Peter Hotez deceives New York Times readers about the odds of dying from measles in the US to persuade parents to comply with the CDC’s vaccine schedule.

On January 9, the New York Times published an article written by Dr. Peter J. Hotez titled “You Are Unvaccinated and Got Sick. These Are Your Odds.” His purpose in writing is to persuade parents to vaccinate their children according to the routine schedule recommended by the Centers for Disease Control and Prevention (CDC). To that end, he purports to compare “the dangerous effects of three diseases with the minimal side effects of their corresponding vaccines.”

“To state it bluntly,” Hotez writes, “being unvaccinated can result in illness or death. Vaccines, in contrast, are extremely unlikely to lead to side effects, even minor ones like fainting.” He laments that “vaccination rates have fallen”, resulting in a resurgence of measles globally. He cites the example of Samoa, where “almost 5,700 measles cases have been recorded since September, resulting in at least 83 deaths. Almost all of those who died were young children.” In the US, he writes, “vaccine hesitancy is contributing to” measles outbreaks.

Hotez presents data ostensibly to enable parents “to compare the risks of becoming ill with measles . . . to the minute chances of experiencing side effects from their corresponding vaccines.” (He also presents risk analyses for the influenza and human papillomavirus [HPV] vaccines, but due to time constraints and the emphasis placed on it by the media, I’m focusing here just on measles). Here is how he graphically presents the data for his risk analysis: A screenshot of Peter Hotez's risk analysis for measles and the MMR vaccine


Hotez goes on to assert, “Moreover, new research reveals that, even when patients recover, the measles virus can suppress the immune system, rendering children susceptible to serious infections like pneumonia and the flu.”

The reason parents are choosing not to get their children the measles vaccine, he claims, is because they believe “misinformation spread after an article implying a link between measles vaccinations and autism was published in The Lancet in 1998; it was retracted in 2010 over concerns about the validity of the results and the conduct of the study. Nevertheless, the false claim that vaccines can cause autism continued to circulate on the internet and social media. The truth is that we have overwhelming evidence from at least six studies involving more than one million children that measles-mumps-rubella vaccinations do not cause autism.”

The Times presents Hotez as a scientist and pediatrician at the Baylor College of Medicine, and in recent years he’s become a leading go-to “expert” for the mainstream media on the topic of vaccines. Undisclosed by the Times is that he’s also a vaccine developer who holds several patents for vaccines against tropical diseases and co-director of the school’s Texas Children’s Hospital Center for Vaccine Development. In 2017, the center entered a partnership with the German pharmaceutical company Merck KGaA to advance development of vaccines for tropical diseases (not to be confused with Merck & Co., the US vaccine manufacturer). 

The center’s purpose, in his own words, is to “secure funding and advance the development of drugs, vaccines, and other health tools . . . that currently the pharmaceutical companies are unable to invest in due to inabilities to promise shareholder returns.” Since pharmaceutical companies view certain proposed vaccine products as an unprofitable venture, the costs are subsidized through “product development partnerships” like Baylor’s. As Hotez explains, a key source of funds is the government, meaning that the costs of vaccine development are being subsidized by the taxpayers.

“Fueling investor hesitancy”, he explains in a paper in Human Vaccines & Immunotherapeutics, “are the recent shortcomings and public reactions to newly introduced vaccines for malaria and dengue despite billion-dollar investments from Glaxo Smith Kline (GSK) and Sanofi Pasteur, respectively, on top of an accelerating global antivaccine movement.”

He doesn’t illuminate why the public had negative reactions to these vaccines. The reason this was so for GSK’s malaria vaccine was that, while it was shown to be initially effective, the protective effect waned over time and after five years of follow up resulted in children being at an increased risk of infection from malaria parasites. The reason this was so for Sanofi’s dengue vaccine was that, after it was implemented into the childhood schedule the Philippines upon the recommendation of the World Health Organization (WHO) and hundreds of thousands of doses were administered under the pretense of a proven “safe” vaccine, it was likewise shown to increase the risk of serious dengue infection among children who had not already experienced a prior infection. The public outrage was all the more pronounced because it was also learned that Sanofi, Philippines health officials, and the WHO had ignored early warnings that the vaccine might cause precisely that outcome.

It is highly instructive that Hotez views the problem not as the proven untrustworthiness of the pharmaceutical companies and government health agencies, but rather the inability of the industry to fund products that are dangerous and cost ineffective. It’s equally instructive that he mindlessly dismisses public opposition as mere “antivaccine” sentiment attributable to some monolithic “movement” rather than reflecting parents’ legitimate concerns, including anger over entire populations being used essentially as subjects of a mass uncontrolled experiment without informed consent. Relevantly, the decline in vaccination rates in the Philippines was a result of this rightful erosion of public trust, which is attributed with causing a major measles outbreak in 2017.

