Great insights! I completely agree that we need more research on why people hesitate to take vaccines and how to address the unfounded concerns that anti-vaccine groups exploit. However, my colleagues and I across the U.S. just had our research on these very topics defunded this week. In termination emails, the NIH stated: ‘It is the policy of NIH [RFK Jr.] not to prioritize research activities that focus on gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment.’ These actions will delay progress in understanding and improving vaccine acceptance for years if not decades.
Thank you, Adam. You raise excellent points about hypothesis testing, evidence and reasons for beliefs. These are all dear to me.
You are right to suggest that we should seek to understand *why* people are hesitant about vaccines.
Here is a partial answer: many people are very concerned about our lack of understanding of what *does* cause autism. Worse, a lack of apparent interest in finding out. Or admitting that autism is even a problem we should address.
When scientists tell the public that the massive increase in the rate of occurrence of autism is all just an illusion, many rightly see this as gaslighting. It is not surprising that some people don't believe scientific claims that the increase, which supposedly doesn't even exist, isn't caused by vaccines.
We can fix both of these. The first step is for scientists — us — to be completely open and honest about what we know and what we don't know about autism. It will be painful to admit that most of the increase is real. Perhaps once vaccine skeptics see honesty about that, they might start to believe that vaccines didn't cause it.
For what it's worth, my speciality is studying the true rate of increase in case occurrence, i.e., incidence. It's the first key in studying the causes.
Thank you for this well-written piece. As a General pediatrician, hospital - based, working in close relationship with community pediatricians, this a hot topic that we face every day, and with growing concern. We are most definitely pro-vaccines, and clear about the solid evidence on the lack of correlation of MMR immunization and autism spectrum disorders. At the same time, we - and parents - believe that 'not all vaccines are created equal' : establishing an equipoise between MMR , Polio vaccines, for example and COVID vaccines is a failed strategy. We also center our practices around the child and his/her support system ( patient and family centered care). As such we can not ignore or dismiss concerned parents after they have read accurate and not-so accurate information in the media and internet of things. I found particularly informational the cited systematic review on addressing vaccine misinformation and wholeheartedly agree with their finding, underscored in your post :'Some strategies, such as scare tactics, appear to be ineffective and may increase misinformation endorsement. Communicating with certainty, rather than acknowledging uncertainty around vaccine efficacy or risks, was also found to backfire' :this was exactly what happened - and failed- with the COVID vaccines: scare tactics were often the rule during the pandemic, nuanced communication of vaccines about risk , benefits and uncertainties led to the universal recommendation of COVID vaccines in children of all ages in the US, something that many scientists, scholars and physicians from other developed nations do not recommend. Well-informed parents are aware of these alternative facts, and they are especially baffled with the repeated slogan of 'scientific consensus' , when such a consensus was and is an illusion. These communication errors and lack of nuance in the official recommendations led to the current situation with record levels of mistrust in science and vaccines.We hope that the leading PH establishment and medical societies can reckon on the mistakes incurred during the COVID-19 pandemic and learn from these communication pitfalls.Unfortunately, we have not seen a candid, clear and sincere recognition and accountability from these mistakes by experts, professional societies or PH authorities on these failed communication strategies : COVID vaccines are still recommended for infants and children of all ages by the CDC...
Regarding the new investigation opened to study the relationship between MMR and autism one more time : this is a refreshing announcement, for us Pediatricians and parents alike. We believe in the concept of reproducibility of science, quite limited nowadays in most of the output from the NIH and the academic and research establishment. We welcome further studies to clarify this matter, that is at the center of the parental concerns in our daily practices. The same concept applies to the cutting of future funds to keep investigating the causes of vaccine hesitancy: we lament that this decision by the NIH as further research on the causes and most effective interventions on vaccine hesitancy are most needed. But we need to be consistent in our approach to science: we should not question further research on the link of MMR and autism , and at the same time criticize the lack of funding for further research on vaccine hesitancy. BOTH topics for further research are welcome by the front-line clinicians.
I just said to my partner, I'm a well educated & pretty smart guy...fact according to my peers...to University degrees, life long learner & active (current) in my profession (approaching 40 yr's).
What my point, there is truly concensus in the medical community & scientific that pharmaceutical companies are not evil nor are they charities & should be profitable.
How profitable can be debated & there is no simple answer.
CoVID vaccines the benefits clearly outweighs the negatives...we don't live in a world of black & white. History may record our current challenges with CoVID & our journey of just shy of 5 yr's as the most significant medical tragedy.
The current madness playing out in the USA that the MMR vaccine is anything short of essential is beyond sad.
