Questioning Offit. Part 2. DTP

Previous chapters:
Chapter 1: Introduction

Thinking is the hardest work there is, which is probably the reason why so few engage in it.
Henry Ford

Offit's chapter 1. The Birth of Fear

Offit begins the first chapter by describing the 1967 documentary "Titicut Follies". The film is a raw depiction of what happens behind the walls of a hospital for the criminally insane. It shows prisoners being hosed down, force-fed, and tortured by an indifferent, bullying staff. The film was so merciless and shocking that the U.S. Supreme Court banned it and ordered all copies destroyed. Titicut Follies became the first and only film in U.S. history to be banned not for obscenity or a threat to national security, but for other reasons.

Offit then compares this film to the 1982 documentary "DPT: Vaccine Roulette", which, in his view, marked the beginning of the anti-vaccine movement in the United States. The first four chapters of the book are devoted to describing and criticizing this film. Offit gives a detailed account of its content: how the DPT vaccine in some children leads to disability, brain damage, paralysis, epilepsy, or intellectual disability. The film features doctors claiming that DPT is a dangerous vaccine, that the risk of complications from it is greater than the risk from whooping cough, and that neurologists, knowing this, don’t vaccinate their own children. The film was aired three times on a local NBC channel in Washington, D.C., and then broadcast nationwide.

Offit describes in detail the reaction to the film—how it shocked both doctors and parents, who began refusing the vaccine en masse. Just 18 days after it aired, congressional hearings were held. Pediatricians and the CDC came to their senses and began to criticize the film as one-sided and for failing to mention how dangerous whooping cough actually is. However, none of the doctors who testified in Congress disputed the fact that in some children, the pertussis component of the vaccine causes irreversible brain damage.

After the film came out, some parents united and created an organization that, in Offit's words, “forever change how American parents thought about vaccines.” One of them was Barbara Loe Fisher—Offit devotes half the book to her. Her son was harmed after his fourth dose of DPT. A few hours after the shot, his eyes rolled back in his head, his head fell to his shoulder, and he quickly deteriorated. Barbara Loe Fisher, together with Kathi Williams and Jeff Schwartz, whose children were also harmed by DPT, founded the group "Dissatisfied Parents Together," later renamed the National Vaccine Information Center. It became the most powerful anti-vaccine organization in America.

Offit writes that “for years doctors had argued that the benefits of the pertussis vaccine outweighed its risks. Now, because of one television program, the public’s perception of those risks was tipping in the other direction. Thousands of parents were choosing not to vaccinate their children.” Lea Thompson, the film’s producer, went on to have a meteoric career in journalism and received nearly every major award in broadcasting. Offit agrees that many of her reports really did help make things better—but no other story had a greater impact than Vaccine Roulette. Thompson considers it the most important report of her life and says she regrets only one thing: "that they didn’t do this story ten years earlier... Because so many kids might not have suffered and so many kids might still be alive." Offit believes that if the U.S. government hadn’t intervened, the show could have led to the complete elimination of vaccines from the American marketplace.

There are no references in this chapter to studies proving the safety or effectiveness of vaccines, so there’s nothing here to analyze. This chapter could easily have come from an anti-vaccine book.


Offit's chapter 2. This England

In the second chapter, Offit claims that the modern anti-vaccine movement actually began not in the United States, but in England, eight years earlier—and he describes exactly how it happened.

In 1973, pediatric neurologist John Wilson spoke before the Royal Society of Medicine and described 50 cases of neurological disorders in children that, in his opinion, were caused by the pertussis vaccine.

Wilson spoke about a child who developed transient blindness and mental deterioration. About another child who vomited for four days, become blind, and died six months later during an uncontrolled seizure. About a girl who became completely paralyzed on one side of her body. His final conclusion was grim: of fifty children studied, twenty-two had become mentally disabled or epileptic or both. Wilson concluded, “We do not think ... that the majority of cases here represent a chance association,” he said. The clustering of illness in the seven days after inoculation and particularly in the first 24 hours” that the damage had been caused by pertussis vaccine.

