David,

With all due respect to you as a physician, I would like to share an alternative perspective on the vaccine safety conundrum [in response to “Advocating for Vaccination,” February 2019].

Without acknowledging our Vaccine Injury Compensation Program has paid out more than $4 billion to vaccine victims over the last 34 years, you have concluded all vaccines are safe for all.

Without mentioning our National Childhood Vaccine Injury Act (NCVIA) or the reasons it was created by Congress, you go on to encourage emergency physicians to become vaccine advocates.

Without mentioning the Vaccine Adverse Event Reporting System (VAERS) or the role emergency physicians should be playing in this passive vaccine safety net, you ignore the fact that 99 percent of possible vaccine-related events are not being considered by the same physicians you suggest become vaccine advocates instead of doing what is more ethical and moral for injured children and their parents.

Without any mention of a $101 million dollar settlement awarded a Florida MMR injured child or the daughter of a Johns Hopkins pediatric neurologist, you ask EM doctors to ignore both NCVIA and VAERS.

Without mentioning a Centers for Disease Control and Prevention–funded Harvard study using an enhanced VAERS showed the actual incidence of illness and injury following vaccines given to Pilgrim Health subscribers was 2.4 percent, you suggest the real incidence is one in a million.

Without further comment on the code of Hippocrates, I urge anyone to find a study on the safety of injected aluminum on the day of birth and each well baby visit during the first year or injections of mercury and aluminum into a pregnant woman.

David Denton Davis, MD
La Jolla, California

Dr. Talan Responds

Thank you for your comments illustrating some concerns about vaccinations. As you have concerns as a physician, just imagine those of our patients.

As long as there are medications and attorneys, there will be side effects and lawsuits. I agree that we have a duty to report all serious medication-related adverse events. It’s helpful to emergency physicians to know about the Vaccine Adverse Event Reporting System (VAERS) that mandates this monitoring. The reporting and investigation of side effects of the original whole-cell pertussis and initial rotavirus vaccines (RotaShield) led to their recall and development of safer and more effective products. Many would point to this as evidence of the success for our current vaccine monitoring efforts.

The Vaccine Injury Compensation Program (VICP) was established through the National Childhood Vaccine Injury Act of 1986 (along with VAERS) to indemnify vaccine manufacturers because their fear of jury awards, like the one you mention, could dissuade them from producing vaccines, but not because vaccines were inherently dangerous products. Just like life-saving antibiotics that we routinely prescribe, vaccines rarely cause serious reactions, such as anaphylaxis that is estimated at one in 1–2 million vaccine doses. However, almost all vaccine side effects (let’s accept the “2.4 percent” you mentioned) are mild and transient. The VICP is a no-fault program in which awards are provided if there is any reasonable association of the vaccine and the side effect. Of note, while conditions like shoulder injury related to the injection and vasovagal syncope are covered, autism, the most prominent current concern, is not a compensated condition. 

The bases for my opinions about the safety of vaccines, relative to their great benefits, are scientific investigations in hundreds of thousands of individuals and their associated followed millions of person-years, some of which I referenced, and the conclusions of medical and public health authorities like the Centers for Disease Control and Prevention, the World Health Organization, and the American Academy of Pediatrics. In fact, since my article, another major study was published that found no associated risk of autism among 657,461 Danish children (representing 5,025,754 person-years) who received the MMR vaccine.¹ Adjuvant vaccines, such as Prevnar and Hib, which have virtually eliminated childhood bacterial meningitis, contain aluminum, but in an amount that is minimal relative to normal human exposure, such as through dietary exposure. However, even with enhanced reporting of temporally associated symptoms by emergency providers, it may be difficult to satisfy skeptics who may attribute cause-and-effect relationships with any number of childhood conditions.

So let‘s be vigilant and informed. The elimination or near elimination of life-threatening diseases due to vaccines is irrefutable, as evidenced by the new outbreaks of measles in the areas of the United States where vaccination rates are low. The readers can weigh the relative merit of our opinions. I am encouraging our emergency medicine colleagues, who are in a unique position as their community‘s medical safely net, to advocate for vaccination with patients and parents. Below is a reference to actual data that may facilitate such dialogue, like the one we have had here.

David A. Talan, MD, FACEP, FAAEM, FIDSA
Los Angeles, California