The Dangers of Anti-Vaxxers and Bad News Reporting (Guest Post by Niels Böge Nothdurft)
This is another guest post written by Niels Böge Nothdurft from Denmark. In this post, Niels discusses the popular fears surrounding the Gardasil vaccine in Denmark and how inaccurate and sensationalistic reporting in the news media contributed to these fears and helped promote dangerous anti-vaccination pseudoscience.
The number of Danish women who get the HPV vaccine known as Gardasil has been in a huge decline the last 1-2 years. I want to tell you the story about how a country that has had around 70-80 percent of its 12 year-old girls vaccinated each year to prevent a deadly disease suddenly experiences such a dramatic decline in the vaccines given, such that only 11 percent of all 12 year-old girls got their last Gardasil shot last year.
The lack of trust in Gardasil appears to originate in the spring of 2015, when the second largest Danish news station, called TV2, began to bring in reports on several anecdotes. The anecdotes were from young Danish women who claimed that they had acquired various illnesses and problems from their HPV vaccinations. The anecdotes were told as their own stories, but a total of 47 anecdotes were also featured in the bottom of a series of articles about Gardasil and the alleged danger it pose.
Some of the problems they claim they have gotten from the vaccine are: dizziness, postural orthostatic tachycardia syndrome (POTS), headaches, sleep problems, acne, infections, dandruff, claustrophobia, gluten allergy, cooking salt allergy, sleeping problems and various pains. Anecdotes are themselves useless as evidence if you want to come to a scientific conclusion. And a claim that a vaccine has caused an allergy to cooking salt, gluten-allergy, and claustrophobia should really make people raise an eyebrow.
I will return to the anecdotes when I talk about the science surrounding Gardasil later in this blogpost. But first I want to cover the news reporting of TV2.
As you might know, it is normal for news reporters to present “both sides,” which makes sense if you are making a news story about politics. But it doesn’t make sense when it comes to science. That is simply because there only is one side when it comes to science and that side is the one supported by the weight of the evidence.
So it is not surprising that TV2 did the thing with both sides when they reported about Gardasil. I would argue that TV2, besides bad reporting, also is to blame for the whole Gardasil “controversy” in the first place. If they hadn’t started to bring articles on a regular basis about the alleged dangers of Gardasil, the “controversy” would probably not have started in the first place.
In their articles about the alleged dangers of Gardasil, TV2 has been using mainly two anti-vaxxer groups from Denmark. They are called Vaccinations Forum and HPV Update.
Vaccinations Forum is a typical anti-vaxxer group, claiming that all vaccines are dangerous, while HPV Update is mainly focused on HPV vaccines like Gardasil, while promoting alternative treatments to people who blame their problems on Gardasil. The treatments they recommend include homeopathy, reflexology, acupuncture and something called Vega test. If I understand Vega test correctly, it is a kind of E-meter test, in which the tester wants to find out what herbal medicine the “patient” needs. A very worrying treatment they recommend is a vitamin-C treatment that is provided by a Danish doctor who is on an authority watchlist because he provides a vitamin-C treatment and is an anti-vaxxer.
I think it is worth mentioning that TV2 brought an article about a radio interview with two famous anti-vaxxers named Diane Harper and Lucija Tomlenovic, both of whom can be seen in various anti-vaxxer YouTube documentaries. The article, with some parts of the interview in it, had the title, “Experts: We do not know if the HPV vaccine’s effect will be lasting.” I have provided a link to the article so you can get a headache from reading it, as I did. 
When TV2 wanted to show both sides of the story, they used spokespersons from both the Danish Health Authority (Sundhedsstyrelsen) and the Danish Cancer Society (Kræftens Bekæmpelse). When they were interviewed, the spokespersons tried to calm people down by repeatedly saying that there is no link between the claimed side effects and the vaccine. The spokespersons did a good job in my opinion, but they were sadly not given much space in the articles to make their case. The main focus was always on the controversial side.
So what about the science?
The science was almost completely absent during the whole Gardasil “controversy,” which is a shame because it clearly shows that there is no controversy in the first place. I could compile a whole list of studies that clearly show that Gardasil is both safe and effective, but the blog Skeptical Raptor has already done that for me.  Ironically, one of the studies on the list is a massive cohort study of 1 million Danish and Swedish girls that showed no increased risk of getting 53 different illnesses from Gardasil. 
Let’s return to the anecdotes from Danish women, who claim that Gardasil has given them several different illnesses and problems.
Anecdotes can be very appealing and full of emotion, which they were in the case of the Danish women. But emotional appeal doesn’t make an anecdote true. If a claim only has anecdotes to support it, you should be very skeptical about the claim, especially if the anecdotes contain some wild claims, like some of the anecdotes from the Danish women did.
The anecdotes and media coverage were apparently enough for the Danish Health Authority to take the claims seriously. They asked the European Medicines Agency (EMA) to launch an investigation of Gardasil and create new hospital units to take care of women who think they have been damaged by the vaccine. The EMA investigation of course found that (surprise, surprise!) there is no evidence that people get sick from Gardasil. But that was not enough to convince the anti-vaxxer groups and a Danish doctor called Jesper Mehlsen, who thinks that Gardasil is dangerous. Mehlsen and some others published a heavily criticized case report study, with only 35 women and no controls,  trying to prove that Gardasil has caused POTS.
