Peter Hotez, Dean of the National School of Tropical Medicine at the Baylor School of Medicine in Houston (among many other positions), is well-known for bringing Neglected Tropical Diseases to the center of medical attention over the last fifteen years. As Founding Editor of PLoS Neglected Tropical Diseases (in which I have published multiple times) Peter has helped spawn a wide spectrum of research on diseases such as Chagas disease, dengue, leishmaniasis, onchocerciasis, and schistosomiasis, among many others. His laboratory is developing vaccines for several of diseases.
More relevant to this post is that Peter is also well-known as a vocal advocate of vaccination, a stance that has led to his being harassed and threatened on multiple occasions by quacks from the anti-vaccination movement. Peter’s efforts in this arena are particularly relevant now given the explosion of measles outbreaks we are seeing in the United States this year most of which are spatially clustered around centers of vaccine refusals. (As I write, the CDC has confirmed 465 cases of measles spanning 19 states up to 4 April; 2014 was the last year for which the annual count was higher, and we are on schedule to beat that count of 667.)
The Department of State Health Services has confirmed 15 cases in ten counties in 2019 so far. So far, Travis County, in which Austin is located, has avoided an outbreak. However, there remains ample scope for worry because Austin and its surroundings constitute an epicenter of the anti-vaccination movement because it has become the adopted home of the defrocked former physician Andrew Wakefield whose fraudulent claims linking autism to vaccines launched the latest version of that movement in 1999. In an attempt to counter Wakefield’s baleful influence in many circles around here, I typically ask Dr. Hotez to speak to my philosophy of biology or medicine classes every year. He will be doing so this Thursday (11 April).
Peter has recently published a remarkable autobiographical work Vaccines Did Not Cause Rachel’s Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad (Johns Hopkins University Press, 2018) and I am using it as a required text in my “Medicine, Ethics, and Society” course right now. I recommend the book strongly top anyone interested in the growing anti-vaccination crisis in the U.S. (and elsewhere, particularly Europe).
Peter’s book is a damning indictment of the anti-vaccination movement drawing attention to the danger posed because of growing uninformed vaccine resistance. In that context, the Wakefield fraud is particularly important because its claim of a connection between vaccines and autism has done much to fuel vaccine resistance. Peter’s response is particularly moving because, as the father of a daughter with severe autism, his personal stake in finding its causes and searching for a cure could hardly be higher. Moreover, as a highly qualified physician-researcher his competence in judging what the scientific evidence shows is equally beyond question.
His conclusion is simple: there simply is no connection between vaccines and autism. In fact, there is no compelling reason to believe any connection between vaccines and any disease. What we should be worried about is that a continued increase in the percentage of people who refuse vaccines for non-medical reasons. Forty-seven states (in the U.S.) allow such exemptions at least on religious grounds even though no major organized religion has challenged vaccination on theological (or other) grounds and many religious organizations have globally been at the forefront of childhood immunization programs. Seventeen states allow some form of personal/philosophical exemption, and this includes Texas.
The chapters in Peter’s book largely alternate between the scientific story of vaccination and his family’s struggle with raising an autistic child. For those who need a proper understanding of the logic (and science) of rejecting anti-vaccination diatribes, Chapters 8 and 9 will be the most important. The former provides the best summary I know of the scientific case against a connection between vaccines and autism. When that association was first claimed by Wakefield, many of us were less than convinced that it should have been taken as seriously as it was and that so much effort should be expended by competent scientists to refute those claims. (Peter summarizes that work beautifully.) With the wisdom of hindsight we see why the evidence against Wakefield needed to be marshalled. For policy makers it is important to have these analyses to bolster support for mandatory vaccination.
Yet, and this is my niggling worry: did all this work make any difference at all? The anti-vaccination campaign marches on. What really makes a difference is when epidemics of vaccine-preventable diseases emerge due to forgone vaccinations. It took the 2015 measles crisis in California to lead to the elimination of non-medical exemptions.
Chapter 9 summarizes what we know about autism. Peter finds compelling the evidence that suggests that abnormalities in brain structure (in particular, macrocephaly) are implicated. If this is true (and at present the evidence consists of correlations, not mechanisms) then there is ample evidence to indicate that the problem begin well before birth, long before an individual is exposed to vaccines. Of course, it is possible that maternal exposure to vaccines during pregnancy is implicated. Dutifully, Peter examines this possibility and shows how implausible it is.
Perhaps more than anything else, Peter’s book draws attention to the glaring problem in Texas (and probably many other states) of the lack of support services for adults with autism and similar conditions. This is in glaring contrast to the plethora of services that were available in Houston until his daughter reached adulthood. Short of cradle-to-grave socialized medicine I do not know of any solution to this problem. (That is why I am assigning it to my class!)
Sahotra Sarkar 