Vaccination is arguably medicine’s greatest success. It has eradicated smallpox and has saved millions from death and suffering from a growing list of preventable diseases. It’s surprising that it has so many critics. Most of them are either not educated in medical science (like Jenny McCarthy) or are educated but prefer to reject science in favor of anecdotal experience (like Jay Gordon). Their arguments have been examined ad nauseum on this blog and elsewhere, and are easy to dismiss. But when I learned that an immunologist had written a book rejecting the whole idea of vaccination, I couldn’t dismiss it so easily. An expert in the field obviously knows more than I do about the relevant science; and if nothing else, she might have some valid criticisms of vaccines that I had overlooked. In 2012 Tetyana Obukhanych, PhD, published a short (53 page) book that is available in a Kindle edition: Vaccine Illusion: How Vaccination Compromises Our Natural Immunity and What We Can Do To Regain Our Health. I read the book hoping to learn something, and I did learn some things, but not anything that would make me question the current vaccine recommendations. I tried valiantly to understand her message; I think I succeeded. I’ll try to summarize what she is saying and explain why I think she got it wrong.
Obukhanych says she started to question vaccines when she became a mother, after she had already begun to notice certain inconsistencies in immunologic theory and certain omissions in published work on vaccine development. Thinking about it from the viewpoint of a mother convinced her that vaccination was “one of the most deceptive inventions the [sic] science could ever convince the world to accept.” She says that acceptance of this invention “has precluded us from seeking to understand what naturally acquired immunity to diseases really is,” and from figuring out an effective, safer way to prevent diseases.
She starts with this astounding definition of immunology:
a science that studies an artificial process of immunization – i.e., the immune system’s response to injected foreign matter. Immunology does not attempt to study and therefore cannot provide understanding of natural diseases and immunity that follows them.
That is demonstrably wrong. In contrast, here’s the Wikipedia definition:
Immunology is a branch of biomedical science that covers the study of all aspects of the immune system in all organisms. It deals with the physiological functioning of the immune system in states of both health and diseases; malfunctions of the immune system in immunological disorders (autoimmune disease, hypersensitivities, immune deficiency, transplant rejection); the physical, chemical and physiological characteristics of the components of the immune system in vitro, in situ, and in vivo. Immunology has applications in several disciplines of science, and as such is further divided.
She claims that immunology can only be studied through unrealistic experimental simulations of the natural process. She says vaccination itself is a disease process but it provides only a puny surrogate of immunity. She says it is not enough to compare the risks of vaccine injuries to risks of exposure to the diseases; in addition we should consider how vaccines achieve their effects and ask whether they truly benefit our children.
Chapter 1. Jenner, the father of immunology and inventor of vaccination, was wrong. He was fooled because he tested his vaccinated subjects for resistance to variolation rather than to natural smallpox, and he didn’t realize that the protection wore off after a few years. As a result, horrible smallpox epidemics occurred in communities where people had been vaccinated once and thought they were still protected. She thinks this proves that vaccination “is not an equivalent of immunity.” (But of course we know that periodic revaccination is necessary for some diseases; and even if smallpox vaccines weren’t perfect, they were good enough for vaccination campaigns to achieve worldwide eradication of the disease.)
Chapter 2. When the tetanus vaccine was developed using modified toxins (toxoids), its success was attributed to the stimulation of antibody production. She claims this assumption has never been properly tested and should be tested by giving the vaccine to a control group of animals that are genetically unable to produce antibodies and then exposing them to infection to find out if they are protected anyway. She claims that anyone suggesting such testing would be slapped down for going against antibody-centered dogma. (I think such testing is more likely to be squelched because of ethical objections to giving deadly diseases to defenseless animals to test an improbable hypothesis.)
Chapter 3. She found a series of 1920s experiments in China that she interprets as showing that natural immunity to tetanus has “nothing to do with antibodies.” Wrong! One study showed that guinea pigs developed natural immunity when fed tetanus spores, but only to the specific strain of spores. The amount of antitoxin they measured in the blood did not correlate to immunity; so they concluded not that antibodies weren’t responsible for immunity, but that some other type-specific antibodies must be involved. Another study found that a third of people in Peking were carriers of tetanus bacteria and had “natural” immunity to the disease. My interpretation of these studies is that they showed that production of antibodies and achievement of immunity could be achieved through intestinal colonization with tetanus spores. Interesting, but what are its implications for medical practice?
Chapter 4. She says the tetanus toxoid vaccine was never properly tested in randomized controlled trials, but was instituted following WWII because tetanus frequency was reduced from WWI levels; and that could have been due to non-vaccine factors. The CDC webpage says that the efficacy of the tetanus toxoid vaccine has never been studied in a vaccine trial. But it has; just to mention one, I found this 1966 randomized double blind study of 1,618 women in rural Colombia that used influenza vaccine as a control and found that vaccinating the adult female population with tetanus toxoid vaccine reduced the death rate for neonatal tetanus from 7.8 per 100 births to zero.
She repeats the naïve argument, so common in anti-vaccine circles, that the death rate from tetanus was already decreasing before the introduction of the vaccine, so maybe the vaccine did nothing. As we have pointed out so many times, it’s not useful to look at the death rate, because fewer patients die as medical care improves. We must look at the incidence of the disease, which drops dramatically in vaccinated populations. The clinical effectiveness of the tetanus toxoid vaccine is virtually 100%; cases of tetanus in fully-immunized people are extremely rare. It would be unethical to deny patients that protection to do a controlled trial of vaccines vs. intestinal colonization.
