[Editor’s note: With Dr. Gorski extremely busy this week, we have a post from frequent guest contributor Braden MacBeth to fill in.]

From the CDC Public Health Image Library #132 via the Wikimedia commons. Child with classic measles day-four rash.

I found myself in that weird part of Amazon again, a part of Amazon that has gotten markedly smaller after a round of anti-vax documentary removals in early March. Family Shots was created and directed by David Sieveking and released in September of 2018. Barring the scientific illiteracy in every frame, it is a competently made film compared to many other quack documentaries I’ve reviewed. The camera work, audio production, and general flow of the film is much better than what I’m used to seeing. I imagine the fact that Sieveking received a grant from the German government played no small part in the improved production. For the first twenty minutes of the film, I didn’t think it was going to go down the anti-vax rabbit hole as far as it did. Needless to say I was very disappointed.

Neonatal tetanus, do mothers need the shot?

Family Shots begins with Sieveking’s wife meeting with her obstetrician. Her obstetrician recommended that she get the TDaP vaccine to protect her baby against tetanus, diphtheria, and pertussis. She felt that it wasn’t necessary and could potentially harm her as she felt she was “very sensitive with a baby inside her”. Ultimately Jessica decides to get TDaP vaccine, going against her gut feeling. According to Sieveking, she fell very ill the day after receiving the vaccine and she was confined to bed for weeks. He also claims she suffered from premature contractions. Of course he believes that this was due to the vaccine:

Neither her gynecologist, nor the family doctor linked it with the vaccination. They assumed it was the flu or gastroenteritis.

That would be because the TDaP vaccine is an inactivated vaccine so you can’t get sick from it. The most common adverse effects from the TDaP vaccine are pain or swelling near the injection site and a moderate fever. I’m unable to find any evidence that the TDaP vaccine can cause the problems she claims to have experienced. Despite two doctors telling them that the TDaP vaccine didn’t cause any of her symptoms they both firmly believe that it did. The film immediately cuts to a conversation between Jessica and her midwife:

It’s not necessary to vaccinate a pregnant woman. Of course if you’re sensitive to it , you may react with premature contractions. As for the risk of tetanus, I’ve worked in the health system for a long time and I’ve never encountered neonatal tetanus, nor have any of my colleagues.

First things first: midwives aren’t doctors. There’s been a lot of research investigating if the TDaP vaccine can cause premature contractions, or preterm births; they don’t. One study published in the Journal of Human Vaccines & Immunotherapeutics tracked the outcomes of 1,758 women in Texas and found that there was no statistically significant difference in the number of preterm births between the women who received the TDaP vaccine, and those who did not. Another study published in The BMJ Open tracked the outcomes of women in two regions of Sweden, and no adverse reactions such as premature contractions were associated with the TDaP vaccine. The TDaP vaccine is perfectly safe, but is it necessary for mothers to get it to protect their newborns?

The TDaP vaccine protects against tetanus, pertussis, and diphtheria, and it’s recommended that all expecting mothers receive the vaccine when they are between 27 and 36 weeks pregnant by every medical organization ever. Receiving the vaccine during this period is crucial because it allows for the greatest number of antibodies to be transferred to the infant during pregnancy. Pertussis was responsible for at least 1,500 hospitalizations and 9 deaths of infants in 2017 in the United States. Tetanus is incredibly rare, and only 29 cases and 2 deaths were reported in 2015 in the US. One reason why the number of cases is so low is that it’s very hard to get tetanus, as it requires the spores to enter through breaks in the skin. The other reason is that you can’t walk into an ER with a paper cut without being asked if your tetanus vaccine is up to date or being offered a tetanus booster at least ten times. However, tetanus is very scary and in a 2011 report by the CDC the per case death rate was estimated to be 13.2%. Newborns are particularly at risk because the umbilical stump can become infected. It’s important that mothers get the TDaP vaccination during the recommended time period to protect their newborns from potentially deadly illnesses; the risks of getting vaccinated are virtually non-existent.

I don’t believe that man’s ever been to medical school

Around 20 minutes in Sieveking begins his quest to find out if his wife’s “skepticism” surrounding vaccines is well-founded or not. He starts by visiting a clinic where a “physician” is lecturing a room full of expecting parents about the necessity of vaccination. The “physician” starts by stating:

Vaccination is one of the most powerful manipulative interventions possible…We’re not in favor of the current vaccine inflation.

