TIME health

For Once the Anti-Vaxxers Aren’t (Entirely) to Blame

Face of the enemy: A molecular model of the whooping cough toxin
Face of the enemy: A molecular model of the whooping cough toxin LAGUNA DESIGN; Getty Images/Science Photo Library RF

Jeffrey Kluger is Editor at Large for TIME.

California's whooping cough outbreak is largely the fault of a harmless but imperfect vaccine

Anti-vaxxers are epidemiology’s repeat offenders—the first and sometimes only suspects you need to call in for questioning whenever there’s an outbreak of a vaccine-preventable disease. So on those occasions when their prints aren’t all over the crime scene, it’s worth giving them a nod. That’s the case—sort of, kind of—when it comes to the current whooping cough (or pertussis) epidemic that’s burning its way through California, with nearly 10,000 cases since the first of the year, making it the worst outbreak of the disease since the 1940s. So far, one infant has died.

Before we start giving out any laurels, let’s be clear on one point: the anti-vaxxers continue to be risibly wrong when they say that vaccines are dangerous (they aren’t), that they lead to autism, ADHD, learning disabilities and more (they don’t), and that you should take your public-health advice from the likes of Jenny McCarthy, Rob Schneider, and Donald Trump instead of virtually every medical and scientific authority on the planet (you shouldn’t). But a safe vaccine is not always the same as an entirely effective vaccine, and here the whooping cough shot is coming up a little short—with emphasis on the “little.”

According to the U.S. Centers for Disease Control, the pertussis vaccine starts off perfectly effectively, with 90% of kids developing full immunity from the disease in their first year after inoculation. But that protection starts to fade in year two, and by the five-year point, only 70% of kids are still protected. Until the 1990s, a more effective formulation was available, but it was replaced due to side effects (pain, swelling and perhaps some fever—not autism, thank you very much). The newer version eliminates those problems, but at a cost to effectiveness.

The waning protection the vaccine affords helps explain the cyclical nature of whooping cough outbreaks, with cases usually beginning to rise every three to five years. Certainly, the anti-vax crowd has not helped matters any. When a vaccine offers only imperfect protection, it’s especially important that as many people as possible get it since this maximizes what’s known as herd immunity—the protection a community that’s largely immune can offer to the minority of people who aren’t.

Last spring’s mumps outbreak in Columbus, Ohio was due in part to a combination of the relatively low 80-90% effectiveness rate of that vaccine and the poor level of vaccine compliance. As I reported in Time’s Oct. 6, 2014 issue, 80% of people who contracted the disease said they had been vaccinated in childhood, but only 42% of those cases could be confirmed. In the current whooping cough epidemic, California health authorities estimate that only 10% of all people who have come down with the disease were never vaccinated. That’s up to 10% more people than needed to get sick, but a lot fewer than the total in Columbus.

The heart of the anti-vaxxers’ argument is not, of course, that some vaccines offer incomplete protection. If it were, they wouldn’t find so many willing believers. For one thing, the large majority of vaccines achieve at least a 90% effectiveness level—and often much higher. For another, it’s hard to make the case that even if they didn’t, imperfect protection would be better than none at all.

Seat belts, after all, aren’t 100% effective at preventing highway deaths either, and condoms don’t entirely eliminate the risk of pregnancy or STDs. But that doesn’t mean you stop using them, because your brain makes a rational risk calculation about the wisdom of taking cost-free precautions. You might not make such smart choices, however, if somebody muddied the equation by introducing the faux variable of imaginary risk—seat belts and condoms cause autism, say.

Persuading people to run that flawed calculus is where the the anti-vaccine crowd does its real damage. A new—and scary—interactive map from the Council on Foreign Relations tracks the global rise or fall of vaccine-preventable diseases from 2008 to 2014. In the same period, during which most of the world saw a 57% decline in cases, North America—driven mostly by the U.S.—showed a stunning 600% increase.

