TIME vaccines

Very Good and Very Bad News in the Vaccine Wars

Just say yes.—but too many Americans say no to vaccines
Just say yes.—but too many Americans say no to vaccines Steve Debenport; Getty Images

Like any trench war, the fight to protect America's kids against disease is proceeding only inch by inch. A new report shows why there's reason for hope—and reason for worry

It’s just as well that no one knows the names of the 17,253 sets of parents in California who have opted not to have their children vaccinated, citing “philosophic” reasons for declining the shots. The same is true of the anonymous 3,097 in Colorado who have made the same choice—giving their far smaller state the dubious distinction of being dead last among the 50 states and the District of Columbia in the simple business of protecting their children against disease.

On the other hand, kudos to you, Mississippi, for finishing number one—with an overall kindergartener vaccination rate in the past school year of 99.7%—and to you, Louisiana, Texas and Utah, for finishing not far behind. Your children, by this measure at least, are the safest and healthiest in the country.

These and other findings were part of the alternately reassuring and deeply disturbing survey from the CDC’s Morbidity and Mortality Weekly Report (MMWR), looking at vaccination coverage for more than 4.25 million kindergarteners and the opt-out rates for more than 3.9 million in the 2013-2014 school year

The report’s top line number seems encouraging. The national compliance rate for the three major vaccines covered in the survey ranged from 93.3% (for chicken pox) to 94.7% (measles, mumps, rubella, or MMR) to 95% (diptheria, tetanus, pertussis).

But even those numbers don’t mean America has aced the test. Vaccination rates need to reach or exceed 95%, depending on the disease, to maintain herd immunity—the protection afforded by vaccinated people to those few who can’t be vaccinated, by giving the virus too few ways to body-surf its way across a population until it finds someone who’s vulnerable. So while a 90% vaccination rate might look like an A, it in fact may be no better than a middling C.

And in some parts of the country, the numbers are much, much worse. As I reported in TIME’s Oct. 6 issue, vaccination refusal tends to be a phenomenon of the wealthier, better educated, politically bluer parts of the country—the northeast, the Pacific coast and pockets around major universities. Those are communities in which folks know just enough to convince themselves that they know it all—which means they know better than the doctors, scientists and other members of medical community at large, who have overwhelmingly shown that vaccines are safe and effective.

That’s part of the reason New York City’s elite private schools have vaccination rates far lower than the city’s public schools, and why, according to a shocking story by the Hollywood Reporter, some schools in the wealthier neighborhoods of Los Angeles have a lower vaccination rate than in South Sudan.

Digging deeper into the MMWR report, there are other, broader causes for worry. There are the 26 states plus the District of Columbia that don’t meet the Department of Health and Human Services’ guidelines of 95% coverage for the MMR vaccine. There are the 37 states that don’t even meet the CDC’s standards for properly gathering data on vaccination rates in the first place. And there are the 11 states with opt-out rates of 4% or higher.

The anti-vaccine crowd frames the refusers as part of a brave vanguard of parents who won’t be hectored into getting their children protections that they, the parents, have decided are useless or dangerous. But it’s worth remembering what the world looked like in the era before vaccines. And you don’t have to work too hard to do that, because you know what it looked like? It looked like West Africa today, where people are being infected with the Ebola virus at a rate of 1,000 new cases per week—on target to be 10,000 by December—where entire families and indeed entire villages are dying agonizing deaths, and where whole populations would line up by the millions for the protection a vaccine would offer.

Vaccine refusal is increasingly the indulgence of the privileged. And it is, as the Ebola crisis shows, the indulgence of the foolish, too.

TIME vaccines

How Words Can Kill in the Vaccine Fight

Farrow: Right ideas, wrong words
Farrow: Right ideas, wrong words NBC/Getty Images

To own the argument you've got to own the language. At the moment, the dangerous anti-vaxxers are winning that war

Chances are you wouldn’t sit down to a plate of sautéed thymus glands, to say nothing of a poached patagonian tooth fish; and the odds are you’d be reluctant to tuck into a monkey peach too. But sweetbreads, Chilean sea bass and kiwifruit? They’re a different matter—except they’re not. All of those scrumptious foods once went by those less scrumptious names—but few people went near them until there was something pleasant to call them. Words have that kind of power.

