Oversimplification (and hubris) can backfire — For once, it wasn’t actually Jenny McCarthy’s fault
Although I’m usually the person writing about vaccines as a journalist, I periodically critique the way others cover vaccination issues as well, particularly when I feel the issue is not covered responsibly. The last time I critiqued such a journalist, it was because of his false balance. This time, I feel obligated to point out the significant flaws in a story whose message, on its face, most would expect me to support. But even if the intentions are good and there are kernels of truth to a story, I cannot support an misleading message that is so oversimplified that it borders on being inaccurate — even if it’s an opinion piece (and especially if it’s then buttressed by a hubristic follow-up “defense”).
In this screenshot of the New Republic website, journalist Julia Ioffe blames her pertussis infection on Jenny McCarthy – but that's not the whole story.
I’m referring to the recent piece by Julie Ioffe in The New Republic, “I’ve Got Whooping Cough. Thanks a lot, Jenny McCarthy.” Ioffe describes her awful experience with pertussis, now on day 72 of the “100-day cough.” Her description is of the disease is spot on, and she does an effective job of conveying how this illness is pretty bad for adults too, even if it’s not as likely to be fatal as it is for babies under 3 months old. I understand what she’s trying to do: she wants to use her experience with a vaccine-preventable disease to convey the irresponsibility of not vaccinating. And with almost any other vaccine-preventable disease covered by immunizations on the CDC recommended schedule, she would have a pretty good case.
But not with pertussis. Using whooping cough, her case is weak, she is uninformed, and her article could actually backfire. You see, Ioffe blames non-vaccinating parents and anti-vaccine advocates such as Jenny McCarthy for her plight, but, for once, this is misplaced blame. Ioffe is correct that whooping cough has come “roaring back,” but it’s because of problems with the current vaccine. Anti-vaccine sentiment has helped the resurgence along, but it’s not the primary culprit. And frankly, if Ioffe were following current recommendations, she would have had her booster and would have been less likely to catch the disease.
Now, Ioffe is a talented and accomplished journalist. She knows how to report and has an impressive resume. But she has not done her homework here, and it shows. It could actually be damaging to the very issue she is trying to help – that of the resurgence of vaccine-preventable diseases due to low vaccination rates fueled by anti-vaccination beliefs and fears. She writes, “The illness has, since the introduction of a pertussis vaccine in 1940, has been conquered in the developed world. For two or three generations, we’ve come to think of it as an ailment suffered in sub-Saharan Africa or in Brontë novels. And for two or three generations, it was. Until, that is, the anti-vaccination movement really got going in the last few years.”
Except she’s wrong. Pertussis, unlike most of the diseases for which we have vaccines, never went away. It has remained endemic since the 1940s. As the CDC’s tracking of annual rates of pertussis shows, the introduction of the pertussis vaccine in the 1940s did dramatically reduce the incidence of whooping cough. And for several decades, cases remained fairly low, almost never exceeding 5,000 cases a year. But the US still saw several thousand cases a year, and there were cyclical outbreaks every three to five years. And if you study that chart closely, you’ll notice the uptick in cases started in the mid-1990s.
That’s no accident. In 1997, a new vaccine called the DTaP (diphtheria, tetanus, acellular pertussis) replaced the previous DTP (diphtheria, tetanus, whole-cell pertussis). The DTP was highly reactive, causing a higher percentage of children to experience high fevers resulting in seizures. Although “febrile seizures,” as they’re known, don’t cause long-term neurological or developmental damage, they are frightening, and it’s understandable that parents and clinicians would seek a vaccine that didn’t cause them as frequently. The DTaP delivered that more attractive safety profile, with a vaccine made from pieces of the pertussis bacterium rather than the whole cell. The problem – though it wasn’t identified until pretty recently – is that the DTaP just isn’t as good as the DTP in preventing pertussis over the long haul, as I’ve written about in detail in Scientific American. In fact, rather than lasting about 10 years or longer, as the DTP did, the DTaP’s immunity may wane in as little as three to six years.
There is no doubt that anti-vaccination sentiment is contributing to pertussis outbreaks. In fact, just over a month ago I wrote in Scientific American about a study in Pediatrics revealing that the areas with the highest cases in the 2010 California pertussis epidemic non-coincidentally overlapped with the highest number of vaccine exemptions (refusals). But most experts agree that vaccine refusers are not driving the resurgence of pertussis. The primary driver is the waning immunity of the DTaP vaccine.
