Musings on Vaccines

The vaccine debate is important to me. 

I have spent a considerable amount of my time, money, and energy to train and work as a doctor, largely because I genuinely care about helping people, especially those who are most disadvantaged (i.e. children from poor minority-ethnic families). Generally speaking, I am persuaded that  vaccines are one of the best means to this end. The vaccine debate is about more than just vaccines though. Its about how we as Christians interact with the health-care system, indeed with any secular system. I think more damage than good has resulted from those who are publicly anti-vaccine, and even MORE damage results from those displaying unhelpful attitudes (even if their vaccine-specific rhetoric is more 'moderate').

Below are some of my musings :) 

Just a few points to note before we begin. Obviously there are legitimate concerns about vaccines (and about the secular health-care system) that need acknowledging and addressing. And despite (mostly) exemplary motives, the health care professions do frequently fall short of the high ethical and communication standards society sets for them. And Christians do have a complex mix of responsibilities that are difficult to balance - which includes a responsibility to think and act differently within the world. This is far from a complete discussion on vaccines, and my aim is mainly to provide some balance to some specific biases I believe already exists. So I won't be delving into the legitimate concerns I acknowledge above - but I'm happy to discuss them if they become relevant in the comments. Also, these musings belong to me and do not officially represent any professional consensus (though I think it closely matches the medical consensus). 

I would like to see a robust discussion in the comments! We're all in need of ongoing learning, and even if our beliefs remain unchanged, I would like us all to become more understanding and empathetic of those who disagree with us. 

Ultimately I just want Christians to be able to navigate this issue well, while remaining Christlike, and without damaging the health of the most vulnerable in society.

NO 'BENIGN' POSITIONS

Refusing vaccines and promoting refusal is not a benign 'natural' decision - just like 'vaccines' are reported to do, refusal has potential to contribute to diseases and death in children, particularly amongst the most deprived. We can't hide behind the excuse of 'not rushing into an unjustified decision', since both are decisions claiming huge consequences. 

And we can't hide behind our individual isolated 'rights' to choose - we also have ethical responsibilities to those around us. The effects of vaccine refusal on our community is not spread by disease, but by rhetoric and attitude as well - and so our responsibilities to others require us to take all these things seriously.

INFORMED RISK-TAKING

We all take informed risks all the time (think about driving a car). Acknowledging risk in no way makes a decision a bad one. And 'risk' has a pretty broad definition when it comes to contemplating different choices - this is important to remember when considering the alternatives to a choice that is deemed risky (i.e. taking vaccines, or driving a car). The 'risk' of NOT driving your car, for example, includes having less time free to work and play and do household chores, and being unable to attend your favourite band's concert in a neighbouring city. Refusing vaccines carries its own risks - not only to you, but to others - and not only of risk of disease, but of spreading ideas and attitudes and rhetoric. People have a right to make their own choice between the various risks, and other members of their community also has the right to ask them to behave in a way which (they think) maximises the wellbeing of the community.

We should never take any risks based on fear or pressure, even if your decision may happen to line up with what's best - don't take vaccines based on fear, but equally don't avoid vaccines based on fear. The motivation behind the legal requirement to interview adolescents away from their parents, and parents away from each other or their midwife / friends etc, is to remove very common external pressures. Its the motivation for 'probing' into the reasons for refusal. People are rarely emotionally coerced into choosing vaccines (though it does occasionally happen, unfortunately) - but this is a common reason for refusal. Obviously it is difficult to achieve freedom from emotional coercion - while still providing information - when one believes there are serious risks behind various choices. But we need to try.

GETTING INFORMATION

The best chance of making an informed decision about risk, is to trust the summaries provided by those who have trained hardest to interpret the evidence and provide such summaries, and who are genuinely motivated by your wellbeing without being too emotionally attached. 

Extensive training is required to make any progress in avoiding our ingrained human biases and interpreting evidence properly. Even with extensive training, it is a headache to navigate these turbulent waters. Its not a simple matter to 'reading' studies or personal anecdotes. We are designed to jump to conclusions quickly, and from that point on to doggedly (subconsciously) interpret the world in a way that supports our conclusions. We can be drastically unreasonable about this. We can't avoid it altogether (doctors suffer from the same human condition), but at least we can minimise it through training, and through maintaining some level of emotional objectivity.

Attempts at providing information for informed risk-taking should avoid the converse problem of information overload. If doctors find it difficult to interpret that evidence, how do we expect those without training - or those with emotional investments - to do so properly? Often people react to this overload by making a decision they deem as a 'natural middle ground' - which actually means sticking with their pre-existing position i.e. vaccine refusal. 

This is why doctors find it difficult to provide 'evidence' for vaccines to concerned parents. The evidence is not simple to navigate (anyone who claims otherwise is lying), but this doesn't mean that conclusions can't be drawn which are overwhelmingly supported. And they have to navigate parental emotional investment, an inclination to refuse vaccines when faced with information overload, and powerful vaccine-refusing rhetoric (claiming that their evidence IS straightforward).

'EXPERIMENTAL' MODERN MEDICINE

The supposed tension between 'modern experimental' medicine and 'alternative' medicine is an illusion - all foods, drugs, and treatments have a degree of uncertainty associated with their effects, but this doesn't mean reasonable conclusions can't be drawn from the evidence. Honesty about the evidence is what leads doctors to recommend what has come to be known as 'modern Western' medicine, over alternatives - there's just more evidence available for the former. Our conclusions about modern medicine are actually more robust than those that can be formed about alternative approaches to health - even IF those conclusions end up being are a complex mix of negative and mildly positive effects. This doesn't mean we've found the best treatments - it just means that, with the greater body of evidence, we can make more certain claims. Homeopathy and vaccine refusal may end up with greater health benefits than vaccines, but they can't meaningfully talk about it because they don't have as much data. Unfortunately money does drive most research, so it is difficult to gather data about treatments that can't be patented - but this doesn't change the fact that we have a better chance of being right about our conclusions regarding modern treatments, than about any claims from alternative medicine. 