That’s true in advertising, in politics and in business too. And it’s true when it comes to vaccines as well—but in this case those words can have a lethal power. The bad news is that in the vaccine word game, the good guys (they would be the ones who know that vaccines are safe, effective and save from two to three million lives per year) are being caught flat-footed by the bad guys (those would be the ones whose beliefs are precisely opposite—and therefore precisely wrong).

The battle plays out on Twitter, with the handy—and uninformed—handle #CDCWhistleBlower repeatedly invoked by virtually every fevered anti-vax tweet like a solemn incantation. The term refers to Dr. William Thompson of the Centers for Disease Control and Prevention, who supposedly blew the lid off of the great vaccine conspiracy by confessing to irregularities in a 2004 study that deliberately excluded data suggesting a higher rate of autism in African-American boys who had been vaccinated. Scary stuff alright, except that the study was poorly conducted, the data was left out for purely statistical and methodological reasons, and the paper itself has now been withdrawn. But the hashtag stain remains all the same—with the usually noble whistleblower label being put to low purpose.

Something similar is true with the widely cited Vaccine Injury Court, another frightening term, except that no such thing exists—at least not by that name. It’s true there is an Office of Special Masters which, under a smart 1986 law, hears the claims of parents who believe their children have been injured by vaccines. The panel was created to provide no-fault compensation in all such cases, since drugs that are as vital and are administered as widely as vaccines could never be manufactured or sold affordably if the companies themselves had to pour millions and even billions of dollars into defending themselves against claims.

It’s true too that the court has paid out about $2.8 billion to parents and families since 1989, but those awards are overwhelmingly for relatively minor side effects that are fully disclosed by the ostensibly secretive CDC for any parents caring to look on the agency’s website. And to put that $2.8 billion in perspective: The money went to 3,727 claimants over an approximate generation-long period during which 78 million American children were safely vaccinated, preventing an estimated 322 million illnesses and 732,000 deaths. If you’re crunching the numbers (and it’s not hard to do) that factors out to a .0048% risk of developing what is overwhelmingly likely to be a transient problem—in exchange for a lifetime of immunity from multiple lethal diseases.

But brace for more anyway because October is, yes, Vaccine Injury Awareness Month. Because really, what does a dangerous campaign of misinformation need more than 31 catchily named days devoted to itself?

Still, there’s no denying that catchiness works, and on this one the doctors and other smart folks are going to have to get off the dime. MSNBC’s Ronan Farrow—who either is or isn’t to your liking depending in part on whether MSNBC itself is—has emerged as a smart, persuasive, often brilliantly cutting advocate for the vaccine cause. And on his Oct. 10 show he deftly filleted the arguments of a vocal anti-vax mother whose child is undeniably suffering from a number of illnesses, but who wrong-headedly blames them on vaccines. In this show as in others he invites his audience to learn the truth about vaccines and to connect with him and one another via the handle #VaccineDebate.

And right there he tripped up. For the billionth time (as Farrow knows) there is no debate. Just as there is no climate change debate. Just as there is no moon-landings-were-faked debate. And just as there was nothing to the tobacco company’s disingenuous invention of a “cigarette controversy,” a fallback position they assumed when even they knew that cigarettes were killers and that they couldn’t straight-facedly say otherwise, so the best they could do was sow doubt and hope people stayed hooked.

Little more than 30 seconds spent listening to Farrow talk about vaccines makes it unmistakably clear where he stands—but the very fact that we now live in a hashtag culture means that it’s by no means certain he’s going to get that 30 seconds. So step up your game, smart people. You want to get the vaccine message out, do it in a way that works in the 21st century. And if that means a hashtag, why not #VaccinesWork or #VaccinesAreSafe or #VaccinesSaveLives. Of course, there’s also the more thorough and satisfying #AntivaxxersDon’tKnowWhatThey’reTalkingAboutSoPleaseStopListeningToThem, but that gets you exactly halfway to your 140-character limit. So keep it brief folks—and make it stick.