Superficially, the measles risk analysis Hotez presents to New York Times readers is persuasive. The way he presents his data, it’s a no-brainer that parents in the US should vaccinate their children since the risks from measles so obviously outweigh the risks from the vaccine. But Hotez is preying on people’s ignorance by presenting an invalid risk-benefit analysis that is not serious and does not address parents’ legitimate concerns about vaccinating their children strictly according to the CDC’s schedule. Rather, the article is transparently intended to deceive parents about the risks in order to scare them into compliance.

This can be demonstrated by examining some of the major problems with his presented analysis.



Problem 1: The Measles Vaccination Rate in the US Has Not Fallen

In the context of his claim that “vaccination rates have fallen”, Hotez adds that “vaccine hesitancy is contributing to” measles outbreaks in the US. However, it’s not true that vaccination rates in the US have fallen. In fact, the trend has been an increase in the national vaccination rate over time, according to CDC data. Here’s what the data looks like graphed over time for the percentage of children aged 19 to 35 months who’ve received one or more doses of the measles vaccine, with a linear trendline: MMR vaccination rate for pre-school aged children in the US


And here’s what the CDC’s data show for the measles vaccination rate for kindergarten-aged children, again with trendline (this dataset starts at 2009, and no data is available for the 2010-11 school year): MMR vaccination rate for kindergarten children in the US


Of course, there is variation in vaccination rates year to year, and vaccination rates certainly vary by community, but Hotez’s suggestion that the trend in the US is a general decline in the vaccination rate is false. The vaccination rate for school-aged children has rather remained steady over time between 94 percent and 95 percent, and if anything has trended upward.

Problem 2: Ignoring the Low Risk of Getting Measles

The most fundamental glaring fallacy of Hotez’s risk analysis is that it is based on the assumption that if the child is not vaccinated, the child will get measles. His title says he’s presenting the odds for a child who doesn’t get the vaccine and got sick. But it isn’t a given that an unvaccinated child will get measles. When he says his analysis is “to compare the risks of becoming ill with measles” with the risks of vaccinating, he is being untruthful since his analysis falsely assumes that the unvaccinated child gets measles.

The fundamental problem with this assumption, of course, is that the chances of a child in the US being exposed to measles, much less becoming permanently injured or killed by the virus, is also very low. Hotez’s failure to take this fact into consideration alone completely invalidates his analysis. Parents living in the US today must consider—and intuitively do consider—the fact that the policy of mass vaccination has succeeded in its goal of reducing measles incidence. The idea that they should place their own child at unnecessary risk of harm from the vaccine for some collectivist concept of a “greater good” is obviously repulsive to many parents, and rightly so.

To do what Hotez fails to do and help quantify the risk of getting measles, according to the CDC, from 2010 through 2019, there were 3,237 reported measles cases, which is an average of about 324 cases per year. The US has a population of about 330 million, so that’s about 1 measles case annually per 1 million population. This compares with the annual odds of being struck by lightning, which is 1 in 1.2 million according to the National Oceanic and Atmospheric Administration.

Problem 3: Ignoring Non-Vaccine Factors of Risk Reduction

The third glaring problem with Hotez’s analysis is that, in the text of his article, he cites the high death rate in the recent outbreak in Samoa as though it was relevant for the risk-benefit analysis of the New York Times’s predominantly American audience. (While the Times certainly has a global reach, according to traffic data from SimilarWeb, more than 78 percent of its website’s audience are in the US.)

His graphic shows a fatality rate in Samoa of 146 deaths per 10,000 cases (83 deaths out of 5,697 cases). What he doesn’t explicitly inform his American readers is that measles mortality differs by population. While mortality remains tragically high in developing countries, in developed countries like the US, the mortality rate is very low. His graph does show the Samoan fatality rate as a separate figure from the “10 to 30 child deaths” that he says occur for every 10,000 people who get measles (which is untrue, as we’ll come to), but he offers no comment on why the death rate in Samoa is so much higher.

Hotez also does not inform his readers that most of the decline in measles mortality seen in the US during the twentieth century occurred before the introduction of the first measles vaccine in 1963. During the pre-vaccine era in the US, measles was seen as a mostly benign illness that, yes, could and did sometimes cause death, but which most children’s immune systems handled just fine on their own, resulting in the development of a robust lifelong immunity. A graph from the US Department of Health showing the decline in measles mortality prior to the introduction of the vaccine in 1963. (CDC)


The obvious question this raises is what factors other than vaccination affect the risk of complications from measles infection. In light of this important question, it’s useful to point out that this dramatic decline in mortality wasn’t true just for measles. In fact, as noted in a paper published in 2000 in Pediatrics, the journal of the American Academy of Pediatrics (AAP), “nearly 90% of the decline in infectious disease mortality among US children occurred before 1940, when few antibiotics or vaccines were available.” Hence, “vaccination does not account for the impressive declines in mortality seen in the first half of the century.”

The dramatic decline in infectious disease mortality is attributed instead to factors associated with a general increase in the standard of living, including improved nutritional status among children. With measles, for example, Vitamin A deficiency is a known risk factor for potentially deadly complications.