Returning to that CDC chart, we see the big uptick occurring in the early 2000s, right about 2003, to be exact. Guess what happened in 2003? All those kids who were vaccinated with the DTaP at 2, 4 and 6 months in 1997 started first grade. What better breeding ground for a highly contagious airborne disease than schools? Fortunately, a booster DTaP is recommended for kids aged 4 to 6, so kids’ boosters should have helped keep rates from jumping immediately, but the correlation between the introduction of the earlier-waning vaccine and the increase in cases is still pretty clear.
Meanwhile, present-day anti-vaccination sentiment – what Ioffe blames in her article – is generally traced back to Andrew Wakefield’s now-retracted Lancet paper no the MMR vaccine in 1998. But alarm – and consequently lower immunization rates – due to this fraudulent paper did not begin immediately after its publication. As Columbia Journalism Review journalist Curtis Brainard documents in his excellent article about the media’s coverage of vaccination concerns, “the scare began to gain momentum in 2001” in the UK, and even a little later in the US.
So the resurgence of pertussis *preceded* the anti-vaccination fears that led to lower vaccination rates (which ARE responsible for increased outbreaks of measles, for example). With regards to this particular disease, Ioffe’s blame is partly misplaced.
Again, anti-vaccination sentiment is certainly doing its part to erode herd immunity and exacerbate pertussis outbreaks, but by oversimplifying the causes and completing ignoring the complexities associated with this particular disease and vaccine, Ioffe is doing a disservice to public health and science reporting, even if it is a commentary piece.
This misleading and oversimplified spin is irresponsible enough on its own, but Ioffe dug her heels in deeper in a follow-up piece about whether she had been vaccinated: “Yes, I Got Vaccinated for Whooping Cough. I Shouldn’t Need a Booster, Too.” Here is where Ioffe’s hubris comes in — as well as a tremendous missed opportunity to actually do her journalistic duty to educate and inform the public. Because of the many commenters asking her if she was vaccinated, she responds in this piece and explains, “I was, in fact, vaccinated against pertussis and all those other childhood illnesses on schedule. The problem, in part, is that the protection offered by the pertussis vaccine wears off by the time you reach adulthood.” (Of course, as we now know, it wanes a heck of a lot sooner than that.) She continues, “Back in those halcyon days when we vaccinated our children, the disease was not bouncing around our population and so it was okay that adults did not get re-immunized.”
Aha, but we’re not back in those halcyon days anymore, and, again, it’s not because of anti-vaccination proponents. It’s primarily because the pertussis vaccine just isn’t as good as it used to be, with non-vaccinating parents contributing to the problem secondarily. In addition, the CDC has known we’re not in those good ol’ days anymore, which is why they updated the CDC’s recommended immunization schedule for adults. Yes, there is a CDC schedule for adults. Did you know that? Ioffe clearly did not, or she would not have said she was “vaccinated… on schedule.” And yes, she should have had her booster.
In fact, the Tdap booster (the equivalent of the DTaP for teens and adults) has been recommended for adults aged 19 to 64 since October 26, 2005, nearly eight years ago. The Tdap recommendation was implemented to replace the every-10-years Td (tetanus-diphtheria) shot that adults were already supposed to be getting. If Ioffe were being vaccinated according to schedule, she should have gotten the Tdap within the past eight years, unless she happened to have gotten the Td in 2003 or 2004, in which case she would be due for the Tdap within the next two years. If the latter is the case, then that sucks for her. But if she was due for the Tdap and didn’t get it, she can blame herself and her doctor for not taking measures recommended by the CDC to protect herself (and others, such as especially vulnerable babies under 3 months old).
Now if she had gotten her booster, on schedule, as she should have, she still might have caught whooping cough if the vaccine’s immunity in her waned before she got another booster. The CDC has been dragging its feet on how to adjust the recommended immunization schedules to address the problems with the DTaP vaccine (with the exception of adding a Tdap recommendation for pregnant women last year). And if that’s the case for Ioffe, again, sucks to be her.
But blaming the anti-vaccination movement for her whooping cough, even if it has, in smaller part, contributed to the resurgence of the disease, doesn’t do anyone any favors, least of all vaccination advocates. The biggest obstacles the public health and medical communities are facing today regarding vaccines trace back to a profound distrust of public health and government institutions, medical institutions and pharmaceutical companies. That mistrust grows in part from a belief that those institutions and the media are not being honest with people, that they are concealing information about vaccines or not telling the whole story. And here comes Ioffe, not telling the whole story.
The problems with the pertussis vaccine are admittedly part of a tricky story to tell. Some readers misinterpret articles about the vaccine’s waning immunity to mean the vaccine is ineffective. Not so. The vaccine is quite effective, and in fact, it’s even more important that children, teens and adults are vaccinated on time to keep herd immunity high. Also, as I’ve mentioned several times, anti-vaccination sentiment is indeed contributing to the problem of outbreaks and epidemics. It’s just not the whole story.