She describes a controlled trial of tetanus patients in Bangladesh where both groups got standard care including tetanus immune globulin, and adding intravenous vitamin C decreased the death rate. She thinks this means that vitamin C is an effective treatment for tetanus. In my opinion, it only showed that adding vitamin C to conventional treatment improved survival in a population that had not been immunized and that may well have been malnourished and deficient in vitamin C.
She even questions the efficacy of tetanus immune globulin for treatment of infection, saying that tetanus toxin acts in the central nervous system and antibodies can’t cross the blood-brain barrier. But they don’t need to: circulating antibodies neutralize antigens in the blood to prevent toxins from reaching the brain.
More unsubstantiated assertions
That was just the first four chapters. In ten more chapters, she goes on to make a whole series of unsubstantiated assertions, false statements, and speculations:
- Immunologic memory is a myth.
- Allergies can’t develop from exposure to allergens alone in the absence of adjuvants.
- Alum in vaccines is the cause of the increasing incidence of allergies.
- Vaccine protection from vaccines doesn’t last as long as immunity from natural infection, immunized people sometimes still get the disease, and vaccines only delay infection until the person is at an age where the infection has more serious consequences.
- The immature immune system of infants can’t deal with natural viruses or even with artificially attenuated viruses, but after the age of two children can withstand childhood diseases without complications.
- Injection bypasses mucosal surfaces whereas natural infection induces mucosal antibodies.
- Mothers can’t transfer vaccine-induced antibodies to their infants in breast milk.
- Vaccines have made childhood diseases more dangerous.
- Flu vaccines create “antigenic sin” (when antibodies cross-react without perfectly matching, thereby “freezing” up the immune system).
- Taking a flu shot is tantamount to playing Russian Roulette and might turn the next flu into a deadly disease.
- It is “unacceptable” to give annual flu shots to young children or to require them for health professionals as a condition for employment.
- Homeopathy is better than Tylenol. It has been proven to work but has been denied the status of a legitimate science only because we don’t understand how it works.
- There is no herd immunity in the US (she even mistakenly says that herd immunity exists when the proportion of non-susceptible people is above 68%).
- Vaccination does nothing to prevent sporadic outbreaks of viral diseases that are no longer endemic but are brought into the community from abroad.
- After you make informed vaccine decisions “you will need to use appropriate legal vaccine exemptions for your child’s school attendance.”
She questions vaccine safety, because:
- Oral polio vaccine causes polio in one out of a half million recipients. (There is a small risk. That’s why countries switch to the injected version as soon as the prevalence of the disease is low enough to make that the better option; the oral vaccine is more risky but its increased effectiveness makes the benefits greater than the risks where the disease is endemic.)
- The inactivated polio vaccine has never been tested. (This claim stands out as egregious nonsense even in this list. One of the largest medical experiments in history was the placebo-controlled field trials of IPV in the 1950s.)
- Babies have died after the HepB shot. (She cites anti-vaccine website testimonials. Reliable sources don’t report any deaths attributable to the vaccine; severe problems are very rare, with serious allergic reactions occurring at a rate of less than one in a million).
- Gardasil, the HPV vaccine, has resulted in “numerous accounts of healthy teenagers who died or developed horrendous neurological problems.” (Here she cites another anti-vaccine website; and again, reliable sources don’t attribute any serious side effects to the vaccine.)
She misrepresents the results of a study on subacute sclerosing panencephalitis (SSPE), a late complication of measles infection. She says the rate of SSPE rose 25-fold in the 1990s because of decreased maternal immuno-protection from vaccinated mothers. The study she cites examined the risk of SSPE following the resurgence of measles in 1989-91, found that previous estimates of risk were probably too low, and it underscored the importance of childhood immunization programs, concluding that the prevention of measles cases through vaccination may prevent more cases of SSPE than was previously recognized.
In the Appendix, she lists a number of blogs, websites, and books that are unreliable sources that provide anti-vaccine propaganda, pro-homeopathy propaganda, and nutritional misinformation.
I am not an immunologist, but it doesn’t take any particular expertise to spot the defects in Obukhanych’s arguments, and at least one immunologist has already noticed the same flaws I did. In the comments on the Amazon website, one of her fellow immunologists — who has studied vaccines, and is also a mother of two — offers a withering critique. She points out that Obukhanych cherry-picks her references and makes statements that she does not back up with references; that she is obviously biased and is writing for those who have decided not to vaccinate and want scientific justification for their decision; that she raises questions that she knows can’t be answered, since human trials where people are deliberately given the disease can’t be approved; that she makes unreasonable demands for perfect immunity; and that even when she raises legitimate points (vaccinated mothers have lower levels of antibodies in their breast milk than women who had the disease) she doesn’t tell the rest of the story (without vaccines, some people would never get the chance to become mothers, and as more people get vaccinated, the risk of the babies being exposed to the disease drops).
Another disapproving commenter on the Amazon website calls the book “exceptionally irresponsible.” I agree, and I would add that it is particularly unworthy of an immunologist.