Meet author Seth Mnookin at Down to a Science tonight.

Down to a Science, one of San Francisco's best monthly science events (run by our very own Kishore Hari), is back tonight to tackle the topic of vaccines and autism. Hari's events always bring together scientific experts and an engaged audience to foster an atmosphere of scientific learning.

Tonight's event features Seth Mnookin, author of The Panic Virus. From Down to a Science's website:

"In 1998 Andrew Wakefield, a British gastroenterologist with a history of self-promotion, published a paper with a shocking allegation: the measles-mumps-rubella vaccine might cause autism. The media seized hold of the story and, in the process, helped to launch one of the most devastating health scares ever. In the years to come Wakefield would be revealed as a profiteer in league with class-action lawyers, and he would eventually lose his medical license. Meanwhile one study after another failed to find any link between childhood vaccines and autism.

Yet the myth that vaccines somehow cause developmental disorders lives on. Despite the lack of corroborating evidence, it has been popularized by media personalities such as Oprah Winfrey and Jenny McCarthy.

In The Panic Virus, Seth Mnookin draws on interviews with parents, public-health advocates, scientists, and anti-vaccine activists to tackle a fundamental question: How do we decide what the truth is? The fascinating answer helps explain everything from the persistence of conspiracy theories about 9/11 to the appeal of talk-show hosts who demand that President Obama “prove” he was born in America."

Tonight's event is at the Atlas Cafe, 3049 20th St @ Alabama St. in the Mission District and runs from 7 – 9pm.

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Daniel Patrick Moynihan

High numbers of vaccinated people act like a fire break
that keeps a disease from spreading.

Because anyone can write anything on the web, it can be hard to know what is fact and what is not. I wrote about this in my last blog. And this issue has become alarmingly apparent in a discussion going on in a recent QUEST blog about vaccinations.

In the comments section of this blog, someone writes that herd immunity is a complete myth. This is wrong. Herd immunity is real and actually makes perfect sense.

Obviously for a disease to spread, it has to go from one person to another (either directly or indirectly). A man with measles on a deserted island won’t spread it to anyone because there is no one else who can catch it. Same thing with an infected man in the midst of a group of people immune to the disease.

If we start adding people to the island, then it can spread. And if we put the man with the measles into a group of susceptible people, then it will flare up into a bona fide epidemic (think America when the first Europeans landed).

Now imagine a city where most of the people are immune. If the man with the measles goes there, odds are he won’t meet anyone susceptible. When he gets better, the disease will disappear. This is herd immunity.

Basically the immune people shield the susceptible ones from the disease. They act as sort of a fire break that keeps the epidemic from spreading. Perfectly reasonable idea.

Of course, it is possible that even though this makes sense it doesn’t actually happen in the real world. I decided to look back at the literature and see if there are any real examples of herd immunity out there. There are lots of them. Here are two.

More than a hundred years ago, scientists were noting that not everyone had to be vaccinated against smallpox to stop an epidemic in its tracks*. Scientists also noticed that when they were wiping out smallpox, not everyone needed to be vaccinated to have the disease disappear. In many places, it was enough if 80% of the population could be vaccinated and revaccinated in a 4-5 year period. So smallpox definitely provides evidence for herd immunity.

A common argument against statistics like these is that the decrease in disease came not from vaccines but from better hygiene. To try to counter this argument, I decided to look at mumps.

A mumps vaccine wasn’t really widely available in the U.S. until 1968. Here is a quote from a really thorough review article from 1993 in the journal Epidemiological Review :

"Mumps notifications have now fallen by more than 95 percent since the introduction of vaccination. Given that vaccine uptake has only recently reached that level among school entrants, that uptake among preschoolers is far below that level, and that mumps vaccine efficacy is probably below 90 percent, this decline in incidence is appreciably greater than would be predicted by direct protection alone. Assuming that the decline in reported cases reflects incidence and not a decline in notification efficiency, then this is evidence for indirect protection of susceptibles by herd immunity."

Since mumps vaccinations didn’t start until 1968, it is pretty unlikely that its decrease has been due to better sewers and washing our hands more thoroughly. No, this is a direct result of vaccines and herd immunity.

In fact the whooping cough epidemic can be explained by herd immunity too. It isn’t that not enough people are vaccinated (at least not yet). Instead, it is that the vaccine has worn off for older kids increasing the number of susceptible people. We now have too few people to have a solid fire break and so flare ups of whooping cough are starting to happen.

So despite what you might read on the web (including in the comments section of this blog), herd immunity is real. There is an overwhelming amount of data out there to support the idea that it protects us from the diseases that used to sweep through our population. Herd immunity is a fact and therefore real whether you believe in it or not.

*Farr W. Second annual report of the Registrar-General of Births, Deaths and Marriages of England and Wales, 1840.

