The importance of relative risk in understanding vaccine effectiveness

A while back I noticed that Greg Beattie was deceiving his readers about pertussis vaccine efficacy by misrepresenting NNDSS data.

Yes, the same Beattie with the bogus claim that vaccines did not reduce infectious diseases. He dresses this up with misleading graphs comparing mortality from vaccine preventable disease to the introduction of X vaccine. These graphs are also bogus in that he omits the impact of vaccine introduction. The stunning success of the vaccine itself and the elimination of infection is always absent from his peculiar artwork.

Beattie’s claim back in 2012 was that the pertussis vaccine failed because high numbers of notifications had been vaccinated against pertussis. This is thunderously misleading in that it’s at the same level as dismissing seat belt safety because most fatalities on our roads involve seat belt wearing occupants. He also avoided explaining all reasons as to why notifications were high. Increased awareness, testing and follow up, pockets of low vaccination driving an epidemic, low booster uptake.

You can check the post here to follow my review of the same data table Beattie used. But it’s pretty simple. By 2011 close to 95% of 0-4 year olds were fully vaccinated by age 2 [NCIRS]. Using the table provided it turns out those not fully vaccinated made up 27.2% of notified infections. Fully vaccinated notifications equal 56.7%.

Relatively speaking a child fully vaccinated against pertussis has a notably reduced chance of being infected. Conversely, the small number who are not fully vaccinated have a frightfully high chance of being infected. To be sure, if 56.7% of notifications collected over 2008 – 2011 are from fully vaccinated children one can argue the vaccine could (and needs to be) more effective. But when the 5% who are not fully vaccinated make up 27.2% of infections, then the claim the vaccine is not effective is patently absurd. A dangerous and irresponsible lie.

Basically this is a story of relative risk being falsely presented as absolute risk. Choose some data and omit other data and the claim looks sound. But the post itself is limited in examining Vaccine Effectiveness vs Relative Risk (Risk Ratio – see screenshot). Understanding related and relative data sets is crucial in grasping how vaccine efficacy can be misrepresented. Regrettably many falsehoods peddled by the anti-vaccine lobby stem from such misrepresentation.

Fortunately an excellent piece addressing this was recently published on The LymphoSite by kill3rtcell. Headed But most of the people who got the disease were vaccinated for it! the post comprehensively addresses vaccine effectiveness, risk ratios and even provides interactive calculators. These crunch values of vaccine effectiveness, vaccination rates and resultant cases in the unvaccinated or vaccinated.

Do head over and read what is an excellent contribution to the deconstruction of misinformation peddled by antivaccinationists.

The screenshot below helps explain what this post accomplishes.

relative risk

© kill3rtcell – The LymphoSite

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Greg Beattie misleads Health and Community Services Committee

Vaccination is an invasive medical procedure carrying unquantifiable risk and dubious benefit

♠ Greg Beattie, August 19th 2013 ♠

On Monday August 19th the Health and Community Services Committee (QLD) held a public hearing.

Entitled The Inquiry Into The Public Health (exclusion of unvaccinated children from childcare) Amendment Bill 2013 the transcript can be found here.

As reported in Brisbane Times the Committee rejected the amendment which would have seen unvaccinated children banned from accessing Child Care centres in QLD. Yet the same Committee specified in it’s report that it has not rejected supporting a bill with allowance for medical constraints or conscientious objection against immunisation. Despite the wide ranging abuse of the conscientious objection loophole to vaccination, such a bill is now in place for daycare in NSW.

In his opening address on August 19th, Committee Chair, Mr. T. J. Ruthenberg M.P. stated in part:

Witnesses are not required to give evidence under oath, but I remind witnesses that intentionally misleading the committee is a serious offence.

I remind those present that these proceedings are similar to parliament and are subject to the Legislative Assembly’s standing rules and orders. [Copy here]

The first speaker, President of the deceptively named Australian Vaccination Network, Mr. Greg Beattie began misleading the Committee immediately. This included:

The Australian Vaccination Network was formed to assist people in their search for information on this issue and to protect their right to make choices freely.

We support debate, because we recognise that it is through discussion that the truth is permitted to bubble to the surface.

