Dear friends, Firstly I would like to thank the community for the overwhelming engagement with the topic of vaccination and to my letter, and other excellent submissions I have seen on Lakewood Scoop. I think we can all only gain from open transparent discourse. I would also like to thank the editors at the Lakewood Scoop for facilitating this important community discussion.
Declaration of bias – In my responses to the last letter in Lakewood Scoop I outlined my funding sources and my email is available with a cursory search. I have nothing to hide. I am receiving no financial gain for writing these articles, nor does it improve my business, since I am paid a university salary and do not see patients directly in the United States. The patient care I do provide in Malawi when I am there is provided pro bono, and the Lakewood Scoop is not very widely read in Malawi anyway. I also don’t much like the public exposure, but must involve myself in this issue under the positive mitzva of rappo yerappe and the negative one of lo saamod al dam re’echa. You all know exactly who I am and how I get paid. Some persons responded by claiming I am corrupt in some way. I would ask that persons making such statements also provide – as I have done – their full names, contact details, funding sources and affiliations, so readers can judge. Some persons have emailed me personally saying that I am uneducated about vaccines. With this I agree. Though I am very well trained in vaccine science, but as in every area, what remains to be learned is infinitely greater than what has already been achieved, as a drop in the ocean the great Rabbi Eliezer put it. Yes I am a doctor (both medical and research) but I do not ask you to trust me on that basis, I have invited you to question me. So please let us all talk to one another bedarchei noám. We are real people, not anonymous screens and keyboards.
I would like to address a few questions that have come up, that I did not have time to address sufficiently in the online responses.
Topic 1: “Other” ingredients in vaccines
A number of persons have raised questions regarding the safety of ingredients other than the immunogen (the ingredient that generates the desired immune response) contained in vaccines.
This is a big area, so I will just address some headings really, veídach zil gmor (the rest [I encourage you to] go and learn)!
There are three broad groups of “other” ingredients in vaccines, namely preservatives, stabilizers and adjuvants. Additionally there may be miniscule amounts of residuals from the manufacturing process.
The use and safety of such ingredients is regulated by the United States Code of Federal Regulations. And the associated testing and licensing form part of each vaccine product’s Biological License Application to the FDA.
I will explain each category.
Preservatives:
For vaccines to be administered safely they must be protected from being contaminated by bacteria or fungi. Without this, vaccines would be dangerous, and tragedies have occurred in the past because of contaminated material. There are a range of chemical compunds used for this, and the law requires that they be used in non-toxic amounts. I should add that every substance can be toxic at doses that are too high. Even oxygen or water – the basis of life – when administered at too high doses can be deadly. So the dose matters. One widely known preservative that was once used in some vaccines (not all) but is no longer used in pediatric vaccines in the US is thimerosal (or thiomersol) which is a derivative of mercury. Even though studies have shown that the amount used is safe and although the World Health Organization and the Global Advisory Committee on Vaccine Safety found no evidence of concern, there was community concern about its use, and it was removed from routinely recommended pediatric vaccines in the US in order to sustain community confidence in the vaccine program (so you should know your voices are heard!).
(Given the strong feeling about thiomerosal I expect some respondents of Lakewood Scoop will respond strongly to this point. I state in advance that I will not have time to address issues raised by such responses, please understand I am not avoiding you, there is available evidence out there and I cannot revisit everything to everyone’s satisfaction.)
Stabilizers:
For vaccines to remain active and given the tiny amounts of immunogen in vaccines, in order for this active ingredient to be effectively delivered to the recipient, there needs to be material in which the immunogen is delivered. This material also needs to protect the immunogen from being destroyed by temperature changes etc. Examples of stabilizers are sugars, salts, buffers (to maintain the correct acidity), amino acids and proteins (like gelatin or albumin). The last of these, proteins, can carry a very very remote risk of an allergic reaction. There is also a theoretical risk of transmission of other infections, but in the trillions of doses that have been given over years, this has not occurred.