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Public health officials in the Bay Area are concerned that not enough children are starting kindergarten with all their immunizations. (Credit: CDC/ Judy Schmidt)

Reported for KQEDnews.org

Concerned by the steady increase in the number of children who are starting kindergarten without proof of updated vaccinations, public health officials in the Bay Area will meet in November to look into the possibility of tightening the system that allows parents to opt out from mandatory immunizations.

Six percent of the state’s kindergartens – up from 2 percent a decade ago – have so many unvaccinated children that public health officials consider them “sites of concentrated vaccine-preventable disease risk,” according to a 2009 report by the California Department of Public Health. At these schools, more than 10 percent of the students were exempted from providing proof that they’re up to date with all their vaccines.

Ten percent may seem like a small number, but it’s enough to “put a school at risk of an outbreak of a vaccine-preventable disease if the disease was introduced,” said Dr. Robert Schechter, chief of the immunization branch of the state Department of Public Health, located in Richmond.

The issue is of increasing concern to medical leaders in California, where a whooping cough outbreak this year has made more than 5,000 people sick and resulted in the deaths of nine babies.

“Increases in the numbers of children whose parents choose not to immunize them are concerning,” said Kathleen Harriman, an epidemiologist with the department’s immunization branch. “In Europe, it was a drop in childhood immunization rates that allowed previously controlled diseases to become endemic again.”

Officials strive to keep immunization rates high enough to confer “herd immunity,” or “community immunity,” to the population. Herd immunity occurs when the vaccination of a portion of the population provides protection to unvaccinated people.

Depending on the disease and the community in which it might occur, in order for unvaccinated people to be protected against communicable diseases, approximately 75 to 95 percent of the population has to be vaccinated against them, medical experts say.

“For example, the level of vaccine coverage necessary to retain herd immunity to measles, a vaccine preventable disease that has recently caused outbreaks in schools, is estimated to be 83 percent to 94 percent,” said Schechter.

The 20 states that appear in green – California among them – allow parents to get a personal belief exemption for their child. The states highlighted in pink allow parents to opt out of vaccination only for religious reasons. (Credit: Institute for Vaccine Safety, Johns Hopkins University). Enlarge this map.

California is one of 20 states that allow parents to opt out from providing proof that their children have received mandatory vaccinations by stating that they are philosophically opposed to their child being vaccinated.

All states except for Mississippi and West Virginia allow parents to opt out because of their religious beliefs. And every state allows for children who have a medical reason to opt out.

In California, children starting kindergarten must show proof that they have had five doses of the whooping cough vaccine, four of the polio, three of the hepatitis B, two of the combined measles-mumps-rubella and one of the chickenpox vaccine, or that they have been sick with the chickenpox instead.

California’s vaccine exemption system is among the easiest in the country, said Dr. Saad Omer, of the Emory Vaccine Center at Emory University in Atlanta, who has compared exemptions around the country. California law requires only that a parent sign a form called a personal belief affidavit – also known as a personal belief exemption – stating that immunizations are contrary to his or her beliefs.

In total, 10,280 kindergartners in California had personal belief exemptions in 2009. That’s 2 percent of all the state’s kindergartners.

Omer found that in states where getting an exemption is easy, such as in California, the rate of whooping cough was at least 50 percent higher than in states that made it more difficult for parents to opt out.

“It’s not just an abstract legal requirement,” Omer said. “It has an impact on disease rates.”

California is in the midst of a whooping cough epidemic that has made roughly 5,300 people sick in 2010 – the most cases reported in 60 years. Nine people have died, all of them babies. Eight of them were under two months of age, too young to be vaccinated against the disease. The ninth baby had received the first dose of the vaccine two weeks before getting sick, according to the California Department of Public Health.

Whooping cough is the common name for pertussis, a bacterial respiratory infection that causes a persistent, fitful cough that can be life-threatening for infants. Highly infectious, it gets its name from the characteristic “whoop” sound that happens as people gasp for breath, although many babies under six months of age don’t develop the whoop.

In California, some counties where the rates of personal exemptions are high have suffered more cases of whooping cough. In Marin, for example, 7 percent of kindergarten students had personal exemptions – the highest rate in the Bay Area. The county has been particularly hard hit by whooping cough, with more than 300 cases so far this year. But other counties that have been hard hit by the disease, such as the Central California county of Madera, don’t have particularly high rates of vaccine exemptions, said Catherine Martin, executive director of the California Immunization Coalition, a non-profit group in Sacramento.

This map shows the rate of personal belief exemptions in California counties in 2009. (Credit: California Department of Public Health) Enlarge this map.

In Marin, two private schools have the county’s highest rates of personal belief exemptions. At the Marin Waldorf School, in San Rafael, 31 of the 49 kindergartners had personal belief exemptions in 2009, a rate of 63 percent. So did eight of the 19 kindergartners at Mill Valley’s Greenwood School.

Among Marin’s public school districts, the two schools with the largest number of kindergartners with personal belief exemptions are in the Ross Valley School District. At Brookside Elementary, 15 out of 126 kindergartners have exemptions this year, a rate of 12 percent, and at Manor Elementary, 16 kindergartners – or 25 percent of the school’s 58 kindergartners – have exemptions.

