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Let me start by getting this out of the way: Vaccines are one of humankind’s greatest health care achievements, along with antibiotics, clean water, and good sanitation. There should be no argument about this at all.

Vaccines save millions of lives each year — children and adults — and prevent tremendous personal misery caused by infectious diseases. Some vaccines, such as the one against human papillomavirus (HPV), even prevent some types of cancer from developing in adult women and men.

Despite these enormous successes, vaccines are being aggressively attacked by a number of groups, many of which are well-organized and financed. Some of them have suggested that vaccines are more harmful than the diseases they prevent, which is nonsense.

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Why do people oppose vaccinations? There are lots of reasons. The most frequently given one, the raison d’etre of the misinformation campaigns, is that childhood vaccines are dangerous, though I’m still waiting to see a single piece of creditable evidence to support this. One other theme featured prominently in their messaging is that pharmaceutical companies can’t be trusted.

That’s a sad truth: The awful reputation of the pharmaceutical industry is now inhibiting the use of some of its most lifesaving products. Tuesday’s spectacle of seven pharma executives being grilled by the Senate Finance Committee on high drug prices is just the latest example of the industry’s black eye.

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Why are so many people suspicious of pharma in general and vaccines in particular? It’s pretty easy to figure it out. The industry has been engaging in bad behavior for several decades, and these self-inflicted wounds have turned much of the public against it.

It wasn’t always this way. In the early 1950s, parents across America feared that the frequent polio epidemics sweeping the nation might leave their sons or daughters crippled, or even worse, confined to an iron lung. The first polio vaccine, developed by Dr. Jonas Salk, eased those fears. Salk was rightly considered a national hero, and was especially lauded for refusing to patent the vaccine.

Pharma companies became among the most admired (as well as the most profitable) businesses in America. In the last half of the 20th century, they brought to market a cornucopia of medicines that combatted previously untreatable diseases. Drugs were developed for heart disease, rheumatoid arthritis, high blood pressure, anxiety, pain, bacterial infections, asthma, contraceptives, cancer. The 1990s brought the first drugs based on recombinant DNA technology, adding a large number of new treatments to fight disease. Pharma companies also developed vaccines.

Then came the scandals. They haven’t involved just one company. Over the past two decades, we’ve seen scores of pharma and biotech companies hauled into court for a variety of serious, and in some cases deadly, infractions. What kinds of high crimes and misdemeanors have poisoned the well of public opinion? Here’s a sample from just the last few years:

More widely reported are the stories about drugs pulled off the market due to safety concerns (multiple companies), or ones that reveal how pharma payments influence doctors’ prescribing habits for brand-name drugs (multiple companies).

Finally, let’s look at criminal and civil penalties (both state and federal) racked up by the industry over the last couple of decades. According to a Public Citizen analysis, the industry settled 373 cases between 1991 and 2012, paying $35.7 billion for numerous violations. These cases included illegal off-label marketing, overcharging Medicare and Medicaid, kickbacks, concealing data, and poor manufacturing practices. The largest penalties weren’t levied on obscure companies nobody’s ever heard of. They fell squarely on the shoulders of Big Pharma: GlaxoSmithKline, Pfizer, Johnson & Johnson, Merck, Abbott, Eli Lilly, Novartis, AstraZeneca, Bristol-Myers Squibb, and others. These various offenses have, not surprisingly, led to pharma being portrayed as the villain in numerous movies and TV shows.

The pharma industry has established a solid history of shooting itself in both feet via the number and size of these scandals. I’ve suggested over the years that the industry adopt a set of well-defined ethics policies. The response? Rather than try to repair the damage, the industry has simply decided that its monopoly pricing power provides the ultimate insulation from criticism.

Unlike other companies that have trashed their reputations and then struggled mightily to repair them (Wells Fargo is a good example), drug makers know that people will buy their products no matter how much the public dislikes their companies. You generally can’t purchase medicines from a competing company. You can (sometimes) go elsewhere to buy them, like drug tourism trips to Mexico and Canada, if you’re willing to deal with the hassle and expense. Drug companies don’t have to treat their customers well when they have that kind of leverage.

Though the public can’t do much about it, they have clearly noticed the continuous wave of scandals that has enveloped the industry.

All of this has contributed to the prominent anti-pharma themes voiced by the anti-vaxx crowd. At a recent rally in Washington state to defeat legislation aimed at eliminating personal vaccine exemptions, many in the crowd held “Separate pharma and state” signs. Bernadette Pajer, head of the anti-vaccination group Informed Choice Washington, recently said, “I know vaccines are designed to protect children from infection, but they are pharmaceutical products made by the same companies that make opioids.”

Many people, such as those with diabetes who struggle to pay for their lifesaving medicines, share this antipathy towards pharma. Most people don’t realize that vaccines are the least profitable division of the companies that make them. They’re so unprofitable that many drug makers walked away from producing vaccines years ago.

