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Autism and Vaccine

adowton's picture

Biology in Society Senior Seminar

Bryn Mawr College, Fall 2010
Session 4B:
Vaccination and autism

 

  • Vaccination: Why do we do it?
  • The anti-vaccination movement
  • Andrew Wakefield and his article in the Lancet
  • The Science seems concrete…but the anti-vaccination movement persists

What we are protected from with the MMR vaccine
Caused by a virus in the paramyxovirus family, Measles is a highly infectious disease that is responsible for the largest amount of child deaths worldwide. Despite the availability of this vaccine, 197, 000 deaths resulted from measles globally in 2007. About 10 days after exposure, an infected individual will run a fever and have other typical flu-like symptoms (cough, runny-nose, red eyes etc) as well as small white spots in the mouth on the cheeks. A rash will erupt after a few days appearing first on the face and neck, later spreading over the body. Most worrying are the complications that can occur with the measles. Encephalitis (swelling of the brain caused by infection), blindness, pneumonia and diarrhea can all occur as a result of contracting the virus (WHO-Measles).
The vaccine also provides protection against a viral infection called the Mumps. Fever, headache, fatigue and characteristic swelling of the salivary glands are the most commonly experienced symptoms (CDC- Mumps). However, much rarer and more serious complications can arise such as encephalitis, inflammation of the testes, ovaries and breasts (Mumps, 2008). Mumps is contagious from about 3 days before, to 9 days after the onset of symptoms (CDC-Mumps). The virus can be caught by exposure to a coughing infected individual, or through other respiratory fluids (Medicine plus). There is currently no treatment for Mumps and while it is not as deadly as the measles, it certainly makes sense to avoid transmitting the disease altogether by use of the effective vaccination available.
The third disease the MMR vaccine offers protection against is the Rubella virus (the German Measles). Spread by coughing and sneezing, this virus causes fever and a rash for several days (CDC-Rubella).
 
The beginning of the anti-vaccination movement:
Ø  Ironically, the success of vaccines in preventing deaths has also contributed to the increasing numbers of parents that choose not to vaccinate. Thanks to the MMR vaccine, millions of lives are saved. Many parents who decide against vaccination have never witnessed something like the measles kill a child. Inexperience in this regard renders parents inappropriately dismissive of something that’s “just the measles”.  (Calandrillo, (Abstract Only)).
-Frontline: The Vaccine War (15:20-17:50) Cases of vaccine preventable diseases.
Ø  The CDC website has a common questions section containing an interesting topic entitled; “what would happen if we stopped immunization?” It states that between 1935 and 1963, deaths due to measles were averaged to be 450 annually (CDC -What Would Happen). To give a clear idea of the effect a loss of herd immunity could have, the CDC estimates that if we stopped vaccinating altogether, we could expect measles deaths to rise to about 2.7 million per year worldwide (CDC- What Would Happen). While this is an extreme example of loss of immunization, the point is still the same; as immunization rates dwindle, the rate of measles will increase. Between January and April 25th of 2008, 64 cases of measles were reported in the US. These 4 months saw more measles cases in the nation that over the entire year of 2006 (Grady, 2008).
Ø  When immunization rates drop, ‘herd immunity’ is threatened. Herd Immunity occurs when the majority of the population has been vaccinated, and the result of that, is that the unvaccinated population is safe as well because of the lack of people available to infect them (Iannelli, 2008).
Ø  “Actress Holly Robinson Peete recalls, "When my son was two-and-a-half, he was just recovering from an ear infection and had been on antibiotics, therefore his immune system was suppressed. He had already missed several appointments for his vaccination so his pediatrician wanted to catch him up on all of them in the same day. Although I asked if he'd consider waiting or breaking up the cocktail, which contains three viruses, he laughed me out of the office and belittled me. I firmly believe that it took my son to a place of no return and his body could not handle it. He had a violent reaction with convulsions and then he stopped talking and slipped into a silence. He no longer said, 'Hi, Mommy,' he no longer responded to his name and he no longer made eye contact."
Ø  Jenny McCarthy, who has been outspoken in her criticism of vaccines, said in a Time interview, "If you ask a parent of an autistic child if they want the measles or the autism, we will stand in line for the f___ing measles."
Ø  "Those who question the benefit of mass immunisation are not all irrational non-believers. Most support vaccination but are concerned at - and question the necessity for - the large number of vaccines and the early ages at which these are given. Many have studied the research, only to find - as I have - contradiction and uncertainty. They deserve to be treated with respect and given the opportunity for an open and honest debate.” - Dr. Richard Halverson, letter to the British Medical Journal