Hotez demonstrates a total lack of curiosity about what the risk factors are for measles complications. This reflects the attitude of public health officials back in the 1960s. Rather than directing resources toward determining the risk factors and developing targeted interventions for children at higher risk, vaccination was selected as a one-size-fits-all solution, and science ever since has been trapped in this myopic and pharmaceutical-centric approach to disease prevention. The narcissistic attitude of public health officials in 1962 in declaring the goal of eradicating measles in the US within a year with just a single dose of the vaccine—despite measles being recognized as a “self-limiting infection of short duration, moderate severity, and low fatality”—was that this should be done because “it can be done.”

Needless to say, the assumptions underlying that policy were wrong.

Problem 4: Misinforming about the Fatality Rate of Measles in the US

As just noted, Hotez claims that the childhood death rate for measles is 10 to 30 deaths per 10,000 cases, implying that this is true for the US population. He does not specify his source for this claim. (He has a note in the article presenting a broad range of sources, but without identifying which sources were used for which data.) Presumably, he is just relaying the CDC’s claim on its website that “Nearly 1 to 3 of every 1,000 children who become infected with measles will die from respiratory and neurologic complications.” On another page of its website, the CDC states, “For every 1,000 children who get measles, one or two will die from it.” But during the pre-vaccine era in the US, according to the CDC’s own data, there were about 500 deaths annually out of an estimated 3 – 4 million cases. That’s not 10 to 30 but 1 to 2 deaths for every 10,000 cases. The Institute of Medicine (IOM) in a 1994 report likewise stated that, in developed countries like the US, “the measles fatality rate is 1 per 10,000 cases”. The explanation for these contradictory numbers is that the CDC is deceptively using only reported cases in its denominator. Of the estimated 3 – 4 million cases, most were mild infections that did not lead to hospitalization or complications. Only about 500,000 cases were reported annually. The CDC’s statement that one or two children will die for every 1,000 children who get measles either is a bald-faced lie that ignores the fact that most cases weren’t reported or means that the fatality rate today is an order of magnitude higher than it was in the 1950s and early 1960s. Indeed, mass vaccination has resulted in a shifted risk burden and an increased rate of deaths per reported cases, as we’ll come to. The point for now is that Hotez deceitfully presents a fatality rate for measles at least 10 times greater than that shown by CDC data and accepted by the IOM for the US population in the absence of vaccination.

Problem 5: Misinforming about the Risks of Vaccination

According to Hotez’s graphic, there are only three adverse events associated with the measles vaccine.

He states that only 3 febrile seizures occur for every 10,000 people who get the measles vaccine. He says in a footnote that such seizures “are not associated with long-term effects”. He adds that febrile seizures “also occur overall in 2 percent to 5 percent of all children 6 months to 5 years of age”, but, of course, the US childhood population is highly vaccinated, and Hotez doesn’t provide any data on the rate of febrile seizures among children vaccinated according to the CDC’s schedule compared with the rate among completely unvaccinated children.

Contrary to Hotez’s claim that febrile seizures are not associated with long-term harm, a recent study in JAMA Pediatrics, a journal of the American Medical Association (AMA), found that recurrent febrile seizures are associated with an increased risk of epilepsy and psychiatric disorders and, for children who later developed epilepsy, an increased risk of death.

Another study published last year in JAMA Network Open found febrile seizures to be associated with an increased risk for “sudden unexplained death in childhood (SUDC)”.

A Lancet study published online in 2018 similarly found an association between febrile seizures and an increased risk of psychiatric disorders later in life.

In a study published in 2018 in the journal Brain & Development, Japanese researchers found febrile seizures to be associated with an overall “18.76-fold” increased risk of developing epilepsy, with higher risk for children who were female, had recurring febrile seizures, or had autism.

A paper published in Cell Reports in 2018 stated that “early-life seizures are associated with language deficits and autism that can result from aberrant development of the auditory cortex.”

A study published in Seizure in 2017 concluded that seizures “tend to recur and increase the risk of development of epilepsy in the patient.”

A 2017 study in Pediatric Neurology found febrile seizures and epilepsy to be associated with an increased risk of being clinically examined for early symptoms of neurodevelopmental disorders, including autism.

Another study from earlier in 2017 noted that the measles vaccine increases the risk of potentially seizure-inducing fever and suggested “a possible genetic basis for susceptibility to developing fever due to measles vaccines.”

These more recent studies contradict the finding of a study published in JAMA in 2004 that found no association between febrile seizures and the risk of epilepsy. However, that earlier study also admitted that “little is known about the long-term outcome of febrile seizures following vaccination.”

In other words, the science on this, far from being settled, has just begun. More directly to the point, Peter Hotez’s statement that febrile seizures after vaccination “are not associated with long-term effects” is false.

