Science and Skeptics - Ne'er the two shall meet

A young child is currently seriously ill in Gold Coast hospital Brisbane's Mater Hospital (my apologies, the name of the hospital was incorrect in my original post), diagnosed with whooping cough (pertussis). Kailis Smith has not been vaccinated because he was too young. At only 6 weeks old, he is fighting for his life after contracting pertussis. While he has had many treatments for his pertussis including blood transfusions, his prognosis at this point in time is uncertain. I wish him and his family all the best for a complete recovery and a quick release from hospital.

Why do I bring this child up now? Well, a reporter with the Gold Coast Bulletin, Shannon Willoughby, has written an article about Kailis entitled Immunisation is a Must. In this article, Shannon says things like:

Anti-immunisation is just selfish. Plain and simple.; and,

With babies dying and children and adults once again contracting diseases that were virtually wiped out, there needs to be more of a tough line approach to immunisation.

She has not called for compulsory vaccination, but that is the implication here and it is an implication that should never, ever be raised by any reporter, especially one as ill-informed about this issue as Ms Willoughby.

This article and Kailis' case has been cynically used by the Skeptics and Stop the AVN for their own purposes of blaming the unvaccinated for the upsurge in pertussis that has been evident in Australia for the last 3 years and around the world for the last 20.

For people who claim to worship science and abhor anything smacking of pseudo-science, the skeptics have an amazing ability to ignore anything scientifically-based that disagrees with their worldview. This sort of denial is something you are more likely to see in religious fanatics or cults where there is a strong reliance on faith at the expense of truth. No matter what the evidence which they can see with their own eyes from scientific sources, these people will continue to blame those who have made an informed choice not to vaccinate or to vaccinate selectively for disease in both the fully-vaccinated and those too young to have had their shots.

Evidence such as:

Comparative genomics of prevaccination and modernBordetella pertussis strains

Background

Despite vaccination since the 1950s, pertussis has persisted and resurged. It remains a major cause of infant death worldwide and is the most prevalent vaccine-preventable disease in developed countries. The resurgence of pertussis has been associated with the expansion of Bordetella pertussis strains with a novel allele for the pertussis toxin (Ptx) promoter, ptxP3, which have replaced resident ptxP1 strains. Compared to ptxP1 strains, ptxP3 produce more Ptx resulting in increased virulence and immune suppression. To elucidate how B. pertussis has adapted to vaccination, we compared genome sequences of two ptxP3 strains with four strains isolated before and after the introduction vaccination.

Results

The distribution of SNPs in regions involved in transcription and translation suggested that changes in gene regulation play an important role in adaptation. No evidence was found for acquisition of novel genes. Modern strains differed significantly from prevaccination strains, both phylogenetically and with respect to particular alleles. The ptxP3 strains were found to have diverged recently from modern ptxP1 strains. Differences between ptxP3 and modern ptxP1 strains included SNPs in a number of pathogenicity-associated genes. Further, both gene inactivation and reactivation was observed in ptxP3 strains relative to modern ptxP1 strains.

Conclusions

Our work suggests that B. pertussis adapted by successive accumulation of SNPs and by gene (in)activation. In particular changes in gene regulation may have played a role in adaptation.

Though this is a very technical article, what this means is that use of the vaccine has caused the strain of bacteria that causes whooping cough, b. pertussis, to change in order to survive. The new strains are producing a much more potent toxin (pertussis bacteria per se does not cause the symptoms of whooping cough; instead, it is a toxin that they produce when they are attacked by the immune system that causes the symptoms) than the older strains and this is leading to more severe cases and more deaths in children as seen last year in the US and Australia.

Here is another article on the same subject from the Centres for Disease Control, an organisation that the skeptics and SAVN consider to be one of their temples of enlightenment. Yet when this bastion of truth publishes a study that they don't agree with, they conveniently ignore it.

Bordetella pertussis Strains with Increased Toxin Production Associated with Pertussis Resurgence

Before childhood vaccination was introduced in the 1940s, pertussis was a major cause of infant death worldwide. Widespread vaccination of children succeeded in reducing illness and death. In the 1990s, a resurgence of pertussis was observed in a number of countries with highly vaccinated populations, and pertussis has become the most prevalent vaccine-preventable disease in industrialized countries. We present evidence that in the Netherlands the dramatic increase in pertussis is temporally associated with the emergence of Bordetella pertussis strains carrying a novel allele for the pertussis toxin promoter, which confers increased pertussis toxin (Ptx) production. Epidemiologic data suggest that these strains are more virulent in humans. We discuss changes in the ecology of B. pertussis that may have driven this adaptation. Our results underline the importance of Ptx in transmission, suggest that vaccination may select for increased virulence, and indicate ways to control pertussis more effectively.

