The Rhetoric of No Jab No Job
Banner photo. Nov 3rd, 1919. Rally in Toronto against Compulsory Vaccination – image taken from ‘Dissolving Illusions’ by S. Humphries and R. Bystrianyk. Original photo from City of Toronto Archives.
Article edited 11/09/2020
Introduction
Back in 2015 the laws of Victoria and Australia took a significant change in direction. The notion of informed medical consent, without coercion, was weakened. Informed consent to vaccination was treated as a whimsical historical position that did not bear scrutiny in the face of the ‘evidence’. Coercion to vaccinate was introduced by the removal of certain federal payments for parents of unvaccinated children as well as the introduction of the No Jab No Play laws in Victoria, which prevented children from attending pre-school childcare unless they were fully compliant with the childhood vaccine schedule.
In 2015 Jill Hennessy, the then Victorian Health Minister, defended these changes with the words, ‘The science is clear’. At the same time Daniel Andrews, the Victorian Premier, told the Sunday Herald Sun that parents who refuse vaccinations "put your child and every other child at risk".
Premier Andrews’ argument won the day, and the No Jab No Play law was passed in Victoria, with bipartisan support, as well as support from the Australian Medical Association. In order to highlight the need for childhood vaccination the campaign ‘Light for Riley’ was widely publicised; tragically Riley died at one month old from whooping cough in 2015. He was too young to have received the pertussis vaccination, and it was assumed he acquired the disease from an unvaccinated person. The ‘Light for Riley’ campaign was a central part of winning public support for the No Jab No Play law.
Mr Andrews’ statement from 2015 has become the standard argument amongst politicians of all hues across many nations to justify the creeping introduction of mandatory, or heavily coerced, vaccinations, against the previously held ethical position of Informed Consent to Medical Treatment. Now similar ideas are being presented to argue that all of us should receive a covid vaccination. Australian Prime Minister Scott Morrison has said the vaccination will be as ‘mandatory as possible’. Access to work, travel, restaurants and other setting may become contingent upon receiving the vaccine. No Jab No Job laws are now being proposed in Australia.
The position of Premier Andrews has been extended and can be stated thus:
If people refuse a vaccine, they put both themselves and others at risk.
So let’s examine this general statement. For the sake of naming we shall call it the popular vax position. Before it is even possible to examine the substantive points raised by the popular vax position, we must first explore the power of the rhetoric contained in this position. Without an understanding of how we are emotionally manipulated we cannot hope to examine the situation with sobriety.
Rhetorical Devices in the Popular Vax Position
In order examine the ‘popular vax position’ we need to first confront one of the most powerful and widespread of all rhetorical fallacies, that of the ‘Poisoned Well’. The Poisoned Well is the defining feature of the Cancel Culture, and the fallacy that creates schisms ad nauseam. In short we refuse to listen to an argument because it comes from a disparaged individual, group, or position; the argument is assumed wrong because of where it comes from, without ever examining it. It might be an article in the wrong sort of media outlet, or a policy by the wrong political party. It can be extended to ignoring someone’s argument due to their sex, age, or even skin colour (such as the situation at the infamous Evergreen College). If someone can create a pejorative label they can use the Poison Well fallacy, and ‘defeat’ arguments in the minds of people without ever addressing the issues raised. Perhaps the most common way to ‘poison the well’ today is to label something a ‘conspiracy theory’, where only information reported in official or mainstream sources are accepted as true.
Let us be clear; some people make mistakes in their arguments. But refusing to engage with someone who has made mistakes in the past, even a lot of mistakes, is not the same as showing that the current argument is flawed.