Hotez’s graphic says that abnormal blood clotting occurs in “1 case per 25,000 to 40,000 doses” of measles vaccine. He doesn’t specify his source, but these are the same numbers provided by a 2009 article in Paediatrics & Child Health that noted an “increasing body of evidence” supporting a link between the measles vaccine and idiopathic thrombocytopenic purpura. The authors acknowledged that one of the limitations of their estimate was that it was based on data requiring treating physicians to document receipt of any vaccines within the previous month, whereas another study had found that doctors had only inquired about recent vaccination in 15 percent of cases with vaccine-associated thrombocytopenia. Hence, the figures presented are likely to be underestimated.

Hotez’s graphic also says that 1 to 3.5 allergic reactions occur for every 1 million doses of measles vaccine administered. He specifies no source, but this is the same estimate presented in a 2015 study in Clinical and Translational Medicine that compiled data from prior studies looking at the risk of allergic reaction to the measles vaccine, including a 2008 study in Archives of Disease in Childhood that says the best estimate of the incidence of anaphylaxis for the combination measles, mumps, and rubella (MMR) vaccine in the UK was a study showing a much higher rate of 14 allergic reactions for every 1 million doses administered. Another prior study cited is a 2003 CDC study in Pediatrics looking at data from four health maintenance organizations in the US and estimating 1.1 to 3.5 cases per 1 million doses administered. However, the authors acknowledged this “likely represents an underestimate of the risk”, and for the site “with the most comprehensive data”, the risk for anaphylaxis from the measles vaccine was estimated to be 14.4 cases per 1 million doses. That result was considered an overestimate because of confounding: since children frequently receive multiple vaccines at once, it was impossible for them to know which vaccine caused the allergic reaction (or whether it was the combination itself that caused it). The point is that we really don’t know, and the numbers presented by Hotez are, according to the CDC’s own research, likely underestimated.

Whereas Hotez acknowledges only those three possible adverse reactions to the vaccine, Merck acknowledges numerous others. Under federal regulations, manufacturers are required to warn consumers about “adverse events for which there is some basis to believe there is a causal relationship between the drug and the occurrence of the adverse event.” On its product package insert, Merck lists among the possible side effects of its measles vaccine the following: fever, syncope (fainting), headache, dizziness, vasculitis (a condition in which the immune system mistakenly attacks the blood vessels, causing inflammation that can lead to serious problems, including aneurysms), pancreatitis (inflammation of the pancreas that occurs when the digestive enzymes it produces begin digesting the pancreas itself), diarrhea, vomiting, parotitis (inflammation of the parotid glands), nausea, diabetes mellitus (diabetes), thrombocytopenia (the disorder Hotez mentions in which there is an abnormally low amount of platelets that help blood to clot), anaphylaxis (the life-threatening allergic reaction that Hotez acknowledges), arthritis (joint inflammation), arthralgia (joint pain), myalgia (muscle pain), encephalitis (inflammation of the brain that can cause permanent brain damage or death), Guillain-Barré syndrome (an autoimmune disorder in which the immune system attacks the peripheral nervous system, which can result in paralysis or death), febrile seizures, afebrile seizures (convulsions without fever), pneumonia, measles-like rash, and death.

This is not to say that the vaccine is known with certainty to cause each of these adverse events. They are just an acknowledgement by Merck of the uncertainty and the biological plausibility that their product might cause any of these outcomes, based on the limited data available from clinical trials and postmarketing surveillance.

This brings us to another fact that parents must take into consideration, which is that the clinical trials used by the manufacturers to obtain licensure from the Food and Drug Administration (FDA) consider only short-term adverse reactions. They do not consider long-term detrimental effects. They aren’t designed, for example, to determine whether vaccines administered according to the CDC’s schedule can contribute to the development of neurological disorders, autoimmune diseases, cancers, or other chronic illnesses later in life. This is highly concerning given the epidemic of chronic illness among children. A study published in Academic Pediatrics in 2011 estimated that at least 43 percent of children in the US have one or more chronic health conditions.

Essentially, after obtaining licensure, the population becomes the subject of a mass uncontrolled experiment. Once a vaccine is licensed and recommended for routine use, it’s typically considered “unethical” to conduct randomized, placebo-controlled studies on the grounds that it wouldn’t be right to deny the placebo group the benefits of the vaccine—which is, of course, the fallacy of begging the question.

For vaccines already on the market, there is the Vaccine Adverse Event Reporting System (VAERS), but it’s recognized that this passive surveillance system suffers the problem of severe underreporting of adverse events.

Researchers also conduct observational studies using population data, such as from private health care networks or government registries, but this type of study design has methodological limitations and tends to suffer from the problem of selection bias, such as the common “healthy user” bias.

As an example of this type of selection bias, a 2015 JAMA study found that children with elder autistic siblings are less likely to get the measles vaccine, presumably because their parents have heightened concerns about the vaccine contributing to the development of autism in the younger sibling and so skip the shot.

This suggests that observational studies comparing the risk of autism between children who received the measles vaccine and children who didn’t are prone to a healthy vaccinee bias wherein children at higher risk of developing autism tend to be pooled within the “unvaccinated” cohort. Consequently, the appropriate conclusion to draw is not that children who are vaccinated have no greater risk for autism but that children at greater risk for autism are less likely to be vaccinated.