“I think it is very easy for parents to sign the waiver,” said the school district’s nurse, Laurel Yrun.

As for why Marin County parents seem more likely to sign a waiver than parents in other California counties, she said, “It’s a good question. We’re a wealthy county; this is a community of fairly well-educated people, probably with good access to medical care. It’s interesting. I don’t know.”

Yrun said most of the parents who are signing exemptions in her district are doing so because they have opted not to give their children a particular vaccine. Only a minority of parents are opting out of vaccines altogether, she said. The most popular vaccine to skip in her district is the hepatitis B, followed by polio and the measles-mumps-rubella, she said. The whooping cough vaccine was the least likely to be skipped in her district, she said.

Nonetheless, the district was hard hit by whooping cough during the past school year. In Marin, only 87 percent of kindergartners had been vaccinated against whooping cough in 2009, compared to 93 percent statewide.

The California Department of Public Health hasn’t studied the characteristics of the parents who obtain exemptions. But research by Omer and his colleagues in Colorado, Massachusetts, Missouri and Washington confirms Yrun’s experience. They found that only 25 percent of exempted children didn’t receive any vaccines at all.

In the case of whooping cough, other factors in addition to personal belief exemptions have contributed to the epidemic in California, said Martin, of the California Immunization Coalition. For example, immunity to the bacterium that causes the disease wanes over time, so a large number of teenagers and adults are currently unprotected.

A whooping cough booster shot will become mandatory for middle schoolers in July 2011. (Credit: Gabriela Quiros)

Children receive the fifth dose of the DTap vaccine that protects against whooping cough at age four or five. But by the time they’re 10 or 11, they need a booster shot called Tdap, which only became available in 2005. In September, Gov. Arnold Schwarzenegger signed into law an update to the health code that will require schools to check that children starting middle school have received the Tdap booster shot, starting in July of 2011.

Public health officials in the Bay Area have been concerned about the increase in the number of parents choosing to opt out of mandatory vaccinations since before this year’s whooping cough epidemic. They trace the change to what Emory University’s Omer refers to as “the Wakefield affair.”

In 1998, English doctor Andrew Wakefield published a study of 12 children linking the measles-mumps-rubella vaccine to autism. The paper caused rates of vaccination to fall and cases of measles to climb in the United Kingdom. Wakefield’s research has since been discredited. In February, the medical journal the Lancet retracted his paper, saying that its authors had made false claims about how the study was conducted.

Nonetheless, the paper’s effects are still being felt, said nurse Yrun.

“That’s been refuted, but once it’s been out in the media, parents hang onto it,” she said.

Concerns were also raised about thimerosal, a mercury derivative used as a preservative in some pediatric vaccines. It was eliminated in the United States from all but some flu vaccines in 2001. And numerous studies have found no connection between thimerosal and autism, the most recent of which was a Centers for Disease Control paper published in September.

“While we still need to find out the cause of autism, it seems quite clear that vaccinations are not one of them,” said Dr. Robert Benjamin, public health officer of Alameda County.

Benjamin is one of the public health officers who will be attending a meeting organized by the California Immunization Coalition in mid-November. The meeting will bring together a small group of private doctors, public health officials and representatives of medical associations interested in discussing possible changes to the personal belief exemptions, said the coalition’s Catherine Martin.

Benjamin said that in Alameda County, 11 percent of the people who have contracted pertussis had a personal belief exemption.

“While it doesn’t sound like a large percentage, it’s significant not only in that these kids are acquiring pertussis, but they’re also transmitting it,” he said. “This is where the personal belief exemption is an individual decision which has large societal and community ramifications.”

Benjamin said he would like to change the exemption’s wording so that it makes parents reflect on the impact their decision might have on the community. Or he would like to make it more difficult to obtain.

After studying personal belief exemptions around the country, Emory University’s Omer has come up with a guideline for those designing exemptions.

“It shouldn’t be easier to have your child exempted than to have your child immunized,” he said.

Omer has found that replacing a pre-printed form with a letter crafted by the parents in which they explain why they want the exemption could be an effective way to curtail the number of exemptions. Some states even require the letter to be notarized. A counseling session, viewing a video, or visiting the health department are some of the educational measures that have also been effective, he said. His team didn’t study the language of the exemptions in detail, he said. So he said he couldn’t comment on whether adding new wording to California’s form might help.

When the California group meets, the biggest challenge they might face is deciding who should be given the job of educating parents, if an educational component is agreed upon as the solution.

“To be honest, everybody is challenged budget-wise and everyone wants others to do the job,” said the immunization coalition’s Martin. “Some may feel it’s the schools’ job to educate the parents. Other people believe it’s the doctors’ and public health departments’ job. But the doctors and health departments are feeling stressed because of reimbursements and budgets.”

In fact, the state Legislature, facing record deficits, reduced the budget of the Department of Public Health’s infectious disease branch immunization program by $18 million last week, Martin said.