Of course the poisoned well fallacy would not be so strong and widespread if it were not supported by a raft of other fallacies which cloud our judgement by engaging our emotions. In the modern world the fallacy of Argumentum ad Nauseam is constantly there, in the form of internet memes and adverts. These memes and adverts do not address what is a complex argument; they simply repeat the prior position, without citations or an evidentiary basis. Social media extends the fallacy of ad nauseam when related memes are posted by multiple groups and ‘friends’, giving rise to the fallacy of argumentum ad numerum – just because a large number of people hold a belief it does not make it true. If an idea is repeated by multiple on-line friends the idea gains an emotional traction, as we might fear being ‘blocked’ or ‘unfriended’ by our online social network if we question the ideas presented. Fear enters our thoughts and the argument gains emotional traction without even a hint of addressing the evidence. The fallacy of Unaccepted Enthymemes comes to aid of the internet meme, and is a further step in ‘othering'. An enthymeme is an unstated assumption; internet memes are too short to state the underlying assumptions; but they are an effective tool for promoting underlying assumptions. These assumption or beliefs can form part of our identity, and can help us connect with others. By engaging with difficult thoughts that address our beliefs, stated or unstated, we risk losing some of our existing assumptions about the world. This may end up causing us to change our identity and lose our social group. Some conversations appear as an existential threat, as by merely engaging in them a person risks being ‘othered’, as that person openly permits their assumptions to be challenged. Given this threat to an identity, some conversations may be considered nasty, hateful or selfish. The poisoned well helps to raise all these fears and confused thoughts, merely by thinking of looking at certain sources of information, without even addressing the arguments. This gives rise to the final step in othering, that of insulation from alternatives. A social or professional circle may find an idea so threatening that it will not even permit it being voiced. An extreme version of this was used at Evergreen College to disparage the act of engaging in any form of constructive dialogue. Bizarrely, dialectical reflection was labelled as coming from an exclusively white European tradition, which the students in question considered a poisoned well. Consequently, by labelling dialogue as ‘White’ it meant that alternative ideas never had to be addressed. This goes a long way to explaining why the poisoned well is so successful and so rampant in the world today.
So we turn to the popular vax position. To question it risks being called anti-vax, one of the modern poisoned wells. In a triumph of irony those who merely look at the vax arguments can be labelled as irrational. Further as the statement comes from both a Premier and a Prime Minister, to question it implies that you believe in the possibility that the state may not have the best interests of the public at heart, and that means you have entered the world of conspiracy theories. A person risks being both castigated and ostracised by questioning the popular vax position – all before we have examined the position itself, and long before we have exhausted the powerful rhetoric contained within this briefly stated position.
The emotional strength of the popular vax position is perhaps its greatest power, as it encourages us to put aside academic and intellectual positions as it leverages the most emotional of issues, namely children and infants. The popular vax position has three appeals to fear inside this brief sentence: to not be vaccinated risks one’s own health; to not be vaccinated risk other people’s health including infants; further other people that do not vaccinate risk your health. The emotional implication of getting vaccinated is that you have done your bit for the community; it brings a sense of relief. By contrast to not be vaccinated carries a burden of guilt or secrecy. Even if you do not believe you are at risk from a given disease, you know that others believe you are risking innocent people, and they may well cite the ‘Light for Riley’ campaign as evidence of this. Given the proximity of the No Jab No Play law to the death of Riley Hughes, Premier Andrews knew that the most powerful of the emotional appeals is that the lives of infants are jeopardised by the unvaccinated. The popular vax position holds a bunch of emotional appeals: fear, anger, reasonableness, selfishness are all there to be seen. Notice that all this emotional leveraging is achieved without actually addressing the issue of whether or not the statement has any validity. Indeed in political rhetoric emotions are often raised precisely to cloud our judgement, and make it harder for people to engage in reasoned discussions.
A further problem with the popular vax position is that of One Sided Assessment, and not just once, but on at least two counts: that is the risk to the individual of being unvaccinated is considered, as is the risks to others of an individual not being vaccinated. However the risks to the individual of being vaccinated are not considered and neither are the risks to others of someone being vaccinated. Of course these risks for and against vaccination will vary according to multiple factors, not least the disease itself, and the specific action of the vaccination for that disease.
Lastly in order to ensure that the popular vax position does not fall foul of the fallacy of Petitio Principii (or ‘begging the question’) we must identify the claims that it makes, and see if they are substantiated with the evidence that we can find. Within the popular vax position there are two claims which need to be substantiated. Firstly that vaccinations are effective in preventing individuals from acquiring diseases which pose a serious health risk. Secondly that vaccinations prevent the transmission of the specific disease that presents a serious health risk to others. Like all medication, vaccines are not 100% safe or 100% effective, and this fact can give rise to an anti-vax fallacy – that of unobtainable perfection. However the fact that perfection cannot be achieved does not mean that those who refuse vaccines are acting responsibly – this also needs to be examined directly.
Substantive Matters
Now we have highlighted the emotional appeal of the rhetoric present in the popular vax position, as well as noting the failure of the position to look at risks on both sides, we can at last engage with the substantive claims, albeit partially, which have been identified within the popular vax position.
For the purposes of being direct we will start with an examination of the substantive issue that won the day in 2015, namely the risk to others of the unvaccinated, as highlighted by the death of Riley Hughes from the ‘vaccine preventable disease’ whooping cough (pertussis).
A paper from Israel, written in 2000, looked at a similarly tragic case to that of Riley Hughes.