Money can cause most people (not only doctors, but alternative treatment proponents as well) to become untrustworthy, including doctors. NZ has one of the least medical biased systems in the world precisely because the money side of things is removed from the picture. The politicians deal with money and advertising and purchasing. This means doctors are restricted in which treatments they can offer, but this is a reasonable sacrifice for the benefit of being free from monetary pressure and advertising bias. We are free to act based on our genuine concern for people's welfare. This is why we recommend vaccines. There is nothing more sinister going on - for most of us as individuals, anyway. 

NEGATIVE EFFECTS

The 'side effects' of vaccines have always been exaggerated - but they are gradually getting minimised by the accumulation of evidence. By far the majority of concerns regarding vaccines have been systematically and thoroughly disproven as we gather more data, and the position in favour of vaccines becomes stronger and stronger. There are still some unanswered questions and uncertainty - particularly surrounding newer vaccines - but the track record of allaying fears is encouraging.

Studies that demonstrate side-effects are often poorly designed to produce bias. Or, when incorporated into the big picture of all the OTHER evidence available, they don't produce significant results. Many of the studies are also taken out of context and interpreted in a way that was never intended - for example, most countries have a system for reporting adverse effects to medicines and vaccines. Even when legally 'mandatory', the data collected is still ultimately volunteered by health professionals or patients - so the system is automatically biased to collect data confirming patient's suspicions. There are no measures in place to confirm the validity of this reporting, or to discover the 'real' incidence of such 'adverse effects' in the vaccinated / unvaccinated populations. These systems can highlight areas for further robust research, but they can't produce conclusions on their own because of the rampant bias.

An important consideration is incidental correlation (as opposed to causation). People really do just randomly die, have seizures, develop influenza, get early menopause, have headaches and nausea, etc - all for no apparent reason. A certain proportion of vaccine takers will also have these things, but not caused by the vaccine. But those that occur after vaccines will get noticed, remembered, and reported (unlike many of the others). This is especially true for childhood vaccines, which are given around the time that such symptoms / effects can become obvious (e.g. learning disabilities, epilepsy, etc), leading to the assumption that the vaccine was causal.

Vaccines can contain heavy metals, but at lower concentrations than many foods. They contain immune-stimulating molecules (some call these 'toxins'), but vastly fewer than what babies encounter through their normal external environment. Very few vaccines have any link to human embryos, but some do require normal human cells to culture - these cells are almost always obtained from replication after replication stemming back to two aborted foetuses decades ago. They are normal human cells, the don't make their way into the finished vaccine product, and no further embryos are aborted for vaccine development or research.

HPV VACCINE

There has been recent debate over the HPV vaccine, a relatively new vaccine which differs to most others in that it doesn't prevent a nasty childhood disease. It prevents infection with the HPV virus - a sexually-transmitted virus which is the major cause of cervical cancer. So the vaccine prevents adult cancer which is typically seen as a consequence of behavioural choices - hardly the virtuous image of vaccines we typically recognise. Because it is new, we have less data available for this vaccine than for other vaccines. And we are still learning (as we should) about the full effect of the vaccine - both positive and negative.

Some take issue with the idea that children are vaccinated to prevent an STD. Why assume they will contract the disease? Why not aim for abstinence until marriage instead? However, HPV is NOT a disease only of sexual license - any number of partners >1 can pass it on (and likely will, given that most people are infected). It can also be passed on without sexual contact. And multiple 'partners' doesn't necessarily equal immorality - think of divorcees, remarried widows, victims of abuse, and those used to live in sin but have now repented. Its not that we're questioning a child's morals - we're trying to protect them from future worry.

NZ cervical cancer rates are very high (internationally speaking). While the numbers may seem small, the risk of cancer needs contextualising - its higher than the risk of dying on our roads. This priority of cervical cancer probably resulted in more 'rush' for the HPV vaccine than for other drugs/vaccines. But this doesn't make the rush unreasonable - we just need to inform parents that there's slightly more uncertainty about its effects.

CHRISTIAN ATTITUDES

Christians are called to love, gentleness, submission, grace, humility, and a focus on the good God has preserved in society. Whereas in-submission, speaking your mind too quickly, being prideful about your viewpoint, and not giving people the benefit of the doubt is seen as anti-Christian. There's no simple formula about how to integrate these things with our commands to be wise and to stand against injustice and societal evils. But its something we should feel the weight of. This should come through our discussions.

The rhetoric I hear around vaccines all too often demonstrates the opposite - we don't 'feel the weight' of getting our attitudes right. We just blurt our minds out. We just assume we (somehow) know better. We automatically distrust others. We are happy to use misleading rhetoric (choice of words, selective reporting of facts, distraction techniques, etc) to maximise the powerful effect of our opinions till it is way out of proportion to what they deserve. For example, doctors aren't out to 'bully' you into taking vaccines, or to 'experiment on little girls' - we genuinely want to help. But stating the facts (we try to talk to pre-sexual girls away from their parents about the vaccine in order to minimise emotional coercion) just doesn't have the emotional impact. Would Christ be pleased with such rhetoric? Does it display Christ-like attitudes? I don't think so.

What frustrates me most is that displaying these opinions on the internet contributes to much of the devastation I have to deal with daily, and makes it more frustrating and difficult because the people I'm trying to help don't trust me. Those most affected by these opinions are the poor and disadvantaged - something people often don't realise when they make such statements.

Obviously I need to have the same attitudes in my promoting of vaccines. That's something I'm working on :) Hopefully the discussion in the comments below will be help!