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Vaccine manufacturers list everything used in the manufacturing process of a vaccine, not only what is in the actual, finished vaccine. Imagine reading the ingredients for a bag of peas if the manufacturer had to list everything used to grow the peas: “Soil,” “cow manure,” and the numerous chemicals found in the fertilizer would be listed. Similarly, many of the items listed as vaccine ingredients are used to create the vaccine but are not contained in the final product. Ingredients that are worth noting are:

Aluminum Salts: These are used in some vaccines as “adjuvants,” which are mild immune stimulators that help make vaccines more effective. The aluminum salt stays where the vaccine was inserted in the body and is slowly absorbed over time. Aluminum is a very common element -- the third most common element in the Earth’s crust -- and we constantly eat, drink, and breathe it. The aluminum in vaccines is such a small amount, and is cleared from the body so effectively, that we can’t even detect a change in the amount of aluminum in the body after vaccination.

Thimerosal: This is a preservative that used to be in some vaccines to keep them sterile and safe. Oregon banned thimerosal in pediatric vaccines necessary for school entry immunization requirements. Thimerosal was removed from all childhood vaccines in 2001. Some versions of the flu vaccine that are shipped in multi-dose vials contain thimerosal to keep the vaccine sterile between uses, but it has not been found to be unsafe. Thimerosal contains a small amount of ethyl mercury, which does not accumulate in the body and is quickly cleared out by urination. The type of mercury found in a can of tuna fish -- methyl mercury -- is more dangerous because that does accumulate in the body. Regardless, the vast majority of flu vaccines come in single-use syringes and does not contain any thimerosal or other preservatives.

Immunizations are some of the most studied, regulated, and monitored medical products available. They undergo rigorous testing for years before they are made available to the public. They are then monitored for safety indefinitely through two separate but connected surveillance systems: The Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink (VSD). For more information about the safety of vaccines, and a list of studies, check out this resource from the American Association of Pediatrics.

Vaccines are extensively tested before being licensed for general use and continue to be monitored regularly after licensure. For details about the licensure and recommendation processes, check out this resource from the Children’s Hospital of Philadelphia.

Yes! Vaccines have been tested against placebo (an inactive injection). The MMR vaccine was even tested against an unvaccinated population: Because it was one of the first immunizations developed, there was a large population who were completely unvaccinated at the time it was studied.

Vaccines are made by taking a naturally-occurring illness and either destroying it or weakening it to the point that it cannot cause disease. When it is injected in your body, it allows your immune system to practice responding to it. Immunizations use your immune system’s natural ability to protect you from illness by letting it have a “dress rehearsal” at fighting off an illness. The antibodies you make from immunizations are the same that you would make from contracting the disease, but, with vaccines, you don’t have to get sick in order to get immunity.

Yes. We immunize against the most dangerous infections because there are real risks to catching these illnesses. For example, for every 1,000 cases of measles, we can expect to see approximately: 200+ hospitalizations; 80-100 cases of dehydration from diarrhea; 70 ear infections; 60 cases of pneumonia; 6-7 seizures; 1-2 deaths; and 1-2 cases of encephalitis (25% of patients with measles related encephalitis will have permanent brain damage). As of November 2019, we’ve had over 1,250 confirmed measles cases in the United States, the most in over 20 years.

Different vaccines have different levels of protection. For example, the measles immunization is 97% effective after the second dose, and its immunity lasts a lifetime. Others, like the tetanus vaccine, are very effective but need booster doses over time to offer continuous protection. The flu shot is less effective and needs to be updated each year. No vaccine is 100% effective, which is why community immunization rates must be high in order to keep vaccine-preventable diseases at bay.

Immunization is only effective if around 95% of the population does it. Once rates start to drop below 95%, we begin to see outbreaks of disease. The more people decline vaccines, the more outbreaks of preventable diseases occur (like the measles outbreaks throughout the United States in 2019). There are also some people who cannot have vaccines. Some people are too young, some have a medical condition that compromises their immune system, and some have a severe allergy that prevents them from receiving immunizations. These people rely on the rest of us to be vaccinated and prevent exposing them to disease.

Immunizations are recommended at the times in our lives that we are most susceptible to bad outcomes from getting sick. Our immune systems can respond to a huge number of things without becoming overwhelmed, and the small exposures from routine immunizations are a drop in the bucket of the number of things our immune system encounters in a single day. In fact, because we know which parts of a bacteria/virus are best at creating immunity, we can put just those parts in the vaccine, so the number of things your immune system needs to process from a vaccine is far lower than if you got the illness it prevents.

There is no benefit to giving shots one at a time or otherwise delaying vaccines. We give immunizations when children are young because that is when they best respond to immunizations and are most susceptible to disease. Spacing out or delaying vaccines leaves your child at risk of catching these illnesses, and there’s no evidence that giving multiple vaccines at the same time is harmful. The best protection for your child is to vaccinate her on time.

There has been a huge amount of research into this question and no connection whatsoever has been found between immunization and autism. The most recent research has looked at very large populations of children (600,000+) and found no relationship between vaccines and autism, even in families with other risk factors for autism diagnoses.

MTHFR stands for methylenetetrahydrofolate reductase, an enzyme that is involved in many processes in our bodies. There are several versions of this enzyme, and, depending on which version you inherited from your parents, your individual enzymes may be more or less active. A large percentage of us have variations in this enzyme, and as many as 40% of us have a lower-functioning variant of the enzyme. Some have argued -- without evidence -- that these genetic variations increase susceptibility to “vaccine injury.” There is no evidence that an MTHFR gene variation makes one more likely to react negatively to a vaccine, and there is no reason to avoid immunizations just because you have an MTHFR gene variation. In fact, because these variations are so common, it is not recommended to test for them at all. For more information you can read this article by The Atlantic.

Even though vaccines are extremely effective, they are not perfect. For example, a vaccine that is 90% effective means that 1 in every 10 people who are vaccinated will not be fully protected from the disease. When the disease affects a community, unprotected people are more likely to be infected. This includes those who were not vaccinated and the 10% of people who were vaccinated but did not get full protection. Vaccinated people who get the disease can experience a milder form of the disease. For example, for whooping cough (pertussis), we know that vaccinated children have fewer symptoms, are sick for a shorter time, and are less likely to spread the disease to others. We need more than one dose of most vaccines to get the protective immunity. Some vaccines require booster doses throughout a lifetime to maintain protection.