“Misinformation is not like a plumbing problem you fix. It is a social condition, like crime, that you must constantly monitor and adjust to.” -Tom Rosenstiel
As a society, we are blessed to live in an age of abundant and easily accessible information. However, it can be difficult to distinguish between what is true and what is false. As pediatric providers, we have become aware of this- especially when it comes to parents who are concerned about vaccine safety. These concerns must be acknowledged and addressed. Along with providing medical advice and resources for reliable information, we should also be educating parents on how misinformation is presented.
Here are some important things to consider when it comes to misinformation about vaccines:
- Pseudoscience- this is when an article claims to be scientific and factual, but in fact, does not employ the scientific method. It takes years of education and professional experience to acquire the skills to differentiate between a properly conducted study vs an improper one. This is why most respected journals use peer review prior to publishing articles. It is extremely easy to publish a poor article with ambiguous data, often skewed to show a preferred outcome, while ignoring/ not presenting conflicting outcomes. These kinds of articles are usually published in undistinguished journals or “naturopathic” websites.
- Correlation does not imply causation. This is the statistical principle that just because two things coincide with each other, they are not necessarily caused by or related to each other. For example, if we plotted autism diagnoses made in the last 50 years, we would see a steady rise. Next, if we plotted the sale of organic food products in the last 50 years, we would also see a steady rise. So, does this mean that organic food consumption causes autism? Well, we cannot say, because correlation does not imply causation. It is a common practice of these anti-vaccine articles to imply that as the rate of vaccination increased, so did the rate of autism, therefore vaccinations cause autism. However, the scientific data points us to the fact that vaccination rates increased due to public health efforts and thus the rate of morbidity and mortality of these infectious diseases rapidly declined. We are also aware that the rate of autism diagnoses has increased due to better screening tools and better guidelines to diagnose a child with an autism spectrum disorder. This allows early access to interventions that are focused on providing autistic children with the tools they need to maximize their optimal development.
- Adverse event vs side effect: Both terms are commonly used interchangeably. However, we will differentiate them here so that we can better understand them in the context of vaccine studies. An adverse event is any undesirable medical occurrence during the use of a pharmaceutical product which DOES NOT necessarily imply a causal relationship with the product. A side effect is an effect that is different from the primary action of the drug, it is usually foreseen by doctors, and patients are warned about it (ex. fever after the vaccine). The Vaccine Adverse Event Reporting System (VAERS) is a national program established for vaccine safety and co-sponsored by the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). The purpose of this program is to serve as an early warning or signaling system to identify rare adverse events. There are limitations to the program: it is not possible to find out from VAERS data if a vaccine caused the event, reports made can lack detail or have errors, and reporting can fluctuate with media/ public attention. Awareness of VAERS is important because many of the anti-vaccine studies will cite VAERS to link vaccines to directly causing unwanted outcomes (such as neurodevelopmental disorders).
- Misquoting/ out of context use: another common practice in pseudoscience is to misquote legitimate scientific research in their articles as evidence of support of their views. For example, there was an ad in the Nov 2005 New York Times issue by the group Generation Rescue, in which they were thanking the researchers that did “groundbreaking research on the connection between mercury and autism”. The ad listed 19 citations of articles, none of them demonstrated that mercury causes autism.
- There is no need to fear anymore: Many articles, and even some misinformed pediatricians are quick to assume that diseases like tetanus or measles are not a real threat anymore. Due to the effectiveness of vaccinations, there is an absence of vaccine-preventable diseases in communities. Some pediatric providers are even allowing parents to delay vaccines, acknowledging that they’ve never seen tetanus at their clinic. However, this can have disastrous consequences. As was evident by the Disneyland measles outbreak, vaccine-preventable diseases are ever lurking as a threat to any unimmunized child. Tetanus spores are present in the soil, and illnesses like measles, mumps, and rubella are just a plane ride or jam-packed amusement park away from infecting defenseless children.
- Herd immunity is the concept that a large population of immunized people provides protection to those who are not immunized. Many consider it a social obligation. A newborn baby cannot get the pertussis vaccine. Pertussis in an older child may not lead to mortality, however, when this older child spread this extremely contagious illness to the newborn baby, it very well can lead to mortality. This baby depends on members of the community (the herd) to be immunized against pertussis and act as a barrier against the deadly infection. The same goes for immunocompromised children (ex. leukemia, organ transplant patients) who cannot get live vaccines. They depend on herd immunity to protect them from life-threatening infections.
- There are many ways to evaluate whether a website has reliable information for vaccines. A good website will clearly state who is the responsible party for the site, how it’s funded and will have a way to contact the information provider. Facts and opinions should be distinguishable and proper scientific evidence should be presented without bias. However, be wary of inaccurate citations, or citations of studies that are illegitimate. Another sign of a bad website is when the information is presented as stories about adverse events versus scientific evidence. When in doubt, double check your information. Try to find the same evidence cited in other papers that are published in reputable journals. And if you are still unsure, you can always ask your pediatric healthcare provider for their thoughts.
Here are some well-known websites with reliable information for vaccines:
- The National Network for Immunization Information (NNii) Web site (www.immunizationinfo.org or www.nnii.org)
- The CDC’s vaccines and immunizations Web site (www.cdc.gov/vaccines)
- The World Health Organization’s Global Advisory Committee on Vaccine Safety Web site (www.who.int/immunization_safety/safety_quality/vaccine_safety_websites/en/index.html)
- The Vaccine Education Center at the Children’s Hospital of Philadelphia Web site (www.vaccine.chop.edu)
- The Immunization Action Coalition Web site (www.immunize.org) is more suitable for health professionals than parents. It makes available all of the CDC’s Vaccine Information Statements in many languages.
I do not believe that pseudoscience is born out of bad intentions. I believe that without a solid understanding of science and statistics, data can easily be misinterpreted. A data set may seem to point in one direction, but after you conduct the proper statistical analysis you come to find out that the findings are not statistically significant. This may be due to low sample size, improper data collection, improper randomization of subjects, and so on.
Misinformation about vaccine safety is something that pediatric healthcare providers need to be talking about with parents. We should encourage parents to openly discuss their concerns without fear of being judged. Knowledge is power for all and we should strive for the truth always.
Yomna Farooqi, MD
Barrett ADT, Stanberry LR. Vaccines for Biodefense and Emerging and Neglected Diseases. Amsterdam: Academic Press/Elsevier; 2009.