Srugo, I., Benilevi, D., Madeb, R., Shapiro, S., Shohat, T., Somekh, E....Lahat, N. (2000). Pertussis Infection in Fully Vaccinated Children in Day-Care Centers, Israel. Emerging Infectious Diseases, 6(5), 526-529. https://dx.doi.org/10.3201/eid0605.000512
In the conclusion of this study of the whole cell pertussis vaccine is the rather damming statement.
“The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection. Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection.”
The conclusion of this important and sensitive study was to show that whole cell pertussis vaccination prevents the vaccinated person from becoming ill, but not from being infected by the disease: the vaccinated person can become an asymptomatic carrier and transmitter of the disease. In the paper a number of individuals with close contact to the infant were found to be infected with pertussis. One of these vaccinated individuals was the likely source of the fatal infection. This provides clear evidence that a person vaccinated with whole cell pertussis vaccine poses a serious risk to the unvaccinated person.
The paper by Srugo et al does not end matters. The whole cell pertussis vaccine has been replaced by the acellular pertussis vaccine.
So we note the title of the paper by Warfel et al
Warfel, J. M., Zimmerman, L. I., & Merkel, T. J. (2014). Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proceedings of the National Academy of Sciences of the United States of America, 111(2), 787–792.
https://doi.org/10.1073/pnas.1314688110
Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model
Again the vaccine protects the recipient from getting ill, but does not prevent infection or transmission of the disease. However this does not conclude matters as this was not a human study. In this regard there have been cases of vaccinated health workers asymptomatically transmitting pertussis. There was a reported case from Melbourne in 2015.
“A healthcare worker with whooping cough has been in contact with dozens of mothers and their children in Melbourne, alarming families who fear an outbreak of the potentially deadly disease.”
In addition to this single case of a vaccinated asymptomatic carrier there were two Australian studies on the same topic.
In 2010 an Australian report entitled “Nosocomial pertussis infection of infants: still a risk in 2009” was published. Here is one of the issues raised by the report.
“Vaccinated health care workers can contract pertussis infection and their symptoms are likely to be modified compared to classic pertussis; nevertheless they can be responsible for transmission to others, especially vulnerable infant contacts.”
“The burden on the health system arising from a pertussis infection in a (vaccinated) health care worker in a high-risk setting is also described with the hospitalisation of 4 infants, and prophylactic antibiotics given to 73 new mothers, infants and health care workers.”
https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3404e.htm
In 2014 a study from Western Australia called “Finding the ‘who’ in whooping cough” had the simple subtitle ‘vaccinated siblings are important pertussis sources in infants 6 months of age and under’
https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3803c.htm
The ‘Who in Whooping Cough’ study considered the idea that the rise in whooping cough was precisely because of the change from whole cell pertussis vaccine to the acellular vaccine. However as we have already seen from the study by Srugo et al, the whole cell vaccine did not offer protection from infection, simply from the symptoms of the disease.
Given all this it is hard for a parent of a new born infant to know what to do, especially if they have another child in day care or at school. The simple position of the popular vax position is naïvely dangerous with respect to whooping cough. The ‘Who in Whooping Cough’ study suggests that repeated and regular vaccination of community members is the way to protect infants from pertussis. It is hard to see how this position is supported by the literature.The pertussis vaccine does not prevent transmission, and therefore cannot create herd immunity, which is the goal of mass vaccination programs.
If we now return to the tragic demise of Riley Hughes, which was used to promote the No Jab No Play law, it is hard to see how vaccinating children in child care protects infant siblings against pertussis. Without knowing the source of infection for Riley Hughes, looking at the existing studies, the likely source of the infection would have been a vaccinated sibling, one of his parents, or even a medical worker. That is to say, the most emotive of the implicit claims identified in the popular vax position is without substance. The premise of the No Jab No Play law is baseless. The fallacies of one sided assessment and of begging the question have both been committed when it comes to the popular vax position, with respect to the potentially lethal disease of whooping cough.
Further, given the existing Australian studies on the topic of pertussis transmission, from 2010 and 2014, the positions of Health Minister Jill Hennessy and Premier Andrews, in promoting No Jab No Play in 2015, appear to be ill informed at best.
The method of looking through the rhetoric of vaccinations (or any other topic), with all its powerful emotions, is to look for evidence. Ascribing sources of information as reliable or unreliable (a synonym for the poisoned well) is of no consequence. We look for views which can be supported by real world data. No matter how eminent a source, if a position cannot be supported by evidence it is unsubstantiated.
We now turn to the one sided assessment of risk to self. We will consider two possible risks to self following a vaccine: adverse effects caused by the vaccine, such as anaphylaxis; long term adverse effects on health.