TIME Cancer

The New HPV Vaccine Could Be 90% Effective

hpv image
Getty Images

An even more effective vaccine against human papillomavirus (HPV), which can cause cervical cancer, may be on the horizon, according to new research published in Cancer Epidemiology, Biomarkers & Prevention. Merck announced that it’s investigating a 9-valent HPV vaccine that protects against nine total types of HPV—five more than the current one on the market.

The current vaccine, GARDASIL, also manufactured by Merck, is effective against 70% of cervical and other HPV-related cancers and protects against two of the main types that cause cancer—type 16 and 18—as well as two more that cause most cases of genital warts, types 6 and 11. The potential new vaccine, which isn’t named yet, will protect against approximately 90% of cervical cancers, says study author Elmar Joura, an associate professor of gynecology at the Medical University of Vienna in Austria (who received grant support, lecture fees and advisory board fees from Merck). It protects against the HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58.

MORE: HPV Vaccine Cuts Rates of Genital Warts 61%

Coverage against those extra strains could be good news for women worldwide, as some races are prone to different types of HPV. In East Asia, HPV 52 and 58 are more common than in the U.S. or Europe, Joura writes in an email to TIME. “The good thing is that the nine valent vaccine will equalize these differences,” Joura writes. “The grade of protection will be the same worldwide.”

In the study, Joura and his team analyzed data from 12,514 women and found that of those ages 15-26 who had precancers, 32% had more than one type of HPV—that number was 19% for women between the ages of 24 to 45.

MORE: There’s a Vaccine Against Cancer, But People Aren’t Using It

The FDA is currently reviewing the vaccine, and Joura expects them to reach a decision by the end of 2014. “The vaccine will hopefully be available soon after,” he wrote.

TIME health

Dear Rob Schneider: Please Shut Up About Vaccines

The doctor is in the house: by all means, take vaccine advice from this guy
The doctor is in the house: by all means, take vaccine advice from this guy

State Farm dumps ad campaign after Deuce Bigalow's ignorant remarks about vaccinations

If there’s one thing I regret about the job I’ve done raising my kids, it’s that when it was time to get them their vaccines, I did not heed the wisdom of a man who is currently filming a TV series with a storyline titled “The Penis Episode, Part 2.” And if that doesn’t convince you about this deep thinker’s credibility, consider that his earlier body of work includes such powerful pieces as The Hot Chick, The Beverly Hillbillies movie and Deuce Bigalow Male Gigolo.

How’s that for a guy worth listening to? Not.

We are talking, of course, about Rob Schneider, the Saturday Night Live alum who parlayed a single character—Richard Laymer, the obnoxious office guy—into a career of small-bore, dropped pants, toilet joke movies, plus the occasional cartoon voiceover. Nothing wrong with those kinds of projects; they’re honest work and the checks generally clear.

But Schneider is at the center of a much-deserved storm this week, after State Farm Insurance announced it was pulling a new ad campaign featuring the comedian in a reprise of his office guy role, since—while the company whose job it is to help people live better, healthier, more fiscally secure lives wasn’t looking—its newly minted star has been popping off about (deep sigh here) the hidden dangers of vaccines.

Take this observation from Dr. Bigalow, in a widely circulated video shot when he was campaigning against a California law that would have made it harder for parents to refuse vaccines:

“The efficacy of these shots have not been proven. And the toxicity of these things—we’re having more and more side effects. We’re having more and more autism.”

Or this one: “You can’t make people do procedures that they don’t want. It can’t be the government saying that. It’s against the Nuremberg Laws.”

It’s actually worth watching the entire jaw-dropping display, because Schneider somehow manages to thread the extraordinary needle of being wrong on every single point he makes. Remember in high school when they used to say it was impossible to score a zero on the SATs because you get a few points just for writing your name? Schneider, presumably, would have left that part blank.