In Marin County, nurse Yrun said she’s curious to see how the efforts to change the exemptions system will pan out.

“It’s a huge issue to tackle,” she said. “Even though they’re a minority (parents who exempt their children), they have some pretty strong beliefs.”

But the whooping cough epidemic has raised concern among parents who are giving their children all their vaccines.

“Some people in the district were very angry,” she said. “We had parents calling and asking what the district was doing about the un-immunized children. I reassured them that the county is trying to reduce it. The public health department has gone out and had physicians talk to parents. But when you have events like that you usually have the people who believe in vaccinations who show up. The department has advertisements, they have a campaign – they’re using cows to depict herd immunity. It’s just now starting.”

To find out how many children might be under-vaccinated at your school, download the 2009 Immunization Status of Kindergarten Students in California (.pdf, 676 KB).

Watch our QUEST story about Northern California researchers searching for the causes of autism.

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Neal Snider, 34, got his whooping cough vaccine at San Francisco's Adult Immunization and Travel Clinic on Wednesday. His wife is seven months pregnant. Credit: Gabriela Quiros

Reported for KQEDnews.org

The whooping cough epidemic that has killed six babies and made an estimated 1,500 people sick in California this year is exposing holes in the state’s immunization system, which leaders in the public health community are now racing to patch.

Last month, the California Department of Public Health declared whooping cough an epidemic. Public health officials are urging anyone who has contact with children under the age of one to get a whooping cough booster shot called Tdap.

“California is the worst state for whooping cough,” said Andrew Resignato, director of the San Francisco Immunization Coalition, a partnership of state agencies, community groups and medical organizations.

The state saw a five-fold increase in the number of reported cases of whooping cough in the first half of 2010, compared to the same period last year.

Whooping cough is the common name for pertussis, a bacterial respiratory infection that causes a persistent, fitful cough that can be life-threatening for infants. Highly infectious, it gets its name from the characteristic “whoop” sound that happens as people gasp for breath. But the name might be misleading. Many babies under six months of age who contract pertussis don’t develop the whoop, said Dr. Stephen Parodi, chair of infectious disease for Kaiser Permanente Northern California.

Booster shot advised

Health care providers should be able to provide their patients with the Tdap booster shot, which is covered by insurance, said Amy Pine, director of the Communicable Disease Prevention Unit at San Francisco’s Public Health Department. And those who lack insurance can get the shot through their county public health department, either for a small fee or for free.

At the Adult Immunization and Travel Clinic at San Francisco’s Department of Public Health, almost 500 people have received the Tdap shot in July. That’s twice as many as did in July of 2009, said Pam Axelson, the clinic’s nurse manager.

“We’re getting a good response,” she said.

Elsie and William Leal dropped by for their shot because their daughter is six weeks away from giving birth to their sixth grandchild, a boy.

Elsie Leal got the booster shot to protect her soon-to-be-born grandson. Credit: Gabriela Quiros

“We want to make sure that we don’t give him anything,” said Elsie Leal. Everyone in their family, from their 25-year-old grandson to their 3-year-old granddaughter is in the process of updating their pertussis immunization. “Anyone who wants to see the baby is going to get it,” she said.

This is the response public health officials are hoping for. Though pertussis affects both adults and children, infants under six months are the most at risk for infection and death, due to the fact that they are not yet fully immune to the disease. Babies receive immunizations against pertussis, which are called DTaP, at two, four and six months, then again between 15 and 18 months. Infants aren’t fully immune until they have received the first three doses.

“We try to promote the concept of cocooning,” said Amy Pine, of San Francisco’s Public Health Department. “This is vaccinating anyone around a child who’s too young to be vaccinated.”

The state is recommending that anyone older than age seven receive the booster shot. Health providers are giving priority to pregnant women and women who have just given birth, as well as the people in contact with children under one or pregnant women. They’re also prioritizing health care workers.

Interviews with people getting the shot Wednesday show that information on the epidemic hasn’t yet reached all health providers. Leal said it took her a week to find a place that would give her the Tdap. She said that both her obstetrician and her primary care doctor refused to immunize her.

So did the pharmacy near her house in Dolores Heights, which told her that the shot is only for people under 64. Leal is 72. Nurse Axelson said that the booster shot also is safe for people over 64. She added that Leal’s doctors’ refusal to give her the booster shot might be related to the fact that ordering vaccines is a time-consuming process for doctors’ offices, involving significant paperwork.

The state Department of Public Health doesn’t track the number of adults who are immunized against pertussis, said Ralph Montano, spokesman with the department. But it does track the number of kindergartners who have received their shots. He said that 98 percent of children entering kindergarten in California have been immunized.

Statewide, about 43 percent of adolescents have been immunized against whooping cough, according to the U.S. Centers for Disease Control.