RFK Jr spouting less than half-truths & not encouraging vaccinating anyone other than those with a valid medical contraindication should be unconscionable yet he continues to profits from the garbage products & services he promotes. Natural immunity from acute measles certainly results in lasting immunity but the risk of being hospitalized due to pneumonia (RFK'S reference to 'miraculous' results from a cocktail of an antibiotic...sdt for an atypical pneumonia, steroid debatesble benefit Rx pneumonia, cod liver oil, OMG), meningitis, bacterial infection (rationale for an antibiotic), antibody amenesia for previous disease & SSPE albeit rare.
The death of any child from a preventable disease is unquestionably one to many & there had also been an adult death.
Debate if you may other vaccines but please stop questioning the life saving benefits of the current MMR vaccine that requires to documented doses. Those who have not had two doses please get a 2nd. Those in the questable period of natural immunity (varies by country) get a booster dose, no need to have a titre obtain.
Shout back at me if you choose but my fiduciary duty is to those I serve.
My only concern is the challenge of communicating the true science to those misinformed & doing my part to help ensure those at risk are being protected. JJF Phm 🇨🇦
This would be an interesting conversation. Currently reading “We want them infected” by Jonathan Howard, MD. I can’t say the current administration inspires much confidence.
The Wakefield fiasco is used to smear all those with scepticism about the current vaccination policies as swivel-eyed loons.
The most reliable evidence on the benefits and harms of vaccines is from the Danish group run by Professor Benn. They have decades of data on the all cause mortality from vaccinations, mostly from Africa, but some European studies as well . The results are unequivocal. Live vaccines improve mortality over and above the benefits conferred on the target disease. The reverse is true for inactivated cell vaccines, especially in girls, where mortality is worse after vaccination compared with the unvaccinated.
It is not any surprise that there is increasing scepticism about vaccines generally after the misinformation put out by the health authorities on the Covid vaccines. Anyone who read the initial report on the Pfizer vaccine in the NEJM would have picked up there were 3 serious problems on the study that invalidated the impressive claims made. The Astra-Zeneca vaccine, hailed as a UK triumph, vanished within a year because of serious adverse complications. I was a hospital doctor in the UK all my working life and had 4 Covid vaccinations. Having now read extensively, I would not have had any. The efficacy is unknown and the side effects were much greater than claimed. The last post by Adam had some pretty looking graphs of antibody levels with time. Unfortunately, there was no acknowledgement that this is a surrogate measure of vaccine efficacy, and actually have not relevance at all to in the field immunity. There is as much obfuscation of evidence on the pro vaccine side and the anti vaccine side.
The review you cite about independent studies on measles vaccination and the link to autism is in no way ‘independent’. The authors are CDC employees whose job it is to argue for vaccine safety. To quote one their sentences. “Vaccines are extensively tested for safety and efficacy before relicense”. This is just plain false. Pre-licensing studies are too small to establish safety, liability for mandated childhood vaccines is carried by the state, not the manufacturer. The CDC carried out an extensive program of suppressing information, especially on social media, concerning benefits and harms of Covid vaccines.
If I've understood correctly, you're claiming that: 1) it is 'unequivocal' that all inactivated vaccines cause more mortality than they prevent; 2) there is no evidence on the efficacy or effectiveness of COVID vaccines; 3) antibodies have no relevance to protective immunity; 4) the independent studies listed in the above review paper are not independent because they were later cited in a CDC-authored review.
If these are your specific claims, I'd be happy to explain why they're incorrect.
1) Read up on her studies; there are many. A short summary is Lancet Infect Dis 2020 Oct;20(10):e274-e283
2) The data is so contested that nothing can be certain.It is well known that drug company sponsored studies are too subject to manipulation that the results cannot be relied upon. This phenomenon predates Covid studies.
3) That is correct. The relationship of antibody blood concentrations to in the field protection is unknown. Antibody levels are a surrogate measure.
4) This 'study' you cited was a review by CDC employees doing their job in promoting vaccines. Reviews that are not systematic reviews are probably essentially cherry picking the data to support a conclusion. Systematic reviews, where the search methods, inclusion and exclusion criteria for study bias, and analysis are all detailed such that other workers could replicate the review, are the reviews that can be assessed as a full assessment of the evidence.