Adjuvants:
These are chemicals whose purpose is to increase the effectiveness of the vaccines, by enhancing the immune response. One such example is alum (a form of aluminum), which has been used in vaccines for almost 100 years. Concerns are heard in the community about the safety of this chemical. Apart from the many years of accumulated experience with its use, specific studies that have examined this issue in depth have shown alum to be safe. As scientific techniques improve studies are continuing all the time, and this issue continues to be actively studied in 2018. Scientists keep postulating and testing ways of examining whether alum is not safe, and so far it remains safe. Lay readers should note that it is a strength of science that it tries to disprove its own hypotheses. Accumulated evidence and many studies show alum is safe, but if new evidence emerges that it might not be safe, it is important that such new evidence is published and addressed. An attitude of just assuming that things are fine and not pursuing possible concerns is irresponsible, arrogant and will rightfully undermine community trust. But at the same time it would be wrong to conclude that “the jury is out” on the safety of alum, or some such conclusion. The overwhelming weight of much evidence is consistently reassuring. And the most reassuring thing is that the scientific community keeps looking at this issue critically.
Residuals:
This is a substance that remains in the vaccine as a result of the manufacturing process. One example that sounds scary is the chemical formaldehyde, which is a known toxin at high doses and is a carcinogen. Formaldehyde however is also a naturally occurring substance in the body and exists in the blood at low levels as part of normal physiological functioning. The key issue here is, again, dose. The total accumulated amount of formaldehyde that a child is exposed to from all vaccinations received is miniscule compared to the natural amount of formaldehyde that is produced and cleared by the body each day. A 2013 study by the FDA concluded that they “do not find it plausible that vaccine-related formaldehyde…[is]…unsafe.”
There are many other substances that are a part of the vaccine manufacturing process. Clearly I cannot discuss each and every one, nor can I respond to every respondent to Lakewood Scoop that asks “what about this?” and “what about that?” though I respect the questions. We cannot cover the whole field here, I hope most people would understand and accept that. I will also say that I am certainly not an expert in vaccine manufacturing, though I hope most of you would accept that I am not trying to sidestep any sensitive topics. The main message I want to convey is that all these “other” substances in vaccines are known about, monitored, regulated and evaluated. The scientific literature is active on this issue, and safety concerns are raised and pursued. This is good, because the only way to remain safe is to avoid complacency. The same holds on our streets and the same holds in science.
Topic 2: Herd protection
Herd protection (differs slightly from herd immunity, but for a non-technical audience not much nafka mina) occurs for many infectious diseases, but not all. It depends on the mode of transmission, whether there is a carriage state for the organism and other factors determining transmission dynamics, it is not the same everywhere. Intuitively, for most infectious diseases if there is less of the disease around (lower prevalence) as a result of it not being the right season or because of widespread vaccination, then there will be fewer new cases arising (lower incidence). If vaccination also reduces or halts onward transmission that can also protect the unvaccinated. For example, with the bacterium Streptococcus pneumoniae (a major cause of bloodstream infection, meningitis and pneumonia) the introduction of the childhood vaccine in the US and the UK was associated with substantial reductions in disease also in older age groups. It is thought that about 65% of under-5 year olds need to be vaccinated for this herd protection to occur, though research is ongoing. Measles however is a among the most infectious of all transmissible diseases, and thus achieving herd protection requires very high rates of community vaccine coverage, around 94-95%. This is difficult to achieve, especially where there is reticence to vaccinate among some subgroups in the community. For some conditions, like pertussis (whooping cough) almost all the life threatening cases will occur in young infants who are too young to be vaccinated, so herd protection is particularly important. It is especially important that young adults are protected since they are the ones having young children. Protection conferred by the pertussis vaccine wanes by about 10-15 years following vaccination (even pertussis disease does not generate great immunity), making young adults (even those vaccinated as infants) vulnerable again, as then are their subsequent newborns. For this reason in many places the pertussis vaccine is now given in pregnancy. Other methods that have been tried around the world include giving a booster in adolescence or “cocooning” that is vaccinating the family of the newborn. Bottom line – herd protection is an important phenomenon but is not equal across all infections or places. Now the notion of herd protection is often used in moral arguments about our obligation to be vaccinated in order to protect others. I want to separate fact and value here. We should continue to evaluate the drivers of herd protection in order to maximise the overall community impact of vaccines. Studying herd protection mechanisms is important. We should use the best available evidence about herd protection. However, what we as a society do with such facts, in terms of motivating behaviour change say, is a matter of values and moral argument. So is something that should be discussed and debated. Moral deliberation should be informed by best available science and should themselves guide the science, but are separate to science.