Babies receive a large number of vaccines to prevent a large number of serious illnesses that could seriously harm or kill them. I would think a physician would be in favor of getting newborns vaccinated to protect them from these illnesses as soon as possible. However, Sieveking mentioned at the start of the segment that he was visiting an anthroposophical medical clinic. I thought anthroposophical medicine was just a different form of medical training in Germany, similar to osteopathic medicine in the US, but it turns out anthroposophical medicine is just another form of alternative medicine quackery based around the beliefs of Rudolf Steiner. Long story short: it’s a combination of naturopathy, homeopathy, and schizotypal personality disorder. Sieveking even has the audacity to state: “The lecture sounds rather ideological, but at least the speaker is a qualified physician”. I was unable to find out who the “physician” in this segment actually is, but their advice should be disregarded because it’s insane:

The official recommendation is to start vaccinating at nine weeks. In one day the child receives over 20 vaccines; all at the same time. The earlier I start to vaccinate, the higher the dosage has to be. As the immune system is still so underdeveloped it doesn’t know what to do with it. And, irritatingly if I vaccinate at one year, I need far fewer doses than if I start to vaccinate at nine weeks. Once the child is walking, the immune and nervous systems have both reached an initial level of maturity. So for us, as anthroposophical doctors, that is the perfect time to vaccinate.

There’s so much wrong here I don’t know where to begin. At no point will a child receive over 20 vaccines at the same time. The highest number of vaccines a child would receive simultaneously during the CDC’s recommended vaccine schedule I could come up with is seven vaccines for the following: hepatitis B, tetanus, diphtheria, pertussis, haemophilus influenzae type b, pneumococcal, and rotavirus. While some of these vaccines protect against a number of strains of the same virus totaling over 20, to say that’s the same thing as receiving over 20 vaccines is a stretch. Furthermore, I have no idea where he got this “the lower the age, the higher the dosage” idea is from; the dosage is the same for most vaccines no matter what age the person is. Furthermore, why should the dosage of the vaccine matter? Vaccines are safe at whatever dosage they’re approved to be given at. The most glaring problem with his proposal is that beginning vaccination at 1 year as opposed to 9 weeks leaves the child vulnerable to vaccine-preventable illnesses during that span of time.

Adjuvant lies

Every antivax documentary tries to argue that the adjuvants in vaccines are dangerous despite the fact these arguments have debunked thousands of times by people who are much more qualified and well-mannered than myself. Sieveking focuses on the “dangers” of the amount of aluminum in the vaccines. To learn more about the safety of the aluminum adjuvants in vaccines, Sieveking had the opportunity to sit down with Dr. Klaus Cichutek, the president of the Paul Ehrlich Institute. The Paul Ehrlich Institute is a federal agency under the German Federal Ministry of Health and is responsible for the researching and testing vaccines and medicines. Dr. Cichutek explained to him that aluminum adjuvants are a necessary component in vaccines, decades of research proven that they are safe, and that vaccines are necessary to prevent the spread of dangerous diseases. Surely Sieveking would be satisfied with this answer? Of course not. This is an antivax documentary!

Sieveking decides to visit an international symposium on the “link” between vaccines and auto-immune diseases to “find out whether these adjuvants can be dangerous”. Potential links between specific vaccines and autoimmune diseases have been investigated and it’s been shown repeatedly that there is no link between vaccines and auto-immune diseases. Sieveking shows footage of multiple known antivaxxers giving talks starting with Cristopher Exley:

You are seeing now for the first time, some fundamental science underlining the possibility that aluminium adjuvants can produce toxicity from the injection site. The question then arises, do we need to be more cautious? Are there other toxic events associated with aluminium adjuvants and vaccination?

He shows a slide of brain scans of people with Mild Cognitive Impairment and Alzheimer’s disease, implying that aluminum adjuvants could cause those conditions. There is no evidence that the aluminum adjuvants in vaccines is the cause of those conditions despite Exley trying so desperately to prove it. Exley has published at least one paper in a low-quality journal proposing that there is a link between aluminum in brain tissue, and autism. Dr. Gorski published a post in RetractionWatch criticizing the poor methods, questionable data, and the fact that it was funded by the Children’s Medical Safety Research Institute, a known anti-vaccine group. Despite the shoddy research, many anti-vaccine groups cling to it as if it is indisputable evidence that the aluminum adjuvants in vaccines are harmful. The amount of aluminum in vaccines is negligible and is not readily absorbed by the body.

The symposium segment of Family Shots really shows you what this film is all about: it is a hardcore antivax film masquerading as being about a concerned parent investigating “real” risks of vaccines. It ends with this speech from a speaker whom I was unable to identify:

So again, I’m not saying do not vaccinate your children. I’m only saying that we don’t have a grasp of the actual risk, because the objective research has never been done. It should be done with people who don’t have ties with the pharma. We have to have an independent body that will conduct the trial.