Such noble sounding words. Soon we were back to the Beattie Aussies more readily identify with (Bold mine):

Vaccines are aggressively marketed. In fact, possibly no commercial product or service in the history of mankind has been so vigorously and thoroughly marketed. The backdrop of the campaign is fear – fear that your child, if not vaccinated, may suffer and ultimately die from an illness.

The fundamental slogan ‘Vaccines save lives’ expands into a story of how children frequently died from these illnesses until vaccination arrived and changed everything. Ironically, one of the few things we know without doubt is that this story is false. All who care to look for themselves find that vaccines played no significant role in the great fall in deaths.

The deaths did fall dramatically but, as can be seen in the appendices to our submission, it had nothing or little to do with vaccination.

He continues on. Empirical evidence is in stark dissonance to the “fundamental slogan” of vaccine manufacturers. Thus, parents are questioning “the integrity of the whole marketing campaign”. Er, are they? But why? Beattie lies with sophisticated aplomb:

For example, promoters claim that there is a scientific consensus that vaccination is safe. However, consumers are aware that countless studies have been published in the scientific literature indicating a relationship between vaccines and a host of serious conditions, including anaphylaxis, encephalopathy, lupus, type 1 diabetes, chronic fatigue syndrome, paralysis, multiple sclerosis, Bell’s palsy, arthritis, autism, asthma, seizures and many more.

Courts have repeatedly decided in favour of some of these relationships, including autism, and huge amounts of money have been paid out for death and serious injury. Still, the promoters deny their existence, saying they are not proven.

Beattie uses the fact that up to 75% of pertussis notifications have received the vaccine at some time, to generalise against all vaccines. Finding this out parents begin to wonder what benefit there is he warns. A perfect segue into this outright lie: Vaccination is an invasive medical procedure carrying unquantifiable risk and dubious benefit.

Beattie seems intent on annoying Committee member Dr. Alex Douglas. When the Committee comes to ask questions Dr. Douglas begins:

I would like to start with Mr. Beattie. I thought that was an extraordinary presentation based on the fact that last month the Health Care Complaints Commission in New South Wales made some pretty damning statements about your organisation.

In view of the fact that you have made a presentation which is incredibly similar to what was stated as certainly being reprehensible — I could use a variety of words — I would like to know what you have done since then to actually reappraise your position in view of what you have just stated today?

Beattie wants to know where his abomination and that to the HCCC “tie together”. Dr. Douglas refuses to be drawn in, informing Beattie “Basically, you are restating the same argument. It is the same argument”. He then asks if Beattie is aware of what Steve Hambleton had said about, “your continuing statements which are of the same ilk as presented here today?”.

Of course Beattie claims to have no idea, so Dr. Douglas enlightens him:

He said that your repeated presentations bring you great discredit and are, in fact, not helping the nation at all.

In summary form, the results of what you are doing are doing irreparable harm to the communities across Australia and are, in fact, driving down getting our immunisation rate above the magical number of 93 per cent.

Beattie replies, “That is because Steve Hambleton is a promoter of vaccination. Our organisation is a promoter of free choice. At the moment our organisation is under severe attack from all who those who would want to promote vaccination…”.

He also insists vaccination uptake is rising a treat thanks very much, choosing to ignore the reality of complacency or refusal, wherever and for whatever reason.

All up it was a predictable scheme of lies and deceit from Greg Beattie, made all the worse in view of the organisation he was representing. The fact the bill was not passed had nothing to do with the rubbish he put forward. The AVN Inc. are well exposed as a self-serving untrustworthy gang for whom truth and evidence mean nothing.

Submissions to the Inquiry can be read here.

Australian Vaccination Network crashes and burns on seminar tour

As many know, Australia’s leading anti-vaccination lobby group, the deceptively named Australian Vaccination Network recently finished it’s “tour” of Western NSW.

The tour itself was an abysmal failure. Billed Vaccination and Health Rights – a seminar for parents and health professionals it attracted mainly aged hippies and conspiracy theorists. The most compelling development was rumoured to be Greg Beattie shouldering Meryl Dorey out of the spotlight.