Wakefield and his article:
Almost incredibly, the trigger for what would become a worldwide controversy was a single scientific research paper published in a medical journal - the Lancet - in February 1998. Written by a then-41-year-old laboratory researcher, Dr Andrew Wakefield, and co-authored by a dozen other doctors, it reported on the cases of 12 anonymous children with developmental disorders, who were admitted to a paediatric bowel unit at the Royal Free hospital in Hampstead, north London, between July 1996 and February 1997.
Backed by a press conference and a video news-release, the five-page paper’s claims received huge media attention, and were followed by a sustained attack on the vaccine. This included further publications by Wakefield, criticising MMR, and led to an unprecedented collapse in public confidence in the shot, which, since the late 1980s in the UK and the early 1970s in the US, has been given almost universally to children, soon after they are one year old, almost eradicating measles and rubella.
The prime cause of the alarm was findings in the paper claiming that the parents of two thirds of the 12 children blamed MMR for the sudden onset of what was described as a combination of both an inflammatory bowel disease and what Wakefield called "regressive autism", in which language and basic skills were said to have been lost. Most disturbingly, the first behavioural symptoms were reported to have appeared within only 14 days of the shot.
Although the research involved only a dozen children, and its results have never been replicated, many medical breakthroughs have begun with small-scale observations, and, if true, Wakefield's findings might have been the first snapshot of a hidden epidemic of devastating injuries. "It's a moral issue for me," he said at the 1998 press conference, where he called for a boycott of the triple MMR, in favour of breaking it up into single shots, to be given at yearly intervals. "I can't support the continued use of these three vaccines, given in combination, until this issue has been resolved."
As the doctor campaigned, UK vaccination rates slumped: below the level needed to keep measles at bay. Even Tony Blair became embroiled in the controversy when Wakefield supporters suggested - the Blairs say wrongly - that the prime minister’s youngest son was not vaccinated with MMR. Meanwhile in America, a ferocious anti-vaccine movement took off, after Wakefield appeared on the CBS network's 60 Minutes programme in November 2000, speaking of an "epidemic of autism". This was followed by claims that all vaccines are suspect: either due to their content, or because of an increase in the number given to children.
(Taken from http://briandeer.com/mmr/lancet-summary.htm)
The Science:
o   “A Population-Based Study of Measles, Mumps and Rubella Vaccination and Autism” involved a retrospective study on Danish Children born between 1991 and 1998. It examined the incidence of autism spectrum disorders in the unvaccinated group of children during these 7 years, and compared it to the incidence of vaccinated children. The study concluded that evidence indicated a lack of association between the MMR vaccine and autism (Madsen et al., 2002).

o   CDC funded this follow-up study in Italy that compared neuropsychological outcomes of children at ages 10-12 years who were randomly assigned to receive one of two forms of diphtheria-tetanus-acellular pertussis vaccine (DTaP) in the first year of life, one containing thimerosal and the other containing 2-phenoxyethanol. As a result, children who received the thimerosal-containing DTaP vaccines had a higher cumulative exposure to thimerosal from all vaccines (137.5 micrograms of ethylmercury) in their first year compared with children who received the other form of DTaP (62.5 micrograms of ethylmercury) during the same age range. Ten years after vaccination, the two groups were tested on 24 neuropsychological outcomes. The overall results of the study do not support neurological or developmental harm to children resulting from thimerosal exposure. This strong study adds to the body of scientific evidence that thimerosal in vaccines is not harmful to children. The results are published in Pediatrics (2009 Feb:123(2): 475-482).

o   The National Institute of Child Health and Human Development (NICHD) and CDC collaborated on this study of regression in autism focusing on a possible association between the onset of autism in regression cases and measles-mumps-rubella (MMR) vaccination. This case-control study was performed by Collaborative Programs of Excellence in Autism sites utilizing screening data from 351 children with ASD (both with and without regression) and 31 typically developing children to describe the children’s early acquisition and loss of social-communication milestones. The study provided no evidence of an association between regression in ASD and MMR vaccination. The results of the study were published in the Journal of Autism and Developmental Disorders (2006 Apr;36(3):299-316).