Topic 3: Reporting bias and vaccine safety surveillance
We learn by reading and hearing about things in the world. It is sometimes difficult to separate out our evaluation of the quality or importance of some piece of information from the volume of that information. A simplistic example – if my 3 year old is screaming and whinging there may be something seriously wrong, or maybe her brother just took her toy. But if my 3 year old is rachmana litzlan listless and not feeding well, there is less noise but much more cause for concern. This silly example is just to separate out the importance of something from how loudly we hear about it. The same holds in what we hear about vaccines in general. When an adverse event occurs (that may be real and very serious, nothing silly when this occurs) it is often spoken about widely, yet when the millions of doses are given without any problem nobody informs us of this. You hear bad news, you don’t hear when nothing happens. By the very same logic, since most infections resolve with no severe effects we might hear someone say that “40 years ago I had measles and I turned out fine”. We are more likely to hear from such survivors than from those who lo aleinu died of measles, for 2 reasons: A) there are far more people who survive measles than do not, B) Survivors are alive to tell of their illness years ago, while those who died cannot speak. So information about disease being mild and vaccines being harmful are magnified by reporting bias. It is therefore very important that there is solid epidemiological surveillance to give a high quality evaluation of adverse events of both vaccination and of disease. For example in vaccine safety we would want to know about serious but rare things, even if their rarity makes it difficult to detect. This can be challenging and requires a great deal of funding over years. I agree with many concerned persons who call for more funding for vaccine safety monitoring. Such funding has to compete with more glossy research priorities. A good case example – many countries used to give the live oral polio vaccine (OPV). There is a rare risk that the live vaccine could itself cause polio (this is called Vaccine Associated Paralytic Polio or “VAPP”). In the US this risk was about 1 in 1.4 million. In addition, the vaccine can change genetically and be able to circulate and cause polio (this is called Vaccine Derived Poliovirus or “VDPV”). Between 1988 to 2015 there were 813 documented community circulating VDPV cases identified (half of these were in Nigeria). That is 813 cases in 27 years. Most of the world’s children received this vaccine over the same period, that is millions upon millions of doses. Nevertheless, as polio vaccination rates are high globally and as a result polio elimination is occurring in most countries (but for a few notable exceptions) and the risk from polio drops, so the risk from VAPP and VDPV became unacceptable even though it was tiny. As a result of this changing risk:benefit balance the world is changing from using the live oral polio vaccine to the injectable killed polio vaccine (which cannot cause VAPP or VDPV), this is a gargantuan undertaking. The US already made this change in 2000. Good global surveillance of both polio disease and of polio-vaccine adverse events led to a global policy change, entirely driven by vaccine safety concerns. The vaccine research and policy community takes vaccine safety very seriously. We subject all children to vaccines. We subject our own children to vaccines. We want these vaccines to be safe for our children in the same way that you readers want them to be safe for your children. You love your children at least as much as I love mine, and I love mine just as much as… well actually nobody could possibly love their children as much as I love mine…
Lastly, I would also like to clarify a general point. I stated in my letter that with respect to the question of autism, measles vaccines are entirely safe. I stand by that statement. But after reflection I think it is more prudent to say that in terms of all their other risks for adverse events, that vaccines in general are not entirely safe but that they are very very very safe. Of course adverse events occur. Mild and transient events are ubiquitous and resolve, serious adverse events do occur but very rarely. But the most important point of all to understand is that the risk of NOT vaccinating is far greater than the risk of vaccinating. Not vaccinating will result in a return of infections (like measles as we see now) whose complications are more common and more severe than the adverse effects of vaccines. This is especially the case for measles at the moment since measles cases are presently still occurring. But it will continue to be the case even once measles incidence (i.e. new cases occurring) is hopefully brought under control by the public health authorities. Even then, measles is likely to be reintroduced into the Jewish community from Eretz Yisroel or other places.