Subtracting the obligatory four heads of the Doreys and Beatties, attendance was likely anything from 4 to 15 across various venues. This silliness may have cost over $7,500 if food, fuel and dodgy accommodation is included. To the surprise of many it cemented the disgust which with Meryl Dorey, Greg Beattie and the other misguided members of the antivax movement are regarded.

The “fury” expressed by residents of Tamworth appears typical of the reception the AVN received. The vicious online reception that the public of Tamworth laid out and the pummeling the AVN received in the comments attached to that article ensured Tamworth attracted the highest attendance.

Another piece, Controversial AVN vaccination group in Tamworth briefly covers the event. It includes the grab for money the AVN is known for;

Participants paid $12 to attend the meeting and were given information on the AVN legal fighting fund appeal where they can donate money to help the AVN fight their own pending legal cases and also to support the “fighting fund for non-vaccinating partners.”

The group says it helps parents in court proceedings fight their ex-partners or spouses who seek orders of the court to vaccinate their children.

Sounds darn tootin’ except “the group” has never done any such thing. Nor do they have any pending legal cases. This is a bald faced lie and an outright scam. I can be no kinder.

So, their largest turnout included critical journalists and the “ninja academic”, Scotty Harrison. Scotty is an Armidale local and PhD candidate in Health Economics. Scotty – the most qualified individual on the entire tour – took the stage and worked his way quickly to evidence based figures on the history of vaccines. Within 12 minutes he had demolished the thrust of a life time of deception from Greg Beattie (video below).

Greg Beattie: His antivax lies were demolished before his eyes

Scotty didn’t just lay bare the lie that decreases in mortality before vaccination, supposedly refute the efficacy of vaccination. Improved living standards led to increased recovery – but not reduced incidence of disease. He also raised the reality of vaccine preventable disease-induced disability. Then furthermore spoke of his own struggle with ADD, asthma, allergies and eczema. There is no evidence they are due to the vaccines he received as a child, he concluded.

He makes it quite clear vaccines brought about the elimination of the incidence of disease. When pre-vaccine recovery meant a lifetime of scarred lungs or severe brain damage or being bed ridden with multiple organ damage, the onus is upon people like Beattie to convince us just how vaccines are supposedly useless. As seen below the video, even in the present day (wherein no changes in living standards have occurred) the impact of vaccination on disease is striking.

Delightfully, Dorey and Beattie didn’t expect any presentation that might be in dissent to their theme. They refused Scotty’s invitation to return the next night. Keep an ear out for the spontaneous applause on Scotty’s point on how poorly the vaccination “debate” is being conducted. Strange then that this enthusiasm vanishes once his content is known.

As much as one may want to support the AVN in their quest for legitimacy, “because every story has two sides”, I’m afraid that’s presently impossible.

This trip was an unmitigated disaster.

Over to Scotty…


The impact of vaccination on measles and Hib incidence in recent & very recent times

(Above) Hib vaccine introduced to Australia


(Above) Hib Vaccine introduced to Kenya, Kilifi district

Tracey Spicer talks vaccine conscientious objection

In all cases, those infected were not fully immunised

– The Cambelltown measles outbreak –

Are antivaxxers “nutters” or “freaks”?

So disastrous has the denial of vaccination for vulnerable infants and children been, that such frustrated descriptions come up time and again. Parents who seek reputable information are left in no doubt that vaccine denial is ill informed and a mistake of significantly high risk.

As the consequences of the anti-vaccine movement more and more take the form of outbreaks of entirely preventable disease, a greater percentage of Aussies looks upon vaccine denialists with disgust. Regrettably the fierce combative stance of vaccine denialists is probably feeding the rising disdain across the community.

The measles outbreak which began in Cambelltown NSW in May led to this article in the Herald Sun on August 15th. Sydney Schools on Disease Alert:

The health scare involving 40 cases concentrated in the Campbelltown area comes as new medical research shows a record number of parents are refusing to immunise their children.

Ten of the reported cases in the South West Sydney Local Health District (SWSLHD) have put sufferers in hospital in the past two months.

The majority of those affected have been school-aged children and babies under 12 months old. The Department of Education confirmed four high schools and a number of primary schools had circulated letters of warning to parents.

