The Immune Deficiency Foundation states, “Years ago, a diagnosis of a PI [primary immune deficiency] meant extremely compromised lives… Today, with early diagnosis and appropriate therapies, many patients diagnosed with a PI can live healthy, productive lives.” Modern treatments have reduced the risk of many immunocompromised children so that they are able to attend school.

The strategy continues from the prior discussion on hepatitis B vaccines – PIC tries to set up subtle distortions so that they can persuade the reader to believe that vaccines aren’t really all that necessary for our immunocompromised children. Immunocompromise does come in different shapes and sizes, so it is correct to state that an individualized treatment plan is necessary for each child, but, some of the modern treatments that are referenced include vaccines! Immunocompromised children are better protected than sixty years ago because there are many more vaccines as well as medicines.

Although vaccination often results in protective levels of antibodies in immunocompromised children,3-7 clinical vaccine safety trials typically exclude immunocompromised subjects. In addition, vaccines have not been evaluated for their potential to cause cancer, genetic mutations or impaired fertility in the general
or immunocompromised population

What this statement omits is the fact that clinical trials have always included healthy patients first, and included special populations later (such as people with immunocompromise). People in this situation have indeed been tested and sometimes, they don’t mount an adequate immune response. It is false to assume they have never participated in clinical trials – they are just tested after the initial trials are completed. The second sentence here is false due to omission of later trials. While it is true that the initial clinical trials do not directly test the ability of some vaccines to cause cancer, genetic mutations, or impaired fertility, this is because they don’t have infinite resources and cannot test everything under the sun in one trial. These particular conditions are chosen in this PIC article due to their emotional effect – it is not because PIC actually cares about any of these conditions.

When one actually takes a cursory review of the literature (not even a thoughtful one), it is plainly obvious that all these conditions have been assessed. The Dana Farber Cancer Institute, an institute that professionally studies cancer and produces research on it, has looked, and refutes the link between vaccines and cancer. While it is possible that cancer is diagnosed after the receipt of a vaccine in individual people, this is not shown as a trend across the board – going along with the biology of most cancers which requires multiple failures in the immune system and molecular checkpoints that allow cancer to grow unchecked over years.

What about the genetic mutations? The misconception that COVID vaccines cause genetic mutations comes from a malicious misinterpretation of a Swedish study. While it is true that the investigators were able to find mutations in liver cancer cells in a petri dish, this does not generalize to the entire population because we aren’t all living with liver cancers all the time.

The other way this is misinterpreted in the older vaccines is from the assertion that many conventional vaccines are built with the use of bacteria or human cell lines during some of the steps of the manufacturing process. While it is well known that exposure of live human cells to to foreign DNA or fragments, can cause significant inflammation, the manufacturers take great pains to filter out or chop up that excess DNA during the manufacturing process so there is little DNA left in the final product. A real life analogy is a poison ivy plant. Brushing your arm against a poison ivy plant can indeed cause a significant skin reaction, but if someone was there ahead of time to chop up the plant so all you had to do was step on the fragments, it can no longer cause a rash on your arm.

What about infertility? This one has been rehashed again and again over the years – antivaxxers are not that creative. This one is rehashed because it carries a strong emotional meaning, but again, it is false. PIC loves to try and get the emotional brain to override the logical brain. COVID vaccines do not cause any change in fertility; this has been demonstrated over and over again. The most common two vaccines that carry complaints about fertility are the HPV vaccine and the Tdap vaccine – and again, both have no impact on fertility (HPV source here). Overall take home point – the PIC group just stop reading for more studies when it suits them.

The vaccination status of other schoolchildren does not pose a significant risk to immunocompromised schoolchildren for the following reasons (Table 1):
• Some vaccines cannot prevent the spread of the bacteria or viruses they target.
• Immune globulin (plasma containing antibodies) is available for immunocompromised children exposed to certain infectious diseases.
• Some infectious diseases rarely cause complications in immunocompromised schoolchildren.
•Not all infectious diseases are contagious.
•Some infectious diseases are not spread in schools.

This paragraph contains lie after lie, with the usual strategy, deception by omission of important facts. The most important reason is that we have lots of real life evidence, that when vaccine preventable diseases spread in schools, immunocompromised children are disproportionately at risk. By the way, measles vaccine strongly decreases transmission when the community has enough members who are vaccinated. One study explaining the multiple risks of measles in the immunocompromised patient is shown here. Yet another study describes the serious consequences of measles in one type of immunocompromise. To drive home the point, hear it directly from a parent of a child with immunocompromise due to cancer, who had to deal with measles coming from an unvaccinated child.

The most famous example of giving an immune globulin after an infectious disease is rabies – and while rabies does have a vaccine, giving the post-exposure prophylaxis consists of much more medication and many added painful injections. When the protocol is not closely followed, there is a significant failure rate. In a more familiar illness, varicella (chickenpox), giving post-exposure prophylaxis or dealing with late diagnoses carries a higher failure rate (person ending up with an infection) than getting vaccinated. The take home point here is that while the immune globulins are a decent safety net, its not reasonable to gamble with the actual infectious diseases with people whose immune systems are compromised in some way (it would be like saying well, car crashes are kind of OK as long as they occur some of the time).

The assertion that infectious diseases rarely cause problems in immunocompromised children is an attempt to obfuscate basic statistics. What I mean by that is, the studies available on the immunocompromised population are going to be smaller than the studies available for the general population, because by definition, fewer humans with compromised immune systems exist. The mere fact that these studies are smaller does not refute the serious consequences that these infectious disease create in the immunocompromised population. Some infectious diseases are indeed spread more outside of schools than inside schools, but this emphasizes the need to vaccinate this population with all the vaccines that are safe and effective for them. For this point they are referring to hepatitis B and HPV; however both diseases are a relevant concern to the immunocompromised. Immunocompromised patients are at risk of catching hepatitis B disease or reactivation of prior disease. Hepatitis B vaccine most definitely functions in the immunocompromised, but sometimes it requires a different or more extensive schedule to get protective antibodies. For HPV, just like with hepatitis B, the disease can be more serious in the immunocompromised person compared to the person with a normal immune system. In an analogous fashion, HPV vaccine is safe and effective in this population, but sometimes requires extended doses. Just because these diseases don’t really occur in school (which is false, hepatitis B can live on objects) doesn’t mean they are irrelevant.

The fourth bullet point refers to tetanus, but this is another attempt at deception because although PIC acknowledges that tetanus is not spread from person to person, people with immunocompromise are still susceptible to cuts being exposed to dirty metal or soil, the usual transmission vector of tetanus. Tetanus vaccination is both safe and effective in this population.

In summary, the attempts of PIC to minimize immunocompromise can result in serious adverse medical consequences to patients who are actually immunocompromised. In reality, people in this situation can lead close to normal lives, but they need to be protected as best they can in an individualized treatment relevant to their type of immunocompromise.