Closing the immunization gap

Immunity against pertussis wears out with time, said Kaiser Permanente's Stephen Parodi. Children should get another shot between 4 and 6, and then another one at 11. Adults who haven’t received a booster shot should get one, and research is ongoing as to how long the immunity provided by that shot will last, he said.

Until the Tdap booster shot was developed in 2005, adolescents and adults didn’t have a way to keep up their immunity against the disease. Now that the booster shot exists, public health leaders are looking for a way to make sure that adolescents receive it. Most states have established a mandate for adolescents to get the shot around the time they enter 6th or 7th grade. California is one of 11 states that have no such mandate.

California Assemblyman Juan Arambula, I-Fresno, is sponsoring a bill that would change that, by eliminating the age limits now set by the state Health and Safety Code. The code now says that public health officials can only compel children to get vaccinated against pertussis before they turn seven.

The measure, AB 354, passed the Assembly by a vote of 74-2 in May and is awaiting a vote in the state Senate. [UPDATE: Governor Schwarzenegger signed the bill into law on Sept. 29. Starting in July 2011, children entering grades 7 through 12 will have to show proof that they received a whooping cough booster. As of July 2012, only children entering 7th grade will have to get the booster shot.]

Disease misdiagnosed

Health officials are concerned that doctors might be misdiagnosing the disease. In all six deaths this year, health providers who saw the babies misdiagnosed the disease.

A seven-week-old girl who died in Los Angeles County earlier this month was misdiagnosed by her doctor three times and by emergency care personnel twice, according to a summary of her case distributed to public health leaders by the state Department of Public Health.

“People don’t recognize it,” said Resignato. Doctors may confuse pertussis with an upper respiratory infection, bronchitis, allergies, or a cough caused by asthma, he said.

Initially, pertussis can look like a common cold, causing a runny nose and maybe an achy, sore throat, said Parodi. That is followed by what he described as an annoying cough that typically lasts two weeks, but can last up to six weeks. The cough can be so bad that it causes patients to pass out or throw up.

“This can be a particular problem for little children,” said Parodi. “They can have trouble with breathing. This is what gets people to the hospital.”

The disease is treated with antibiotics. Patients are contagious from when they become ill until three weeks afterward. If they receive treatment, they will no longer be contagious after five days of antibiotics. The recovery period can take six to 14 weeks from when the patient first got sick.

“That’s another good reason to get vaccinated,” said Parodi. “Who wants to be sick for three months?”

Latinos disproportionately affected

Latino babies under six months are getting infected at a much higher rate than other babies that age. According to the state Department of Public Health, Latino babies under six months old have a rate of infection of 94 per 100,000 babies – twice the rate of African-American babies and almost three times the rate of white babies.

All of the four baby girls and two baby boys who have died from pertussis this year were Latino and hadn’t yet turned two months old. Three of them lived in Los Angeles County, and one each in San Bernardino, Fresno and Stanislaus counties.

Public health officials said Latino newborns might be at a higher risk for infection because they live with extended families, which puts them in contact with more people. Latinos in California are also under-immunized, said pediatrician Jaime Ruiz, from the Mission Neighborhood Health Center in San Francisco.

“The Latino population isn’t always aware that there are clinics where they can get vaccines for free, if they qualify by income,” said Ruiz. “And if they are migrant farm workers, they are moving around.”

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Who would have thought that vaccines would make us smarter?

Vaccines, clean water and freely available medicines may be good for more than your child’s health. They might actually make her smarter.

The idea is that brains take an awful lot of energy to develop and infections sap some of that energy. If someone has a lot of infections, this lost energy will mean less brain development which will mean a lower IQ.

Infections invariably affect the amount of energy a person gets. Think about how rundown you feel when you’re sick.

They can decrease your energy through symptoms like vomiting and diarrhea that affect nutrition absorption. And in every case infections activate the immune system which takes a lot of energy.

The brain is an obvious place from which to get that energy because it is such an energy hog. For example, newborns put 87% of their energy towards brain development and kids and adults use 44% and 25%, respectively.

The connection between lost energy and brain development makes intuitive sense, but where’s the proof? The main evidence for this idea comes from a recent study where the authors try to explain why average IQ varies across the world the way it does. Some countries have higher average IQs than other countries. Same thing with different regions of the world.

Lots of reasons have been put forth to explain these findings but none has really panned out. For example, one idea is that people who settled in cold places needed more brainpower to survive than did people in tropical places. As if finding a cave and lighting a fire is more taxing than surviving lions, leopards, cheetahs and who knows what else. Clearly a bit of Caucasian bias there…

The authors looked at lots of explanations like this and none of them came close to explaining the disparities as well as infection rates. They found that countries with higher chronic infection rates had a lower average IQ.

Not only that, but the authors argue that a continuing decrease in infections explains the Flynn effect. Dr. Flynn noticed that average IQs keep rising after industrialization (although ours may have leveled off in the mid-1990’s). So the idea is that a country’s IQ continues to increase as more and more of its people gain easy access to vaccinations, clean water and medicines.