You see, the mutations in pertussis bacteria and its increase in virulence were first noticed in the Netherlands in the early 1990s. There, acceptance of pertussis vaccination was virtually universal and despite (or because) of that, they were seeing increasing numbers of cases and more hospitalisations with some deaths for the first time in many years - exactly the situation we are seeing in Australia.

Instead of burying their heads in the sand like those pseudo-science loving skeptics, they researched and continue to research why this is occurring. Their answer (and these two articles are quite recent - published in 2010 and 2009 respectively) is that low vaccination is not the reason for the resurgence and increase in virulence we are seeing - use of the vaccine is.

When I say this, it is bollocks according to them. When scientists say it, it is ignored or denigrated.

When Julie Leask, a long-time supporter of full vaccination and a scientist working at the Medical Faculty of the University of Sydney wrote in a blog on Croakey that:

The current approach to the anti-vaccinationism movement is missing the mark.

Health professionals often seem to think you can just feed vaccine dissenters the facts, educate them and this will correct wayward thinking.

This demonstrates a poor understanding of the anxieties and wider social shifts at the heart of vaccine debates. These include mistrust driven by poorly handled health scares (CJD in the UK), a thirst for discrete causes of idiopathic ills (eg, autism), increasing tendency to question medicine, middle-class “intensive parenting”, and the appeal of natural health practices.

Tactics like The Skeptics’ which seek to demonise antivaccination polarise the issue taking away any room for grey in a complex issue (vaccines are great but not perfect).

They also give the AVN a media profile which would potentially attract fence-sitting new paid-up members who otherwise would not have contacted the once nearly bankrupted AVN.

When she wrote this piece, the skeptics were up in arms. How dare someone from 'their side of the fence' dare to question their tactics?  On the 6th September, 2009, Paul Gall wrote on the wall of the SAVN page that:

On the other hand, calling for "full transparency from the authorities" has that familiar ring to it. Or "parents who were raised to value the fundamental truth of the personal narrative"; isn't fallout from such narratives what skepticism seeks to manage? (ed note-quotes are from Julie Leask's Croakey article)

So are the skeptics and SAVN trying to remain true to science or 'manage' those who demand full transparency from scientific authorities and the value of fundamental truths? My guess, from long involvement with these organisations is that the truth is the latter, not the former.

When Julie Leask compounded her 'sin' of trying to understand why parents are questioning vaccination and taking some of the heat out of this debate in a recent article in the Sydney Morning Herald, How Mommy Instinct Outdid Science, the skeptics and SAVN were incensed.

Leask, a firm supporter of vaccines, nevertheless believes the danger posed by a small cabal of anti-vaccinators, at least in Australia, is often overstated; full immunisation according to the national schedule is achieved in 94 per cent of children by age two, and of the remaining 6 per cent a mere half are conscientious objectors; for the others, practical issues such as time or transport difficulties means they have not got around to it.

She sees last year's clampdown on immunisation objectors the Australian Vaccination Network, which lost its charity status and was ordered by the NSW Health Care Complaints Commission to prominently declare its anti-vaccine stance on its website, as an ''intensification of the war between radical non-vaccinators and radical pro-vaccinators''.

Health authorities might do better, Leask said, to be less brittle in their cheerleading.

''We know the vaccine issue is grey. It's not a simple case of vaccines are perfect,'' Leask said, and lack of acknowledgment of their limitations meant ''if you get that disease [despite being vaccinated] then you're going to be disillusioned. If your child gets a mild reaction you're going to be disillusioned.''

These statements were just too close to what the AVN has been saying for over 17 years for the skeptics to accept it without criticism and in fact, they did severely criticise Julie Leask for her quotes in this article.

For anyone who believes that medical decisions should be based on scientific proof and verifiable evidence, it is obvious that the pertussis vaccine, rather than saving children from this disease, has only led to an increase in incidence and virulence. This is shown in the articles above and many others like them.

Why the skeptics and SAVN continue to claim that low vaccination rates (remember, Australia has a vaccination rate of 94% for children by the age of 2 and the rate for pertussis vaccination is even higher) are the reason for three years of non-stop whooping cough epidemics is a matter for conjecture. But claim this they do without a scrap of scientific evidence, proof or even thought.

It is time for them and the media to step up to the plate and start telling the truth about why we have children dying and in hospital from whooping cough. Low vaccination rates have nothing to do with it.