As a preventive measure vaccines must be safe and effective. Those characteristics should be investigated using Epi studies that employ sound design and honest reporting of the findings. Healthy people coerced to take these injections end up sick, crippled, and dead. We always hear the same statement, ‘benefits outweigh the risks’. It is obvious, that regulatory agencies are influenced by the Pharma companies which has been going on for decades. Public trust is gone for legitimate reasons. As a medical professional I see empirical medical knowledge discarded and approaches changed. For instance, paradigm of natural immunity as the strongest immunity was discarded and people who recovered from vivid were coerced to take Covid injections. Natural remedies boosting immune system were discouraged. Healthy people were demonized as “superspreaders killing granny”. What is the current CDC advice regarding measles? ‘Infected people should be promptly vaccinated to decrease the severity of symptoms’. This is idiotic and dangerous. Do you have evidence that those vaccines are ‘life saving’. There is no public knowledge regarding health status and circumstances of that child who allegedly died from measles prior to death, yet, it is used to ignite mass hysteria and fear. There was a mass vaccination campaign in the beginning of the outbreak, yet we are told about most cases were among ‘unvaccinated’. Did they count vaccinated as unvaccinated for several days? Why did previously vaccinated children got sick? Could vaccine virus cause the outbreak? Yes, it could because it is alive and weakened. What is the quality of manufactured vaccine? It has been reported that Covid ‘vaccine’ vials had high levels of contamination and much different concentrations relative to the approved product. Were there any investigations of quality of MMR and other childhood vaccines? There are many factors that affect vaccine safety and efficacy. Your call ‘don’t conduct anymore studies, just talk people into trusting the government and Pharma again’ is condescending and stupid. Vaccines should be investigated by independent studies. The government relies on manufacturers’ reports contaminated with conflict of interest. It became obvious during Covid and probably was going on for many decades prior.
That’s a long list of scattered questions and points, Gish gallop-style, which isn’t conducive to constructive discussion. To take your final statement as an example, the above piece links to a review with several independent studies.
If you could list why each of these studies is objectively not independent, and what specifically you would consider independent and why (I’m guessing the current US administration and CDC would not count as independent?) then this would be a useful starting point.
Adam, thank you as always! I don't have foot print on social media, I hope those with social media access spread this writing Adam.
There is an article, I think it was in WaPo, on the financial conflict of interest of these anti-vac influencers as well incl. RFK Jr!
Great insights! I completely agree that we need more research on why people hesitate to take vaccines and how to address the unfounded concerns that anti-vaccine groups exploit. However, my colleagues and I across the U.S. just had our research on these very topics defunded this week. In termination emails, the NIH stated: ‘It is the policy of NIH [RFK Jr.] not to prioritize research activities that focus on gaining scientific knowledge on why individuals are hesitant to be vaccinated and/or explore ways to improve vaccine interest and commitment.’ These actions will delay progress in understanding and improving vaccine acceptance for years if not decades.
https://open.substack.com/pub/communityimmunity/p/the-cost-of-nihs-vaccine-research?r=4zhyob&utm_medium=ios
Absolutely right about what is to be done. Here is my modest contribution to this end: https://global.oup.com/academic/product/trusting-science-9780197787106?q=kampourakis&cc=us&lang=en#
Maybe we need to be studying people with questions about vaccine safety! That seems to be the issue we are having trouble with.
Thank you, Adam. You raise excellent points about hypothesis testing, evidence and reasons for beliefs. These are all dear to me.
You are right to suggest that we should seek to understand *why* people are hesitant about vaccines.
Here is a partial answer: many people are very concerned about our lack of understanding of what *does* cause autism. Worse, a lack of apparent interest in finding out. Or admitting that autism is even a problem we should address.
When scientists tell the public that the massive increase in the rate of occurrence of autism is all just an illusion, many rightly see this as gaslighting. It is not surprising that some people don't believe scientific claims that the increase, which supposedly doesn't even exist, isn't caused by vaccines.
We can fix both of these. The first step is for scientists — us — to be completely open and honest about what we know and what we don't know about autism. It will be painful to admit that most of the increase is real. Perhaps once vaccine skeptics see honesty about that, they might start to believe that vaccines didn't cause it.
For what it's worth, my speciality is studying the true rate of increase in case occurrence, i.e., incidence. It's the first key in studying the causes.
