Well, I know this will lead to recrimination, and some of you might not like me very much for writing this, but here it goes. I got my 14 month-old the swine flu vaccine. I know, I know. What was I thinking? I was thinking that I would rather feel guilty for having done to much, rather than feel guilty for not having done enough. I was trying to think of which form of guilt would eat me up less inside, and chose the lesser of two evils.

I do not believe that a definitive link exists between Autism and vaccinations, correlation does not equal causation. Research published in the journal Nature last month, indicates that a single-letter change in the genetic code associated with autism may be responsible for the disorder (Arking & Weiss, 2009). 90% of Autism is thought to be genetic in origin. While that 90% is the vast majority of all instances of Autism, I do not think it makes the other 10% feel any better. However, if such a link did exist, I would rather deal with Autism than Polio. While Autism might trap my child within her own mind, Polio will trap her in an iron lung. Yet, though no link between Autism and Vaccines can be linked to scientifically, in the court of public opinion, the issue is far from resolved. In order to end the debate “science must somehow prove a negative — that vaccines don’t cause autism — which is not how science typically works” (Wallace, 2009).

There are other, far more likely causes for the prevalence of Autism. One reason is that we have gotten better at identifying children who have Autism or an Autism Spectrum Disorder. Moreover, in the past 30 years, the average age of first time mothers has increased from 21.4 years to 25.0 years (Matthews & Hamilton, 2009, p. 1). While this might not seem like a sweeping difference, a 2008 study by Durkin, et al, found that “ASD risk increases with both maternal and paternal age and decreases with birth order” (p. 1274). Age is MORE than just another number when it comes to ASD as “each 10-year increase in maternal age was associated with a 20% increase in ASD risk, while each 10-year increase in paternal age was associated with a 30% increase in ASD risk” (p. 1271). Furthermore, Croughan, et al., (2006) found that: “Women who conceive following a history of infertility or after using infertility treatments are at increased risk for several pregnancy and L & D complications as compared to fertile women. Children conceived to these women appear to be at increased risk for adverse birth outcomes and neurodevelopmental disorders [cerebral palsy, mental retardation, autism, seizure disorder, or cancer] by 6 years of age, however, the absolute risks are small” (p. s4-5). Clearly, pointing to vaccines as the cause oversimplifies a complicated issue.

Advocates for alternative vaccination schedules argue that children in the past received a lesser number of vaccinations, and that during that the prevalence of Autism was lower. Few would argue or call for a ban on all vaccines, but they question the need for so many given, some at the same time, as this vaccine schedule might overwhelm the child’s immune system. However, this argument does not hold up to scientific reasoning. Offit & Hackett (2002) found that, “each infant would have the theoretical capacity to respond to about 10 000 vaccines at any one time” (p. 126). Moreover, “parents who are worried about the increasing number of recommended vaccines may take comfort in knowing that children are exposed to fewer antigens (proteins and polysaccharides) in vaccines today than in the past” as “although we now give children more vaccines, the actual number of antigens they receive has declined. Whereas previously 1 vaccine, smallpox, contained about 200 proteins, now the 11 routinely recommended vaccines contain fewer than 130 proteins in total” (pp.126-127). Simply put, there goes that argument.

Can vaccines trigger autoimmune responses which lead to autoimmune diseases? Vaccine polemicists may have a valid point here. Offit et. al (2003) found “Theoretically, if infections can trigger autoimmune diseases, modified forms of infections (ie, immunizations) might also cause these diseases.The mechanism by which natural infections are likely to cause autoimmune disease is termed “molecular mimicry.” Because biological organisms share parts of many genes, some microbial proteins are similar to human proteins. In responding to proteins found on invading microbes, the immune system might also respond inadvertently to self-proteins (“molecular mimicry”) and cause damage” (p. 655). However, this theoretical risk is outweighed by real risks that result from autoimmune response to live, ‘wild’ viruses that one could encounter if not vaccinated “ because infections with wild-type bacteria or viruses are more likely to expose self-antigens and induce levels of cytokines greater than that found after immunization with attenuated or avirulent pathogens, some vaccines are probably more likely to prevent or modify than cause or exacerbate auto-immune diseases” (p. 657).

This finding is of particular interest to me given a family history of Type I Diabetes Mellitus, which has affected two of my siblings from ages 18 months and 24 months respectively. “The likelihood that natural viral infections cause type 1 diabetes is supported by several observations” (p. 656). In the case of my siblings, infection with enterovirus has been implicated. “the best available evidence does not support the hypothesis that vaccines cause type 1 diabetes” (p. 657). So, from an autoimmune standpoint, the real risks posed by infection from live viruses is much greater than the theoretical risk posed by immunization with inactive viruses or bacterium. Until a definitive causal link pointing to an increased risk of autoimmune disorders corresponding to immunization is proven through scientific (not pseudo-scientific) research, I am going to have to cast my lot with the pro-vaccination camp.

My views on vaccinations now are the opposite of those I held when I was pregnant with my daughter. I was going to avoid vaccinating my child, ‘just in case’ but I had a change of heart, or maybe it would be more accurate to say a change of head. I think my college roommate, who was working as an epidemiologist for the CDC, might have issued a severe beating, which I would have richly deserved had I not come around.