Besides the health authorities taking the claims about vaccine dangers seriously enough to create new hospital units, thus spending a lot of tax money, the Gardasil “controversy” has had quite severe consequences for Denmark and especially for Danish women in general.
An obvious consequence is that public trust in at least one type of vaccine has been damaged, very likely beyond any repair. The number of 12 year-old girls who get the first Gardasil shot has dropped from 78-92 percent in previous years to 42 percent last year and only 13 percent so far this year. The trend is no better when we look at the amount of women who complete their HPV vaccination. In previous years, 68-79 percent completed their vaccination, compared to only 11 percent last year and only 1 percent so far this year. 
A very sad consequence of this is that we will see an increase of cervical cancer. Each year 376 Danish women get cervical cancer and each year 99 Danish women die from it, which is a tragedy that doesn’t have to happen, because we have an effective and safe vaccine to prevent it!
Another sad consequence was the panic that followed the Gardasil “controversy.” Many women feared for their health after getting the vaccine and many women reported side effects to the authorities. The reported side effects boomed in 2015, after all the news coverage. 
The panic also reached one of the largest political parties in Denmark, called Dansk Folkeparti (DF), or Danish People’s Party (DPP) in English. Being a highly populist and scientifically illiterate party, or in other words the Danish version of Donald Trump, they almost immediately stated that all vaccination against HPV should be stopped. The DF got some well-earned flak for their statement from organisations like the Danish Cancer Society and the Danish Medical Association, but it doesn’t change the fact that the second largest political party in Denmark now wants to stop HPV vaccination, based solely on some anecdotes.
The consequences of the anti-vaccination movement, bad news reporting, and a lack of skeptical thinking skills can be tremendous and fatal for some of the people, who would have been protected by a vaccine or herd immunity. They lose their lives to a horrible disease. Other people and their families will needlessly suffer physically and psychologically, and people like the 47 women who believe they got sick because of Gardasil will stop looking for answers and instead blame an ingenious product of science for all their problems. Anti-vaxxers makes us all lose.
 Jonatan Rying Larsen, “Eksperter: Vi ved ikke, om HPV-vaccinens virkning er varig,” TV2 Nyheder, May 18, 2015, http://nyheder.tv2.dk/2015-05-18-eksperter-vi-ved-ikke-om-hpv-vaccinens-virkning-er-varig. If you can’t read Danish, you can use Google Translator, which gives a readable and understandable translation of the article.
 The Original Skeptical Raptor, “Gardasil Safety and Efficacy – Debunking the HPV Vaccine Myths,” Skeptical Raptor, October 3, 2016, http://www.skepticalraptor.com/skepticalraptorblog.php/one-stop-shop-science-myth-debunking-gardasil/.
 Lisen Arnheim-Dahlström, et al., “Autoimmune, Neurological, and Venous Thromboembolic Adverse Events after Immunisation of Adolescent Girls with Quadrivalent Human Papillomavirus Vaccine in Denmark and Sweden: Cohort Study,” British Medical Journal 347 (October 2013): f5906. doi: http://dx.doi.org/10.1136/bmj.f5906.
 L.S. Brinth, K. Pors, A.C. Theibel, J. Mehlsen, “Orthostatic Intolerance and Postural Tachycardia Syndrome as Suspected Adverse Effects of Vaccination against Human Papilloma Virus,” Vaccine 33, no. 22 (May 21, 2015): 2602-2605. doi: 10.1016/j.vaccine.2015.03.098. https://www.ncbi.nlm.nih.gov/pubmed/25882168.
 A Danish statistic from the Statens Serum Institut (the Danish version of the CDC) showing the percentage of women born a specific year who have received their first Gardasil shot: http://www.ssi.dk/Smitteberedskab/Sygdomsovervaagning/VaccinationSurveillance.aspx?vaccination=5&xaxis=Cohort&sex=0&landsdel=100&show=Graph&datatype=Vaccination&extendedfilters=True#HeaderText.
Statistic from the same source showing how many girls have received their last Gardasil shot: http://www.ssi.dk/Smitteberedskab/Sygdomsovervaagning/VaccinationSurveillance.aspx?vaccination=6&xaxis=Cohort&sex=0&landsdel=100&show=Graph&datatype=Vaccination&extendedfilters=True#HeaderText.
Word translations to the Danish statistics:
Vaccinationstilslutning = vaccination coverage
Køn = gender
Kvinder = women
Fødselsår = birth year
Færdigvaccineret = finished vaccination
Landsdel = region
Kommune = municipality
 Lægemiddelstyrelsen (Danish Medicines Agency), “Adverse Reactions from the HPV Vaccine,” June 30, 2016, https://laegemiddelstyrelsen.dk/en/sideeffects/side-effects-from-medicines/hpv-vaccination/adverse-reactions-from-the-hpv-vaccine.