May we make good decisions and trust in the Almighty, that we and our children be healthy in order to be le’ovdo be’emes.
For your claim that aluminum adjuvant is safe, please see: “Slow CCL-dependent translocation of biopersistent particles from Muscle to Brain” Khan et al, BMC Medicine 2013, 11:99
There is much, much more. Injected aluminum in nanoparticulate form is much different than ingested aluminum. The body excretes most of the ingested aluminum. Injected aluminum adjuvant is meant to persist in the body to activate the TH2 arm of the immune system. THAT’s the point of vaccines.
Additionally, you have failed to address the epidemic of auto-immune disease, which is much more difficult to treat than a 4 day case of measles. And there is this: Measles can effectively be treated, complications minimized with large doses for 2-3 days at onset, of vitamin A, in addition to vitamin D3 and vitamin Co for immune system support. Vitamin A deficiency is created by measles AND by measles vaccines. To only push the vaccine side of this argument and not inform the public of how to successfully treat both the vaccinated child and the child who has caught a wild case of measles is medically irresponsible.
Furthermore, the author fails to address the issue of human fetal DNA debris, which has been shown, in animal models, the cause stem cells to mutate more than chemotherapy, which then increases the risk of cancer. Everywhere MMR campaigns are launched in the world, childhood cancers increase. These are called “change points.” For more information on this, I suggest the author read the research of Dr. Theresa Deisher, PhD.
To learn more correctly how the entire immune system works and why vaccines do not promote overall, long term health, I suggest the author read Dr. Tom Cowan’s book, “Vaccines, Autoimmunity and the Changing Nature of Childhood Illness.”
Thanks Dvorah Chanah for your thoughtful comments.
One should open with mili de’bdichusa – you know there is a (not so Yeshivish) joke about the Rambam – who was such a great figure and whose work was so overwhelmingly comprehensive, that anybody who wants to find something to support their view could try to find it in there – so people say he is “My-monides”, no he is “My-monides”. (I am joking of course, the Rambam is one of the most consistent intellectual figures there is). My point – I don’t want to get into a referencing battle, your paper says this and my paper says that. But I will refer you to the following:
Ameratunga R et al, Evidence Refuting the Existence of Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA). Journal of Allergy and Clinical Immunology Practice. December 2017; 5(6):1551.
Your point about TH2 is correct in part, though it depends which vaccine. Some vaccines may have a TH1 weighted effect. For the general audience – the immune system is very complex and has many arms. Vaccines of course affect the immune system, that is what they are supposed to do. And different vaccines can function and impact upon different parts of the vastly complex system of immunity we have been blessed with.
Vitamin A is an important part of therapy for measles in vitamin A deficient areas, and may help prevent measles disease complications like blindness. But it is not a cure for measles itself. Nor are the other vitamins you listed. There is no cure for measles, only supportive care for its complications (like ventilation in severe measles pneumonia). The key to measles is its prevention through vaccination of course.
I disagree that I am being medically irresponsible by not talking about what to do when one’s child has measles. If a child has measles the parents should not look up what to do by reading the Lakewood Scoop. They should call their doctor and see when it is safe to come in and not infect others. My comments here are about how we as a community can prevent measles, not what to do if chas vesholom someone is infected.
I’m afraid your other points are not well founded by good evidence.
Best wishes,
Naor
I’ve been neglecting the reply button. I have a few replies in the queue. One is to clarify, I never meant to imply that you are personally responsible for not recommending vitamin A for treating children with measles. It wasn’t meant as a personal attack against you, nor as a suggestion to give medical advice on the Lakewood Scoop. Although, by shaming parents into vaccinating, when you don’t know if a given family might have genetic conditions that would pre-dispose them to damage via vaccines, might also be considered giving medical advice on the Lakewood Scoop. I do understand there has been an increase in adverse reactions since this recent MMR drive.
Would you mind posting supporting links are studies?
Hi Tana,
Doing this would take me too long unfortunately. Everything point I wrote is based on published evidence.