Offit then writes about other doctors who suspected that the pertussis vaccine caused irreversible harm or even death in children:
In 1933, it was Thorvald Madsen of the State Serum Institute in Denmark, who reported on two children who died after receiving the pertussis vaccine.
In 1946, it was Vern and Garrow from New York, who described a case involving twin brothers who died shortly after vaccination.
In 1948, it was Byers and Moll from Boston, who reported fifteen cases of seizures, coma, or paralysis within a day of receiving pertussis vaccine. Most became severely retarded; two died.
In 1960, it was Justus Ström from Stockholm, who described 36 similar cases—and seven years later, 170 cases involving seizures, “destructive brain dysfunction,” or shock after the pertussis shot. (Offit does not mention any deaths. However, in the 1960 article, Ström described four deaths from pertussis vaccination between 1955 and 1958—one child died 20 minutes after vaccination, another six hours later.)

Six months after his lecture at the Royal Society, John Wilson appeared on a British television program—a precursor to DPT: Vaccine Roulette—which also showed children allegedly harmed by the pertussis vaccine.

Wilson was asked whether he was convinced that pertussis vaccine caused permanent harm. “I personally am,” he replied. “Because now I’ve seen too many children in whom there has been a very close association between a severe illness, with fits, unconsciousness, often focal neurological signs, and inoculation.”

The media exploded. Other doctors also sounded the alarm. George Dick, a respected microbiologist at Queen’s University in Belfast, said: “I would not recommend the vaccine for infants living in communities where there is good maternal and medical care." Gordon Stewart, an epidemiologist from the University of Glasgow—who later appeared in Vaccine Roulette—said:

"The Department of Health and Social Security ... refuse[s] to acknowledge brain damage as anything but a doubtful and rare consequence of vaccination. The facts suggest otherwise." David Kerridge, a professor of statistics at Aberdeen University, joined Stewart in decrying the vaccine. “My advice would be to abandon vaccination,” he said.

Wilson’s appearance before the Royal Society and then in the media led to a sharp decline in pertussis vaccination coverage in the UK—from 79% in 1972 to 31% in 1979—and to a whooping cough epidemic.

Next, Offit introduces “the world’s expert on pertussis,” Dr. James Cherry. Cherry has co-authored the leading textbook on pediatric infectious diseases, published hundreds of articles and book chapters on pertussis and pertussis vaccine. Cherry noticed one critical difference between the United States, where immunization rates dropped only slightly, and England, where immunization rates dropped precipitously.

“It wasn’t the public; it was the doctors,” recalled Cherry. “It was the family physicians who really stopped vaccinating.” (A survey by the London Sunday Times in 1977 found that 47 percent of general practitioners “would not recommend” the pertussis vaccine for their patients.)

Offit then writes that, since medical authorities could no longer claim that the benefits of pertussis vaccine outweighed its risks when risk estimates were all over the map, the British Ministry of Health turned to Professor David Miller and commissioned a study to answer that question. Miller’s study was conducted between 1976 and 1979.

Miller and his colleagues launched the most comprehensive, expensive, and time-consuming study to date. Between 1976 and 1979, Miller’s team asked consultant pediatricians, infectious disease specialists, and neurosurgeons to report any children who had serious neurological illnesses, then determined whether those children were more likely to have recently received DTP than normal children. Miller found “a statistically significant association with diphtheria, tetanus, and pertussis vaccine ... especially within 72 hours.”

This study led to a flood of lawsuits against pharmaceutical companies and massive compensation payouts to vaccine-injured children. As a result, pharmaceutical companies raised vaccine prices thirty-fivefold over three years. Manufacturers began exiting the vaccine business, and of the seven companies producing the DTP vaccine in 1960, only one remained by 1984. This caused a vaccine shortage, and as a consequence, the CDC delayed the fourth and fifth doses of the DTP series. In 1986, after a court awarded damages to an infant who was permanently paralyzed from the waist down after receiving DTP, the last remaining manufacturer—Lederle—announced it would stop making the vaccine. Other vaccines were affected as well: “The number of companies making measles vaccine dropped from six to one and those making polio vaccine from three to one. Vaccine makers were getting out of the business. The United States was on the verge of returning to the pre-vaccine era."

In October 1986, the U.S. government stepped in and passed legislation shielding vaccine manufacturers from lawsuits. The government removed liability from the companies and assumed it itself. That the National Childhood Vaccine Injury Act saved vaccination in the United States.

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The second chapter includes three studies cited as evidence for the effectiveness or safety of vaccines. Let’s examine them more closely:

England

Offit writes:

Cherry found that the number of children who died from whooping cough was vastly underestimated. “I noticed the pertussis deaths in the epidemic ... were incredibly low,” he recalled. Cherry knew the reason why: physicians weren’t accurately reporting the disease. “[Doctors] didn’t want the parents to have guilt feelings but it turned out [the doctors] didn’t want to have guilt feelings. So they were reporting [pertussis deaths] as other things.” Cherry found that pertussis hadn’t killed thirty-six British children (as was officially reported); it had killed six hundred.