In all cases, those infected were not fully immunised.

According to Australian Doctor 30,882 parents have objected to the immunisation of their children. 6,000 of the 2 million children on the Australian Childhood Immunisation Register have no vaccine history at all.

As I’ve noted before, enjoying a standard of health that allows the luxury to worry about improbable, irrelevant or indeed, imagined responses to vaccination is truly a marker of their success. In addition the drive and confience for individuals to take control and make decisions about their health is also a positive trend.

The problem, indeed the absolute sabotage of both these trends, are the wild conspiracies aimed at vaccination and the outrageous scams on offer for those who do explore management of health. Regrettably, hand in hand, these two factors have cultivated an anti-science mentality that carries the power of indoctrination.

Today, towering ignorance reigns for many when it comes to “health choices”. Thanks to an industry of stupidity, we are left with parents screeching and snarling for the right to harm their children and to treat them with snake oil. The results can be seen above.

On the same day the above piece was published Tracey Spicer filled in for one of the Murrays on 2UE’s The Two Murrays.

“That terrific group Stop The AVN…”. (Tracey Spicer)

Tracey and Murray spoke to Dr. Jason Cooke on the vexed issue of vaccine denial. Tracey mentions, “that terrific group Stop The AVN”. Here here!

Listen below or visit chirbit here.

Access the MP3 directly here.

Busting Greg Beattie or Two heads are sillier than one

On July 2nd Greg Beattie and Meryl Dorey released a rambling attack on the pneumococcal vaccine.

Bizarrely it was headed “Media Release” and despite listing the contact details of both Greg and Meryl, the Aussie media know anti-health warriors when they see them. It sank without a trace almost immediately.

Still, a look at the context and contents reveal much about the tactics used by both Beattie and Dorey. It proclaimed;

A media release being issued by a self-proclaimed group of ‘experts’, including many with financial links to vaccine manufacturers, is calling for increased use of vaccines against pneumococcal bacteria as a way of preventing pneumonia.

Without letting on, it was actually in reference to this Australian Lung Fiundation media release. They were falsely suggesting a campaign targetting “young Australians” for pneumococcal vaccination was under way. In fact, it is Pneumonia Awareness Week and little wonder they did not link to the many facts related to pneumococcal disease.

On July 3rd, Sky News quoted Professor Booy from the National Centre for Immunisation Research and Surveillance. He had elaborated on implications from a survey completed by GP patients. The survey reached a sample of 2,500 and looked closely at risk factors. Sky News reported:

A survey of 2,500 GP patients found about a quarter of those aged 15 to 64 had at least one risk factor for contracting pneumococcal diseases such as pneumonia and meningitis.

About two in three of those had not been vaccinated, according to research by the University of Sydney’s Family Medicine Research Centre. But most patients – nearly 80 per cent – aged 65 and over had a pneumococcal vaccination.

Risk factors included smoking, diabetes and chronic lung disease.

Okay. So, first off we have our most damning variable to be obfuscated by… (let’s call them Gregyl in the Hollywood fashion). What Gregyl had done was to report on these dynamics as if concerns related to low pnemococcal vaccination rates applied only to the mainstream population. In fact it was specifically related to risk factors which also include diabetes, heart disease, kidney disease and impaired immunity. Infants and the elderly are also deemed at higher risk.

The populations are referred to as “at-risk”. Reflecting this, the Sky News article was headed Vaccine rates low for at-risk pneumonia. To mock this Gregyl headed theirs Australians “at risk” from vaccination campaign (inverted comma’s theirs). In classic foot bullet style this indicates they knew very well there was no campaign targetting Aussies.

Having set the scene Gregyl can control the attack on the vaccine. They ask:

Will increased use of pneumococcal vaccines lead to declines in either the notification or mortality (death rates) from pneumococcal pneumonia?

This is certainly Beattie’s work as he favours irrelevant sources. He includes a 2008 letter from the WHO Bulletin, to answer his own question in the negative. Except he fails.

The letter is not looking at infection from pneumococcal bacteria or death rates from pneumococcal pneumonia following pneumococcal vaccination. It is arguing that the incidence of “clinical pneumonia” is not reduced by this vaccine. Pneumonia can arise from at least 8 strains of bacteria, 7 viruses and various fungi. 