Except…you are telling people not to vaccinate their children? The only thing being shown at this symposium are misrepresentations of the risks and research surrounding vaccines. Vaccines have been shown to be safe and effective, and have saved millions of lives. The objective research on vaccines has been done, you’ve just chosen to ignore it all. The research has been conducted by independent bodies that have no ties to pharmaceutical companies. Sieveking even talked to the president of one such body not 10 minutes earlier. The Paul Ehrlich Institute, the CDC, and the NHS, are all independent bodies that have researched vaccines and all have concluded that they are safe and effective.

Hexavac horror story

Following the talks at the symposium, Sieveking decides to sit down with a former employee of the Paul Ehrlich Institute, Klaus Hartmann. Hartman seems to have had a successful career as an expert witness in vaccine injury cases after leaving the Paul Ehrlich institute about 10 years ago. Hartman states that he chose to leave the institute because “there was a tendency to not want to hear about reported side effects or anything negative about vaccines”. Hartmann claims that there were reported deaths following vaccination with a hexavalent vaccine for infants, Hexavac. Hexavac received marketing approval in the European Union in 2000, but this approval was revoked in December of 2005. The reason for revoking Hexavac’s marketing approval was concerns about it not providing long-term protection against hepatitis B. There doesn’t seem to be any evidence that Hexavac, nor any other hexavalent vaccine, has been associated with sudden infant death syndrome or any other cause of premature death.

Hartman claims that the he evaluated these cases and came to the conclusion that a link seemed possible, and he’s not the only doctor Sieveking interviews that makes such a claim. Sieveking also interviewed Dr. Rudolph Penning, a forensic pathologist at the Munich Institute of Forensic Medicine, who claims he observed unusual infant deaths after they received the Hexavac vaccine. Penning contacted the Paul Ehrlich institute too see if there were any reports of similar cases but his concerns were dismissed. The European Medicines Agency’s Committee for Proprietary Medicinal Products concluded in 2003 that while it appeared there was a possible statistical association, no plausible biological cause for such an association could be identified. Penning was a coauthor on a letter to the editor titled “Unexplained cases of sudden infant death shortly after hexavalent vaccination“, and in the conclusion they state: “So far there is no way to proof [sic] that these infant deaths are caused by vaccination”. This paper has been held up by antivaxxers as airtight proof that hexavalent vaccines can cause sudden infant death syndrome, despite numerous issues with their findings and how they were presented. In follow-up letter to the editor, Dr. Wolfgang Maurer points out numerous issues with the original letter. The original letter was accepted the day it was received because it was the journal’s policy not to review letters to the editor. There was no information in the letter regarding other findings that should’ve been reported if they were following a standard autopsy protocol. The authors also claimed that “mast cell tryptase was slightly above normal” in one child, but they state a few lines later that “there are no reference values available regarding mast cell-tryptase plasma concentrations in this age group.”. They basically did everything wrong, which you can read more about in Maurer’s full response letter. Hexavac was pulled from the market because it did not provide long-term immunity against hepatitis B, not because it was causing deaths and the German government was trying to cover it up. Research has shown that there is no association between vaccination and sudden infant death syndrome.

Now That’s What I Call Oblivious™

Family Shots really gives a close-up of the mindset of parents against vaccination; they’re oblivious to the real threat of vaccine-preventable diseases returning and how dangerous those diseases are. The film is centered around Sieveking’s newborn daughter and follows her as she grows up. Sieveking decides multiple times throughout the film to ignore the advice of medical professionals, public health officials, and other parents, and put his child’s health at risk by not vaccinating her and making other boneheaded decisions. The first of these instances begins about 25 minutes in when talking with his child’s pediatrician about the risk of hepatitis B. The pediatrician says there have been multiple cases of hepatitis B acquired from the needles of drug users. Sieveking takes this to mean that his daughter doesn’t need the hepatitis B vaccine and that he can just sweep playground for used needles. Of course, this simply isn’t the case. Children are at risk from contracting hepatitis B if their mother has hepatitis B, or by coming into contact with bodily fluids infected with hepatitis B. The latter is particularly concerning considering there could be bodily fluids anywhere and young children put their mouths on everything. While hepatitis B isn’t something that parents should have to worry about too much, that’s because of very successful vaccination programs. There are still an estimated 257 million people infected with Hepatitis B worldwide.

The second of these instances begins with an announcement over the radio reporting that there was no end in sight to a measles outbreak in Berlin. Sieveking and his wife discuss getting their daughter the MMR vaccine:

Well, should you do what’s best for everyone else? Or what’s best for your own child? I think it would be better if we don’t vaccinate. Not right now.