If it ends up being true that infection rates and IQ are related, it raises some interesting questions for us here in the U.S. Will areas with lower vaccination rates that suffer more disease outbreaks eventually see a decline in IQ? Will the spread of parasites like the West Nile Virus because of global warming lower the national IQ?

Before ending, I should mention that having a higher IQ isn’t all sunshine and roses. Some studies are noting that countries with a higher average IQ also have more cases of allergies and asthma. One idea is that the immune system has to battle something and if there are no infections, it will turn on itself.

So there may be a trade off between IQ and allergies and asthma. If true, we may want to find that sweet spot where people get just enough infections to keep allergies and asthma at bay but maximize IQ. Or we may just want to go for maximal IQ…

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Why aren’t more parents vaccinating their kids?

Whooping cough has reached epidemic proportions in the state of California. And it is hard to know who to be the maddest at.

Should we be mad at the parents who refuse to have their children vaccinated? Or the scientists who have failed to communicate the safety of vaccines to these parents? Or the bacterium itself since it tends to follow a cycle and get worse every 2-5 years? Or the state of California for being too cheap to provide booster shots for 11 and 12 year olds? Or the insurance companies for refusing to adequately reimburse the cost of a vaccine? As you can see, there is plenty of blame to go around.

I can’t do anything about the bacterium itself and little or nothing about the last two. Penny-wise and pound-foolish seems to be the modus operandi of government and the insurance industry. But it seems like other scientists and I should be able to do something about the first two. The question is what…

The facts are out there. Vaccines are very safe and they do not cause autism. All the follow up studies have failed to find a link between autism and vaccines. And the doctor in the U.K. who published the original paper on the subject has had his license taken away because of the unethical way he did the original study.

There is some risk of adverse side effects from a vaccine but they tend to be small. For example, the whooping cough or pertussis vaccine can sometimes lead to severe side effects like shock or brain inflammation. These only happen 1 in 10,000 and less than I in one million respectively. These are much better odds than the 1 in 200 kids who died from whooping cough before the vaccine.

So why aren’t more parents vaccinating their kids? I have always thought that if people have the facts, then they will come to the “right” conclusion. But this is only true if someone can tell good facts from bad. And without training, this can be very difficult which means most folks need to trust the authorities who are reporting the facts. Unfortunately, as our UK doctor and countless others have shown, not all authorities can be trusted.

Chris Mooney is someone who thinks an awful lot about this stuff and in a recent Washington Post op-ed he concluded that, “…based upon my observation, vaccine skepticism seems closely connected to distrust of the pharmaceutical industry and of the federal government's medical research establishment.” What this means is that the facts are out there and the people who don’t vaccinate their kids know about them, they just don’t trust the folks who did the work.

So we don’t necessarily need more facts or getting the facts out there more comprehensively. We need some out-of-the-box thinking to get around this impasse. Here are three possibilities off the top of my head (note that I didn’t even try to come up with a way to gain trust in the pharmaceutical industry):

1) Build up trust in government agencies

2) Circumvent government agencies by creating new scientifically reliable nongovernmental study groups

3) Increase the public’s scientific literacy

Of the three, the best short term solution is probably to create some reliable alternative to government agencies on controversial sorts of issues like vaccinations. Perhaps something like the Bill and Melinda Gates Foundation could fund a group who would try to build consensus on the need for vaccinations and their relative safety compared to the diseases they protect us from. The group would include people opposed to vaccines like Jenny McCarthy, parents whose children have died from whooping cough, scientists with no stake in the discussion, etc.

Maybe these people get together and start the discussion with the fact that, “In 1920 prior to the development of the ‘DPT’ vaccine, one in 200 children died of whooping cough.” Then they propose ways to solve this problem.

Most likely the solution will be vaccines but who knows, maybe people can come up with something better. If vaccines end up as the solution, then the next step is to figure out how to get more buy in for vaccination. Find out why people aren’t getting vaccinated and then build studies or policy suggestions around that.

If people think kids get too many vaccines too close together, then maybe alternative vaccination strategies should be made available. Maybe some people just get vaccines to the real killers and vaccines like chicken pox and maybe even the measles become optional. Would this get more people on board? Would this provide adequate safety for the public?

Also find out what scientific studies this group wants done and by whom to show that vaccines do not cause autism. Then fund those studies and have people that Jenny McCarthy trusts to do the studies. The study would obviously need to be done by someone qualified to conduct such a study but still, get everyone as involved as possible.

Maybe we could push the pharmaceutical industry to create even safer vaccines. Or maybe have nongovernmental organization make the vaccine instead. If we have Pharma do it, then we’ll have to give them incentives. More profits (since profits on vaccines tend to be mighty low) or maybe some protection from lawsuits.

Anyway, the take home message here is that unlike Joe Friday, most people need more than just the facts. They need for the facts to come from someone they trust.

Here's a recent Forum discussion of the whooping cough epidemic.

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I came to realize that hope has a lot to do with science. It’s the driving force for those who seek cures, for those who work to protect the environment, for those who search for solutions to the pain and problems facing humanity.

