Dr. Peter Hotez is a vaccinologist who works on developing vaccines for neglected tropical diseases (NTDs), most of which affect developing countries and thus get little or no attention from affluent nations like the United States – although climate change will start to push some of the disease vectors (like mosquitoes) across our borders in time. He’s become a pro-vaccine activist in recent years because of the rising volume and, unfortunately, power of the American and British anti-vaccine movements, which have both begun exporting their bullshit to other countries, risking large epidemics in densely populated, emerging nations like the BRICS or the major countries of southeast Asia.

Dr. Hotez is also a father, and one of his children, Rachel, is an adult with autism spectrum disorder. He combines those two facets of his life, personal and professional, in his new book Vaccines Did Not Cause Rachel’s Autism, in which he lays out the indisputable facts of vaccine safety. Weaving stories of Rachel’s life, from the first discovery that she had “pervasive developmental disorder, not otherwise specified,” a now deprecated diagnosis for autism spectrum disorder, through the challenges of her school years and the most recent attempts to find her a stable role in the work force, into stories from his own career, Hotez makes the impersonal personal, while also brooking no nonsense from those who would call him a “shill” or otherwise deny the truth that vaccines are safe and effective.

Hotez is now the chief of Baylor College of Medicine’s National School of Tropical Medicine, based in Houston, which itself ends up a big part of the family side of his story, portions of the book where he lays bare the incredible challenges of raising a child with autism spectrum disorder. Rachel’s case at least sounds like it is on the severe end of the spectrum, with learning disabilities, oppositional tendencies, and monotropist behaviors, although she’s not self-injurious and by the end of the book Hotez has at least some hope that she may have found a job opportunity through an individual coaching program provided via Goodwill. It’s often heartbreaking to read of the immense obstacles Hotez and his wife, Anne, whose voice is also in the book, have faced with Rachel in situations that parents of children without ASD take for granted or even experience as high points.

Of course, for me, the greater appeal of Hotez’s book going into it was his angry, evidence-based arguments against the denialist movement that has given us back the measles, a disease we’d eradicated in the United States twenty years ago, as well as surging cases of other dangerous, often fatal vaccine preventable diseases. Hotez just tweeted as I wrote this post to a Guardian article saying there have been 90,000 measles cases in Europe this year – a disease that is close to 100% prevented by vaccination. Hotez is quite patient in his explanations of how the anti-vaccine myths, notably the one that the MMR vaccine was associated with autism (it’s not, at all), first arose – in that case, because of a fraudulent study, since retracted, that cost the author his medical license – and why every such myth is wrong.

Vaccine denialists really don’t get anything right, and Hotez lays out the reasons in the specific case of the bogus claim that vaccines somehow lead to autism: It is a biological impossibility. Hotez’s book has the best lay explanation I’ve come across of the causes of autism, which, oh by the way, is already present before birth, and thus before an infant receives any vaccines. Autism is an expression of at least 65 already identified genes, as well as potentially hundreds of others, and the claim that a vaccine can cause autism is a sort of post hoc rationalization combined with complete science ignorance. That’s a large part of why these anti-vaccine claims keep changing – it’s the mercury, no it’s the alum, no it’s the number of vaccines administered at once, no it’s the formaldehyde. None of these factors causes autism, or any other disorder or condition. Vaccines can have mild side effects, including a fever and soreness at the injection site; in extremely rare cases, around one in a million, they can cause a serious reaction. Hotez points out that you are more likely to be struck by lightning than to be injured by a vaccine; meanwhile, ten people in the United States died of pertussis alone in 2018, four of them infants under the age of one, although the doubling of pertussis infection rates that occurred around 2012-14 has abated. He also has strong words for the anti-vaxxer lie that measles is a benign childhood infection, focusing in particular on SSPE, an invariably fatal aftereffect of a measles infection, hitting as many as 1 in every 600 people who survived a measles infection as an infant, that involves pervasive brain inflammation, loss of cognitive and motor functions, and death.

For his vaccine and general science advocacy, Hotez has been attacked online and off, with lunatics doxing him, calling his house and his work, and demonizing him on autism support websites (much as they’ve done with Paul Offit, co-inventor of the lifesaving rotavirus vaccine). It’s unsurprising from a movement that has no facts on its side, and that has recently begun targeting communities of color, including Somali immigrants in Minneapolis, with its anti-vaccine messaging, leading, of course, to a measles outbreak in that city (which could then be blamed on immigrants!). Hotez offers several potential policy proposals to combat the rising tide of anti-vaccine and general anti-science sentiment, including ending nonmedical exemptions to mandatory vaccination laws, encouraging scientists to engage in more public advocacy (even if it means they publish less), and increasing investment in disease prevention in developing countries. To his list, I would add improving basic science education in this country; we never learned about vaccines anywhere in my grade school experience, nor did anyone explain how the scientific process works, which would provide students with critical thinking skills that might help them reject the garbage science deniers peddle online. Hotez also has strong, necessary words for the media, who continue to discuss a vaccine-autism “controversy” where there is none, no more than there is controversy that the earth revolves around the sun, a view rather nicely summarized in this recent comic:

In the interest of balance… pic.twitter.com/pDLAzTPz5q

— TwistedDoodles (@twisteddoodles) August 22, 2019

There’s a call to action for everyone in Vaccines Did Not Cause Rachel’s Autism, from asking your state representatives to end all nonmedical exemptions to voting for pro-science candidates to speaking out publicly, regardless of your role, about the safety and necessity of vaccines. Within this story, Hotez also gives us the deeply personal side of being the parent of a child and now adult with autism, a reminder that there are maybe 3 million Americans with autism spectrum disorder and insufficient resources to support them. We can do better on all fronts; Hotez’s book should motivate many people to do so.

Next up: I’m going to finish Wolf Hall in the next 48 hours if it kills me.