o   An interesting example following the proposed link between MMR vaccination and autism was the decision of Japan in 1993, to stop the use of the three-in-one MMR vaccine, and instead, give them separately (BBC, 2002). A study published in 2005 examined the evidence in terms of autism rates that resulted from this decision. Despite the fact that no child received the MMR vaccine after 1993 in Japan, the incidence of autism actually rose (Honda et al., 2005).

o   It is important to recognize that MMR is administered within the first few years of life; coincidentally the same time during which many children are first diagnosed with autism (“A Look at What Causes, and Doesn't Cause, Autism."- CHOP).

  • From the CDC Recent estimates from CDC's Autism Developmental Disabilities Monitoring networkfound that about 1 in 150 children have ASD. This estimate is higher than estimates from the early 1990s. Some people believe increased exposure to thimerosal (from the addition of important new vaccines recommended for children) explains the higher prevalence in recent years. However, evidence from several studies examining trends in vaccine use and changes in autism frequency does not support such an association. Furthermore, a scientific review

     by the Institute of Medicine (IOM) concluded that "the evidence favors rejection of a causal relationship between thimerosal-containing vaccines an autism." CDC supports the IOM conclusion.
  • Frontline: the vaccine war (18:19-19:08) The risks of vaccines

In recent news
FEB 2nd 2010: Lancet retracts Wakefields paper: saying it was scientifically flawed. Organizations such as Generation rescue came out in strong force in support of both Wakefield and his science.
Brian Deer exposes Andrew Wakefield as a fraud: Rather, Wakefield had been payrolled to create evidence against the shot, and, while planning extraordinary business schemes, meant to profit from the scare, he had changed and misreported data on the anonymous children to rig the results published in the journal.

Relevant/Interesting Links:

Summary of class discussion (kwarlizzie)

Annie started the discussion by pointing to a few articles of interest which she had posted unto the page she created for the discussion.
She showed a video of a woman who lived in a community that had a rather high non-vaccination rate, and a video of a pediatric intensivist talking about incidences of vaccine-preventable diseases she had seen over the course of her career. This led to a discussion of whether or not the woman’s (non-vaccination)stance was the right one, or whether it was even a wise one.  The general consensus seemed to be ‘no’, because vaccines are meant to be protective: the absence of incidence of disease does not mean the absence of disease-causing agents. However, Professor Grobstein noted that as mortality and morbidity for diseases reduces (as a result of vaccinations), the more serious adverse reactions from vaccinations appear to be. He also noted that, we do not know ALL the possible adverse reactions that vaccinations can cause.
The discussion moved in a different trajectory after that. We moved from questioning the wisdom of the decision not to vaccinate to the legitimacy of the decision. Naa Kwarley and Sarah seemed to be of the definite opinion that it was not a legitimate decision at all, considering that the initial study that started the fracas, a study by one Dr. James Wakefield, has since been shown to be dubious: the conclusions from the study are shady, the subject size was very small, and Dr. Wakefield has had been receiving money from dubious sources.
Hope remarked that perhaps parents who choose not to vaccinate their children are acting legitimately, because they are making their decisions out of a series of observations that they have perceived.
It seemed that the discussion ended without consensus; rather it ended with the reminder that there really is method to the madness, that the choices of whether or not to vaccinate children are taken, usually after careful consideration and observation of some sort of data, and thus, either choice cannot be dismissed lightly.
Continuing conversation in on-line forum below
Conversation and implications to date (25 September 2010, adowton)
Maybe the key here is to stop arguing about authoritativeness and what bestows it and get back to making the best decisions one can in individual cases using all relevant observations to date and accepting that decisions always have to be made in the face of some uncertainty. (Grobstein)
i think its not always good to place the opinions of doctors or accepted science over personal observation….it makes sense to me for parents, and people in general, to question their doctors. (Hope)
I don't think that parents who worry about the risks of vaccinations should be disregarded as ignorant.  But, also I think that people should trust their doctors to make the right choices for them in regards to vaccinations for children at minimum.  (Kendra)
I believe that my parents are scientifically literate enough to make an educated decision, and that decision was to follow the recommendation of a well-respected doctor who has a greater degree of scientific literacy, and therefore is more likely to make the correct decision, based on that knowledge.  (smaley)
Sometimes personal beliefs have to be overridden for the greater good. (Colette) There shouldn't be a divide between uneducated and educated observations -everyone can make observations….To me, scientists who believe that there is no possible way that vaccines can cause autism in individual cases may be as narrow minded and dogmatic as parents who believe that vaccines are the only possible way that their child developed autism. (lbonnell)
While I do feel that this rejection of vaccines for fear of the unknown seems slightly irrational, debilitating and detrimental to herd immunity, I have a hard time justifying making a vaccine mandatory regardless of philosophical or religious beliefs. While the incidence of these infections remains relatively low in our country, I think it is reasonable for parents to have the choice to vaccinate their child. (dfishervan)

