I’ve been at this blogging thing for nearly 18 years now, with few breaks, none longer than the month that it took me five years ago to move this blog over from its old ScienceBlogs platform to the current, much more amateurish (but completely underway control) WordPress blog. In that time, if there’s one thing I’ve learned it’s how to identify an antivaxxer and their tactics and tropes. (Contrary to what antivaxxers like to claim, there’s more to it than “I know one when I see one.”) Normally, I don’t write a lot about what goes on in the comment section of this blog, but recently there was an exchange that provided what I thought to be a “teachable moment.” Specifically, it’s a question to use to counter the claim, “I’m not antivax.”
Lots of antivaxxers assiduously and vociferously deny that they are “antivax.” We’ve all heard variations of such claims, dating back at least to Jenny McCarthy, which generally take the form of, “I’m not antivax; I’m X,” with X being “pro-safe vaccine,” “anti-mandate,” “anti-‘toxins,’” “a vaccine safety advocate,” and any of a number of other alternatives that are not considered as unsavory as being an antivaxxer. So let’s look at an exchange from earlier this week, when a certain antivaxxer in the comments took extreme umbrage at the Star Wars reference in my last post in which I quoted Jedi master Yoda’s warning to Luke Skywalker during The Empire Strikes Back about the Dark Side of the Force
If once you start down the dark path, forever will it dominate your destiny. Consume you it will, as it did Obi-Wan’s apprentice
I was, of course, being facetious, but not entirely. My purpose was to note how “new school” antivaxxers who have come to prominence spreading misinformation about COVID-19 vaccines were more and more buying into very old tropes, up to the point of agreeing with an old school antivaxxer like Del Bigtree when he started repeating old antivax misinformation about the childhood vaccine schedule. Basically, I suggested that being antivax is like the Dark Side in that, once you start down the path of being antivaccine, even if it’s just one vaccine like the COVID-19 vaccine, it won’t be long before you become more generally antivaccine.
This led one commenter to write:
Interesting that Orac quotes Star Wars. He has a bad case of what I call the “Star Wars syndrome” — the idea that your opponents in a controversy are on the “dark side,” while you are on the side of wisdom and light. Lots of people think this way, and most of the time they are wrong. In many, or most, controversies, both extremes are over-simplified and wrong, and the answer is some kind of complex compromise.
Orac sees the good, wise, scientific pro-vaxxers on one side, and the stupid, cruel, unscientific anti-vaxxers on the other side. He has no idea that someone could criticize some vaccines, or the over-use of vaccines, without being an evil anti-vaxxer. He calls mRNA vaccine skeptics eugenicists, because they think it was a mistake to destroy millions of young lives in order to (supposedly) protect people who are sick with easily preventable lifestyle diseases.
We do not know, and we have no way to find out, if these genetically engineered covid vaccines might be detrimental to health. But medical professionals are not allowed to express any concerns, and that censorship alone should make us skeptical. But not Orac. I have never ever seen him express the slightest concern or skepticism regarding any of the covid policies.
And then a bit later:
As usual, you assume everyone is either an extreme anti-vaxxer or an extreme pro-vaxxer. Typical Star Wars good/smart vs evil/stupid thinking. I am not an “anti-vaxxer,” not by any reasonable definition. I think some vaccines, and some prescription drugs, are over-used and harmful. I don’t have blind faith in the drug industry.
This leads to my lesson in three parts on how to identify antivaxxers who deny they are antivax. Here’s part one, my question:
OK, I’ll bite. Which childhood vaccines do you consider safe and effective and therefore recommend for children without a definite medical contraindication?
Regular readers will see the reasonableness of this question. After all, if you’re “not antivaccine”—by any reasonable definition of “antivaxxer,” yet!—then that implies that you’re not opposed to all vaccines, which further implies that there must be at least one vaccine that you consider safe and effective. If you truly are “not antivaccine,” then it should be easy to rattle off one or more vaccines in answer to this question, right?
Wrong. Here’s part two of the lesson, the response:
Which vaccines do I recommend for children? I am not a vaccine expert (and neither is Orac, by the way). I think risks vs benefits should be weighed, but they can’t be since controlled experiments on vaccines are “unethical.” However, natural comparisons could be done, since not all parents get their children vaccinated.
There are vaccines given to newborns who are not at risk for the disease, for example, and no one benefits except the drug companies.
As for the covid mRNA vaccines — early studies by the vaccine makers showed they were safe, of course. After that, there were no control groups, since that would be “unethical.” We do not know how children, or anyone, might be harmed by mRNA vaccines.
But natural comparisons could be done for these also, since not everyone chose to be vaccinated for covid. For example, hospitals could keep records for how many heart attack patients are vaccinated vs unvaccinated, how many vaccines, which vaccines, how many had covid infections, etc. Similarly for other diseases. Why isn’t that being done?