The risks to self of adverse effects are often dismissed by people saying vaccines are safe. However this view is not shared by the drug companies themselves. In 1986 the US president, Ronald Reagan, signed the National Childhood Vaccination Injury Act. The act indemnifies drug manufacturers from injuries caused to children as part of the childhood vaccine schedule. If there were no risks why would these companies seek indemnification? Now AstraZeneca, the commercial partner for the Oxford study, has already gained indemnity from damages that will result from the new Covid-19 vaccine.
That there is a risk of an adverse event from a vaccine does not mean one should ignore the risks of the disease itself. The decisions are not as simple as one might think in weighing up the different possible outcomes in a reasonable way.
A possible safe guard for No Jab No Play was a medical exemption. It seems sensible that such an exemption should be given to those for whom the risks of an adverse effect are worse than the risks of the disease itself. Initially GPs could grant exemptions on limited grounds. However, only one year after the introduction of No Jab No Play, a letter from the family GP was no longer enough to get a medical exemption. Rather than risk to injury being decided by the family doctor, that assessment is now carried out by a remote bureaucrat.
https://www.abc.net.au/news/2017-11-15/child-vaccination-exemption-letters-from-gps-no-longer-accepted/9151768To support this hardening of the rules the then health minister, Ms Mikakos, used argumentum ad nauseam. Her statement was “We know the science is crystal clear — vaccinations are safe and they are saving lives." In practice, medical exemptions for No Jab No Play do not exist because the bureaucratic line is that vaccines are safe and effective for all. Dicto Simpliciter
The existential threat of the rhetoric to family doctors became very real, as those who publicly raised issues with the vaccine schedule were no longer permitted to practice.
In examining the one sided assessment, the last substantive point we shall look at is that of long term well being for vaccinated individuals. There is scant data on this subject, which will discuss shortly. However on the substantive issue we present a paper from The Lancet.
Mogensen, S. W., Andersen, A., Rodrigues, A., Benn, C. S., & Aaby, P. (2017). The introduction of diphtheria-tetanus-pertussis and oral polio vaccine among young infants in an urban African community: a natural experiment. EBioMedicine, 17, 192-198.
https://doi.org/10.1016/j.ebiom.2017.01.041
We repeat here the highlights given by the authors.
1) When DTP and OPV were introduced in Guinea-Bissau in 1981, allocation by birthday resulted in a natural experiment of being vaccinated early or late.
2) Between 3 and 5 months of age, children who received DTP and OPV early had 5-fold higher mortality than still unvaccinated children.
3) In the only two studies of the introduction of DTP and OPV, co-administration of OPV with DTP may have reduced the negative effects of DTP.
While the children in this natural study did not die from the diseases they were vaccinated against, they had a fivefold mortality compared to unvaccinated children. A single study on a limited number of vaccines does not provide definitive data, but given the radical findings it is hard for anyone to be certain that vaccination reduces the risk of children dying. Interestingly the third highlight suggests the way vaccines are scheduled may have a significant impact on general health outcomes.
The findings from Mogensen et al form part of a wide ranging discussion on vaccines published in the Lancet earlier this year.
Benn, C. S., Fisker, A. B., Rieckmann, A., Sørup, S., & Aaby, P. (2020). Vaccinology: time to change the paradigm? The Lancet Infectious Diseases.
https://doi.org/10.1016/S1473-3099(19)30742-X
In the Mogenses paper, the problematic DTP vaccine is a trivalent vaccine that contains diphtheria, tetanus and pertussis vaccines. As already noted the pertussis part of the vaccine does not prevent the infection, simply mitigates the clinical disease, and as such does not help create herd immunity. Tetanus is not a communicable disease, and so herd immunity is meaningless for this disease. But what of diphtheria?
We present a section from this 2020 review of diphtheria.
Shaun A Truelove, Lindsay T Keegan, William J Moss, Lelia H Chaisson, Emilie Macher, Andrew S Azman, Justin Lessler, Clinical and Epidemiological Aspects of Diphtheria: A Systematic Review and Pooled Analysis, Clinical Infectious Diseases, Volume 71, Issue 1, 1 July 2020, Pages 89–97, https://doi.org/10.1093/cid/ciz808
“Vaccinated individuals can become colonized and transmit; consequently, vaccination alone can only interrupt transmission in 28% of outbreak settings, making isolation and antibiotics essential. While antibiotics reduce the duration of infection, they must be paired with diphtheria antitoxin to limit morbidity.”
So the diphtheria part of this trivalent vaccine cannot create herd immunity either.