We’re fortunate that demand from many developing countries has sparked a renewed interest in making vaccines. It’s unclear how many companies would stay in the vaccine business without that large market. And who else has the capacity and technical expertise to make hundreds of millions of doses of complex vaccines every year? Amazon may be thinking about entering the drug-delivery market, but don’t look for it to start manufacturing vaccines anytime soon.

At the end of the day, we’re stuck in a twilight zone of cognitive dissonance: We’d like to stand up against the pharmaceutical industry’s continuing bad behavior, but at the same time we’re forced to acknowledge we can’t live without its products. This isn’t a time when we can “just say no.” The industry knows and relies on this. As long as it maintains profitability, it will continue to view the scandalous headlines, fines, and settlements as simply a cost of doing business.

And so we are left to deal with one of the “externalities” associated with this negative industry messaging: It helps drive vaccine hesitancy. Improving the reputation of the pharma industry might help turn the tide against the anti-vaccine forces, but we can’t count on that happening. Vaccine advocates must focus their messaging on the value that vaccines create. If vaccine supporters fail, we’ll continue to see waves of vaccine-preventable outbreaks of measles and other contagious diseases.

Whatever your personal feelings are about the pharmaceutical industry, the benefits of vaccines are undeniable, despite what the anti-vaccine folks would have you believe.

Stewart Lyman, Ph.D., is a biotechnology consultant and vaccine advocate who lives in Seattle.

  • This is the most truthfull and fact based article on this site ever!
    Anyone who watched the Congressional Hearing this week without this litany in mind was unprepared. Pharma is still lying to us, with a lot of help form corporate media. I hope that people saw the slick ad campaign pahram launched to counter the hearings and the Medicare for All discussions.

    There was a reason this country used to have laws against this kind of marketing, media manipualtion and lies. Our major TV networks make billions on pharma advertising, and they run them in multiples. The owners of corporate media outlets and health sites online all rely on pharma money through their invesments or through direct cash payments. No one covered how the pharma industry “educates” health journlists, and indoctrinates them either.

    There are credible appearing physicians and billionnaire funded academic institutions reccomending alternative medicine. Even the marijuana industry got in on marketing their product as a wellness product. The internet amplified this kind of muli level marketing, content marketing and misleading medical advice. They could monitor the attention in real time, through monitoring engagmement, shares, patient groups and data collection services.
    There are billions of dollars to be made with this denial, misinformation, and lies, and it attracted some really malevolent profiteers. Millions of Americans have been let down, economically devastated, and manipualted by the pharma, and healthcare industries. Marketing psychologists used magial thinking and other manipualtive tactics to deceptively market all of this.

    Anti Vaxx propaganda is profiable, and every time someone goes online, the first thing they see on any website is a promotion of alternative medicines. None of this cut into profits of big pharma or the medical industry, there were plenty of customers. Physicians told patients they could not be bothered with to try alternative medicine. Once introduced to chiropractors and accupuncurists, vulnerable people were sitting ducks for all of the upselling, quack cures and Anti Vaxx ideaology.

    Thanks to our broken healthcare sytem, a complicit media, and non stop deceptive marketing, the facts are not relevant. Vacccines saved more lives than all other pharma products combined. Nearly every article on healthcare, has to be read while looking for the angle. There is an administration, that appointed industry insiders from a corrupt industry to the regulatory agencies. The FDA and FTC will not put a stop to deceptive marketing, because it is profitable. The FDA ignored reports of drug interactions, and has an agenda to protect the profits of pharma corporations, at the costs of American lives. Accoding to the profiteers, “Healthcare is a marketplace, so people gullible enough to buy into the Anti Vaxx extremism, are fair game.”

    Pharmacies are selling homeopatic remedies for the Flu, Measles and those fake immune system support products, next to the window they dispense pharmaceuticals. They present is as a “choice.”

  • I suggest you write a article outlining experiences of people who have been through the vaccine court. That would really shed light on what fuels the anti vaxxer movement. Oh, that might not be a good move for you. Never mind.

  • I see you are trained well. The first question you posed was; Are you sure you did not already have RA. Exactly the same position the court will immeadatly assume. To perform a proper analysis. One should approach from all directions. You also try to skew what I wrote when you said I sound unsure. In your professional career have you considered that a percentage of the population are susceptible to severe adverse reactions to vaccines? Have you or someone close to you suffered a severe adverse reaction from a vaccine? My opinion is that the anti Vaxxers are most concerned with a loved one suffering a severe adverse reaction then enduring a court battle against well trained litigators and biotech consultants who say the loved one already had that medical condition. Not so much past big pharma business practices that have nothing to do with vaccine manufacturing.

    • You are right I am well trained. I recognize that yes, vaccines do rarely cause serious adverse reactions, which is exactly why the court was created. I also know that bad things happen to good people, and when that happens, people look for some reason to explain it. If I get terribly sick one day, I will try to figure out why. Was it the sushi I had for dinner last night? Was it shaking hands with the sick neighbor 4 days earlier? Was it the vaccination I got 6 months ago? Most times we never find out why we got sick, but some people will blame this on the vaccination simply because other people tell them vaccines are bad. I agree with you that many anti-vaxxers worry about having a bad reaction to a vaccine. Unfortunately, many of their fears are stoked by misinformation about how vaccines work. They should be much more worried about how sick their kids will get if they aren’t vaccinated (e.g. measles can be deadly), and how seriously ill their infected child may make someone who is not vaccine eligible (a baby) or who has an immunocompromised immune system (e.g. a cancer patient). I suffered a severe illness by NOT getting a vaccine. IF you are interested in learning more about this, I’ll suggest you read a copy of Peter Hotez’s new book Vaccines Did Not Cause Rachel’s Autism. Likely available at your local library.