Getting vaccinating against measles, mumps, and rubella as soon as possible is in every child’s best interest. Measles is highly contagious, and killed over 100,000 people in 2017 alone. There is almost no risk to getting the measles vaccine, but the risk of getting measles in an industrialized country has never been higher thanks to anti-vaxxers. Measles is not just a fever and a rash, 1 in 5 children who get measles will have to be hospitalized, it can cause ear infections that cause permanent hearing loss, 1 in 20 will get pneumonia, and measles can cause encephalitis that can lead to permanent brain damage and so much more. Fortunately, those that get measles and survive, hopefully without any permanent effects, will have immunity for life and won’t have to be worried about potentially deadly complications from measles any longer. Sorry, I left out the part where measles can cause subacute sclerosing panencephalitis 6-10 years after a measles infection and results in incurable chronic brain inflammation and death in about 1 in 10,000 people who get measles. I don’t know how a parent could ever refuse a vaccination that would entirely mitigate the risk of their children contracting this disease. In addition, some children, such as those who are immunocompromised, rely on herd immunity to protect them from vaccine preventable diseases that have a very high chance of killing them.

In the end, not only did they decide not to vaccinate their daughter against measles, they thought it would be a good idea to ignore the advice of public health officials and take their unvaccinated daughter to a party in Berlin during an active measles outbreak. He also puts on a hazmat suit to take his daughter to the party to mock the fear people have of a very real threat. Classy.

Fortunately, their daughter didn’t catch measles from the party. Unfortunately, shortly after the party his daughter did get sick, and he expresses worry that she might have caught the measles. She ended up diagnosed with pneumonia, likely because she did not get the pneumococcal vaccine. More than 900,000 people got pneumococcal pneumonia each year in the US and more than 3,500 died in 2013 from pneumococcal meningitis. It is entirely possible that his daughter got sick for absolutely no reason. Did this event give them some drastic change of heart, to get them to see that not vaccinating their daughter could seriously harm her? Of course not! Sieveking even states later in the film that they decided to get a nanny instead of sending their daughter to nursery school due to the risk of infection. Now I’m not a doctor, but I am almost certain that there is a way to prevent kids from getting highly contagious and potentially deadly diseases so that would be much less of a concern for him. It’ll come to me I’m sure…

Conclusion: I can’t believe you’ve done this

In the grand scheme of things, Family Shots is nothing new. It’s the German version of VAXXED presenting the same antivaxxer tropes we’ve seen thousands of times along with a curve ball or two. Documentaries like VAXXED and Family Shots play a huge part in sucking people into the pseudoscience cyberspace. The removal of VAXXED and other anti-vax documentaries from Amazon Prime in March was a big win, but as Dr. Gorski explains: there’s still way too many on these services. So let’s start there. I’d also encourage you to report the film as inappropriate using Amazon’s reporting system. There’s enough of a precedent that there’s a solid chance the film will be removed and that would go a long way in disrupting anti-vaccination groups’ recruitment.

As it stands there have been more than 1,000 confirmed cases of measles in the United States as of July, 2019, the highest in over 25 years. Measles was declared eliminated in the US because we had such an effective vaccination program. Not only are we about to lose out measles elimination status in the US, thousands of young children too young to be vaccinated and people who are immunocompromised are being put in danger for absolutely no reason. This film exists to peddle nothing but ignorance and fear to parents; it has no business existing. Vaccines have been proven to be safe and effective and they prevent millions of deaths from vaccine preventable diseases because we have an effective vaccination program for the most part. As it’s been shown after the past couple of years, even a slightly lower than ideal vaccination rate can lead to massive outbreaks, resulting in expensive hospitalizations, permanent complications, and tons of unnecessary suffering.

Antivax is the weirdest form of quackery to me. I can easily empathize with people who fall into other forms of quackery. Wouldn’t it be great if curing cancer only required a simple vitamin infusion or by cutting out sugar from your diet? But vaccines are what quack treatments wish they were. Vaccines are cheap, very safe, and highly effective. Why would someone want to prove that they are dangerous so badly that they will ignore the mountain of scientific evidence supporting the safety and efficacy of vaccination, and instead listen to cranks who have published research so fraudulent they lost their medical license? At least in the case of the major antivaxxers, such as Del BigTree, because it makes them buckets full of cash.

This review isn’t going to change an anti-vaxxers mind; that’s not the point. As Dr. Novella explains in his post “How to Respond to Anti-Vaxxers“, research has shown there is no clear winning strategy to get parents to change their mind about vaccinating. Films like this feed into new parents’ fear of everything, and have no business being on Amazon Prime. It’s no question that internet misinformation on social media and documentaries like Family Shots have contributed to declining vaccination rates and the return of measles. As a result of that, we’re likely going to lose our measles elimination status in the US soon. It’s time to start talking about what we have to do to get it back.


Posted by Braden MacBeth

I'm a software engineer in Pennsylvania.