I’ve been producing television for more than 40 years, but I’m a relative newcomer to QUEST. I’ve done four pieces so far for the series, and each segment has been a reminder of why I do what I do. I’ve grown from all I’ve learned in researching the topics, doing my best to grasp the ideas and articulate them clearly so others can grasp the content, which is often complex and steeped in a vocabulary all its own. What’s more, I’ve had the opportunity to tell stories that have meaning to people’s lives, and stories with new and hopeful developments.

I came to realize that hope has a lot to do with science. It’s the driving force for those who seek cures, for those who work to protect the environment, for those who search for solutions to the pain and problems facing humanity. I’ve seen excitement and passion in the eyes of scientists when they talk about the difference their research can make in the world.

So it was the human element and the promising science that made “Hepatitis C: The Silent Epidemic” a piece that moved me and will stay with me. The human impact of a story gives it power. So as a producer, I always look for those who are most affected and those who are left out.

One of a number of encouraging sides in the fight to contain and prevent the spread of HCV is the development of the San Francisco Task Force on Hepatitis C and I had the privilege of attending one of their meetings. From patients dealing daily with the potentially deadly liver disease to doctors and community advocates, the room was full of committed and good-hearted people with a range of backgrounds and expertise.

As members of the Task Force talked about what needs to be done to stem the spread of the disease and to develop public awareness campaigns, one of the two African-Americans at the meeting talked about the disproportionate impact of hepatitis C in the black community. She urged the task force to make a concerted effort to reach out to African-Americans. I sensed her frustration as the discussion continued with little or no response to her concerns and afterward I followed her out into the lobby to talk about it.

I must say that everyone we interviewed for this piece shared the concern about the high rates of HCV among African-Americans and expressed agreement on the necessity of developing strategies targeting Black people and particularly African-American men. At the same time, I know that many problems that affect society in general have the most devastating affects on communities of color, and I’m aware that these communities are often underserved or ignored. So I identified with her frustration and was determined to include information on race and hep C in the segment for QUEST. It turns out that her concerns were justified and the facts she presented were accurate and cause for alarm.

African-Americans have the highest rate of hepatitis C in the United States. Hep C is almost twice as common among African-Americans as among Caucasians. And current treatments are ineffective for 70 to 80 percent of black people who are infected with the virus. The rates for Latinos are also high and there are numerous factors that add to the elevated incidence of HCV in communities of color including lack of health care coverage and diet. The alarming rate of hepatitis C among prisoners is also a contributing factor. I recently did a segment on prisons for another KQED program, (This Week In Northern California) and was reminded of the disproportionate number of black and Latino men in California prisons where the HCV infection rates often run as high as 80%. As these inmates are released and return to their cities, neighborhoods and families, they can contribute to the spread of the hep C virus.

The fight to prevent HCV and to find a cure for the disease is woefully under funded, public awareness of the epidemic is minimal, and myths and misinformation about hepatitis C are common. Education and public awareness campaigns that are culturally sensitive and that target specific communities will be critical to stemming the epidemic. And when more effective treatments are developed, keeping the medicine affordable will also be key to eradicating the disease.

Considering how little I knew about hepatitis C before producing this segment and how much I have learned from doing it, I am anxiously awaiting the outcome of the groundbreaking scientific research to find a cure. The predictions are promising and give me hope. I can use some hope. My daughter is African-American, in her mid-forties and has liver disease.

Watch the Hepatitis C: The Silent Epidemic television story online.

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The last time we reported on Swine flu, or 2009 H1N1 virus, the Centers for Disease Control and Prevention was considering whether or not to invest in a vaccine for the new influenza strain.

Now, after several delays, the first batches of vaccines — first, a nasal spray version, then an injectible vaccine — is due to hit hospitals and clinics across the country (and around the world) in the first weeks of October. It's up to each state to decide which groups to prioritize, but pregnant women, young children, and those with certain preexisting conditions such as asthma may be considered priorities. Over the following weeks, the flow of vaccines, produced at five different labs across the country, will steadily increase until, officials hope, any American who chooses to be vaccinated has access to a dose.

To learn more about where to get the vaccine, call: (800) CDC-INFO (800 232-4636) or visit www.cdc.gov/flu.

Here's another good resource for basic H1N1 vaccine info.

In this piece, we profile work taking place at the University of California, San Francisco's Viral Diagnostics and Discovery Center. This lab is home to the ViroChip – a powerful viral diagnostic tool that won its inventor, Joseph DeRisi, a MacArthur "Genius" Grant back in 2004. TheViroChip and other tools are critical to the fight against 2009 H1N1 . Among other things, they may be the first to alert us should the virus mutate into a form that's resistant to the leading antiviral drug, Tamiflu. (Several cases of Tamiflu-resistant 2009 H1N1 have already been reported, but so far they appear to be isolated incidents.)