It’s fitting somehow that the locations of the outbreaks show up on the map as a sort of pox—with the once-clear U.S. slowly becoming blighted from one coast to the other. Misinformation is its own kind of blight—one that’s every bit as deadly as the bacteria and viruses the vaccines were invented to prevent. And it’s the anti-vaxxers themselves who are the carriers of this particular epidemic.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Infectious Disease

Whooping Cough Outbreak Strikes Undervaccinated Michigan County

Grand Traverse County has the state’s highest rates of parents choosing not have their children vaccinated

A major outbreak of whooping cough has struck a Michigan area where many people opted out of vaccinations against the disease.

At a single school in Grand Traverse County, which has the state’s highest rates of parents choosing not have their children vaccinated, there have been 151 confirmed and probable cases of whooping cough, reports local news outlet MLive.com.

“Nobody likes to be the person who says, ‘I told you so,’ but what’s unfolding now is exactly the scenario feared by those worried about the region’s low immunization numbers,” Bradley Goodwin, the president of the Grand Traverse County Medical Society, said.

Cases of whooping cough have been reported at more than 14 school buildings in the area, which has also reported several cases of the highly contagious measles.

Read more at MLive.com

TIME Italy

Italy Investigating 11 Deaths Possibly Linked to Flu Vaccine

The Italian Pharmaceutical Agency has yet to confirm a link

Italy is investigating the deaths of several people who took an influenza vaccine as the total death toll climbed to 11.

An additional eight fatalities possibly related to Novartis AG’s Fluad vaccine have been identified, Bloomberg reports. As a precaution, two batches of the drug were suspended after three people died within 48 hours of getting the shot.

“At the moment it’s not possible to confirm that there is a direct link between taking the vaccine and the reported deaths,” the Italian Pharmaceutical Agency said in a statement. “More complete information is necessary and a thorough analysis of the cases must be conducted.”

Novartis said Fluad, which was approved in 1997, has a “robust” history of safe usage and that there was “no causal relationship” found between the deaths and the vaccine.

[Bloomberg]

TIME HIV/AIDS

It May Be Possible To Prevent HIV Even Without a Vaccine

"We're removing the doorway that HIV uses to get into cells"

Natural immunity is the most reliable way to protect yourself from viruses, bacteria and parasites. And the best way to acquire such immunity, in most cases, is to expose your immune system to the bug in question—either by getting infected or getting immunized.

Until now, such protection was only possible with diseases like chicken pox or polio. But now, scientists at Harvard University say that people might soon arm themselves against HIV in a similar way, but through a different method.

Chad Cowan and Derrick Rossi, both in the department of stem cell and regenerative biology at Harvard University, and their colleagues report in the journal Cell Stem Cell that they have successfully edited the genomes of blood cells to make them impervious to HIV. In order survive, HIV needs to insert its genome into that of a healthy cell, and to infect these cells, HIV latches onto a protein on their surface called CCR5. If CCR5 is mutated, however, it’s as if the locks have been changed and HIV no longer has the right key; it can’t attach itself and the cells are protected from infection. So the scientists tried a new gene editing technique called CRISPR that allows them to precisely snip out parts of a cell’s genome, and they spliced out the CCR5 gene. To their surprise, the technique was relatively efficient, transforming about half of the cells they treated with CRISPR into CCR5-free, or HIV-resistant, cells.

“It was stunning to us how efficient CRISPR was in doing the genome editing,” says Cowan.

Scientists have previously used CRISPR to make another change in how HIV infects cells; they snipped out the HIV genes that the virus inserted into healthy cells. That process essentially returned HIV infected cells back to healthy ones.