  • Parents/persons who are a part of the anti-vaccine movement should not be disregarded as uneducated by the scientific community/community at   large for making sensible conclusions based on observations
  • Vaccine literacy should be promoted to all: How they work, why we have them, what would happen if we didn’t have them etc. With increased knowledge/understanding, perhaps there would be less conflict.
  • The scientific community should aim to be less authoritative and more in pursuit of transmitting information/observations
  • Despite the many epidemiological studies done to refute a connection between vaccination and autism, no one can prove that in any given individual, that won’t be one of the adverse side-effects.
  • Potential consequences of both vaccinating, and not vaccinating, should be examined by  parents whose children are vaccination age, the doctors of these children, and health care officials who write the vaccine schedule.
     

 

Comments

Kwarlizzle's picture

From this discussion, I

From this discussion, I realised that I often forget that if you look long enough, you will realise that people are not stupid; they have reasons for the choices they make that are quite logical, if only you will pause long enough to listen to their POV.

However, I also reiterate that being able to acknowledge the validity of the processes by which someone arrives at their POV does not make their POV more acceptable. But it is important, even if only to remind me that their decisions were made carefully and not rashly, as I often presuppose.

Crystal Leonard's picture

an interesting dilemma

To me, this whole issue comes down to risk analysis. There is a known, relatively high risk of disease associated with not being vaccinated. There is a less understood, smaller risk of developing autism during one's first few years of life for any number of possible reasons that have not been elucidated by scientists. One of these possible causes is vaccination. Coming from a risk analysis point of view, the small unknown risk of vaccination causing autism is insignificant compared to the larger known risk of disease, and therefore, one can conclude that it is negligent to not vaccinate one's children. Of course, trying to make this argument to a worried parent will most likely be fruitless because fear almost always wins out over logic in the public psyche. Since there will always be people who do not want to vaccinate their children because of the fear of autism, the question then becomes should the government require a certain percentage of the population to be vaccinated, and if there's not enough of the population willing to vaccinate their children to meet this minimal percentage what should the government do about it? I don't know the answers to these questions but it's definitely an interesting dilemma because at its core is the issue of individuals' rights versus the protection of the community, which is an issue that can be found at the core of almost all public policy controversies.

mlhodges's picture

      According to my

      According to my independent research, and from what I am gathering from the on-line forum, there is no scientific evidence that says that vaccinations lead to autism. However, as Grobstein points out, there is evidence that not vaccinating leads to huge problems. To me, it is an incredibly selfish (and although I know this is disagreeing with others in the class - ignorant) decision to not vaccinate your child. When you bring your un-vaccinated child into the pediatrician’s office, or the classroom, and your child is unknowingly carrying a serious condition, you are exposing other children to the illness. Suppose the four-year-old girl next to your un-vaccinated son is surviving cancer and has been undergoing chemo for the past six months. Her immune system is very weakened. After your un-vaccinated child stops scribbling with the crayons on the play table, the girl puts one of the crayons in her mouth. A week later the cancer survivor is in the hospital with an acute respiratory infection. Because she is already weak, she struggles with a high fever and can barely breathe. Your un-vaccinated-carrier child is fine, due to a strong immune system, but the weak girl barely survives. By not vaccinating your own child, you are putting other children, who have their own life-threatening conditions, at serious risk. If you choose to not vaccinate your child, you might as well raise them in an isolated glass box and not allow them to have any contact with other humans. Period.