(Instructively, that study actually found vaccination to be associated with a decreased risk of autism, which is itself evidence of selection bias since the null hypothesis is that there is no association, meaning that the rate of autism should be the same for vaccinated and unvaccinated children. Despite confirming the existence of a healthy vaccinee selection bias, which had also been identified by prior studies, this study was hailed by both its authors and the media as showing that the measles vaccine is not associated with an increased risk of autism even in genetically susceptible children, which is a useful illustration of the institutionalized cognitive dissonance that exists when it comes to the special class of pharmaceutical products known as vaccines.)

In short, observational studies don’t enable scientists to control for innumerable potentially confounding variables as well as the randomized, placebo-controlled trial, which is why the latter is considered the gold standard for safety studies. A found association from observational data doesn’t necessarily mean a causal relationship, and a finding of no association does not mean that no association exists.

Returning to Hotez’s focus on death as an outcome, he offers no estimate of the risk of death from the vaccine, but from 2010 through 2017, there were 40 deaths reported to VAERS following measles vaccination. This is not to say that the vaccine caused those deaths. Perhaps only a small percentage of reported vaccine-associated deaths are caused by the vaccine. However, it might also be that deaths following vaccination are not reported to VAERS. While there is a higher chance of reporting for more serious adverse events, severe underreporting, again, is a known problem with this passive surveillance system.

By comparison, according to CDC data, during the same period, there were only 4 deaths attributed to measles. None of these deaths were in children. All were adults aged 25 or older.

This is significant due to what’s known in the literature as “secondary vaccine failure”, or waning immunity. Whereas adults during the pre-vaccine era were generally protected from measles by the robust natural immunity they’d gained from experiencing infection during childhood as well as the natural boosting effect of repeated exposures from children, adults today are at higher risk in the event of infection due to secondary vaccine failure. (Primary vaccine failure is when the vaccine fails to stimulate a protective level of antibodies in the first place, which is estimated to occur in anywhere from 2 percent to 10 percent of children.)

Infants, too, are at higher risk today in the event of infection due to mass vaccination since their vaccinated mothers are less well able to confer passive maternal immunity to their babies with antibodies transferred prenatally through the placenta and postnatally through breastmilk.

This brings us to a caveat that must be emphasized with respect to using pre-vaccine era data on measles mortality, which is that the ratio of deaths per reported cases has since increased due to mass vaccination having shifted the risk burden away from school-aged children, in whom it is generally a benign illness, and onto those at higher risk of potentially deadly complications.

As already discussed, during the pre-vaccine era, this rate was about 1 death per 1,000 reported cases. (Not to be confused with the accepted fatality rate of 1 death per 10,000 cases.) But as noted by two leading experts in a 1994 paper in Archives of Internal Medicine, by 1990, the death rate had risen “dramatically” to 3.2 deaths per 1,000 reported cases, “reflecting the increased incidence of measles infection in infants and adults relative to children older than 1 year of age.” A 2004 study in the Journal of Infectious Diseases similarly attributed the increased death rate in part to “a higher proportion of cases among preschool-aged children and adults.” Another 2004 study in the same journal likewise attributed the “increased mortality among the younger and older age groups” to “the increased risk and severity” of deadly complications for infants and adults.

According to CDC data, from 1999 through 2017, there were 12 deaths in the US for which the underlying cause was determined to be measles. Two cases were infants under one year of age, two others were children aged one to four, and the remaining two-thirds of cases were adults aged twenty-five or older. During the same period, there were 2,393 reported cases of measles. Hence, more recent data show a still-increasing death rate of about 5 deaths per 1,000 reported cases.

Naturally, Peter Hotez does not inform Times readers that the policy of mass vaccination has resulted in an increased risk of death among infants and adults in the event of infection due to public policy having shifted the risk burden by destroying the natural herd immunity the US population was already well into developing, in which adults were generally protected throughout their lifetimes and infants were protected through strong maternal passive immunity until their immune systems were developed enough to be able to fight off the infection on their own.

Problem 6: Asserting the Measles “Immune Amnesia” Hypothesis as Proven Fact

Whereas Hotez would have his readers believe that the risk of dying as a result of getting the measles vaccine is virtually zero and unquestionably lower than the risk of dying if left unvaccinated, the truth is that we don’t know because clinical trials were never done to determine the vaccine’s effect on overall mortality.

This is a problem with all vaccines. An expert review published in June 2019 expressed the concern that “it is impossible to predict what happens in terms of susceptibility to infections in general, of all types, when the immune system is being stimulated through vaccination”.

There are observational studies that have been done in African countries looking at this question. Studies have found the measles vaccine to be associated with a decreased rate of childhood mortality that cannot be attributed to prevention of measles alone. In fact, this has been observed even in areas with no acute measles mortality.

Hotez alludes to this body of research when he claims that “the measles virus can suppress the immune system, rendering children susceptible to serious infections like pneumonia and the flu.”