I’ll be the first to point the finger at the anti-vaccination movement for outbreaks when blame is due, but I will not oversimplify my message or the science simply to make a point or cast blame. No other responsible journalist should either. Ioffe should have taken this opportunity to describe how awful the disease is, provide more nuanced background on why cases have increased (still feeling free to mention the anti-vaccination movement *in context*), and mentioned that the booster is now officially recommended by the CDC for adults — and that she’s living proof of why adults should get it.
After all, that’s why I got my Tdap booster last May.
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*Achoo* Awwww… and to think, there’s only 135 million Flu shots available in the United States for the 2013-2014 Flu season! For the (approx. with Illegals) about 400,000,000 people in the USA.
Interesting how the highest average number of people who get the Flu any given year is 20%. Which is 80 million. Yet, there are around 265,000,000 people can’t get the Flu shot even if they want it. That is, assuming of course, every Flu shot is used. Strange how I’ve never heard of a Flu shot shortage. Oh, well. Less people with whooping cough. Oh, and the lowest percentage on Average is 5%. Which is about 20 million. Out of 265,000,000 people who cannot possible even get the shot. Of course, I am quoting info from WebMD who is quoting from the CDC. So, I’m sure it’s just propaganda. 
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I’m not following your overall point since the whooping cough bacteria and the influenza virus (and, of course, their vaccines) are completely unrelated to one another. The diseases are not even caused by the same type of pathogen (virus, bacteria). Further, the flu shots are manufactured in response to anticipated demand. With more demand, more would be manufactured.
Regardless, there are actually regular reports about shortages in some years. I experienced a shortage myself when I was pregnant in 2010 and wanted the H1N1 vaccine. Even after I did get it, my husband had to wait an extra month for vaccines to be available. Also, an epidemic does not mean that EVERY person in the population, or even the majority necessarily, catch the disease. The R for flu is 1-2, which means an infectious person will likely infect 1-2 others they come into contact with, and presumably they come into contact with many more than that during the week or so when they are contagious.
It sounds as though you simply do not have a strong understanding of these vaccines or how disease etiology, epidemics or epidemiology work. The goal of vaccination is reduce the overall percentage (ideally to zero) of the incidence of the disease. It only 20% of the people typically get it, then we want to reduce that number. It doesn’t matter than 80% aren’t getting it — especially when a proportion of that 20% are dying from it.
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I was referring to the generality (within your own article) of the ridiculousness on whooping cough and non-vaccinating people. A little toungue-in-cheek humor there. I can’t figure out how you didn’t know how I was comparing the two… Unless you don’t read your own writing or have no sense of humor… lol. As far as my lack of understanding. Of course I have one. I see things differently. Kind of like when a few people die of a Shark attack, and the whole world starts chirping that there are Chevy Chase ‘Land Shark’ sightings all over the place!
As far as demand for the Flu shot… seems like this death-bringer called the ‘Flu’ would scare more of us. But, then again, 20% of us are Die hard Republicans and 20% of us are Die hard Democrats. Add both of those together and you get more people who are gullible politically than than the percentage of people who take the Flu shot in any given year. About 1 in 3 actually take the shot. So, I guess 2 out of 3 people are heartless, inconsiderate people who would rather destroy human-kind with a floating disease that uniformly destroys an average of 26,000 (between 3,000 and 49,000) per year… which equates to the Earth-Shatteringly high number of 0.000065 % of our population! Hurry (I am saying this to the Hundreds of millions here who do not take the Flu shot) Get out and get it! Oh, wait… you stand a batter chance of having a fatal auto accident on the way to get the shot (about a 1.2% chance) Okay, don’t get the shot and wind up in the hospital…(Oh, bloody hell, there’s almost 3 times the risk of dying from an infection gotten while IN the hospital!… about 100,000 each year) I am not recommending anything anymore… Except common sense. We all get sick. We all die. Sometimes we die from getting sick. Sometimes we die without getting sick. Sometimes we die from a bad heart. Sometimes we die because we take our own lives. In the end, who is the greater conspiracy theorist? One who supports the fear of the 0.000065% chance of death, or the one that studies deeper and says that we shouldn’t ban stairs just because people fall down them and die? (more than 1,000 per year die falling down stairs). What did they do about that? They created ‘escalators’. (A 2006 study of escalator injuries involving children younger than 19, also used CPSC data to determine that 26,000 (29 percent of which were fatal) escalator injuries involving children were treated in emergency rooms between 1990 and 2002. Falls accounted for more than half of all the injuries, but more than 67 percent of injuries in the 15-19 year age-range. Falls from an escalator often cause more severe injuries and more fatalities. ) What’s my point? If you don’t get it, then you never will. Please continue your ‘Scientific American’ propaganda. I read their article on the non-vaccinations and whooping cough. Very enlightening. I am amazed you write for them. Lol. I like this article too : http://www.bibliotecapleyades.net/salud/salud_vacunas170.htm
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I’ll bow out here because your nonsensical rambling and bizarre, twisted “sense of humor” is not worth my time.