And then there are the cringe-worthy Twitter posts suggesting he has been denied his freedom of speech:

For the record Rob, no, there is no government conspiracy to force vaccines on kids. No, doctors are not bought off by big pharma. No, vaccines are not filled with toxins. And no, this is not a free speech issue—it’s a public health, common-sense and, not for nothing, business issue, since State Farm, like any company, is free to sack a spokesperson who makes them look very, very bad. Simply quoting George Washington does not mean any of the great man’s wisdom rubs off on you. It just means you looked up a quote.

But as long as we’re in the quote game, how about one of your own, from your video harangue: “The government,” you said, “can’t make decisions about what I do to my body.” On this score, you’re right. So please do continue making movies that allow you to appear on posters with a towel on your head, seaweed cream on your face and cucumbers on your nipples. Maybe George Washington would have been pleased with you. State Farm? Not so much these days.

TIME vaccines

Watch a Science Cop Take on the Anti-Vaccine Movement

"Again, and always, they're wrong."

Nothing gets the anti-vaccine fringe going quite so much as believing they’ve found a scandal—some bit of gotcha’ proof that the global medical establishment really, truly is covering up a terrible secret about the dangers of vaccines.

Recently, this always-vocal but rarely-rational crowd announced that they had what they were looking for, with the discovery that a comparatively old study had excluded some data suggesting that African-American children who had been vaccinated were slightly likelier than other kids to have developed autism.

But again—and always—the anti-vaxxers were wrong, misunderstanding the science, misrepresenting the findings, and recruiting the worst possible person imaginable to argue their wrong-headed case.

TIME Research

Journal Retracts Paper that Questioned CDC Autism Study

A paper that claimed government scientists covered up data showing a connection between vaccines and autism has been pulled by its publisher

Earlier in August, the journal Translational Neurodegeneration, an open access, peer-reviewed journal, published a re-analysis of a 2004 paper published in Pediatrics that looked at MMR vaccines and autism. The re-analysis of the data, by biochemical engineer Brian Hooker of Simpson University, claimed to find a higher rate of vaccination against MMR among a subset — African-American boys — of the original study population who developed autism than among those who did not, a finding that Hooker claims was suppressed by the authors of the original paper from the Centers of Disease Control. One of the co-authors of the 2004 paper, William Thompson, released a statement admitting to omitting the data after a secretly recorded conversation he had with Hooker was released on YouTube. (Thompson was not available for comment.)

MORE: Whistleblower Claims CDC Covered Up Data Showing Vaccine-Autism Link

Now, however, the editors of Translational Neurodegeneration have retracted Hooker’s paper, noting on its site that “This article has been removed from the public domain because of serious concerns about the validity of its conclusions. The journal and publisher believe that its continued availability may not be in the public interest. Definitive editorial action will be pending further investigation.”

TIME Infectious Disease

Remember MERS? Scientists Want Treatments to be Ready, Unlike Ebola

MERS is another disease with no cure or vaccine--can scientists get ahead while there's still time?

Do you remember MERS? That’s right, the Middle East Respiratory Syndrome Coronavirus infection (MERS or MERS Co-V). It may seem like a disease of the past now, but there was a time only months ago that we had similar if not equally overreactive fears about whether the disease–which was spreading primarily in the Middle East–could spread through the United States.

In fact, there were a few cases of MERS in the U.S. in May. The CDC told Americans that: “In this interconnected world we live in, we expected MERS Co-V to make it to the United States.” And though the virus is a very different disease from Ebola, it similarly transmits between humans only via direct contact–making health care workers the most at risk. And like Ebola, there is no vaccine or cure.

Right before MERS slipped off our collective radars only to be replaced by the deadly Ebola virus one continent over, the World Health Organization (WHO) reported in July that it had received reports of 837 laboratory-confirmed cases of infection with MERS-CoV including at least 291 related deaths.

So, why is no one talking about MERS right now? Cases and deaths appear to have leveled off for now, which is leading researchers–who are very much still paying attention to the disease–to believe that perhaps it’s seasonal, like the flu. “It appears we are dropping out of MERS season,” says study author Darryl Falzarano, of the National Institute of Allergy and Infectious Diseases (NIAID). “It could be happening again in the spring. It’s possible that MERS could be more chronic, and Ebola is more sporadic.”