So the DTP vaccine increases the all cause mortality rate for the vaccinated individuals, especially girls, in a Sub-Saharan country. Further the vaccine does not provide immunity from the infection for Pertussis or Dipthereia, and so the vaccination program for these two disease cannot create herd immunity. Given the evidence to hand, it is hard to see the value in the DTP vaccine as a tool for improving public health, or as a means of eradicating either diphtheria or pertussis, as the vaccine continues to leave the vulnerable exposed to these dangerous diseases.
The same seems to be true of the vaccines currently being developed for covid-19. The rational for vaccine mandates is to create herd immunity to reduce and eventually eliminate the disease. However the Oxford vaccine, based on the new RNA vaccine technology, did not provide 'sterilizing immunity'. In other words, just like the pertussis vaccine, if you get the vaccine you may suffer fewer symptoms, but you are still infectious.
There is a paucity of data on the matter of long term harm from vaccinations. A major reason for this is that long term studies where children are left unvaccinated are considered unethical. This ethical consideration does not provide evidence to the point, but rather begs the question. Not only does the ethical position beg the question, but it actively prevents data from being generated that can challenge the popular vax position. This failure to conduct appropriate experiments may be ethical, but it cannot be seen as a demonstration that the ‘science is clear’.
It is an often made claim that the ‘science is clear’ and vaccines are largely or wholly responsible for the eradication of ‘vaccine preventable diseases’. The evidence to support this is often presented as a graph, showing a few years before and after the introduction of the vaccine, showing a rapid decline in the disease once the vaccine has been introduced. To counter this popular belief, here we present a graph, created by Suzanne Humphries, showing mortality rates in the USA of five diseases between 1900 and 1965.
Looking at this graph, it is hard to see the difference between the reduction in measles, which has a vaccine, and the graph for scarlet fever, which does not have a vaccine. Further the general patterns of the graphs seem unaffected by the introduction of the vaccines. Of course the value of this data may be contested, for example by choosing to look at case rates rather than mortality rates, or by wanting to look at the data for other diseases. However this graph by Suzanne Humphries shows that the science is far from clear, and that standard graphs encourage hubris about the effect of vaccines on the historical course of communicable diseases. Cum Hoc Ergo Procter Hoc, or the modern version ‘correlation does not equal causation’ seems to apply to the claims made for measles and pertussis vaccination. We offer no explanation here for the shape of the graphs presented, but leave it for the reader to explore Suzanne Humphries’ explanations.
https://drsuzanne.net/dr-suzanne-humphries-vaccines-vaccination/
Conclusion
As shown by the banner photograph to this essay, taken in 1919, the safety of vaccines has been debated for over a century. There is not space in this essay to examine this rich and extensive debate about the evidence and morality of different courses of action. Our goal is to arm ourselves with knowledge of the mechanisms of rhetoric, with its capacity to cloud our judgement with emotions, even when looking at issues that are superficially rational and scientific.
The rhetoric from Premier Andrews for No Jab No Play, namely that parents who refuse vaccinations put their child and every other child at risk is just that, rhetoric. It is too simplistic by far, and at is not substantiated with respect to the specific issue of pertussis infection of infants. The suggestion that infants are only at risk from the unvaccinated is simply wrong. Both the Australian and Victorian governments behaved unethically and unjustifiably in using the Riley Hughes case to promote coercive vaccination laws.
In the contemporary world, those that question the vaccine orthodoxy risk ridicule and being ostracised by friends and family. For those in the medical profession the situation is even more extreme. In many jurisdictions it is not possible to enter the medical profession without being ‘fully’ vaccinated, and having regularly vaccine updates. Further to raise questions about vaccine orthodoxy can result in the loss of registration and the end of a person’s career. The rhetoric of vaccines is seen as part of the profession for medics, thus insulating the profession from the scrutiny of alternate positions. Let us be clear, the rhetoric around vaccinations means that questioning vaccinations is far from whimsical. In looking for evidence around vaccines and vaccine safety, bravery is now a pre-requisite.
Ultimately rhetoric is no substitute for a substantive argument supported by evidence. Using finances, social and professional exclusion, and public ridicule may help leverage the rhetoric, but they still do not form a substantive argument. Rhetoric is powerful precisely because it engages our emotions, rather than our rational self. Keeping a cool head when one’s emotions are being attacked is hard. However in the end, the only mechanism for defeating rhetoric and supposition is not more rhetoric and supposition, but real world evidence of the bigger picture.
Evidence is what is required in suggesting the value of No Jab No Job. Given the time frames involved for Covid-19 clear evidence is unlikely to be available. Rhetoric promotes simple solutions where the reality is complex. But what is the ethical way for a government or the medical profession to behave when there is a paucity of evidence?