Thank you for this well-written piece. As a General pediatrician, hospital - based, working in close relationship with community pediatricians, this a hot topic that we face every day, and with growing concern. We are most definitely pro-vaccines, and clear about the solid evidence on the lack of correlation of MMR immunization and autism spectrum disorders. At the same time, we - and parents - believe that 'not all vaccines are created equal' : establishing an equipoise between MMR , Polio vaccines, for example and COVID vaccines is a failed strategy. We also center our practices around the child and his/her support system ( patient and family centered care). As such we can not ignore or dismiss concerned parents after they have read accurate and not-so accurate information in the media and internet of things. I found particularly informational the cited systematic review on addressing vaccine misinformation and wholeheartedly agree with their finding, underscored in your post :'Some strategies, such as scare tactics, appear to be ineffective and may increase misinformation endorsement. Communicating with certainty, rather than acknowledging uncertainty around vaccine efficacy or risks, was also found to backfire' :this was exactly what happened - and failed- with the COVID vaccines: scare tactics were often the rule during the pandemic, nuanced communication of vaccines about risk , benefits and uncertainties led to the universal recommendation of COVID vaccines in children of all ages in the US, something that many scientists, scholars and physicians from other developed nations do not recommend. Well-informed parents are aware of these alternative facts, and they are especially baffled with the repeated slogan of 'scientific consensus' , when such a consensus was and is an illusion. These communication errors and lack of nuance in the official recommendations led to the current situation with record levels of mistrust in science and vaccines.We hope that the leading PH establishment and medical societies can reckon on the mistakes incurred during the COVID-19 pandemic and learn from these communication pitfalls.Unfortunately, we have not seen a candid, clear and sincere recognition and accountability from these mistakes by experts, professional societies or PH authorities on these failed communication strategies : COVID vaccines are still recommended for infants and children of all ages by the CDC...
Regarding the new investigation opened to study the relationship between MMR and autism one more time : this is a refreshing announcement, for us Pediatricians and parents alike. We believe in the concept of reproducibility of science, quite limited nowadays in most of the output from the NIH and the academic and research establishment. We welcome further studies to clarify this matter, that is at the center of the parental concerns in our daily practices. The same concept applies to the cutting of future funds to keep investigating the causes of vaccine hesitancy: we lament that this decision by the NIH as further research on the causes and most effective interventions on vaccine hesitancy are most needed. But we need to be consistent in our approach to science: we should not question further research on the link of MMR and autism , and at the same time criticize the lack of funding for further research on vaccine hesitancy. BOTH topics for further research are welcome by the front-line clinicians.
Yes a few typos...unable to edit & typing on my phone some are missed
I just said to my partner, I'm a well educated & pretty smart guy...fact according to my peers...to University degrees, life long learner & active (current) in my profession (approaching 40 yr's).
What my point, there is truly concensus in the medical community & scientific that pharmaceutical companies are not evil nor are they charities & should be profitable.
How profitable can be debated & there is no simple answer.
CoVID vaccines the benefits clearly outweighs the negatives...we don't live in a world of black & white. History may record our current challenges with CoVID & our journey of just shy of 5 yr's as the most significant medical tragedy.
The current madness playing out in the USA that the MMR vaccine is anything short of essential is beyond sad.
RFK Jr spouting less than half-truths & not encouraging vaccinating anyone other than those with a valid medical contraindication should be unconscionable yet he continues to profits from the garbage products & services he promotes. Natural immunity from acute measles certainly results in lasting immunity but the risk of being hospitalized due to pneumonia (RFK'S reference to 'miraculous' results from a cocktail of an antibiotic...sdt for an atypical pneumonia, steroid debatesble benefit Rx pneumonia, cod liver oil, OMG), meningitis, bacterial infection (rationale for an antibiotic), antibody amenesia for previous disease & SSPE albeit rare.
The death of any child from a preventable disease is unquestionably one to many & there had also been an adult death.
Debate if you may other vaccines but please stop questioning the life saving benefits of the current MMR vaccine that requires to documented doses. Those who have not had two doses please get a 2nd. Those in the questable period of natural immunity (varies by country) get a booster dose, no need to have a titre obtain.
Shout back at me if you choose but my fiduciary duty is to those I serve.
My only concern is the challenge of communicating the true science to those misinformed & doing my part to help ensure those at risk are being protected. JJF Phm 🇨🇦
This would be an interesting conversation. Currently reading “We want them infected” by Jonathan Howard, MD. I can’t say the current administration inspires much confidence.
The Wakefield fiasco is used to smear all those with scepticism about the current vaccination policies as swivel-eyed loons.
The most reliable evidence on the benefits and harms of vaccines is from the Danish group run by Professor Benn. They have decades of data on the all cause mortality from vaccinations, mostly from Africa, but some European studies as well . The results are unequivocal. Live vaccines improve mortality over and above the benefits conferred on the target disease. The reverse is true for inactivated cell vaccines, especially in girls, where mortality is worse after vaccination compared with the unvaccinated.
