Who Are, or Should Be, the Vaccine Watchdogs?

It’s that time of the year again, when the influenza vaccine is recommended for the public and both public and private organizations spread the message of the vaccine’s benefits. They tell us that it is needed, why, where we can get one, and some of them even manage to throw in a sad story or two about what happens when there are influenza complications. Of course, the antivaxxers come out of the woodwork as well, spreading around lies and misinformation about vaccines in order to scare people away from the safety of vaccination and toward the dangers of scams and “alternative medicine.”

One of the often resurrected “shocking reports” is an opinion piece written by Peter Doshi, PhD. Dr. Doshi wrote in his opinion piece that the benefits of the influenza vaccine may be overblown, while the risks may be understated. Of course, the “report” is not shocking, and has been widely debunked by Dr. Steven Salzberg and by the researchers at Snopes.com. Still, the true antivaxxers continue to bring up this “shocking report” each year, giving Dr. Doshi a lot of publicity.

Perhaps it is this “fame” within the anti-vaccine circles that has made Dr. Doshi write not one but two seemingly anti-vaccine articles this year. First, he complained that the Vaccine Adverse Events Reporting System’s web page was broken and that no one was taking care of it. Well, it wasn’t broken. There was just a glitch in the website. And, as I learned through contacts at CDC, the site was undergoing a major revamping, and there is now a new front page that is working quite well.

Now, Dr. Doshi is complaining that pro-vaccine organizations are not “independent,” using an interesting definition of “independence.” Dr. Doshi seems to contend that pro-vaccine organizations that are receiving money from CDC or the HHS or from drug manufacturers are not communicating independent facts to the public about vaccine benefits and risks. As in previous seemingly anti-vaccine opinion pieces, Dr. Doshi’s arguments have a lot of holes in them. As Reuben wrote on The Poxes, Dr. Doshi is good at the manipulation of language. In his entire opinion piece, Dr. Doshi does not once mention the good that vaccines do in any kind of certain terms. There’s mention of public health heralding the benefits of vaccines, but Dr. Doshi, a scientist (?), doesn’t clarify how good vaccines are and to what populations.

That whole argument aside, what Dr. Doshi and other anti-vaccine opinion pieces do is make me wonder who should be the true vaccine watchdog? Who has the moral, ethical and legal authority to make sure that vaccines are as good as they can be to the most people, and the least likely to cause harm to the least number of people? To many antivaxxers, that group is not the government, or academics, or even scientists. Many don’t want to listen to reason and have just written off all vaccines as being absolutely evil. To some antivaxxers, only a placebo-controlled double-blind study of a group of people randomized into vaccinated and un-vaccinated groups will do, but only if the scientists running said study have zero conflicts of interest.

Good luck with that.

Then there are the people who are on the fence about vaccines. They access the world wide web of information and have stumbled onto some very scary anecdotes about vaccines. Or they see official-looking websites from anti-vaccine organizations with official-sounding names. (The National Vaccine Information Center or the Australian Vaccine Network come to mind.) They read or hear from people in those organizations — people who manage to sound educated and informed, despite spreading misinformation and often times not being educated formally in the subject — and they go with it. Or, if we’re lucky, the fence-sitters do manage to come upon the correct information and go with that.

On the other side of the equation are the people who are convinced that vaccines are, in fact, the best public health intervention of the last century or two. They are convinced because of several things. One group is convinced because they have experienced the decline of vaccine-preventable diseases in their lifetime. They remember dozens of children dying from things like polio, measles, or diphtheria. My grandparents fit into that group. They were not college-educated, but they saw the epidemics and then saw them disappear once everyone in their towns got immunized.

Another group believes that vaccines are good because scientific experts tell them that they’re good. They have learned to trust healthcare providers and other experts when it comes to things related to their health. Yeah, they might dabble here and there in things like homeopathy or home remedies, but they go to their physicians (and physician assistants) for the important stuff, like vaccination. These are probably the baby boomers, like my parents. They’re more likely to be college educated, but they know their limits.

A third group is my generation. We grew up with television shows like Bill Nye The Science Guy or Beekman’s World. Movies like Nerds or Weird Science made “nerds” and “geeks” out to be heroes. Science was cool, and we pursued some sort of science or technology degree. Those who didn’t defer to their scientifically-oriented friends, though. And those scientifically-oriented friends look to the experts as well. And who are the experts?

The experts are the people who have spent their entire lives designing vaccines, testing them, and implementing their widespread use. Other experts are the epidemiologists who counted and investigated cases of vaccine-preventable diseases and saw the decline of the total numbers, the total deaths, and the severity of outbreaks. And other experts are the infectious disease experts who read paper after paper put out by epidemiologists and other researchers, and who synthesize the evidence into actionable intelligence

So we arrive back at the original question… Does it matter if experts work for the government, for an institution of higher learning, or for a drug manufacturer? I propose that it doesn’t much in the way that it doesn’t matter if an engineer who is a PhD in ergonomics or injury prevention tells me to wear my seat belt though they work at Ford or Chevrolet. The overwhelming evidence is that seat belts are safe and that they reduce the risk of serious injuries or death if you’re in a car accident. So why would it matter if someone in the car industry tells me to wear them?

Why would it matter if someone from the drug manufacturing industry tells me that vaccines save lives?

I guess it would only matter if that were my only source of information on the matter. But the truth is that, when it comes to vaccines, we get reliable information from all sorts of different sources that verify each other. It’s a system of checks and balances when it comes to scientific/medical information on vaccines because academics check what the industry puts out, other industry members check on their competitors, and public health (government) agencies regulate the drug industry and are informed from outside by academia and from within by their own experts and own research.

You would have to draw a very convoluted plot to prove that government agencies like CDC, public health agencies like WHO and PAHO, academic institutions like Johns Hopkins University or Duke University, hospital or healthcare organizations like the Children’s Hospital of Philadelphia, and drug manufacturers like Merck or Sanofi Pasteur are all in on some big conspiracy. The number of people in that conspiracy would number in the tens of thousands, if not hundreds of thousands. And we are to believe that all of them are in on it, and that no one has blown the whistle in any significant or credible way? It’s a scary world if that were true.

So, again, who do we trust to be the watchdogs? Do we trust people who have shown themselves to be anti-vaccine and who manipulate data and language in order to misinform the public (even if they’re not doing it on purpose)? Or do we trust the experts, the people who have put in the time and effort to make sure that they know the methods for assessing data and whose education is backed-up by term papers, exams, and peer review?

I’m biased, of course. But I’d like to believe that I would trust the experts more than the opiners. The writers of “shocking reports” who don’t put those allegations to peer review and instead just editorialize are who I would believe. Give me the interplay and (sometimes cutthroat) competition between drug manufacturers, academics, and public health workers any day of the week. At least, if they’re wrong, they pay the consequences of misinforming, instead of being beautified into an anti-vaccine deity.

I'm a doctoral candidate in the Doctor of Public Health program at the Johns Hopkins University Bloomberg School of Public Health. All opinions posted here are my own, of course, and they do not necessarily reflect the opinions of my school, employers, friends, family, etc. Feel free to follow me on Twitter: @EpiRen

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