In a recent paper, a team of National Institutes of Health (NIH) scientists, including Falzarano, report that they’ve concluded that marmosets are the best animal model for testing potential treatments for MERS. The team has tested its fair share of critters, starting with small rodents like hamsters and ferrets, and eventually landing on another type of money called the rhesus macaques.

The trouble with finding the right animal is that viruses react differently depending on the host, and sometimes the cells won’t accept the virus, making testing useless. Though the rhesus macaques were able to contract MERS, their symptoms only grew to that of a humans’ mild to moderate symptoms, which is not as critical for testing as severe.

Now, the finding–published in the journal PLoS Pathogens– is by no means groundbreaking. But it highlights just how difficult and time consuming it can be to develop a drug or vaccine for an uncommon virus. One of the primary topics of debate during the current Ebola outbreak is whether experimental drugs should be used. The two now-recovered American Ebola patients received an experimental drug called ZMapp, and WHO is in the process of developing guidelines for how such treatments should be used. But the inconvenient truth is that even if a drug for Ebola is available, and most manufacturers only have limited amounts, we really have no idea whether they could work. It might just be too late for this outbreak.

But what about MERS?

“You cannot expect magic bullet types of cures off the bat,” says study author Vincent Munster, chief of the Virus Ecology Unit at NIAID. “The viruses we work with are really niche viruses, so there’s not a lot of interest from pharmaceutical companies. But I think this outbreak could propel some recent developments and vaccines.”

There are currently drugs and vaccines in the pipeline undergoing testing for MERS, and like in the current outbreak, they could be considered for last-ditch efforts. Scientists are not just studying how to develop methods to treat MERS, but they’re also trying to determine how it transmits from what appear to be camels, to people, plus whether or not there’s potential it could become airborne. The hope is that as our world continues to become more and more connected, there will emerge an incentive to develop and produce treatments for deadly diseases that we still don’t fully understand.

Thankfully, it appears we have some time when it comes to MERS–at least until spring.

TIME Infectious Disease

Polio’s Two Vaccines Are More Effective When They’re Combined

For decades, there’s been a tug-of-war between the oral and inactivated polio vaccines over which is more effective at preventing the paralyzing disease. Researchers have now resolved the dispute and say that pairing them are better than either alone

When it comes to fighting a virus, having as many weapons as possible, especially in the form of vaccines that can prevent infection, is certainly welcome. And that’s always been the case with polio, which has not one but two effective immunizations that can stop the virus from causing debilitating paralysis. Which is more effective in preventing illness and which is better at stopping transmission of the virus? Scientists report in the journal Science that neither is ideal, but that together, the vaccines are powerful enough to achieve both results. The results “revolutionize our thinking about how to use polio vaccines optimally,” says Hamid Jafari, director of polio operations and research at the WHO, who led the research.

Recent efforts to erradicate polio has pitched the two vaccines against each other. Developed in the 1950s and 1960s, one was made by Jonas Salk using killed polio virus, and the other, developed by Albert Sabin, uses a weakened but still live virus that could replicate in the human gut to deliver immunity. Jafari and his colleagues, report that children vaccinated with the oral polio vaccine who then received a boost of the Salk vaccine showed the lowest amount of virus in their feces—one of the primary ways that the virus spreads from person to person—and excreted these viruses for a shorter period of time than children who had been immunized with the oral vaccine and received a boost with an additional dose of the same oral vaccine.

MORE: WHO Declares Health Emergency on Polio

The WHO’s global effort to eradicate polio has relied heavily on the oral vaccine, because it’s a liquid that can be eaily given to children orally, and it’s cheaper. Plus, the oral vaccine, because it contains a weakened virus that can reproduce in the human gut, helped to reduce the volume of virus excreted in the feces, and thus lower the chances that others coming in contact with the feces could get infected.

