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Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5170 (Published 13 October 2016) Cite this as: BMJ 2016;355:i5170

Rapid Response:

Re: Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review

Fascinating paper!...It suggests that BCG and measles vaccines might reduce all-cause mortality as much as 50% and that DPT might increase all-cause mortality as much as 40%, presumably via non-specific immunologic effects. The reviewers acknowledge limitations in the available data and, of course, they say nothing about other vaccines or the aggregate effect of getting every vaccine on the immunization schedule. Nevertheless, this paper should give pause to vaccine officialdom, who have pooh-poohed concerns about non-specific effects and stress on the immune system, including the following examples:

1) The systemic reactions, including high fevers, caused by some vaccines are not trivial...
2) The negative effectiveness of some flu vaccines means that they increase the risk of illness from influenza; furthermore flu shots may increase the risk of illness from other respiratory viruses (Cowling, CID 54:1718, 2012)...
3) The frequency of Kawasaki disease has marched upward during the last 50 years, right along with expansion of the immunization schedule; this has been ignored, along with associations with individual vaccines (Cunningham, BMJ rapid responses 6/11/10 and 7/6/10)...
4) One dramatic example of an immune system overwhelmed by vaccines was the death of a healthy, young Army reservist; she died from a lupus-like syndrome 33 days after being given smallpox, anthrax, typhoid, hepatitis B and MMR at one sitting (Roos, CIDRAP 11/19/03).

Juxtapose this paper with other items recently published by the BMJ...

There was the news item about pediatrician Robert Sears, who is in trouble with authorities in California for giving a blanket medical exemption from vaccines to one of his patients (BMJ 2016; 354:i5027). He has a long history of skepticism about vaccine safety and effectiveness and respect for parental autonomy. Then there is Catherine Hough-Telford's blog on September 26; she implies that there is no rational foundation for concerns about vaccine safety and effectiveness. Dr. Sears was imprudent, maybe even desperate, but his action is understandable in the face of bullying by officialdom.

In the absence of large, long-term, randomized, controlled trials we have to admit uncertainty about the risks and benefits of vaccines, singly or in the aggregate. For many vaccines, especially newer ones, our knowledge about long-term safety and effectiveness is quite limited. Vaccines are licensed when limited trials, mostly funded by manufacturers, demonstrate efficacy and the absence of frequent, severe side effects. However, post-marketing surveillance, particularly for delayed, rare, serious adverse events, is half-hearted or non-existent. VAERS, our main system for safety monitoring, records fewer than 1% of adverse events following vaccination.

U.S. vaccine policy is unique, with the most extensive list of recommended vaccines and a system of rigid mandates (AAP policy statement, Pediatrics 8/29/16). Personally, I am baffled by officialdom's failure to distinguish between the importance of measles vaccine for American children and, for example, hepatitis B vaccine. Crowcroft and colleagues are concerned about the safety, effectiveness and cost of newer vaccines, and they perceive serious ethical problems in the vaccine approval process (BMJ 2015;350:h308). In the U.S. officialdom habitually exaggerates the good news about vaccines and understates or ignores the bad news; our annual campaign for flu vaccine is perhaps the most flagrant example.

Some vaccines (e.g. measles) are very good indeed, but for now we cannot say whether current vaccines in the aggregate are increasing or decreasing all-cause morbidity or mortality. This fascinating paper's conclusions are tentative, but it suggests that some humility about vaccines is in order.

Competing interests: No competing interests

16 October 2016
Allan S. Cunningham
Retired pediatrician
Cooperstown NY 13326 USA