You could start from a major Vaccines textbook which covers many of these issues, they have full references, nowadays often only in their online editions.
Best wishes,
Naor
Thank you Dr.Bar Zev for sharing your knowledge in a non condescending way. I am sure that you create a kiddush Hashem each day as you interact with all types of people. We’d love to have you here in Lakewood.
one sided again and you pro guys never answer the anti concerns
all you say is its no true with no valid answer
vaccines are dangerous stay away
Thank you Dr. Bar Zeev. It was very informative.
I was wondering though, why we have never seen any population studies comparing vaccinated kids to unvaccinated kids. That should be a very easy study to conduct. Actually I don’t understand how you can prove safety with out having these population studies. .
Dear wise grandmother,
For vaccines in clinical development the comparison of vaccinated to unvaccinated occurs all the time.
But once a vaccine is licensed and is in use it is not ethical to conduct clinical trials where one arm is allocated to not receive vaccines. Access to vaccines is a human right.
Even then however one can conduct observational studies, from which vaccine effectiveness can be derived. (I have published some of these) Such studies are not free of bias though, and may under or overestimate the true effectiveness.
Safety needs to be studied in long term population studies even after a vaccine that was safe in clinical trials is licensed. This is because for very rare adverse events, it may take millions of doses until such rare events are detected.
An example where this occurred was in the history of rotavirus vaccines. Following licensure of a safe vaccine, very rare adverse events were detected that led to the vaccine being withdrawn from use. New vaccines were developed that have been shown to be much safer. In the intervening years between the first vaccine being withdrawn and new vaccines being available, hundreds of thousands of children around the world got sick with rotavirus disease and many died. So saving a few rare cases, led to the deaths of many. This is a fascinating topic unto itself, and raises many important ethical questions. The rotavirus vaccines in use today are well tested in large scale population studies and are very very safe.
Thank you for you answer but I think you misunderstood me.
Of course it is not ethical to withhold vaccines once it is in the CDC schedule. What I meant was, why are there no retroactive population studies? Meaning, there are areas where vaccination rates are very low, such as in certain counties in Northern California. Why can’t we look at the incidence of autism, asthma, diabetes, auto-immune diseases, (others?) in a population of kids 0 – 18 who are not vaccinated and compare that to the know incidence of these diseases in the general population of kids 0 – 18. These are the kinds of tests that are done for a variety of things such as smoking and exercise. Should be rather easy and should give a wealth of information.
These kinds of studies occur a lot. Though retrospective studies can be very biased by confounding and secular trends. Confounding is when a third issue C seems to link A to B. For example in an imaginary study I find that coffee leads to lung cancer, but this is because I didn’t realise that people have a cigarette with their coffee. And secular trends (not people going OTD!…) but changes over time unrelated to the exposure of interest. There are risks of ecological fallacies also, and many other such concerns. Doing retrospective studies with historical controls across different regions is very difficult to do well, mainly because there is high risk of comparing apples with oranges. It can be done, but is difficult and should be interpreted with great caution.
“Those kinds of studies occur a lot” Do you mean in general, or for vaccines? Yes, of course, these studies occur a lot in general. That’s why we have such good information about the benefits of exercise and the dangers of smoking. Even if there are confounding factors, good studies take that into effect. My original question stands. Are there any population studies done comparing chronic illness in unvaccinated kids versus vaccinated kids. If not, why not?
It would be great if we could have Dr. Bar-Zeev debate with another pediatrician and researcher who takes the opposing view. Having a live public debate in an open forum to bring the science from both sides would be helpful to all! If Dr. Bar-Zeev wishes to contact me regarding a debate, I would be happy to set one up. I give my permission to The Lakewood Scoop to pass on my email address to Dr. Bar-Zeev.
Dear Aviva,
I am happy to inform the public, but the merits of a debate are dubious. This is not a level playing field with two equally valid expert views.
I am not trying to be right. I don’t aim to vanquish some opposing view. I am trying to inform parents and grandparents.