There you have it, strong evidence that this “I’m not antivax” antivaxxer is, in fact, an antivaxxer. Why? Simple. Notice how careful he was to avoid directly answering the question by naming even a single vaccine that he considers sufficiently safe and effective to recommend for general use. Notice further how he then starts parroting common antivax talking points, such as dismissing ethical concerns about trials of vaccines in a rather odd way, saying that “controlled experiments” are “unethical” according to us. On the surface to a medical professional, it sounds like a mess, but if you know antivax lingo the meaning is very clear.
What is likely meant by “controlled experiments” are “randomized, placebo-controlled” experiments.” Of course, randomized placeb0-controlled clinical trial are done all the time with new vaccines. All the COVID-19 vaccine thus far in use underwent large randomized, placebo-controlled clinical trials before being granted emergency use authorization (EUA) and then later FDA approval. The same is true for the major childhood vaccines. Thus doing RCTs on vaccines isn’t unethical per se.
So what kind of RCTs of vaccines would be unethical? Longtime readers know that a favorite antivax trope dating back years and years has been to demand a large “vaxxed/unvaxxed” study. Sometimes this call is for a prospective randomized controlled trial of vaccinated versus unvaccinated children to look for differences in the prevalence of autism, autoimmune diseases, and all the other things that antivaxxers have falsely blamed on childhood vaccines. Such a trial would indeed be unethical because it would violate clinical equipoise, the necessary ethical precondition for any RCT that there be genuine uncertainty over which group, control or experimental, would fair better. In the case of such a study, we know which group would fair worse, the group not getting vaccinated, who would be expected to suffer far more from vaccine-preventable diseases. Because for such a trial it would be known in advance who would be harmed (and that it would be not by a little), a vaxxed/unvaxxed RCT of the vaccination schedule could never be ethical. Although antivaxxers don’t concede that such a trial would violate clinical equipoise, they have moved on and now advocate for epidemiological “vaxxed/unvaxxed” study approaches, sometimes doing some seriously awful studies themselves to try to demonstrate that unvaccinated children are healthier.
The rest of the antivaxxer’s response is, of course, a bit of JAQing off, in combination with changing the subject from what the question was about, the childhood vaccination schedule, to COVID-19 vaccines and repeating common anti-COVID-19 vaccination tropes. It’s all concluded with a flourish of conspiracy mongering, in which it’s asked, “Why aren’t these studies that I think are so important not being done?” The implication, of course, is that there’s some sort of cover-up, rather than that the sorts of studies being demanded are far more complex and less helpful than antivaxxers think. However, the pivot to common antivax tropes wasn’t necessary for me to know that this was an antivaxxer. Just the refusal to answer the question with even a single vaccine considered sufficiently safe and effective to generally recommend was enough.
The pivot to antivax tropes did help, though. So did this additional response challenging the characterization of “antivax,” which is part three of the lesson, watching the “I’m not antivax” antivaxxer dig himself in deeper:
I am antivax because I think there should be studies investigating possible harmfulness of the required vaccines? I am antivax because I think drug industry profits should not be the only factor in deciding which and how many vaccines to require? Because I don’t think all vaccines are good and more vaccines are better?
That last straw man about not thinking “all vaccines are good and more vaccines are better,” in particular, could have come from any antivax website or blog going back to 2004, when I first started blogging, and probably well before that. It is a common (and very old) straw man of the position of vaccine advocates. Also, if there’s one thing I’ve learned about antivaxxers, it’s that no study of vaccine adverse events is enough. Maybe there should be studies determining if there’s a correlation between vaccination and getting hit by lightning, too.
A number of responses were spot-on, but I’ll quote this one:
What would you call someone who can only say that we need ‘studies investigating possible harmfulness’, without acknowledging the results we do have from the studies that were conducted? Wanting (more) research into vaccines does not make you ‘anti-vax’. Ignoring the research we have does.
It’s not asking questions that make you an anti-vax’er – it’s not wanting the answer does.
Correct. So does demanding studies of ever more harms from vaccines without considering what we already know.
When I discussed this lesson on Twitter, to my surprise there were some who admonished me for “giving away the secret” of this test. I reassured them that, first, this was never a secret and, second, that there was nothing to fear, mainly because most antivaxxers, even when they know it’s a trap, find it impossible to suggest even one vaccine that they consider sufficiently safe and effective to generally recommend and, for those who actually can, that vaccine is usually the tetanus vaccine. Again, though, anyone who can’t name a single vaccine they consider safe and effective is, at the very least, not provaccine and, far more likely, is antivaccine.
Also, this is far from the only arrow in my quiver or question in my armamentarium. Fear not.