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“The CDC has been dragging its feet on how to adjust the recommended immunization schedules to address the problems with the DTaP vaccine (with the exception of adding a DTaP recommendation for pregnant women last year). And if that’s the case for Ioffe, again, sucks to be her.”
That should be adding a Tdap recommendation for pregnant women, correct?
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Yes, it should! I’ll correct that now. Thank you!
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The whooping cough booster shot is free in NZ for pregnant women. I only found out about adults needing booster shots when I took my daughter in for (I think) her 6 month shots. The nurses then told me that it’s recommended all adults in close/frequent contact get the booster and she then mentioned that I should’ve gotten it while pregnant as it’s free… well if someone had told me!! You would think this would be something that’s mentioned with all the other important maternity things like taking folic acid.
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I suppose this is a stupid question, but why did we abandon the long lasting DTP vaccine in favor of this new one?
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It’s not a stupid question at all. The DTP was discontinued because it was more reactive than the current vaccine. That means a higher percentage of adverse events occurred among children who received the vaccine, and some of them were frightening or disturbing to parents. It does not appear that they caused long-term damage, although there were a few rare cases reported of “prolonged convulsion or encephalopathy” that occurred around the time of the DTP shot and could not be determined to be caused by it or not caused by it. This CDC MMWR link can tell you more about the DTP: http://www.cdc.gov/mmwr/preview/mmwrhtml/00041645.htm
If you scroll down to Table 3 on that page, you’ll see that a fever over 105 occurred in 1 of every 330 doses, and persistent, inconsolable crying for at least 3 hours occurred in 1 of every 100 doses. A collapse or a seizure (usually caused by high fever) occurred among 1 of 1,750 doses. Again, none of these were determined to lead to long-term damage, but you can imagine how scary it would be as a parent to have a child who cries inconsolably for three hours or who has a seizure following a routine vaccination. These events were considered not worth the benefit when another vaccine could be developed. However, at the time the new vaccine was adopted, the earlier waning immunity was not known.
For other detailed questions about the DTaP and Tdap, these two sites offer great information:
http://www.immunize.org/askexperts/experts_per.asp
http://www.immunizationinfo.org/vaccines/diphtheria
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[…] don’t think it does. Other journalists have politely pointed out some logistical and technical reasons these children probably aren’t to blame. But the above […]
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I fail to see where the CDC has a schedule of recommended booster shots of TDP of DTaP for adults. Here’s the link for CDC recommendations. I started by looking, being interested in whether I should get a booster or not. I don’t see it.
http://www.cdc.gov/VACCINES/VPD-VAC/pertussis/default.htm#recs
I still don’t know.
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I’m baffled by your confusion because the very link you provided says at the top “Health officials now recommend that adults and adolescents receive one dose of the Tdap booster vaccine to protect against whooping cough. It is especially important that those in contact with infants younger than 12 months of age are up-to-date with pertussis vaccinations. The Tdap booster is recommended in place of one dose of the Td (tetanus-diphtheria) booster.” Then, if you click on Summary of Vaccine Recommendations (http://www.cdc.gov/vaccines/vpd-vac/pertussis/recs-summary.htm), it states in the chart for adults aged 19 and older: “Any adult 19 years of age and older who has not received a dose of Tdap should get one as soon as feasible – to protect themselves and infants. This Tdap booster dose can replace one of the 10-year Td booster doses. Tdap can be administered regardless of interval since the previous Td dose. Shorter intervals between Tdap and last Td may increase the risk of mild local reactogenicity but may be appropriate if your patient is at high risk for contracting pertussis, such as during an outbreak, or has close contact with infants.”
This states clearly that adults should receive the Tdap (not the DTaP, which is only for infants) every 10 years in place of the Td. The Tdap and DTaP are protective against the same diseases, the former for adults and adolescents and the latter for infants and children up to 6 years old. There is no such vaccine as the TDP and the DTP (or DPT) is no longer given in the US. Does this explain what you were looking for?