Worse, the letter deals with dynamics in developing nations. It is utterly and irrevocably deceptive to cite the dynamics of infectious disease in low income nations and apply them to a developed nation such as Australia. 50% of all cases of bacterial pneumonia globally, test positive for Streptococcus pneumoniae. It is the leading cause of CAP – Community-acquired pneumonia – in Australia.

To answer the question above – Yes most certainly.

As shameful as that was, Gregyl continue with:

Are those aged between 15 and 64 truly at greater risk of contracting or dying from pneumonia caused by pneumococcus as these ‘experts’ have stated?

The question is misleading as the issue at hand is at-risk, chronically ill patients. Beattie supplies an Australian Institute of Health and Welfare graph of pneumonia mortality per 100,000 citing age groups 0 – 14, 14 to 64 and 65 plus.

His aim is again to answer the question in the negative.

Predictably it shows a drop in pneumonia for the lower age groups from 1907 to 2006. It also shows a rise and fall for 65 plus from 1907 to 1967. It then tapers off reflecting the increased life expectancy and better health of older Aussies.

Of course, I should dismiss this graph out of hand as it covers all pneumonia cases. Yet it’s worth noting that a common misconception about pneumonia is that it’s a “really bad” cold or flu. In truth pneumonia strikes after infection with influenza or another disease that leaves one chronically ill or at-risk.

As more and more vaccines have been introduced, particularly pertussis, influenza, pneumovax, hepatitis B and follow up with boosters became common place, the health of Aussies has increased markedly. Thus the causes of pneumonia of all types have been less likely to exploit weakened immunity or chronic disease problems.

So in effect, Beattie’s graph actually reinforces the essential need for pneumococcal vaccination because it shows the power of vaccines in protecting at-risk Aussies from pneumonia.

Thanks to Beattie’s graph we have an answer backed by The Australian Institute of Health and Welfare. Yes, most certainly.

Next is:

What percentage of all cases of pneumonia are caused by pneumococcal bacteria?

Now it’s time to leave Kansas entirely Dorothy. Beattie links to the American Lung Association Pneumonia Fact Sheet, claiming that 14% of all cases of pneumonia are attributed by the ALA to pneumococcal bacteria. What Beattie has done is taken the male discharges (589,000) and female (643,000) from 2006. This total = 1,232,000 pneumonia discharges for 2006.

He then gets an August 2009 annual estimation of 175,000 cases to get his 14%. It goes without saying that his claim, “according to the ALA, blah, blah…” is a lie. There’s nothing wrong with making rough conclusions from different sources but Beattie had no reason to a.) falsely attest to an annual figure and b.) falsely attribute it to the American Lung Foundation.

Let’s check that paragraph:

Streptococcus pneumoniae or pneumococcal pneumonia is the most common cause of bacterial pneumonia acquired outside of hospitals. The bacteria can multiply and cause serious damage to healthy individual lungs, bloodstream (bacteremia), brain (meningitis) and other parts of the body, especially when the body’s defenses are weakened. It is estimated that 175,000 cases of pneumococcal pneumonia occur each year, with a fatality rate of 5-7%, or even much higher among the elderly

Now it’s time to address Gregyl’s focus on pneumonia. Remember, Gregyl is attacking pneumococcal vaccination. The trick so far has been has been to focus on pneumonia and ignore meningitis and septicaemia. This enabled Beattie to invent or ask the wrong questions.

The notion of streptoccocus pneumonia cases being minor compared to other types is nonsensical. As noted way above, of all bacterial pneumonia cases, Streptococcus pneumoniae bacterium is isolated 50% of the time. It is the leading cause of pneumonia acquired in the community. So for Joe Bloggs, it may as well be 100% of cases. We can see by the graph above that the greatest variable is age – not type.

So to answer this question – It makes no difference.

Beattie is almost cornered by his lies. Next up is:

Will use of the pneumococcal vaccine reduce the incidence of illness?