The latest results, however, suggest that the technique may be useful even before HIV gets inside cells. CRISPR could be useful in treating HIV patients if it can replace patients’ own immune cells with the blockaded versions. The cells Cowan and Rossi used were blood stem cells, which give rise to the body’s entire blood and immune system. In order to work as a potential treatment for HIV, patients would provide a sample of blood stem cells from their bone marrow, which would be treated with CRISPR to remove the CCR5 gene, and these cells would be transplanted back to the patient. Since the bone marrow stem cells populate the entire blood and immune system, the patient would eventually have blood cells that were protected, or “immunized,” against HIV. “We’re removing the doorway that HIV uses to get into cells,” says Cowan.

To test this idea, they are already working with another research group to see if the HIV-impervious cells can treat mice infected with HIV.

Because healthy cells would be barricaded from HIV, the process might also lead to a cure for the disease. While the results are currently being tested to treat animals already infected with HIV, it may also be possible to one day transform a person’s immune cell genomes to be protected against the virus. Some people are already fortunate enough to be protected this way—a small percentage of people of European ancestry have natural immunity against HIV because they have two copies of mutated CCR5. They have been well studied and so far, their CCR5 aberrations don’t seem to be linked to any known health issues. “They are totally normal except for the fact that they are resistant to HIV,” says Cowan. “That’s a heartening thing: to have a group of people who are alive today who have been studied and looked at and seem totally fine.”

That’s why clinicians who research the virus and treat HIV patients are excited by the possibilities of CRISPR-aided strategies. If it’s possible to close the door on HIV, then it may be realistic to start thinking about closing the door on the AIDS epidemic in the near future.

Read next: How Meditation May Help People With HIV

TIME global health

Watch TIME’s Jeffrey Kluger Discuss How to Eradicate Polio

People in three countries still suffer from the disease

Since the development of the first polio vaccine in the 1950s, the number of cases of the devastating disease has been reduced by 99 percent. But despite that extraordinary progress, people in three countries still suffer from polio. Now, Rotary International, along with the World Health Organization, Centers for Disease Control and Prevention and UNICEF have brought the world tantalizingly close to eradicating the virus for good.

In recognition of World Polio Day, watch as TIME editor-at-large Jeffrey Kluger moderates Rotary’s live-streamed event in Chicago, on Friday at 7:30 PM, EDT.

MONEY Health Care

Why You Should Forget About Ebola and Get a Free Flu Shot Instead

Flu Shot Sign
Getty Images

Americans are nearly as worried about Ebola as they are about catching the flu. But influenza is the risk you should pay attention to. And you probably don't need to spend a penny to protect yourself.

Take a break from worrying about Ebola and get a flu shot this fall. While the Ebola virus has so far affected just four people in the United States, tens of millions are expected to get influenza this season. More than 200,000 of them will be hospitalized and up to 49,000 will likely die from it, according to figures from the Centers for Disease Control and Prevention.

A new HuffPost/YouGov poll of 1,000 adults found that the flu is perceived as only slightly more threatening than the Ebola virus, however. Forty-five percent of people polled said that the flu posed a bigger threat to Americans than Ebola, but a substantial 40% said it was the other way around. Fifteen percent said they weren’t sure.

“Ebola is new, mysterious, exotic, highly fatal, and strange, and people don’t have a sense of control over it,” says William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University.

Influenza, on the other hand, is a familiar illness that people often think they can easily control, Schaffner says. “They think, ‘I could get vaccinated, I could wash my hands’ and prevent it.”

Yet that familiarity may lead to complacency. Flu shots are recommended for just about everyone over six months of age, but less than half of people get vaccinated each year.

Now there’s even more reason to get a shot. The health law requires most health plans to cover a range of preventive benefits at no cost to consumers, including recommended vaccines. The flu shot is one of them. (The only exception is for plans that have been grandfathered under the law.)

The provision making the vaccine available with no out-of-pocket expense is limited to services delivered by a health care provider that is part of the insurer’s network.

Depending on the plan, that could include doctors’ offices, pharmacies, or other outlets.

Medicare also covers flu shots without patient cost sharing.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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.

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