Leading Edge
Vaccine safety: informing the misinformed
At the time of going to press, the first major vaccination
campaigns to prevent pandemic H1N1 are getting
underway. The vaccine might not have been ready in
quite the volume hoped; nonetheless, for the production
of vaccine in any substantial quantity in such a short time
while still providing seasonal vaccine, those involved—the
scientist, the pharmaceutical companies, and the chickens
that laid the millions of eggs used—should be applauded.
Whereas most people are concerned about if and when
they will be able to access the vaccine for themselves,
their children, or their vulnerable loved ones, a small
but vociferous minority seek to undermine the efforts
of vaccine production and distribution by playing on
fears over vaccine safety. Concerns about the vaccine
have centred on suggestions that it may actually cause
influenza, that it might, as happened with influenza
vaccination in the 1970s, be associated with a small
number of cases of Guillain-Barré syndrome, and that
it has not been adequately tested. In the USA, there is
also concern that the multidose vaccine, which has been
produced to help meet the ambitious production targets,
contains thiomersal, a preservative previously removed
from vaccines.
All these concerns can be addressed. The only live
vaccine used is a cold adapted virus, so the chances of it
causing illness are vanishingly small. Vaccine production
has changed substantially since the 1970s. H1N1 vaccine
has been produced by the same methods as the seasonal
vaccines distributed around the world each year with
few side-effects beside the occasional sore arm or case
of minor congestion; and it has received safety testing,
which was part of the reason for the delay. And, finally,
thiomersal was not removed from vaccines for safety
reasons, but simply because it was not needed in single-
dose vaccines.
The fears of most people can be allayed through
constructive interaction with health professionals
and clear presentation of the relative dangers of
vaccination and of non-vaccination. However, a growing
antivaccination movement in the USA, Europe, and other
developed countries continues to fan the flames of doubt.
The movement has typically relied on promulgation of
spurious associations between vaccination and a shifting
collection of disorders that develop in children around
the same time as vaccination—most notably autism.
www.thelancet.com/infection Vol 9 December 2009
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Although lately, as study after study has shown no links
between vaccination and long-term illness, the argument
R Maisonneuve, Publiphoto Diffusion/SPL
has retreated to the unassailably amorphous assertion
that receiving a lot of vaccines is probably bad.
Immunisation has saved millions of lives worldwide
since the introduction of smallpox vaccine more than
200 years ago. But programmes are undermined by
people choosing not to vaccinate, thus decreasing
herd immunity, and reported outbreaks of vaccine- For more on influenza vaccine
activity see Reflection and
preventable infectious diseases, such as measles and Reaction page 720 and
pertussis, are becoming more common both in the USA Personal View page 784
and western Europe. For more on pandemic
influenza H1N1 see
The antivaccine movement has gained its greatest Newsdesk page 729
grounds among relatively wealthy, relatively well- For more on AIDS denialism see
Media Watch page 735
educated, middle classes who believe that they are
acting in the best interests of their children when,
before their child receives vaccination, they choose
to do a little research. Much of this research comes
from what antivaccine advocate and Hollywood star
Jenny McCarthy—who claims to have cured her son of
autism—has called the “University of Google”. But those
who turn to the internet find that many sites on vaccine
safety that are accessible to lay people are generated by
the antivaccine lobby, who effortlessly duplicate their
presence to the exclusion of most sources of evidence-
based information.
Debate about vaccination is certainly useful: in this
issue, a Personal View article advances a hypothesis
that might help to improve future influenza vaccines,
but the authors acknowledge that there is no evidence
to not continue with current vaccination strategies.
But just as the AIDS-denialists featured in this month´s
Media Watch continue to advance their dangerous
theories in the face of evidence and informed opinion,
the antivaccine movement has time and again proven
that rational informed argument can often do little to
counter the conviction of belief.
So how can this pernicious movement be tackled?
The likely solution will not only be found in continuing
to accrue evidence that debunks their claims, but also in
becoming savvier about disseminating that evidence.
Concerned parents will continue to attend the University
of Google; researchers, medical professionals, journalists,
and bloggers need to ensure that they get the right tutors.
■ The Lancet Infectious Diseases
719