But in places where polio infections were rampant, such as northern India, the oral vaccines didn’t seem to be doing much good at reducing the burden of disease. Even when children were getting the recommended three doses, rates of infections remained high. “The transmission pressure was extremely high in these areas that were densely populated, had a high birth rate, poor sanitation and high rates of diarrhea,” says Jafari. In those regions, it took an additional 10 to 12 vaccination campaigns—about one a month to provide children with additional doses on top of the recommended three doses—to finally control the disease and limit spread of the virus. It turns out that the immunity provided by the oral vaccine wanes over time.

In order to eradicate the disease, public health officials knew they had to do better. So they tested whether adding in the inactivated vaccine would help. And among 954 infants and children aged five years to 10 years who had already received several doses of oral vaccine, adding a shot of the inactivated vaccine did help them to shed less virus compared to those who received another dose of the oral vaccine.

PHOTOS: Endgame for an Enduring Disease? Pakistan’s Fight Against Polio

With polio currently endemic in Pakistan, Cameroon, Equatorial Guinea, and the Syrian Arab Republic, the WHO declared the spread of polio a public health emergency of international concern, and issued temporary recommendations for all residents and long-term visitors to those countries to receive a dose of either the oral or inactivated vaccine before traveling out of the country. In other countries where polio has been found, such as in some sewage samples and fecal samples from residents in Israel, health officials have also advised residents living in those regions to receive a dose of inactivated polio vaccine in order to limit spread of the virus.

“The inactivated polio virus vaccine is becoming an important tool in preventing international spread of polio,” says Jafari. Whenever outbreaks of the disease occur, health officials are now recommending that even vaccinated individuals who could be infected but not get sick, receive an additional shot of the inactivated vaccine in order to limit the amount of virus they shed and spread to others.

TIME Infectious Disease

Fake Cures and Ebola-Drug Sensationalism Need to Stop, WHO Says

WHO says there's too much hype for unproven treatments, and too many people claiming to have cures on social media

“Recent intense media coverage of experimental medicines and vaccines is creating some unrealistic expectations, especially in an emotional climate of intense fear,” the World Health Organization (WHO) wrote in a statement sent to the media on Friday.

Public fear and anxiety of Ebola is understandable, the WHO says, since the disease has no known cure or vaccine. But the organization warns that there needs to be more reason when it comes to fervor over experimental drugs that are in very limited supply. The WHO says that the public needs to understand that the majority of treatments available are not approved, and have not been tested in humans.

One of the more disturbing outcomes to come out of the Ebola treatment fervor are fraudulent cure claims on social media. “All rumors of any other effective products or practices are false. Their use can be dangerous. In Nigeria, for example, at least two people have died after drinking salt water, [which was] rumored to be protective,” the WHO writes.

Twitter is full of individuals claiming to know of Ebola “cures,” which the WHO is trying to combat, like the one below:

The U.S. Food and Drug Administration (FDA) put out a warning letter to consumers on Thursday about products claiming to treat Ebola. “Since the outbreak of the Ebola virus in West Africa, the FDA has seen and received consumer complaints about a variety of products claiming to either prevent the Ebola virus or treat the infection,” the letter says. “There are currently no FDA-approved vaccines or drugs to prevent or treat Ebola.”

Earlier this week, a WHO panel deemed it ethical to use experimental drugs and vaccines during the Ebola outbreak in West Africa, but it is still developing use guidelines from a panel of experts. The WHO says the Canadian government is donating doses of an experimental vaccine, adding that “a fully tested and licensed vaccine is not expected before 2015,” WHO says.

Recent numbers for Ebola continue to rise. The latest case numbers from WHO put the number of cases at 1,975 and deaths at 1,069. The WHO reports that there have been no new cases of Ebola detected so far in Nigeria, which is the most recent country to have a small cluster of the disease. The WHO says it is in the process of scaling up a massive international response. The CDC is currently tracking cases to prevent further infections, and the World Food Programme is delivering food to over one million people currently quarantined in zones where the borders of Guinea, Liberia and Sierra Leone meet.

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