It is not any surprise that there is increasing scepticism about vaccines generally after the misinformation put out by the health authorities on the Covid vaccines. Anyone who read the initial report on the Pfizer vaccine in the NEJM would have picked up there were 3 serious problems on the study that invalidated the impressive claims made. The Astra-Zeneca vaccine, hailed as a UK triumph, vanished within a year because of serious adverse complications. I was a hospital doctor in the UK all my working life and had 4 Covid vaccinations. Having now read extensively, I would not have had any. The efficacy is unknown and the side effects were much greater than claimed. The last post by Adam had some pretty looking graphs of antibody levels with time. Unfortunately, there was no acknowledgement that this is a surrogate measure of vaccine efficacy, and actually have not relevance at all to in the field immunity. There is as much obfuscation of evidence on the pro vaccine side and the anti vaccine side.
The review you cite about independent studies on measles vaccination and the link to autism is in no way ‘independent’. The authors are CDC employees whose job it is to argue for vaccine safety. To quote one their sentences. “Vaccines are extensively tested for safety and efficacy before relicense”. This is just plain false. Pre-licensing studies are too small to establish safety, liability for mandated childhood vaccines is carried by the state, not the manufacturer. The CDC carried out an extensive program of suppressing information, especially on social media, concerning benefits and harms of Covid vaccines.
If I've understood correctly, you're claiming that: 1) it is 'unequivocal' that all inactivated vaccines cause more mortality than they prevent; 2) there is no evidence on the efficacy or effectiveness of COVID vaccines; 3) antibodies have no relevance to protective immunity; 4) the independent studies listed in the above review paper are not independent because they were later cited in a CDC-authored review.
If these are your specific claims, I'd be happy to explain why they're incorrect.
1) Read up on her studies; there are many. A short summary is Lancet Infect Dis 2020 Oct;20(10):e274-e283
2) The data is so contested that nothing can be certain.It is well known that drug company sponsored studies are too subject to manipulation that the results cannot be relied upon. This phenomenon predates Covid studies.
3) That is correct. The relationship of antibody blood concentrations to in the field protection is unknown. Antibody levels are a surrogate measure.
4) This 'study' you cited was a review by CDC employees doing their job in promoting vaccines. Reviews that are not systematic reviews are probably essentially cherry picking the data to support a conclusion. Systematic reviews, where the search methods, inclusion and exclusion criteria for study bias, and analysis are all detailed such that other workers could replicate the review, are the reviews that can be assessed as a full assessment of the evidence.
As a preventive measure vaccines must be safe and effective. Those characteristics should be investigated using Epi studies that employ sound design and honest reporting of the findings. Healthy people coerced to take these injections end up sick, crippled, and dead. We always hear the same statement, ‘benefits outweigh the risks’. It is obvious, that regulatory agencies are influenced by the Pharma companies which has been going on for decades. Public trust is gone for legitimate reasons. As a medical professional I see empirical medical knowledge discarded and approaches changed. For instance, paradigm of natural immunity as the strongest immunity was discarded and people who recovered from vivid were coerced to take Covid injections. Natural remedies boosting immune system were discouraged. Healthy people were demonized as “superspreaders killing granny”. What is the current CDC advice regarding measles? ‘Infected people should be promptly vaccinated to decrease the severity of symptoms’. This is idiotic and dangerous. Do you have evidence that those vaccines are ‘life saving’. There is no public knowledge regarding health status and circumstances of that child who allegedly died from measles prior to death, yet, it is used to ignite mass hysteria and fear. There was a mass vaccination campaign in the beginning of the outbreak, yet we are told about most cases were among ‘unvaccinated’. Did they count vaccinated as unvaccinated for several days? Why did previously vaccinated children got sick? Could vaccine virus cause the outbreak? Yes, it could because it is alive and weakened. What is the quality of manufactured vaccine? It has been reported that Covid ‘vaccine’ vials had high levels of contamination and much different concentrations relative to the approved product. Were there any investigations of quality of MMR and other childhood vaccines? There are many factors that affect vaccine safety and efficacy. Your call ‘don’t conduct anymore studies, just talk people into trusting the government and Pharma again’ is condescending and stupid. Vaccines should be investigated by independent studies. The government relies on manufacturers’ reports contaminated with conflict of interest. It became obvious during Covid and probably was going on for many decades prior.
That’s a long list of scattered questions and points, Gish gallop-style, which isn’t conducive to constructive discussion. To take your final statement as an example, the above piece links to a review with several independent studies.
If you could list why each of these studies is objectively not independent, and what specifically you would consider independent and why (I’m guessing the current US administration and CDC would not count as independent?) then this would be a useful starting point.
What is your definition of independent studies? would you mind to elaborate?
What kind of medical professional you?