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I was passed along an article reporting that a new study found that despite having the highest number of vaccines in its recommended schedule, the United States is ranked 34th in infant mortality rates (IMR) in the world.

Mercola presents this here.

The report abstract is here and the full text is here.

From the conclusion:

A closer inspection of correlations between vaccine doses, biochemical or synergistic toxicity, and IMRs, is essential. All nations—rich and poor, advanced and developing—have an obligation to determine whether their immunization schedules are achieving their desired goals.

Here's their plots of number of vaccines in a country's schedule with infant mortality rate.

IMR vs. number of vaccines

In other words, I take this to mean that they are suggesting that vaccine toxicity has a causal relationship to infant deaths, or that the vaccines are innefective, despite a high number in one's scheduled dosage recommendations.

I immediately wondered what contributes to infant mortality rate. Is it just vaccine-preventable illnesses and the paper is suggesting incorrectly that vaccines are ineffective? Do deaths during delivery count... and can those even possibly be related to vaccination schedules?

They mention that there are 130 categories of infant deaths:

Many nations adhere to an agreed upon International Classification of Diseases (ICD) for grouping infant deaths into 130 categories. Among the 34 nations analyzed, those that require the most vaccines tend to have the worst IMRs. Thus, we must ask important questions: is it possible that some nations are requiring too many vaccines for their infants and the additional vaccines are a toxic burden on their health?

They only discuss SIDS as a potential vaccine side effect; I would be curious to know what the other 130 categories are and whether or not they have a possibility of being related to vaccines.

They mention some limitations here...

This analysis did not adjust for vaccine composition, national vaccine coverage rates, variations in the infant mortality rates among minority races, preterm births, differences in how some nations report live births, or the potential for ecological bias. A few comments about each of these factors are included below

This followed by a discussion of why they don't think these categories would sway the results [much].


My Questions:

  • Is this paper's methodology/conclusion sound? Is there a valid concern here about a potential causal relationship between vaccines and infant mortality rates?
  • Are there studies that have alternative explanations to why the US infant mortality is high compared to similarly developed nations?
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    +1 question greatly asked, and I hope it will settle a lot of misinformation on this subject. – Zenon Jun 29 '11 at 16:07
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    The high infant mortality in the US has another reason: Too many parents refrain from seeking medical attention because they buy into either new-age woo or fundamentalist religion, which in some jurisdictions does not count as harmful neglect... – Lagerbaer Jun 29 '11 at 16:54
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    +1 What a great question. I hope it attracts an answer of similar quality! – Brian M. Hunt Jun 29 '11 at 17:07
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    @Lagerbaer: I'd be thrilled for you to provide sources for this and illustrate the high contribution from such causes to the IMR. – Hendy Jun 29 '11 at 17:23
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    Countries that require the most Vaccines also have the best tracking of IMR. In developing countries with no vaccines when a child dies it is buried and no one ticks the box most of the time. – Chad Jun 29 '11 at 17:28
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The first author Neil Z Miller is the director of the Thinktwice Global Vaccine Institute, which is decidedly anti-vaccination as a short look at their website will confirm. He also published a series of books on vaccination. This does not mean the paper is necessarily biased, but it is an undisclosed conflict of interest which is not a good sign.

They are also not providing any evidence for causation, the linear regression graphs in your question is essentially the whole analysis the authors performed.

There is an excellent deconstruction of this specific study by David Gorkski on the Scienced Based Medicine blog. I recommend to read the whole article, I will only summarize a few points here.

David Gorski also notes the conflict of interest that I observed when I researched the first author. One aspect he point out is that the authors used only the data for one year (2009) and only for countries with IMR lower than the United States.

Miller and Goldman only looked at one year’s data. There are many years worth of data available; if such a relationship between IMR and vaccine doses is real, it will be robust, showing up in multiple analyses from multiple years’ data. Moreover, the authors took great pains to look at only the United States and the 33 nations with better infant mortality rates than the U.S. There is no statistical rationale for doing this, nor is there a scientific rationale. Again, if this is a true correlation, it will be robust enough to show up in comparisons of more nations than just the U.S. and nations with more favorable infant mortality rates. Basically, the choice of data analyzed leaves a strong suspicion of cherry picking.

When I saw the graph on the right with the grouped data I was suspicious as I could not see any reason to arbitrarily group the data. It looked like a cheap way to make the plot look better, not like an analysis that would actually provide more insight. David Gorsky shares my suspicion and notes

More dubiously, for some reason the authors, not content with an weak and not particularly convincing linear relationship in the raw data, decided to do a little creative data manipulation and divide the nations into five groups based on number of vaccine doses, take the means of each of these groups, and then regraph the data. Not surprisingly, the data look a lot cleaner, which was no doubt why this was done, as it was a completely extraneous analysis. As a rule of thumb, this sort of analysis will almost always produce a much nicer-looking linear graph, as opposed to the “star chart” in Figure 1.