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[…] clarifications were pointed out in this article by Tara Haelle. But what struck me was the content of a bunch of anti-vaxer commenters who swarmed the original […]
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Be this as it may, if one turns to the measles vaccine uptake data (PDF) from Wales, there are two distinct troughs. Both are in the same bin in the incidence data, though.
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I would appreciate it if you could do a post on the recent baboon study of pertussis transmission to help put it into perspective for the average mom like myself. For example explaining the science of being an asymptomatic carrier of pertussis from the vaccine. It isn’t that you can get the bacteria from the acellular vaccine correct? More that you can still be a carrier and be protected from pertussis at the same time?
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I actually just wrote about that study for Scientific American, but it won’t be out until a future issue. I’ll go ahead and write up a blog post that explains what it did (and didn’t) say
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Thank you that would be great what I have seen so far has done very little to provide history, depth or perspective on it (I would have at least expected more from the New York Times but that didn’t happen) so looking forward to it.
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Hello,
First – new reader and thrilled to find your blog. I’ve been acting as the facebook mediator between science and my anti-vaccine family members. Your blog saves me a tremendous amount of time as family science advocate. So thanks for doing this.
Second, in the course of these discussions the PNAS paper was raised. I’ll look forward to hearing your thoughts when they’re published at SA or here.I took a few things from the work, and thought the findings were an important first step. One key deficiency, or at least something I’d really like to know when evaluating the finding, is whether aP vaccination alters the _frequency_ of transmission from infected to naive animals. The co-cage transmission data were understandably limited, but even so I didn’t see the issue raised even though it relates directly to their conclusions regarding the aP vaccine and airway colonization.
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I’m glad my blog is helpful! I am working on that post now re: the PNAS paper. I’ve been delayed because of the holidays and some family stuff going on. I’m not sure if we can know enough about frequency of transmission from those results, honestly. Because only a couple animals were used in the third part of the experiment (the one finding aP-vaxed baboons transmitting to naive animals) and because it is still an animal model study, it would be near-impossible to extrapolate much from that could be used to estimate possibilities at the population level. My brief on it will be in SA in the February issue, but it’s just a brief, and I’ll be going into more detail here on the blog. I interviewed a few immunologists when I wrote it, however, including one of the authors of the paper, so I may be able to shoot them an email to inquire further about that.
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Right on. Thanks!
Agreed about the limits of their system (and really, who wants to see more baboons get sick?). Thinking about it more, I found myself looking for a discussion of the issue rather than enough data to address it. More practical ways exist to address population-level questions
The data were sufficient to highlight an important aspect of the aP vaccine, and they identify a super useful wedge between symptoms vs. colonization that can be used in future work.
Anyway – thanks again. I’ll check back.
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Thanks for this important clarification. I’m 50 and DID have the booster recently, but still contracted a debilitating case of pertussis. It has hit me with a strength I couldn’t have imagined and certainly makes it humiliating to go out in public, and sometimes scary as I struggle to breathe. I admit it was my gut reaction to feel anger at the anti-vaxxers, but I appreciate your explanation that the story is more complex than that.
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In a sense, you can place a little blame at the anti-vaxers’ feet, but it predates Jenny McCarthy. The reason we went to the acellular vaccine was concern about the seizures that could result from fevers following the whole cell vaccine. Those seizures don’t cause any long-term damage, but Barbara Loe Fisher (founder of the anti-vax NVIC) pushed the idea that they did and was instrumental in the change happening. To be fair, it was also because of her that we ended up with VAERS and Vaccine Safety Datalink post-licensure monitoring, as well as the vaccine injury compensation fund, so good came of that. But we’d be better off with the whole cell vaccine now.
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[…] issue at the moment because rates have been climbing in a big way over the past decade. I’ve written before about the reasons for that: primarily the waning effectiveness of the vaccine with some […]
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[…] to the U.S. This issue has flared up in the media previously now and then, usually name-dropping Jenny McCarthy as a scapegoat and providing the obligatory “vaccines aren’t related to autism” line. Those past blips on […]
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[…] to the U.S. This issue has flared up in the media previously now and then, usually name-dropping Jenny McCarthy as a scapegoat and providing the obligatory “vaccines aren’t related to autism” line. Those past blips on […]
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[…] her part too. But many parents have concerns about vaccines, and these days, McCarthy is just a convenient scapegoat, a tired trope for those too lazy or ignorant to realize how many others are out there besides […]
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[…] to the U.S. This issue has flared up in the media previously now and then, usually name-dropping Jenny McCarthy as a scapegoat and providing the obligatory “vaccines aren’t related to autism” line. Those past blips on […]