My involvement in the effects of vaccination on the microbiome discussion seems to be wrapping up as most of the anti-vaxers involved have admitted that they either don’t understand science, don’t care about it or are disillusioned by it. Amusingly, these are the same people who offered plenty of criticism about the lack of science cited when I wrote about my personal experience as an anti-vax mom. Yet, when we’re actually discussing a specifically scientific issue, they want to lean back into their personal experiences. Whatever.
Ultimately what has happened in that discussion is that the anti-vaxers want to give all the credit for reduction in disease to anything other than vaccination, while at the same time blaming individual vaccines for nearly everything that has emerged in public health since the introduction of the vaccine. I’m exaggerating the case here, but that’s pretty much what’s going on. There was much resistance to the well-studied observation that disease from S. pneumoniae dramatically declined following the first Prevnar vaccine. But absolute insistence that Prevnar is directly responsible for the increase in MRSA based on scant evidence that the vaccine has any effect on MRSA. It was all followed up with a dire prediction that “the current system is going to end up killing a whole lot of people and someone will be able to overcome the noise and connect it to the vaccine. ”
The vaccine either reduces carriage of the microorganism S. pneumoniae or it doesn’t. If it does, then we can start to hypothesize about the consequences of that. Giving the vaccine all of the credit for the bad stuff (even future calamities) but no credit for the marked reduction in Strep related diseases is wildly illogical. The vaccines appear to have only a modest impact on carriage of microbe species overall, or may have no significant impact on carriage, as suggested by this study that will be published in January 2015.
If they don’t affect carriage of Sp then all of the hypotheses that hinge on that– like the idea that increased rates of MRSA is due to Prevnar– go sailing out the window. You can no longer blame Prevnar for the prophesied future microbial takeover.
The picture is incomplete because the microbiome is an emerging field of study. That is often the case with science, and we don’t just abandon efforts to improve our situation until we’ve answered every question. Sometimes we may not know which questions to ask until we’ve actually made some attempts to affect a change. This isn’t only science, but life.
In conclusion (on my part) the results of hundreds of studies have given no cause for alarm despite some concerns about serotype replacement popularized by the media over the past 7 years or so. The disagreements between myself and my anti-vax counterparts seem to be based primarily on who is willing to make predictions of calamity based on incomplete knowledge. In the medical world there’s an approach called “watchful waiting” or “expectant management.” While “watchful waiting” has been shown to have outcomes just as good or better when it comes to some health conditions, it’s use is only medically justified in certain circumstances. Preventing infectious disease isn’t one of those circumstances.
It seems like the very cautious anti-vaxers also want this approach to apply to vaccines. The flawed assumption is that in the absence of a crystal clear understanding, it will always be safer to do nothing. When it comes to prevention of infectious diseases, watchful waiting doesn’t get us anywhere. The recommended vaccine schedule has been determined to be superior to any type of watchful waiting for everyone except those with known, diagnosed medical contraindications.
In the absence of preventive vaccination programs, contagious diseases will be much more common. The “watchful waiting” alternative in this situation means waiting for an outbreak or an epidemic to spur some people to either rush to vaccine clinics or seek medical care for the disease they catch. That’s simply not the best approach.