They'll be looking out for another important mutation too: That's if 2009 H1N1 changes enough so that the current vaccine for it — the one coming out in October — no longer works. (This kind of subtle virus mutation is the reason we need new flu vaccines every year.) So far, this does not seem to be the case.

Listen to the Predicting Swine Flu radio report online.

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The swine flu virus. Credit: C. S. Goldsmith and A. Balish, CDC.

As this story is being produced, the reports on swine flu are changing hourly. Cases are popping up closer and closer to home, and the CDC is updating several times a day on the spread of the virus, and plans to fight it.

The $64,000 question is how worried we should be.

Swine flu is largely untreatable: The two effective antiviral drugs, Tamiflu and Relenza, must be taken within 48 hours of infection to stop the spread of the virus.

That leaves a vaccine. Vaccines are relatively straightforward to create, but they take time. If swine flu becomes a deadly pandemic (meaning it's not only widespread — a pandemic – but more lethal than it appears to be so far) the demand for vaccines would likely far outpace supply. According to Art Reingold, at UC Berkeley's School of Public Health, it could take years for doses to reach everyone in the world who's vulnerable to the disease. Here in the US, we have very few vaccine producing facilities, which means we'd be competing with other countries' priorities to treat their own citizens.

Our story focuses on what could, one day, be the answer to pandemics like this one: a universal vaccine. Scientists like Harvard Medical School's Wayne Marasco believe that, in just a few years, we might be able to inoculate ourselves against nearly all influenza viruses – like a tetanus shot, against the flu. Universal vaccines will come too late for our current swine flu pandemic. But they may well be our response to pandemics of the future.

Listen to the Swine Flu and You radio report online.

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You're as likely to be struck by lightning
as to have a severe reaction to a vaccine.

I was reading an article in Time last week about parents not vaccinating their children. The story was about how this phenomenon is becoming more widespread.

These kinds of stories are weird to me because vaccines are pretty safe. The risk of an adverse side effect is incredibly small. For example, the risk for anaphylaxis from the Hepatitis B Virus vaccination is around 1 in 600,000. This is about the same risk as being struck by lightning (1 in 700,000).

Of course, the article wasn't talking about known risks. Instead, it was referring to a hypothesized link between vaccines and autism.

People proposed this link when they noticed that cases of autism and the number of vaccinations were rising at the same time. Of course, just because two things happen to occur at the same time, this does not mean they are causally linked. For example, the increase in global temperature is not related to the decrease in the world's populations of pirates (despite what the Pastafarians say).

So how could an increased number of vaccinations cause an increase in the number of cases of autism? I have seen two ideas put forth. The first is that thimerosal is to blame. The second is that there are so many vaccinations now that we are stressing out the body's immune system. Most likely neither idea is valid.

Thimerosal is a mercury-based preservative that used to be used in vaccines. Even though there haven't been any good studies on the effects of thimerosal on brain development, everyone knows mercury is bad for the brain. So the idea behind thimerosal makes some sense.

Back in 2001, vaccine manufacturers decided to eliminate thimerosal from their vaccines. We would predict, then, that cases of autism should go down significantly if thimerosal was linked to autism. They haven't. In fact, in one California study, cases have continued to climb. So thimerosal is most likely not to blame.

Another point that has been made is that there are so many vaccines now that we are stressing out our bodies' immune systems. Again, this concern is unfounded.

Vaccines are injections of viral proteins. Our bodies see the proteins and raise antibodies to them. Then when a virus invades, we have antibodies that recognize the virus and target it for destruction.

It is the number of viral proteins that matter in terms of taxing the body's immune system and not the number of vaccinations. All of the current vaccines put together do not have as many viral proteins as the old smallpox vaccine (150 vs. 200). So the number of vaccines is unlikely to be the issue.

What all of this means is that vaccines are probably not responsible for the significant increase in the number of cases of autism. What is responsible? No one knows for sure.

It may be that the rise just comes from all of us recognizing the symptoms more. Or it could be due to some cause we don't know about or understand.

What we do know is that vaccines save many lives. I assume no one wants to go back to the early 20th century when polio epidemics swept the country. For example, 2,500 cases of polio ended up at one Los Angeles hospital between May and November of 1934. And in 1952, the U.S. had 21,000 cases of paralytic polio.

We can prevent this sort of thing from happening by making sure everyone is vaccinated. And yet there are people who choose to hide behind the people who take the miniscule risk of getting vaccinated.

Is this a matter of free choice? Should parents be allowed to opt out of vaccinating their children even if it risks society at large?

One idea, I suppose, is to have people who choose not to be vaccinated to sign a waiver saying they accept full responsibility for their actions. In practice this would mean that health insurance and the government would not be responsible for their children's health care bills if they become ill with one of the diseases they refused to be vaccinated against.

And if your infant, grandma, or immuno-suppressed cousin came down with a disease these folks refused to be vaccinated against, then you could sue the un-vaccinated for damages. The common good isn't enough to encourage these folks. Perhaps threats to their pocketbook will be.

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