First, according to the cited source, it wasn’t 600, but 362 (see Table 6, p. 24). Second, according to many sources—including some Offit himself cites—it’s entirely possible that the vaccine also caused a certain number of deaths, and that the drop in vaccination coverage, even if it led to more deaths from pertussis, may have reduced deaths from other causes. Therefore, comparing the number of deaths from pertussis with and without vaccination is meaningless in itself. What should be compared is overall infant mortality from all causes. Did it increase when pertussis vaccination coverage declined, even though there was a pertussis epidemic between 1977 and 1979? No—it continued todeclineat the same rate. Then, when vaccination coverage began to rise again by the mid-1980s, the decline in infant mortality slowed down.

The same applies to the second paper Offit cites. Its authors analyze the same data and conclude that, in the late 1970s, mortality from respiratory diseases stopped declining at the same rate as before. They suggest that this was likely due to pertussis. Like Cherry, they do not consider overall infant mortality, only mortality from respiratory causes.

What Offit does not mention is a 1984 study that found that after the sharp drop in DTP vaccination coverage in England—due to public fear of the vaccine—mortality from pertussis unexpectedly fell fourfold. Among unvaccinated children over one year old, the hospitalization rate dropped fivefold. This study, which is crucial to the thesis being discussed yet ignored by Offit, was not conducted by an anti-vaccine doctor but by the British government's epidemiological research laboratory—the equivalent of the CDC. The authors note that pertussis hospitalizations occurred primarily among children from lower socioeconomic classes. Most of the children aged over 1 year who died were already chronically ill when they developed whooping cough, and 83% of infants who died were from low socioeconomic classes. This aligns with other studies showing that declines in pertussis mortality—like those from typhoid, scarlet fever, measles, and other infections—are primarily due to improved living conditions and better access to nutrition.

Japan

Offit writes:

In Japan, after health officials placed a moratorium on the vaccine, the number of hospitalizations and deaths from pertussis increased tenfold.

The cited source contains no data whatsoever about hospitalizations or about a tenfold increase in pertussis mortality. It merely states that in 1979, 13,000 people contracted pertussis in Japan and 41 died. Did the 1979 pertussis epidemic in Japan lead to increased infant mortality? Again, no. Mortality continued to decline at the same pace.

What this study also says—and what Offit fails to mention—is why Japan suspended use of the vaccine in the first place. There had been numerous reports of neurological reactions after vaccination, and then two infants died within 24 hours of receiving the shot. Despite the pertussis outbreak, Japan did not return to the whole-cell DTP vaccine. Vaccination resumed only after new acellular vaccines had been developed.

Sweden

Offit also says nothing about Sweden, where pertussis vaccination was discontinued in 1979 after it was found that 84% of those who got sick had been fully vaccinated with all three doses. Over the next six years, three pertussis deaths were recorded—two of them in children with severe congenital conditions. After vaccination resumed, Sweden recorded nine deaths from pertussis in 11 years. In other words, during the unvaccinated period—despite the epidemic—mortality was lower than after vaccination was reinstated.

Moreover, even before mass vaccination began, by the mid-1950s, pertussis mortality in Sweden had already nearly disappeared. Justus Ström, in the very 1960 paper Offit cites in this chapter, wrote that pertussis no longer posed a serious threat. Mortality was one in a million, and clinical pertussis developed in only 65% of exposed children in Stockholm. He pointed out that the same had happened with other once-feared diseases, such as scarlet fever and measles (Sweden wouldn't start measles vaccination until 11 years later). Ström questioned the necessity of universal pertussis vaccination, given the increasingly mild course of the illness and extremely low mortality. He also noted that the rate of neurological complications from the vaccine was higher than from pertussis itself. Ström wrote that one in every 6,000 vaccinated children developed a neurological disorder, and one in 17,000 either died or was left disabled.