I think criticism is good, and breadth of thinking is good. The way we think about vaccines may differ and that is fine. There should be properly informed conversation and good decisions that best protect our children. Parents should have their valid questions addressed.
I am not afraid of being proven wrong. I aim every day to find how I am wrong. Thinking “how might I be wrong? What might I have missed?” will make me I hope a better scientist and diagnostician.
But a debate format inherently misrepresents the weight of existing solid evidence on the safety and efficacy of vaccination.
Best wishes
Naor
Now all the anti vaxxers please comment about every discredited “expert ” who claims to find a problem with an ingredient that doesn’t really exist in the vaccine
@devorah chana
Although it seems you raise serious questions, your counterargument is ill founded.
Dr. Cowan is a shamanic practitioner who has zero education in Medicine and biology. He has a PhD in history which is completely irrelevant to his work. Clearly, his cult and book are merely a front to push his own anti medicine agenda.
Additionally you make an argument regarding fetal recombinant DNA. Rather than refuting her statement point by point I refer the reader too this article “more horrible antivaccine science from Theresa Deisher”. While this isn’t a reputable medical journal it is sufficient for this purpose.
Dr. Bar Zev has already addressed the concerns regarding alum so I won’t comment any further. Suffice it to say that the level in vaccines are far below the required to cause any brain damage.
Autoimmune disease is a real problem for those affected by it. Yet, 99.9 percent of us do not present with any illness that will remotely interact with any substance in vaccines. Just playing a pure numbers game behooves anyone not to vaccinate on the very highly improbable chance that you will present with any adverse reaction.
Unfortunately the anti vax community will grab onto any evidence that upon due diligence will show as a false argument. To those on the fence regarding vaccines please ask your question to qualified doctors and don’t rely on some unverified ‘research’ you read on the internet.
Any links to the evidence that is claimed?
Would love to see safety studies on aluminum being injected. I’ve only seen studies that show how dangerous.(injected, NOT digested)
Thanks!
Hi Chana B,
Short shabbes afternoons at the moment, but you will fill at least one with these:
Eickhoff, Vaccine 2002
Exley, Trends in Immunology 2010
Mitkus, Vaccine 2011
Glanz, Vaccine 2015
Hawkes, Toxicology 2017 [this one is a letter, so not direct evidence]
Karwowski, Academic Pediatrics 2018
Principi, Vaccine 2018
But better to spend shabbes on more real learning.
Enjoy!
Naor
Vaccines are safe yet nearly 4 billion dollars has been compensated to parents of vaccine injured children?
Of course adverse reactions are rare if doctors call it coincidence and don’t report it to VARES. If we trust our own health department who says VAERS gets as low as 1% of adverse reactions and deaths reported to them. There is no long-term studies on vaccines using a true placebo. The package insert it’s self states that it has not been tested for mutagenic carcinogenic…..
As far as I know the only study on aluminum is on ingested aluminum please don’t compare injected and ingested . Injected takes it straight into the blood stream where it sticks to the bones and accumulates in the brain . Even if the amount of aluminum in one vaccine is safe which it is not the nearly 74 vaccines we get today is insane and the amount of aluminum by age 6 is beyond words
Hi Chaim,
Yes more investment in robust longitudinal surveillance would be wonderful.
Not all vaccines are tested in pregnant humans for example. But there is an increasing call by medical ethics groups that they should be, because in some situations pregnant women really need these vaccines (Ebola is a very powerful example, but not relevant for the US, Zika is another that may yet become more relevant locally). So if I don’t test a vaccine in pregnancy I cannot say that it is or is not mutagenic. That’s why the package insert says things like that. (Animal studies can sometimes be useful but not absolutely so.)
You say that as far as you know the only one study is on ingested aluminum. This is because your knowledge doesn’t go far enough (and to be fair neither does mine). In another of my responses I quickly off the cuff listed a whole bunch of studies examining injected aluminum. The total amount of aluminum from a full life-course of vaccines is not beyond words, it can and is measured in precise amounts.
Not sure where your 74 is from.
Thanks
Naor
Hi Dr,
Thank you for all this info! What are we supposed to do as parents when all the schools allow children who are not vaccinated into school even though this will cause the outbreak to continue and spread?
