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I spend much of my time as a high-school science teacher trying to explain to my students how science works. The scientific method, as we rather pompously call the way science is done, is really quite a simple concept — observe, without preconceptions, and then draw conclusions based on those observations.

Of course, it’s not always that easy. There is an additional layer through which observations must be filtered — established science. If I start observing, let’s say, neutrinos travelling faster than c, the speed of light in a vacuum, a speed which for some time now has been understood to be God’s speed limit for the universe, then I’ve got some serious explaining to do, and my conclusions will need to take into account both the established understanding of why c has, until now, been understood as the fastest possible speed, and why it could be that particles have been observed exceeding that speed.

But even within this complication, the idea of c being the fastest possible speed in our universe is simply an observation, albeit one that has its basis in sound mathematical modelling and one that has been tested to within an inch of its existence over a century or more. If evidence to challenge that idea is presented, then that evidence must be similarly evaluated, tested, scrutinised, and, if the new evidence holds up, the theory that says that c is the fastest speed possible must be abandoned.

And so it should be with any scientific discourse. There is no room for dogma, for unquestionable facts, for ideas that have become so firmly entrenched that they cannot be challenged. But that is precisely what has happened in a number of fields — climate change is a classic example, but the one I’m going to risk looking at today is vaccination. Both of these topics is a battlefield of mud-slinging, of deeply-entrenched beliefs and opinions on both sides, that intelligent, open and honest debate is, at least in popular fora, all but silenced, with each side preaching to its own choir and hurling abuse at the other. This is not how we do science.

A recent blog post by Jennifer Raff of the University of Texas, Dear Parents, You Are Being Lied To, has made its way round the internet lately. It’s been picked up by the Huffington Post, and I Fucking Love Science, among others, and, rather sadly, it shows more clearly than ever the danger of science becoming settled, becoming canonised as dogma, being put so far beyond challenge and question that no intelligent debate about the topic can ever be tolerated, and that any debate that does take place is couched in such broad, simplistic terms as to be all but meaningless.

The debate about vaccination, such as it is, has descended so far into black-and-white, right-and-wrong binary bickering that it is now very difficult to find a sensible discussion of the matter. Dr. Raff offers a diatribe supporting vaccines, on that contains such gems as:

They say that vaccines haven’t been rigorously tested for safety.
But vaccines are subjected to a higher level of scrutiny than any other medicine. For example, this study tested the safety and effectiveness of the pneumococcal vaccine in more than 37,868 children.

They will say that doctors won’t admit there are any side effects to vaccines.
But the side effects are well known, and except in very rare cases quite mild.

Vaccines? Vaccines? This, right here, is the entire problem that we face. There is no nuance, no subtlety, no willingness to engage in sophisticated argument any longer. On both sides, “vaccines” is a thing, a monolithic construct much as “drugs” has become a single thing in much of American discourse, even as Colorado and Washington show the ability to distinguish between the deadly and the trivial and legalise marijuana while continuing to outlaw heroin.

The problem with the current discourse on vaccines is this very lack of nuance. Vaccines exist to address a wide range of medical needs, and must be considered individually, on their own bases, not as a single construct. Let’s actually do that, shall we? Let’s do some grown-up thinking.

Smallpox is a nasty, nasty disease. If it doesn’t kill you, you’ll likely spend a good amount of time wishing it would. The first vaccine was developed to combat this very illness — the story of Edward Jenner injecting test subjects with cowpox germs is quite well-known. And it has been quite splendidly effective — the World Health Organisation have declared it eradicated since 1979. We no longer vaccinate against smallpox. Clearly, some vaccinations are simply unnecessary.

Other illnesses have, similarly, become less essential. Take tuberculosis for example — I was vaccinated as a teen, as was standard practice in the United Kingdom in the early 1980s. But, given the effectiveness of the vaccine, TB is a relatively rare disease in the UK today, and vaccination is no longer a matter of course, but rather is administered according to assessed need. This, I would suggest, is a sane, rational, evidence-based approach to vaccination. It is also, I would argue, a proportionate response to a the risks of a very harmful illness.

Polio, similarly, is an awful disease, with a simple immunisation process and a very high success rate — last year saw less than 500 cases worldwide. The case for vaccination against polio is clear — it is still at large, and immunisation is required to prevent its spread outside the handful of countries where cases were reported.