Those who do not vaccinate are relying on herd immunity to protect their children (Wallace, 2009). How convenient that one feels entitled to ride the coattails of other’s herd immunity, without contributing anything except hysteria to the collective. It’s probably going to be of small comfort when your child gets Bordetella pertussis. Why does this piss me off so much? “Outbreaks of vaccine-preventable disease often start among persons who refused vaccination, spread rapidly within unvaccinated populations, and also spread to other subpopulations” (Omer, et al., 2009, p. 1984). Vaccines do not always work for every individual, and every vaccine. Individual physiological and biological variants within individuals may not provide that individual with herd immunity. That is why it is so important that everyone ‘buy in’ and vaccinate (Wallace, A). To think that you could safely implement an individualized plan of immunization goes against the very concepts which underlie controlling and preventing infectious diseases. Immunization is not, and cannot be a democratic process if it is going to work. One cannot have it both ways, taking benefits, while eschewing the risks.

“Vaccine refusal not only increases the individual risk of disease but also increases the risk for the whole community. As a result of substantial gains in reducing vaccine-preventable diseases, the memory of several infectious diseases has faded from the public consciousness and the risk–benefit calculus seems to have shifted in favor of the perceived risks of vaccination in some parents’ minds. Major reasons for vaccine refusal in the United States are parental perceptions and concerns about vaccine safety and a low level of concern about the risk of many vaccine-preventable diseases. If the enormous benefits to society from vaccination are to be maintained, increased efforts will be needed to educate the public about those benefits and to increase public confidence in the systems we use to monitor and ensure vaccine safety” (Omer, et al, 2009, p. 1986-1987).

Ever larger numbers will opt out, until a critical threshold is reached, wherein one finds the reemergence of infectious diseases previously thought to be eradicated via vaccination. When large numbers of children start dying of preventable diseases, misguided but well-intentioned parents and their children will have to face dire consequences that will make Autism pale in comparison.

Why has pseudo-science become more important that science in the debate over vaccinations. Wallace (2009) concludes that: “There will always be more illogic and confusion than science can fend off.” Psuedoscientific claims need not carry the burden of proof, and thus can offer greater comfort and a more complete and definitive explanation than scientific reasoning would allow. So the misguided parents attack vaccines as if they were ferocious giants, but this amounts to little more than tilting at windmills.

How did this become a debate in the first place? It may be that vaccines are victims of their own success. “High immunization coverage has resulted in drastic declines in vaccine-preventable diseases, particularly in many high- and middle-income countries. A reduction in the incidence of a vaccine-preventable disease often leads to the public perception that the severity of the disease and susceptibility to it have decreased. At the same time, public concern about real or perceived adverse events associated with vaccines has increased. This heightened level of concern often results in an increase in the number of people refusing vaccines” (Omer, et al., 2009, p. 1981).

Vaccinations have a become a proxy for all our fears about our children. All the uncontrolled and uncontrollable x-factors that we might even be able to name, but still keep us up at night. We are uneasy about the risks that our children face, from melamine-tainted formula, lead in children’s toys, pedophiles, and chaos in general. What we are really scared of is human frailty, which affects all of us. Sadly, there is no vaccine for the human condition.

Arking, D., & Weiss, L. (2009, October). A genome-wide linkage and association scan reveals novel loci for autism. Nature, 461(7265): 802-808. doi: 10.1038/nature08490

Croughan, M., Schembri, M., Bernstein, D., Chamberlain, N., Purcell, N., & Camarano, L. (2006). O-9Maternal and childhood outcomes following infertility and infertility treatments. Fertility and Sterility, 86(3), S4-S5. doi: 10.1016/j.fertnstert.2006.07.012

Durkin, M. S., Maenner, M. J., Newschaffer, C. J., Lee, L., Cunniff, C. M., Daniels, J. L., et al. (2008). Advanced parental age and the risk of autism spectrum disorder. American Journal of Epidemiology, 168(11), 1268-1276. doi: 10.1093/aje/kwn250

Matthews, T., & Hamilton, B. (2009, August). Delayed Childbearing: More Women Are Having Their First Child Later in Life. NCHS Data Brief No. 21. US Department of Health and Human Services, Center for Disease Control and Prevention, National Center for Health Statistics. Retrieved from www.cdc.gov/nchs/data/databriefs/db21.pdf

Offit, P. A., Quarles, J., Gerber, M. A., Hackett, C. J., Marcuse, E. K., Kollman, T. R., et al. (2002). Addressing parents' concerns: do multiple vaccines overwhelm or weaken the infant's immune system? Pediatrics, 109(1), 124-129. doi: DOI: 10.1542/peds.109.1.124

Offit, P. A., & Hackett, C. J. (2003). Addressing parents' concerns: do vaccines cause allergic or autoimmune diseases? Pediatrics, 111(3), 653-659. doi: 10.1542/peds.109.1.124

Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. The New England Journal of Medicine, 360(19), 1981-1988. doi: 10.1056/NEJMsa0806477

Wallace, A. (2009, October). An Epidemic of Fear: How Skipping Shots Endangers Us All. Wired, 17(11): 1-7. http://www.wired.com/magazine/2009/10/ff_waronscience/