He’s referring to the hypothesis of measles “immune amnesia”, which was conceived to try to explain the observation of an association between vaccination and decreased mortality from other diseases. It has been known since the pre-vaccine era that measles can cause a temporary suppression of the immune system that increases the risk of secondary infections. (Hotez’s graphic states that the “most common cause of death” is pneumonia, for example, which in many cases is caused not by the measles virus itself but by some secondary infection.) The “immune amnesia” hypothesis is that measles does not just cause a temporary immunosuppression but a long-term effect that may “wipe out” acquired immunity to other infectious diseases.

One problem with this hypothesis is that it’s based on the additional observation that measles virus infection results in a depletion of antibodies and the B-cells that make them. In the paradigm of vaccination, this would seem to equate to an elimination of immunity. Indeed, for the purposes of vaccine licensure, the production of antibodies is treated as equivalent to immunity. The problem with this framework is that antibodies are neither always sufficient nor even necessary for the development of immunity.

Measles itself happens to provide a perfect example of that. Children with a disorder rendering their immune system incapable of producing a protective level of antibodies are still protected from measles due to another branch of the immune system known as cell-mediated immunity. Children suffering from deficits in cell-mediated immunity, on the other hand, can still die of measles despite producing levels of antibodies considered “protective”.

A study published in BMJ Open in 2016 emphasized another major problem with the “immune amnesia” hypothesis, which is that “all available studies—including the present one—suggest lower mortality rather than excess mortality among those who survive the acute phase of measles infection.”

To repeat: what studies show is that measles infection is associated with a lower risk of dying from other diseases, not a higher risk as assumed under the “immune amnesia” hypothesis.

In other words, while the live virus vaccine seems to train the immune system in ways that provide “non-specific” benefits, so does infection with the wild virus. This should not be too surprising since the vaccine is intended to cause an immune response similar to that caused by infection. As a 2002 study published in the journal Vaccine observed, in populations where measles is a “mild disease”, which certainly includes the US, “measles infection may be associated with better overall survival than no measles infection.” Studies indicate that “lower post-measles mortality compensates for acute measles mortality and as a consequence, measles infection has a lower than expected overall impact on survival.”

In fact, apart from training the immune system to protect the host from other pathogens, measles infection during childhood has been associated with a decreased risk of numerous other diseases later in life, including degenerative bone disease, certain tumors, Parkinson’s disease, allergic disease, chronic lymphoid leukemia, both non-Hodgkin lymphoma and Hodgkin lymphoma, and cardiovascular disease.

In another paper published in Expert Review of Vaccines in 2018, top researchers in the field of “non-specific effects” of vaccines once again emphasized that a fundamental problem with the “immune amnesia” hypothesis is that, “in the five published studies which examined whether post-measles infection is associated with long-term excess mortality, there is a trend towards lower subsequent mortality for individuals who survived acute measles infection.”

The authors of that paper also stressed that “vaccines need to be evaluated for their effects on overall health”, which would require a shift from the existing outdated paradigm in which vaccine safety science and the regulatory apparatus of the US government is stuck.

And whereas the live virus measles vaccine seems to train the immune system in beneficial ways similar to measles infection, non-live vaccines have been associated with detrimental non-specific effects. The diphtheria, tetanus, and whole cell pertussis (DTP) vaccine, for instance, which is the most widely used vaccine in the world, has been associated with a significantly increased risk of childhood death. (The DTP vaccine has been replaced in the US with an acellular pertussis vaccine, DTaP, which is also a non-live vaccine.)

In a review published last year, Peter Aaby and Christine Benn, two leading researchers in this field involved in the aforementioned research, once again pointed out that, contrary to the “immune amnesia” hypothesis, studies rather have “suggested that measles infection could have a beneficial effect on survival” and hence have “refuted the hypothesis”.

As Christine Benn has also remarked with respect to that recent review, “No vaccines have been studied for their non-specific effects on overall health, and before we have examined these, we cannot actually determine that the vaccines are safe.”

Problem 7: Misinforming about the Vaccine-Autism Hypothesis

Hotez’s graphic states that there is no risk of autism from the measles vaccine. By his telling, “fears that vaccines can cause autism” originated “in the late 1990s” because of “an article implying a link between measles vaccinations and autism” that was published in The Lancet in 1998 but “retracted in 2010 over concerns about the validity of the results and the conduct of the study.”

But that narrative is demonstrably false. The 1998 Lancet study was not the origin of parental concerns about vaccines causing autism. The claim that the study made “the false claim that vaccines can cause autism” is itself a false claim that’s incessantly circulated by the mainstream media. The truth is that the authors explicitly stated that they did not show a causal relationship between the measles vaccine and autism. Rather, they merely relayed the observation from children’s parents or doctors that developmental regression occurred following vaccination, and they reasonably hypothesized that there might be a link, suggesting that further studies should be done to investigate this possibility.