Science educators, researchers, doctors, nurses, the internet –everybody- should belabor this point. Get vaccinated for the sake of others. There shouldn’t be a choice because there’s not enough real evidence against vaccinations. But there sure is enough scientific evidence regarding the importance of vaccinations. As Colette said, “sometimes personal beliefs have to be overridden for the greater good.”

 

Serendip Visitor's picture

Great point, but you miss a very important fact...

The vaccinated child in the chair on the other side is just as likely as the unvaccinated child to carry the same virus! Vaccination does not prevent the vaccinee from having an undetectable, mild infection of the "vaccine preventable" disease (being a "carrier")...Your argument holds no water. Fact is, that child, undergoing chemo is at-risk no matter where she goes in public (even from the hospital staff).

Paul Grobstein's picture

vaccination/autism: seeing science for what it is?

Interesting, rich conversation.  Like smaley, it made me think of several of our earlier conversations about situations where "scientific" findings come into apparent conflict with other perspectives (cf The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures). 
I say "apparent" conflict because I'd like to think that situations like this could be better handled if everyone involved better understood that what is at issue is not "science" versus other ways of making sense of the world but rather differences in the observations being summarized by different people or groups of people.  Yes, there is a body of "scientific" literature consisting of epidemiological studies that indicate no correlation between vaccination and autism.  And there is a body of "scientific" literature documenting the importance of broad coverage for vaccination programs to be effective.  And these ought to be regarded as relevant by anyone making vaccination decisions.  At the same time, these do not, as we discussed in class, compel a particular choice in individual cases.  Epidemiological studies cannot "disprove" the possibility of adverse effects of vaccination in individual cases, and other personal observations are also relevant in the decision-making process of individuals. 
What all of this suggests to me is that the "scientific" community needs to be clearer about the nature of the understandings it offers, the basis for those understandings, and their limitations.  And others need to have a better appreciation of the potential relevance of that for their own lives. My guess (hope?) is that people would be less inclined to dismiss the "scientific" literature if they were more familiar with it and if it was presented as a potentially useful body of observations rather than something "authoritative."  Conversely, I think science would be well-served in its own advancement  by paying more attention to individual variation (as it is in fact doing in some areas).
To put it differently, it seems to me that the vaccine/autism controversy is better seen less as a conflict between "science" and .... other ways of thinking, and more as a situation (one of many) that should encourage greater attention to how scientists perceive themselves, to how science is presented, and to science education in general.  The apparently continuing controversy over the Wakefield paper and its handling is a further argument in this direction, one that might be worth more attention than we gave it in class.  Both scientists and non-scientists are, it seems to me, inclined to attribute to publications in the "scientific" literature a much greater degree of authoritativeness than is warranted.  Maybe the key here is to stop arguing about authoritativeness and what bestows it and get back to making the best decisions one can in individual cases using all relevant observations to date and accepting that decisions always have to be made in the face of some uncertainty. The importance of the "herd effect" in vaccination programs notwithstanding, we can certainly tolerate, and might even be better off accepting, some individual variation in the decisions people end up making in their own lives. 

hope's picture

i think its not always good

i think its not always good to place the opinions of doctors or accepted science over personal observation. it makes sense to me that parents noticing the onset of autism in a kid shortly after a vaccine would attribute the illness to the vaccine.  we talk about parents being too guided by emotion or fear, but its worth considering that doctors are also subject to emotion and fear. maybe they are are afraid of an outbreak or just insulted by or dismissive of anyone who doubts or questions them. and honestly no doctor is going to care as much whether a kid gets autism as the kid's parents will. so it makes sense to me for parents, and people in general, to question their doctors.

knorrell's picture

While I have received all of

While I have received all of my shots, I completely understand why someone would have reservations for getting shots.  The unknown risks of medication are serious and should be questioned by parents.  But, on that note, parents should also consider the risks of not getting the recommended/required shots.  Not getting the shots, as mentioned in class, are detrimental to the child, as well as children that come in contact with that child.  While the parents who believe that the MMR vaccine causes autism, and I believe that they fell educated in this belief, they should seek out current information in regards to this belief.  I wonder what parents feel when their child has a disease that they could have vaccinated against.  But, I don't think that parents who worry about the risks of vaccinations should be disregarded as ignorant.  But, also I think that people should trust their doctors to make the right choices for them in regards to vaccinations for children at minimum. 