  • I know all about adverse reaction reporting and the court you are talking about. You have one year to address the court from the time you get vaccinated if you think you suffered an adverse reaction. Many times people do not realize the vaccination caused a adverse reaction until it is too late to go to court. Until you or your family member suffers an adverse reaction then attempts to get compensation you have no idea what these people experience. Caused or worsen is verbiage used by the VA in decision letters. I am sure the anthrax vaccine made me have rheumatoid arthritis and degenerative joint disease. As I said before. This is a fact. I am sure. I think is not low confidence in big pharma that causes us unwashed, uneducated idiots to have vaccine hesitancy. It is because it is very difficult to get the government to compensate people who have adverse reactions and you cannot sue the vaccine manufacturer. If the government compensated people who suffer adverse reactions without a major drawn out court battle there might not be so many crazy uneducated people with “vaccine hesitancy”.

    • I stand corrected. A person has three years from onset of symptoms of adverse reaction to file with court for compensation.

  • I agree vaccines are necessary to prevent outbreaks of diseases. However I know some people are susceptible to severe adverse reactions. If not, why is there a government program to compensate people who have adverse reactions? Why is it impossible to sue a vaccine manufacturer? This is why there is vaccine hesitancy. I know firsthand. I am service connected with the VA because the anthrax vaccine caused or worsened my rheumatoid arthritis. This is a fact. I cannot sue the manufacturer. What I am telling you is more on point than your article.

    • Much of the information you seek can readily be found online, so I’ll not duplicate it here. Look up the Vaccine Adverse Event Reporting System (VAERS) to understand how this works. The vaccine court exists precisely for people like you who believe they were injured by a vaccine. The burden of proof in vaccine court is way below the standard of proof you would require in a plaintiff suit against a vaccine manufacturer. You should take that path if you feel you’ve been injured. I should point out that your statement “the anthrax vaccine caused or worsened my rheumatoid arthritis” covers a lot of territory. Did you have RA before getting the vaccine? You sound unsure. How do you know that your RA simply didn’t get worse on its own over time, as it does for many RA patients? You should discuss these matters with an attorney and see what they have to say.

  • I know some people will have researched the Cutter incident, but the majority of parents certainly will not have. They will, however, have seen the headlines of the massive financial settlements pharma seems to be constantly making, and how Purdue seems to be shouldering much of the blame (and rightly so) for the opioid crisis. Surveys of parents asking why they are hesitant on vaccines tend to report the other issues I raised as being more important, such as fear of harming their kids, or not liking having the government tell them what to do. Many of these other issues get discussed time and again, which is great, but the reason I wrote this piece is that I haven’t seen this particular point discussed much, if at all. I’m a vaccine advocate, and if we are to make progress in convincing people to immunize their kids, I would argue it’s important to uncover all of the issues that contribute to the problem. You can’t fix what you don’t understand.

  • You may have left out the Cutter incident thinking it was too long ago, but I assure you, people who read the research about vaccines have read about it. In fact, the problems with pharma and the accessibility of vaccine research combined are vastly underestimated by “experts” on why people hesitate to vaccinate. I am neither a doctor or scientist but I have spent hours reading the research on vaccines on the NIH website, The Lancet, Pubmed, Google scholars and more. We are reading alot of the research, contrary to the stereotype that anti-vaxers or partial vaxers are uneducated and misinformed.

  • I thought for sure this article would bring up the biggest vaccine disaster of all time. The Salk vaccine was the killed poliovirus. A batch of the vaccine from Cutter Laboratories was not properly killed and gave a bunch of kids polio. It was a big deal at the time. It also caused the Sabin live-virus vaccine to be favored, which is what I got on a sugarcube in the early 1960’s. In more recent times, the Salk vaccine became favored again because polio had been so thoroughly stamped out that the Sabin vaccine had become the largest source of new infections in the developed world (generally occurring in immunocompromised people).

    • The Cutter incident was indeed a huge black eye in the vaccine field. For those not familiar with it, a batch of live polio did not get properly inactivated, leading to predictably disastrous results. I didn’t cite it because that happened in 1955, long before today’s anti-vaxx supporters would have heard of it. I focused on the past 20 years or so of pharma misdeeds because those are the ones most people today would have seen and heard about. Paul Offit’s book about the Cutter Incident is a great read and recommended for those who want to learn more about the early days of vaccine production.

  • That photo says 1952, I think it’s later or has nothing to do with the Salk vaccine, the vaccine was available in 1955. I remember well, our parents took all five of us to a Marin County center where the vaccination was first available.

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