As pointed out by Catharina from the Just the Vax blog, the paper also contains an error regarding the german vaccination schedule. The German Childhood Vaccination Schedule recommends additionally Hepatitis B from birth on, as well as MMR and Chickenpox vaccinations starting at 11 months.

There are other studies that examined the association of SIDS (sudden infant death syndrome) and vaccinations, a meta analysis concluded that vaccinations help to prevent SIDS

Immunisations are associated with a halving of the risk of SIDS. There are biological reasons why this association may be causal, but other factors, such as the healthy vaccinee effect, may be important. Immunisations should be part of the SIDS prevention campaigns.

US infant mortality rate

There is a report from the CDC addressing the high infant mortality rate in the United States: Behind International Rankings of Infant Mortality: How the United States Compares with Europe.

  • Infant mortality rates for preterm (less than 37 weeks of gestation) infants are lower in the United States than in most European countries; however, infant mortality rates for infants born at 37 weeks of gestation or more are higher in the United States than in most European countries.

  • One in 8 births in the United States were born preterm, compared with 1 in 18 births in Ireland and Finland.

  • If the United States had Sweden’s distribution of births by gestational age, nearly 8,000 infant deaths would be averted each year and the U.S. infant mortality rate would be one-third lower.

  • The main cause of the United States’ high infant mortality rate when compared with Europe is the very high percentage of preterm births in the United States.

The conclusion is that the higher rate of preterm infants explains a large part of the higher infant mortality rate, but not the whole discrepancy between Europe and the United States.

The following figure shows the IMR comparison if you exclude births earlier than 22 weeks, the US rate is significantly lower, but still higher than in most european countries.

enter image description here

However, infant mortality rates for infants born at 37 weeks of gestation or more are generally higher in the United States than in European countries.

The report does not speculate what the source of the remaining difference between Europe and US infant mortality rate could be.

Conclusion

The whole paper looks more like a fishing expedition to me than a thorough and objective analysis. They used an arbitrarily limited subset of the available data and did not correct for any potential confounding factors. This looks suspiciously like they played around with the data until they found the correlation they searched for, especially given the known bias of the authors.

  • Fantastic answer -- thanks for all that digging! I did find it odd that the US IMR for pre 37 weeks birth is lower than European rates... but just a few points down it says that our IMR is higher because we have a lot of pre 37 week births. The overall IMR for pre-term births must still be quite a bit higher than full term, then, right? – Hendy Jul 9 '11 at 22:17
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    What would the chart look like if we did use the average infant mortality for a wider range of western countries over a larger number of years? That could be a very convincing refutation of the Mercola claims. – matt_black Oct 17 '15 at 13:59
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    Great answer. So do we know why the USA has so many more preemies? – A E Oct 17 '15 at 15:03
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    @Hendy What's going on is that the US is better at handling preemies but our overall stats are worse because we have more preemies. – Loren Pechtel Mar 3 '17 at 3:19
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    @Zibbobz There's also a problem with the data. Infant mortality + stillbirth rates are much flatter than infant mortality rates. That strongly suggests the infant mortality rates aren't being correctly reported. – Loren Pechtel Jun 30 '18 at 4:00
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In addition to what Mad Scientist said,

  • The neonatal infant mortality rate (first 28 days) is generally much higher than the post-neonatal infant mortality rate, yet this is before most vaccines are administered. So why did Miller choose to compare "number of vaccines" to total infant mortality instead of post-neonatal infant mortality?
  • And why not consider 5-year mortality - data which is very easy to get? If Miller means to imply that vaccines cause immediate death and not death within 5 years, why hasn't anyone but him and his research partner noticed?
  • The study only includes countries with low infant mortality rates (specifically in 2009, unlike, say, Wikipedia which offers five-year averages for the last 65 years). OECD countries like Mexico and Turkey with high infant mortality are excluded. There are dozens of countries with more than 10 times the average infant mortality of countries in this study.

Obviously, there is reason to suspect that the correlation reverses when more countries are added, more years are added, when post-neonatal mortality is considered, when deaths with a known cause are excluded or when parental wealth and other factors are controlled for. But someone needs to actually go out, gather the data and redo the analysis - googling, I didn't find any other study on this. I couldn't even find an effort to reproduce or refute the results with easily-located data.

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    Isn't it considered polite to leave a comment explaining why you are downvoting someone's very first post? – Qwertie Jun 29 '18 at 23:31
  • It's likely because answers are expected to stand on their own, not as supplements to another answer. – Erik Jun 30 '18 at 12:55
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    @Erik this adds enough new information and is too long for a comment (plus comments can't be nicely formatted), so posting it as an answer is appropriate. If this site were a wiki you'd add it as a paragraph to the article, but the SE format doesn't allow for that. – jwenting Jul 5 '18 at 10:47
  • As to your first point, vaccines during pregnancy could be related to infant mortality. The flu vaccine during pregnancy has been added to the CDC list in the US. Also, it's not clear how common it is to give a vaccine like HepB on the first day of life. – Diagon Jun 14 at 18:21

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