CDC Aims to Appease Vaccine Critics « The Washington Independent
One autistic girl — a 9 year old from Atlanta whose illness is linked to an underlying medical condition — has suddenly shifted the debate on the possible link between vaccines and autism. It’s not that Hannah Poling’s case significantly alters the evidence. But it has introduced uncertainties that pose a logical stumbling block for officials defending vaccines.
This has created a defensive posture in the Dept. of Health and Human Services, which was already struggling to maintain parental confidence in vaccination amid a number of small measles outbreaks around the country.
Illustration by: Matt Mahurin
On Friday, the Centers for Disease Control’s Immunization Safety Office presented a five-year plan for expanding research into vaccine safety. The announcement, made at a regular meeting of a vaccine policy work group, the National Vaccine Advisory Committee, had been planned well in advance. But with the Poling case creating renewed anti-vaccine outcry, HHS took pains to invite vaccine critics. Improving vaccine safety “is a priority of the department, from the secretary on down,” said Dr. Bruce Gellin, head of the office that coordinates government responses to critical vaccine issues. Addressing a meeting attended by about 50 members of the public, many of them vocal critics, he added: “a crisis in confidence in vaccines could easily become a public health crisis.”
Since 1998, parents of autistic children have been blaming selected vaccines for their childrens’ illnesses. Several large epidemiological studies have demonstrated that neither the measles-mumps-rubella vaccine, nor exposure to the vaccine preservative thimerosal, has any link to autism. Still, parental refusal to vaccinate children seems to be growing. Four different measles outbreaks this year have been linked to unvaccinated youngsters.
Even as the evidence against the autism theories has grown, some parent groups have lumped autism with other childhood syndromes like attention deficit disorder, asthma, juvenile diabetes and severe allergies, blaming “over-vaccination” for all these problems. There is no evidence this is true, but the apparent increase in such conditions has led many parents to search for culprits in the common exposures of post-industrial society. Some of the increases are due to better diagnosis, while some have unknown causes. Because nearly all children are vaccinated, it is impossible to completely rule out such theories, though they have little biological plausibility.
The guardians of 4,900 autistic children have filed claims in a national vaccine court established in 1986 to compensate children who offer plausible arguments of injury from vaccines.The trials involving the autism claims are expected to last for years.
But in November, the government conceded one of the claims. The parents of Hannah Poling have shown that she suffered a high fever and eventually became autistic following the administration of five shots when she was about two years old. She was later diagnosed as having a mitochondrial disorder, a condition in which brain cells malfunction because they lack energy to deal with stresses like fever.
Parent groups who continue to insist that vaccines are to blame for autism have heralded the case as evidence for their position. A 2005 study in Portugal showed that 7 percent of autistic children in one patient group had mitochondrial dysfunction. Another study, discussed at a meeting of neuroscientists this week, showed that 23 of 37 autistic children referred to a clinic with muscle-tone problems had mitochondria defects as well. Might such an underlying condition predispose kids to vaccine damage?
Most experts, like Edwin Trevathan, director of the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention, have discounted the significance of the Poling case. No one has previously linked vaccines to mitochondrial disorders, he pointed out. However, doctors have often seen that fevers from vaccine-preventable diseases led to the onset of neurological disorders in kids with mitochondrial dysfunction.
But absolute certainty on the extent of vaccine damage in this subset of children is not available — partly because mitochondrial disorders are poorly understood. Last year, research into mitochondrial diseases got fewer than $12 million in NIH funding, according to Douglas C. Wallace, an expert on mitochondrial medicine at the University of California-Irvine. Questions as basic as the cause and the rates of mitochondrial disorders are unknown. Diagnostic methods are crude.
“This case raises a whole series of questions for which we have no answers,” said Wallace. The incidence of autism in mitochondrial patients, and the impact of infections or vaccinations on triggering the disease, are also unknown, he said. “Everything is this area is hypothetical.”
In an op-ed article in The Atlanta Journal-Constitution on Friday, Dr. Jon S. Poling, Hannah’s father and a neuroscientist, said that her case could help vaccine safety if it led to the use of a good diagnostic tool for mitochondrial disorder that would enable doctors to screen out babies for special treatment. But while such a tool might improve parental confidence, it isn’t clear how physicians would use it even if it existed. Kids with mitochondrial disorders are more prone to get sick following an infection, which in some ways would argue for more aggressive, earlier protection with vaccines.
Anti-vaccinists say the case argues for giving fewer vaccines in each visit. But scientists say there’s nothing about multiple vaccines, per se, that would harm children. Without scientific evidence, what’s the basis for deciding which vaccines should be delayed?
Terry Poling, Hannah’s mother, has said that something in the vaccines might have caused, rather than triggered, her daughter’s mitochondria to fail. If this were true, however, there would be no way to screen such children for special vulnerability to vaccines. Terry Poling testified at the hearing, and I asked her later about this inconsistency. “You’re right,” she said, “there would be no biomarkers if the vaccine itself caused the damage.”
At Friday’s meeting, CDC vaccine scientists presented a plan for studying vaccine reactions in children with underlying conditions like Hannah’s. They also stressed their willingness to allow the “public” a “place at the table.”
“I’m not a suit. I have a story too,” said John Iskander, the Immunization Safety Office’s acting director. Iskander noted that he had cases of vaccine-preventable deaths in his family, and also a nephew with autism. “Although I don’t expect you all to believe this, I enjoy the work when we do find a risk as much as I do when we don’t find one.”
Lou Cooper, the former president of the American Academy of Pediatrics and a venerable advocate for children, expressed optimism about the meeting. “I know a majority of the people in this room. I trust all of you, your integrity and your humanity,” he said. “What’s dividing us is the gaps in our knowledge. When we have all the facts we tend to come to the same conclusions.”
He was followed by Nadia Carrini, a young woman who said she was speaking on behalf of her 12 year-old brother. According to Carrini, children are being used as “human guinea pigs,” exposed to vaccines that “have created the sickest generation in the history of America.” The implacable conviction with which she spoke indicated that it will take more than good studies to convince some people.
The vaccine establishment needs public confidence in order to protect public health. But is its goal to empower opponents of vaccination, or to get them to stop spreading dangerous nonsense over the Internet? It might never bridge the gap between science-based informed opinion and those who demand changes in vaccine policy based on no evidence. A place at the table is fine. But people with knowledge have to be in charge.
Or, to paraphrase a line from the early 1960s musical, “The Unsinkable Molly Brown,” someone has to stand up and say: “The Lord has answered your prayers; the answer was no.”