Apart from routinely lying that the study claimed to have found a causal link, the mainstream media are fond of pointing out that the lead author of the study, Andrew Wakefield, was stripped of his medical license in the United Kingdom for the concerns about the conduct of the study mentioned by Hotez. What the media never inform readers is that one of Wakefield’s coauthors, John Walker-Smith, was also stripped of his license but appealed and was reinstated on the grounds that the accusations against him were spurious and unsupported by the available evidence. The reason Wakefield didn’t also appeal was because, unlike his colleague, his insurance policy wouldn’t cover the costs.

The fact that parental concerns about vaccines causing autism existed long before the 1998 Lancet study is easily demonstrated by the fact that the Institute of Medicine acknowledged this concern in a report published in 1991. Specifically, the IOM found “no evidence” to support a causal relationship between the DTP vaccine, which was unsurprising given the IOM’s observation that no studies had been done to test that hypothesis.

Peter Hotez and the mainstream media in general would have people believe that the only reason parents think that vaccines can cause autism is because they’ve been duped into that belief by a fraudulent study falsely claiming to have found a causal association. The truth is that the belief that vaccines can cause autism originated from parents who witnessed their children developmentally regress after vaccination. This belief existed before the 1998 Lancet study and would persist today had it never been published in the first place.

Hotez also would have his readers believe that studies have since falsified the hypothesis. The CDC itself boldly asserts on its website that “Vaccines Do Not Cause Autism”. To support this claim, the CDC cites several observational studies and a 2004 IOM review that explicitly acknowledged that the hypothesis cannot be excluded by observational studies. In fact, not one of the observational studies reviewed even considered the possibility of genetically susceptible subpopulations.

To say that studies have found no association between vaccines and autism is practically meaningless in light of the fact that no studies have been designed to test the hypothesis that vaccines administered according to the CDC’s routine childhood schedule can contribute to the development of autism in children with a genetic or environmentally caused susceptibility.

As the IOM observed in a 2013 review, “No studies have compared the differences in health outcomes . . . between entirely unimmunized populations of children and fully immunized children”; “existing research has not been designed to test the entire immunization schedule”; “studies designed to examine the long-term effects of the cumulative number of vaccines or other aspects of the immunization schedule have not been conducted”.

Going even further in his denialism, days after his New York Times article was published, Hotez claimed on Twitter that “Vaccines do not injure children.”

Yet the federal government administers a program called the Vaccine Injury Compensation Program (VICP), which awards compensation to children who suffer any of a list of adverse events acknowledged to be caused by vaccines. These outcomes are listed on what’s known as the Vaccine Injury Table. Children suffering from a table injury after vaccination are presumed to have suffered from a vaccine injury absent some other more likely explanation for the outcome. For injuries not listed on the table, the burden of proof is on the petitioner to show that vaccination was the most likely cause of the injury. The government can also settle cases, in which case awarded compensation is not deemed to be an acknowledgment that vaccination caused the injury.

One of the adverse events listed for the measles vaccine on the Vaccine Injury Table is encephalopathy, which encompasses any type of brain damage, disorder, or disease. This includes encephalitis, which is brain inflammation. Whereas Hotez flatly denied that any vaccine causes any injury, even the manufacturer of the measles vaccine, Merck, acknowledges in its world-bestselling medical textbook, The Merck Manual, that “Encephalitis can occur as a secondary immunologic complication of certain viral infections or vaccinations.” (Emphasis added.)

In one famous VICP case, the government acknowledged that vaccines can cause brain damage manifesting as symptoms of autism. The family of a girl named Hannah Poling was awarded compensation for her having suffered a table injury, which was encephalopathy. She regressed into diagnosed autism after receiving nine vaccine doses at once at nineteen months of age. The government conceded that the vaccines she received “significantly aggravated an underlying mitochondrial disorder, which predisposed her to deficits in cellular energy metabolism, and manifested as a regressive encephalopathy with features of autism spectrum disorder.”

The head of the CDC at the time, Julie Gerberding, publicly admitted that, in children “predisposed with a mitochondrial disorder”, vaccines can cause brain damage that manifests as “symptoms that have characteristics of autism.”

Hannah also happened to be a patient of a leading expert on autism, Dr. Andrew Zimmerman, who served as an expert witness in VICP cases on behalf of the government until he informed the government’s lawyers that vaccines can cause autism in children with mitochondrial dysfunction. His services were then deemed no longer required by the government lawyers, who went on to falsely claim, in order to deny compensation in a later case, that it was Zimmerman’s view that vaccines cannot cause autism. (Dr. Zimmerman testified to this in an affidavit last year.)

Even Dr. Frank DeStefano, the director of the CDC’s own Immunization Safety Office and a top researcher whose name appears on a number of the studies the agency cites to support its claim that vaccines don’t cause autism, has acknowledged that “it’s a possibility” that vaccines could cause autism in genetically susceptible children, but that the problem is it’s “hard to predict who those children might be”, and trying to determine the underlying cofactors that might place certain individuals at greater risk of vaccine injury is “very difficult to do”.