Cherry

Offit also neglects to mention in Chapter 2 that James Cherry—whom he calls the world’s leading expert on pertussis—is a critic of the acellular pertussis vaccines (which replaced DTP in all developed countries) and has called for new vaccines to be developed. Cherry claims that the immunity from the acellular pertussis vaccine is very short-lived. He also believes that the main reasons for the rise in pertussis cases in the 21st century are not anti-vaccine movements but the replacement of DTP with the acellular version, the pertussis bacterium's adaptation to the vaccine, and improved diagnostics thanks to increased awareness and the introduction of PCR and other serological tests to detect pertussis. His view is supported by other pertussis experts, including Offit’s mentor and the "godfather of vaccination," Stanley Plotkin. The fact that today’s pertussis vaccine is largely ineffective is rarely discussed in the media but is a mainstream view in the medical literature. This is why more and more doses are being added to immunization schedules. In the U.S. and some other countries, six doses of the pertussis vaccine are now recommended, plus one during pregnancy. Some countries—such as Belgium and New Zealand—have already added a seventh pertussis dose to their schedules, in addition to the maternal dose.

Furthermore, in his 2004 study, James Cherry found that just one month after pertussis vaccination, only 20% of people had detectable antibodies to pertussis toxin. But that’s not the most important part. Cherry described the phenomenon of "original antigenic sin" in relation to pertussis vaccines. Because the vaccine lacks one of the main pertussis toxins, the immune system does not develop immunity to it. So when a vaccinated person becomes infected with pertussis, their immune system fails to prevent the infection. Worse, due to the effect of original antigenic sin, the immune system will never learn to respond effectively to the pertussis bacterium. Cherry argues that children who received the acellular vaccine will remain more susceptible to pertussis for life, and that this cannot be undone. Moreover, the more doses a person receives, the stronger the effect of original antigenic sin becomes. In addition to that, Cherry believes the acellular vaccine is ineffective because it lacks all pertussis antigens and because it skews the immune response toward humoral (antibody-based) immunity. (This topic was discussed in more detail in my first book in the chapter on pertussis. It is also described in Susan Humphries' book Dissolving Illusions)

In 2004, Cherry proposed that revaccinating the population every 10 years might help reduce pertussis incidence. But in a 2015 article, he admitted that this assumption had proven false. As a result, in 2019 he proposed vaccinating all adults and teenagers every three years. So far, Austria has come closest to implementing this plan: since 2023, it has recommended pertussis revaccination every five years.

Conclusions

To sum up this chapter, Offit’s main argument boils down to the idea that in countries where pertussis vaccination coverage declined, epidemics occurred, leading to some deaths. Even if we momentarily set aside the aforementioned studies that contradict this view, Offit's argument rests on an implicit assumption: that the vaccine reduces mortality. But is that really the case?

There is no randomized controlled trial (RCT) demonstrating that any pertussis vaccine reduces overall mortality. However, there are studies showing that the DTP vaccine significantly increases mortality. In developed countries, children began receiving the pertussis vaccine en masse in the mid-20th century without comparing mortality between vaccinated and unvaccinated groups. In Africa, however—where vaccination was introduced much later—such studies have been conducted. For instance, a 2004 study showed that before vaccines were introduced in Guinea-Bissau, mortality among children absent from village health checks was the same as among those present. Then, between 1984 and 1987, among children vaccinated with DTP between the ages of 2 and 8 months, mortality over the next six months was twice as high as among unvaccinated children. Similar results were found in several other studies in Guinea-Bissau as well as in other African countries[1][2][3][4][5][6][7][8][9][10][11][12][13][14]. One study conducted in Guinea-Bissau and published in 2017 found that the risk of death was ten times higher in children vaccinated with DTP than in those who were not. The authors conclude that “all currently available data suggest that the DTP vaccine may kill more children from other causes than it saves from diphtheria, tetanus, or pertussis. While the vaccine protects against its target diseases, it may simultaneously increase susceptibility to unrelated infections.”

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The prologue, introduction, and first two chapters contain 107 footnotes, which include 40 footnotes with studies.

The studies cited show the following:
There are parents who prefer not to vaccinate their children, and their numbers are growing (7 studies)
Some doctors refuse to accept unvaccinated children (1 study)
There are outbreaks of vaccine-preventable diseases, some of which are linked to unvaccinated individuals (10 studies)
Pertussis used to kill many people but now kills very few (2 studies)
How doctors reacted to the film DPT: Vaccine Roulette (1 study)
Increase in lawsuits related to the DTP vaccine (5 studies)
Pharmaceutical companies stopped producing DTP (3 studies)
Vaccines are not safe (8 studies)
3 studies are cited to prove vaccine effectiveness and were discussed in this entry.