There is, quite clearly, a case to be made, a very strong case, in favour of vaccination against a wide range of dangerous, debilitating conditions. But there are also plenty of diseases on some countries’ vaccination schedules that really, simply don’t need to be there. Perhaps the most obvious example is chicken pox; in the United States, the Centers for Disease Control recommend “two doses of the vaccine—the first dose at 12 through 15 months old and a second dose at 4 through 6 years old.” Chicken pox is simply not a life-threatening or debilitating disease, and yet the CDC continue to recommend vaccination.

Chicken pox has been removed from the vaccination schedules of countries such as the UK and New Zealand. But in America, fail to have your child vaccinated against chicken pox and you can be labelled an “anti-vaxxer.” Anti-vaxxers are, apparently, anti-science; apparently, since I don’t agree with vaccinations against chicken pox, I’m an anti-vaxxer, and therefore scientifically illiterate, but I’m in good company, it would appear.

Much of the anti-vaxxer movement…wait, let me stop for a second. “Anti-vaxxer movement?” How can anyone engaging in scientific discourse be anti-anything? Unless, of course, you’re anti-(anything that’s not actual, real, supported by evidence science). And how can you have a movement in science? “I’m philosophically and morally opposed to leptons?” “Covalent bonds are of the devil?”

But anyway. Among those who argue against all vaccination — itself as weak a position as those who argue for all vaccination, since it’s a position that tolerates no nuance, no dissent, no close analysis — there is a fatal problem, in the shape of one of the most obnoxious abuses of science of recent years. The MMR vaccine controversy engineered by Andrew Wakefield in 1998 is well-documented, so I won’t rehash it in any great detail here; it’s enough just to remind ourselves that, despite deliberately falsified and fraudulent reports to the contrary, there is no established link between the MMR vaccine and autism. By all means challenge the appropriateness of vaccinating against measles (probably a good idea, especially if you’re in the third world), mumps (probably unnecessary; the complications for males, while quite unpleasant, are very rarely life-threatening) or rubella (highly recommended, for girls), but please don’t try to cite Wakefield’s comprehensively discrediting writings. You can’t — you simply can’t — make the case that vaccines, that huge, broad, vast class of medicines, cause autism.

Just because people who don’t vaccinate have shot themselves in the foot with the Wakefield fiasco, though, this does not mean that pro-vaccination types have won the battle, and it is now acceptable to condemn anyone who doesn’t totally buy into the vaccination schedule of the country you live in. As we’ve seen, the British and New Zealand health services could easily be condemned by American supporters of blanket vaccination as “anti-vaxxers,” since children in these two countries are not routinely given the varicella vaccine.

There is no such thing as “vaccines.” There simply isn’t, any more than there is such as thing as “drugs.” Some drugs are inherently dangerous, some are, when administered thoughtfully and carefully, very beneficial. The same is true of vaccines — there is plenty of merit in keeping a lid on polio, or tuberculosis, and there is a lot to be said for preventing rubella in girls before they can reach child-bearing age. But similar arguments cannot be made for mumps, or chicken pox, and yet it is impossible to hold even such a slightly shades-of-great opinion on vaccines without being labelled, by one side, an “anti-vaxxer” because I question the need for chicken-pox vaccines, or a “vaccinator” by another because I do see merit in vaccinating against polio.

Science is many things, but one thing it simply is not is settled. There is, and always will be, debate on either side. It is dangerous to scientific thought and progress to imagine that the book is closed on any area of science, on any branch of scientific endeavour or exploration. That includes the science of vaccination.

One response to “On vaccines, science, and open minds”

1. Kat says:

   June 5, 2014 at 4:25 am

   Hi!

   Thanks so much for this reasoned response to the vaccine/immunization issue.

   I was wondering whether you or anyone else has any data on how many vaccinated children/people come down with the diseases that they’ve been vaccinated against. In all the news coverage that there is when there is a supposed outbreak, I never hear anyone talk about how many of the people taken ill have actually been vaccinated. There just seems to be an assumption that it’s people who haven’t been vaccinated.

   Before I start rambling with far more questions than answers, I’ll stop here.

   Cheers : >

   Kat (England)

   Reply