You should start relying on Hashem, and realize that you cannot control everything, as a matter of fact, you cannot control anything!
Dear Dr. Bar -Zev in case in regular medical visit , doctor always make evaluation and tests, before prescribe drug. In immunisation we have to just trust on doctors word, that it safe and effective . How it is same dose could be effective for everyone with chemicals we known in bigger proportion will be very dangerous . Could you explain this ? Also on CDC website i see only safety researches made by CDC affiliated institutions , why they are not give it to really independent scientists ? It like shoichet could give his own heksher on his shchita..
Dear Moshe,
I’m not entirely sure I follow your question. In case of illness, as you describe, a diagnosis has to be made for the individual concerned and treatment decided. Vaccination is given to all persons. Vaccines are tested in healthy persons and given to healthy persons. (All the more reason that vaccines need to be super safe.) Humans all have very similar physiology and immune systems. Illness is unique to the individual, health is generally the same. Like the famous line by Leo Tolstoy: “All happy families are alike, each unhappy family is unhappy in its own way” (no doubt the English doesn’t do justice to the original Russian).
Vaccine safety studies are undertaken by the CDC and by many other groups independent of the CDC. The FDA, the Institute of Medicine of the National Academies of Sciences, Engineering and Medicine, academia (there is an Center for Vaccine Safety at my university for example, run by top notch scientists, who are cleaner than your house on erev peisach, and are totally independent of the CDC). Vaccine policy is made by global bodies also outside the US, like the Strategic Advisory Group of Experts on Immunization of the World Health Organization. In the case of the latter, all their deliberations, slide sets, notes from discussions, transcripts etc are all available to any person with internet access. You can see discussions and deliberations in full detail. There is nothing hidden. The science is peer reviewed, and anyone with a vested interest should not and generally does not act as a reviewer.
A shoichet doesn’t give his own hekhsher, but a shoichet is also neéman to the extent that he is also regularly checked.
Thank you for your question,
Naor
“Shmuel try wording that differently. Ask the doctor if he thinks that this outbreak justifies kids being sent home. Or better yet, let’s have dr. Shanik on here. He’s been the driving force behind this policy, the least he can do is come here and explain himself.
I just realized someone else criticized Dr. Cowan, not you Dr. Bar-Zeev, Apologies. This is an awkward forum for constructive discussion and it takes up too much of my time here. I bother because I feel really terrible for the families who choose not to vaccinate and how shabbily they are being characterized and treated. Also, if I have mispelled your name, I apologize. I do like your approach more than most. The name-calling and lashon hara MUST stop.
Families who chose not to vaccinate put their children and the children of others at risk. If the rest of the community is upset at them, then I can understand that. People who are immune suppressed are writing to me literally afraid to be in public places. Why should they be subjected to genuine fear? I agree that everyone should be respected, and spoken to decently. But although I do respect the people who do not vaccinate, that does not mean that I should respect their choice to put my children at risk. I should and will continue to be critical of such choices. I think such choices should be characterized for what they are – misguided, irresponsible and wrong. I have learned that even the best people, genuinely the best of people, can make choices that are wrong.
Lo sisna es achicha is immediately followed by hocheiach tocheeach es amisecha.
I find it interesting that immunosuppressed people are afraid of being in public places, your implication being due to measles. It seems that the flu is a significantly bigger killer, do they hibernate? Or is this fear irrational? For that matter should the community be upset at those who do not get the flu shot? That’s a lot of people to be upset at.
My point is, I find that argument lacking.
P.S. I am also immunosuppressed, and no, the world doesn’t owe me anything.
Under reply to comment #9, there are some medical studies listed to show safety of aluminum.One of them is a study by Exley in 2010. However more recently, Exley has stated, “I did not see a role for aluminum in autism. And I didn’t see a role for aluminum in vaccines in autism. I have to change my mind now on both of these. I have to change my mind that aluminum has a role in autism, I believe it now does.” You can find more information at “A lone FDA scientist could end the autism epidemic.”