This is one of the fundamental problems that public vaccine policy apologists like Peter Hotez refuse to acknowledge: it treats vaccination as a one-size-fits-all solution despite individual variability in risk for the disease a given vaccine is designed to protect against and individual variability in the risk of the vaccine causing serious harm. Hotez joins public policy officials in unscientifically refusing to recognize that the risk-benefit analysis must be done for each vaccine and each individual child.

The idea that government bureaucrats with none of the specialized knowledge of the individual required to conduct a meaningful risk benefit analysis should dictate to parents what’s in their child’s best interest is both ludicrous and tyrannical.

Yet Hotez is a fierce opponent of the right to informed consent when it comes to vaccination and heavily involved in political activism, using his credentials as a scientist to advocate for the elimination of non-medical exemptions to routine childhood vaccinations. The use of government force to compel parents into compliance with government policy goals is incompatible with the right to make an informed choice about any medical intervention free from force, fraud, deceit, or any other form of coercion.

The VICP, by the way, was established under a 1986 law that also granted broad legal immunity to manufacturers of vaccines recommended for routine use in children by the CDC. The purpose and effect of the law is to shift the financial burden for vaccine injuries away from the pharmaceutical industry and onto the taxpaying consumers.

If Hotez were correct that “Vaccines do not injure children”, then obviously there would be no case to be made that the government should continue administering the VICP, and the pharmaceutical companies should have nothing to fear from the revocation of legal immunity.


Peter Hotez’s goal with his New York Times article is to persuade parents that it’s in their best interests to get their children the measles vaccine in compliance with the CDC’s schedule. But to that end, he presents a risk analysis that is fundamentally flawed and deceptive.

His whole analysis depends on the false assumption that to forego vaccination is to accept the risks associated with measles infection, whereas parents living in the US today must also take into consideration the fact that the odds of their child being exposed to measles in the first place—much less being permanently injured or killed by the virus—are very small. He claims vaccination rates have been falling when in fact the trend over time has been an increase in the proportion of children who’ve received the measles vaccine.

Hotez also overstates the risk of death from measles by claiming a fatality rate of 10 to 30 deaths for every 10,000 cases despite the CDC’s own data showing a pre-vaccine era fatality rate in the US of just 1 per 10,000 cases, which is the rate accepted by the authoritative Institute of Medicine. The caveat to this is that the rate of deaths per reported cases has since increased, but this is an unintended albeit foreseeable consequence of having shifted the risk burden away from children and onto infants and adults. Hotez also presents the fatality rate in the recent Samoan outbreak of 146 deaths per 10,000 cases, offering no comment on why the death rate would be so high there compared to the pre-vaccine-era rate in the US and other developed countries of 1 per 10,000—a difference in risk attributable entirely to factors other than vaccination.

Hotez also grossly understates the risks of vaccination, acknowledging only three possible adverse events associated with the measles vaccine and stating on Twitter less than a week after his article was published that “Vaccines do not injure children” despite the government administering the Vaccine Injury Compensation Program to indemnify the pharmaceutical industry against lawsuits for serious adverse events acknowledged to be causally associated with vaccines, despite the measles vaccine’s own manufacturer acknowledging that vaccines can cause encephalitis, and despite the government’s acknowledgment that vaccines can cause brain damage manifesting as symptoms of autism in genetically susceptible children. He falsely claims that vaccine-associated febrile seizures are not associated with long-term harm, which is yet another indication either of his dishonesty or, assuming good faith, that he just hasn’t been keeping up with the science.

Hotez claims that the idea “that vaccines can cause autism” is “misinformation” despite no studies ever having been conducted that were actually designed to test the hypothesis that vaccines administered according to the CDC’s schedule can contribute to the development of autism in genetically susceptible children and despite the admission from even the CDC’s own head of vaccine safety that it’s possible that vaccines might cause autism in genetically susceptible children.

The refusal of public policy apologists like Hotez to address parents’ countless legitimate concerns and the insistence on offhandedly dismissing those concerns as though totally unfounded is precisely why they are finding it so hard to persuade “vaccine hesitant” parents to line up their children to get all the shots in strict compliance with the CDC’s recommendations.

As long as people like Hotez continue to take the alternative approach of using fear, deception, and government coercion to compel parents into compliance, an increasing number of parents will continue to raise reasonable questions, express legitimate concerns, and trust their own judgement as to what’s in their children’s best interest rather than placing their faith in untrustworthy government bureaucrats who have none of the knowledge required to be able to conduct a meaningful risk-benefit analysis for the individual. As long as public policy apologists like Hotez continue to threaten our children’s health by insisting upon vaccination as a one-size-fits-all solution and continue to threaten our liberty by assaulting the parental right to informed consent, the number of parents who not only question public policy but who stand up and speak out against it will continue to grow.

[Correction appended, January 24, 2020: As originally published, this article stated that that the Texas Children’s Hospital Center for Vaccine Development in 2017 partnered with Merck, the manufacturer of the measles vaccine used in the US. This is incorrect. The center partnered with the German pharmaceutical company Merck KGaA, not the US company Merck & Co. The text has been corrected.]

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