Astonishingly he then blurts out, with no references:

  • Most adults and children carry the bacteria without symptoms
  • The vaccine won’t stop us coming into contact with the bacteria
  • Levels of meningitis, septacaemia and pneumonia have not gone down
  • Death rates are increasing in the elderly since introduction

The disease is spread by droplets from person to person. The Department of Health and Ageing note:

Pneumococci can be isolated from the upper respiratory tract in children and, less frequently, adults, and can spread directly from the nasopharynx to the respiratory tract which may cause otitis media, sinusitis or pneumonia. Pneumococci are also able to enter the bloodstream to cause invasive disease which may manifest as meningitis, pneumonia, septicaemia…

What then about notifications and hospitalisations from pneumococcal disease? Are they rising?

Pneumococcal disease notifications and hospitalisations, Australia, 1998 to 2007

Absolutely not. No idea where these guys get data from but it certainly won’t back what they claim.

How are the most vulnerable, the young and old faring? What of Gregyl’s increased disease and death in the elderly?

Pneumococcal disease notification rates, Australia, 2002 to 2007, by age group and year of diagnosis

No. Not here. Even remembering that the elderly show reduced immune responses to vaccination.

So the answer is – Yes, it will control the illness.

Next we get:

Will vaccinating against 23 strains of pneumococcal bacteria provide true protection against pneumococcal pneumonia?

After telling us it lives in the upper respiratory tract Gregyl now admits there are 91 different strains, and the vaccine targets 23. This is a genuine query and results suggest the vaccine will protect against the strains, compared to notification.

Notification rates of IPD cases with serotypes contained in the 7-valent pneumococcal conjugate vaccine (7vPCV), versus notification rates for other non-7-valent serotypes, Australia, 2006–2007 compared with 2002–2004, by age group

The Immunization Action Coalition offer:

What causes pneumococcal disease?

Pneumococcal disease is caused by Streptococcus pneumoniae, a bacterium. There are more than 90 subtypes. Most subtypes can cause disease, but only a few produce the majority of invasive pneumococcal infections. The 10 most common subtypes cause 62% of invasive disease worldwide.

In a concerted effort to mislead, Gregyl claims that, “studies in multiple locations around the world” have shown bacterial vaccines to lead to serogroup replacement. They fail to cite one study. Then again use the WHO Bulletin letter on developing nations to argue the point. Finally they claim this has happened with pertussis leading to “potentially more dangerous strains of bacteria”.

As has been explained here countless times no “more dangerous” strain of pertussis has evolved. In fact the opposite is supported by data. Fatalities are less than 1997 and 2000, whilst hospitalisations are about the same. This is parallel to far more notifications. More so, Tom Sidwell has demolished the notion of pertussis bacteria evolving around the vaccine.

Lastly we get:

Is there any evidence at all that use of this vaccine has led to a decline in either incidence of or deaths from invasive pneumococcal disease?

It’s followed by the use of NNDSS total notification figures of invasive pneumococcal disease in Australia to argue that there has been no change. Whilst the graphs above show a definite change USA research also backs significant reduction in infant infection and a reduction in mortality for all other age groups.

Yet most offensive is that NNDSS notifications tell us nothing about vaccination status. Every notification might be unvaccinated or every one may be vaccinated. Yet you’re tricked as if 100% of Aussies actually have been vaccinated. Nothing suggests infection even originated in Australia? This is one of Dorey’s old tricks. The fact is that it is an unrelated data set dealing only with notifications.

So our final answer? Yes, there is an abundance of evidence.

All up this was an appalling and scurrilous attempt to both scare the public into believing a vaccination “campaign” was under way and use this to fallaciously attack a very successful vaccine. Along with rotavirus, pneumococccal vaccination is on rapid roll out in developing nations. A major reason for this is it’s outstanding success here.

Dorey and Beattie, or Gregyl if you prefer, have been caught out at every single turn in this so-called “media release”. Not only does other evidence refute these absurd claims, even the evidence they provided upholds the importance of this vaccine’s success.

To be fair there was another question about making an informed choice. Which is code for will parents be provided with more codswallop of this type. As it had all just vanished in a puff of smoke I could see no point in answering.

In conclusion, to Gregyl and particularly Greg Beattie I am grateful for the chance to answer Yes to all those questions.

No matter how distorted they were.