?

Each of these points is mainstream thinking according to the bulk of experts in the field. The likelihood of any one of them being wrong requires a massive revision of our common understanding of the world. Let's take them one at a time:

1- The standard story among countless historians is that viruses like smallpox were responsible for the majority of deaths among Native Americans following the arrival of Europeans. Sure, it's possible that the history books have it wrong, and I'm sure there are people denying these facts, but I've never even heard of them. Refutation of such a well established historical fact as this would require truly staggering evidence.

2- Smallpox is generally understood to be eradicated. Diphtheria, measles and polio are vanishingly rare, with polio on the very of eradication globally and measles and diptheria no longer considered endemic in the United States. Cases of these diseases in developed countries number in the low single digits annually. As in item 1, to doubt this fact is to invoke a global coverup of massive proportions. Either millions are still dying of these diseases in obscurity, or these diseases were never a scourge in the first place. A credible position on either point requires massive evidence.

3- This point is less obvious than the first two, but still quite

If you truly think that the answer any of these questions is yes, then the burden of proof