smaley's picture

Educated Decisions

 I feel that the controversy about vaccines and autism is a very interesting one, and that it relates very closely to several of our previous conversations. Because I have not read any of the literature relating to this controversy, I do not feel that I personally can make an educated decision as to whether or not the MMR vaccine has truly caused autism in some children. Just as Colette’s parents did, mine trusted that my pediatrician was well informed when it came to the risks and benefits of the vaccines that he gave to my brothers and me. While he would always explain to my parents the risks and benefits, I don’t know of a single instance when my parents went against his recommendation that the benefits far outweighed the risks. While some may say that my parents were just blindly following, and that they should have questioned my doctor more, I don’t feel that this is the case. While questioning the system is without a doubt a good thing in many circumstances, neither of my parents are doctors, and just as they would go to a lawyer for legal advice, they were paying my pediatrician for medical advice. I believe that my parents are scientifically literate enough to make an educated decision, and that decision was to follow the recommendation of a well-respected doctor who has a greater degree of scientific literacy, and therefore is more likely to make the correct decision, based on that knowledge. I’m not trying to say that parents have no right to question the system or their children’s doctors. Instead, I think there is a certain level of restraint that must be shown, since mass panic is all to easy to achieve, and it often does significantly more harm than good.  

Colette's picture

I have never had to give much

I have never had to give much thought to the relationship between autism and the MMR vaccine. There never been a question as to whether I should or should not receive this or other vaccines. My parents and I have always trusted my pediatrician to recommend the proper thing to do. There should be some skepticism about whether medicines do or do not work. Everyone knows that medicine doesn’t work 100% of the time and that they all have side effects.

                We know that the government examines how well these medications are working, what could disrupt the effects of vaccines, and how to prevent any adverse affects states need to put the health of the general population first. Sometimes personal beliefs have to be overridden for the greater good. The world is pretty crowded and we catch diseases from one another to protect their populations firms, schools, etc. should not allow anyone who has not been vaccinated to enter their premises. Until a disease is eliminated world wide it is not safe to stop vaccinations

lbonnell's picture

uneducated and educated observations

I don't think institutionalized science is the only way to figure things out. There shouldn't be a divide between uneducated and educated observations -everyone can make observations. Parents without formal science training are definitely capable of making observations of their children and their observations are often used in the diagnosis of autism. Parents can be better observers than trained professionals because parents are exposed to nearly everything their child does while the clinician only sees a small segment of behavior. 

Scientists should not reject parents' observations on the grounds that the parents are uneducated. At the same time, scientists should be open to the idea that people outside of institutionalized science have relevant summaries of observations. To me, scientists who believe that there is no possible way that vaccines can cause autism in individual cases may be as narrow minded and dogmatic as parents who believe that vaccines are the only possible way that their child developed autism. Like we discussed in class, we don't know the etiology of autism and can't say for sure if vaccines are related to individual cases, even though many population studies suggest that they are not. 

Serendip Visitor's picture

Brian Deer

Firstly I would advise you not to use parts of Brian Deer's website .
secondly you missed this excellent film about Brian and his part in the investigation

Selective Hearing, Brian Deer and the GMC
http://www.viddler.com/explore/ziggy/videos/1/

dfishervan's picture

What risk to take?

    The issue of autism and the MMR vaccine is an interesting one as it asks society to consider abandoning something known because of a fear of the unknown. We can pretty confidently assert that the MMR vaccine is capable of preventing certain types of life-threatening infections however, we are still uncertain about this vaccine’s connection with autism. This unconfirmed risk of autism has caused parents to reject the known benefits of vaccines. While I do feel that this rejection of vaccines for fear of the unknown seems slightly irrational, debilitating and detrimental to herd immunity, I have a hard time justifying making a vaccine mandatory regardless of philosophical or religious beliefs. While the incidence of these infections remains relatively low in our country, I think it is reasonable for parents to have the choice to vaccinate their child. However, the parents should be aware that opting out of vaccinating their child might limit their child’s ability to participate in certain activities. This was not the stance I had when coming into Monday’s class but, I was affected by Professor Grobstein’s comment on the heightened significance of unknown complications when the risk of infection is low. Not to sound naïve or idealistic, but I also wonder if less people in the United States (and other countries where the risk of infection was low) got vaccinated, whether or not we could divert our vaccination hysteria/resources to countries where vaccination is not prevalent and infection poses a greater risk.

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