Also the Mitkus study is mentioned. This study did not study the same type of aluminum that is in the adjuvants, and it did not study children receiving the aluminum, but rather adults.
@so Measles is much more infectious than flu with a higher percentage of complications. We aren’t used to it because B’H we were close to eradicating it.
The world does owe those who have suppressed immune systems. It’s called arvus!
Instead of just parroting the physicians, let’s examine the facts.
The flu has a considerably higher death rate than measles.
Here are some numbers from the pre-vaccine era, from the US vital statistics:
1920
measles deaths 7712
influenza deaths 62097
1963
measles deaths 364 (1 in 11,000 cases not 1-2 in 1,000)
influenza deaths 7083
Also note the tremendous decline in the death rate for measles over those 50 years.
@Tzvi P:
maybe also check the stats in the cdc website as to the decline of people infected with measles before and after the introduction of the vax.
Hi Tzvi,
I agree that influenza is also a really important public health issue.
Note though that influenza virus was discovered in 1933 (I think…). Influenza deaths before then are based on all severe acute respiratory disease. Actually even now flu surveillance has a range of case definitions, not all are lab confirmed. So comparing numbers like you have done is not entirely valid.
(Interestingly the name “Influenza” was first used in Italy already hundreds of years ago and comes from the idea of astral influences and fate. Of course we hold “ein mazal leYisrael” and we should follow the advice the hkb”h to Avrohom Avinu “tze me’itztagninus shelcha”. This suggests to me relying on good science and approaching data analysis correctly.)
Deaths decline from many causes as the population improves economically, nutritionally, hygienically, micronutriently and so on, as child labor becomes illegal, etc. Mortality declined in the 19th century, apart from a blip in the 1860’s from the civil war and in 1918 from the H1N1 flu pandemic. And as you imply, these declines preceded vaccines and antibiotics. Vaccines are very important, and so too are many advances we have seen in the last 150 years.
Best wishes,
Naor
Dear Dr Bar-Zeev
it’s a real pleasure and honor to have a Yarei Shamaim and professional as yourself to address this issue;
As in most areas of human knowledge, real experts often reach different opinions about the same issue;
Same situation in Halacha
In Halacha, we are suppose to follow the majority opinion (of experts)
, including medical issues
I don’t doubt that there some expert medical opinion who are ‘anti-vax’
but would you have any data as to what the real numbers are , among medical professionals , of those who are for and those who are against?
I don;t really expect that this will sway many of the misguided individuals, but if it makes a couple of them to ponder on this, it may be a bit of help
Thank you
Dear Shlomo,
There are not really “two sides to a debate” here.
It is universally accepted that vaccines reduce the risk of disease.
It is also universally accepted that vaccines cause harm. Strong evidence exists that shows that these real harms are either common-and-mild or severe-but-exceptionally-rare. In other words – harms are real but vaccines are very very very safe.
Strong evidence exists that not vaccinating leads to a return of infectious diseases that are harmful.
Strong evidence exists that the risk:benefit balance is clearly in favor of vaccination.
This is the position of every medical body in the world, every professional society, every university, every government, and virtually all individual practitioners.
Detractors of vaccination claim that the harms from vaccination are substantial. This is not the case.
Detractors also claim that the research aiming to uncover harms is insufficient. This is also not correct, such research exists and is continuously ongoing. Though more research into any possible harm is important, and on this point I not only agree but encourage such research.
Some detractors also claim that diseases are mild and need not be prevented. This claim is false.
In their view the risk benefit balance is not in favor of vaccination. This view is a dangerous misjudgement of the vast bulk of available evidence.
Sometimes some detractors claim that there are cover-ups or corruption or conspiracies. Such conspiracies do not actually exist. But it is correct that everyone must be aware of possible bias in their thinking and their work, and that funding mechanisms need to guard against such bias.
Some detractors make moral claims – such claims cannot be true or false but they may be right or wrong. Such claims can and should be argued against (at times even vociferously) if you hold a contrary moral view.
kol tuv
Naor
Dear Dr :
Thank you so much….
it’s really unfortunate that many individuals (including talmidei chachimim)
make light of the reality you so clearly delineated
Kol Tuv