This blog entry is authored by M. Katie Charles, one of Orin Levine's graduate students at The Johns Hopkins Bloomberg School of Public Health. This post is the first of a three-part series entitled "Tomorrow's Vaccine Policy Leaders."
Consider that you are among the 50 million Americans geographically relocating this year, bouncing between primary care physicians. In addition to the transport of both your necessary and superfluous belongings, you must transition all your personal records and family documents. Though we are in the midst of a piecemeal transition to electronic medical records, your documents likely include hard copies of health records. And they are your responsibility.
At a new doctor's office, your head spins with the obligatory inquisition that comes with new patient intake forms. Past hospitalizations, surgeries, and major medical conditions may be easy enough to recall, but your vaccination history? Think through the past ten years: have you received a tetanus booster? It's possible that you have an uncannily vivid memory of the soreness you felt the next day, but can you remember for the rest of your family? Has your toddler received his third dose of Hepatitis B vaccine? What about haemophilus influenzae type B? And what about your teenagers and your spouse? Again, it's your responsibility.
If you are particularly conscientious, you may have preemptively contacted your doctor's office for a medical record transfer. Maybe you logged your vaccination history diligently into a spreadsheet, completed a vaccine card from a prior physician, or used my mother's yellow-steno-notebook-and-pencil vaccine tracking system. But method aside, I believe that there would be resounding American agreement that the process of maintaining vaccination history is not particularly "user-friendly."
Even for those who have not recently moved or changed health care providers, a substantial amount of personal initiative is required when it comes to vaccination. The U.S. Centers for Disease Control and Prevention (CDC) explicitly asserts that most states' policies are that parents of school-aged children -- not the family doctors -- hold the responsibility to maintain vaccination records. For the average parent to know which vaccines may be missing, he or she must be able to read and understand the American vaccine schedule. Because the Advisory Committee on Immunization Practices (ACIP), which serves as the primary advisory body for vaccination in the United States, delineates separate schedules for children, teens and adults, keeping track of these timelines is no small task for the family organizer.
The issue only becomes more complicated if you need to consider immigration, divorce, joint-custody, emancipated children or estranged parents. The U.S. Department of Health and Human Services reports in the Healthy People 2020 Goals that only 68 percent of children ages 19-35 months are fully vaccinated for recommended vaccines -- a number that drops between 37 and 47 percent for the recommended adolescent vaccines. Lest we assume no steps have been made toward reconciliation between human forgetfulness and complicated vaccine schedules, I draw your attention to some earnest attempts.
To expand upon a number of online templates for personal vaccine record keeping, the pharmaceutical company Novartis created Vaxtrak a 2010 iPhone application. This free tool helps subscribers record past vaccinations, makes personalized immunization reminders and locates vaccination clinics through a global positioning device. (Once again, "There's an app for that," showing movement in the right direction, for iPhone users at least).
State health departments do a better job of addressing the needs of wider demographic groups, but lack the universality, personalization and finesse of their tech-savvy counterparts. Also, they record only childhood immunizations. If you want help recreating your vaccination record, there is no shortage of suggestions from public health departments and vaccination advocacy groups: "Ask your high school, post-secondary school, college health service or previous employers for dates of any immunizations." "If your physician has retired, check with medical record storage companies (small fee associated)." "Look in your baby books."
Keeping track of vaccinations shouldn't be this difficult. If health officials, academics and students like myself are going to continue touting vaccines as the greatest accomplishment in public health and an essential health program for the masses, then it's time to prove we mean it. The "do it yourself" policy is no longer adequate, much less acceptable, with the declining status of American health in an era of booming social networks, smart phones, wired cities and generalized, widespread connectedness. The United States is in dire need of a federal, nationwide vaccination tracking system, sophisticated enough to record a lifetime of immunizations, remind individual patients of upcoming vaccinations and communicate between patient and care provider -- regardless of residence.
This system will not only be an enormous step for American citizens and their overworked health care providers, but it would make an important public health statement by helping the majority of citizens who honestly want to keep up with their vaccination schedule and protect their kids through immunizations. Those who are unwilling to vaccinate will be held accountable for their decisions, as logged in a national system, accessible to all their health care providers. As vaccine-preventable diseases continue to pop up throughout the United States, it's time for national public health officials to show support for the people and keep us all honest about our vaccination history.
About the Author
M. Katie Charles is a Master's of Science in Public Health candidate in the International Health Department at The Johns Hopkins Bloomberg School of Public Health.
Follow Dr. Orin Levine on Twitter: www.twitter.com/orinlevine
David Katz, M.D.: Why Patient Care Needs To Get Personal
August 2011
Expert Review
A large number of autoimmune disorders have a gastrointestinal (GI) dysfunction component that may interplay with genetic, hormonal, environmental and/or stress factors. This narrarive review investigates possible links between autism, immune system abnormalities and GI symptoms in a subgroup of children with autism. A literature search on Medline (1950 to September 2010) was conducted to identify relevant articles by using the keywords ‘autism and gastrointestinal’ (71 publications) and ‘autism and immune’ (237 publications), cross-referencing and general searching to evaluate the available literature on the immunological and GI aspects of autism. Sufficient evidence exists to support that a subgroup of children with autism may suffer from concomitant immune-related GI symptoms.
RESEARCHERS have for the first time identified two biologically different strains of autism in a major breakthrough being compared with the discovery of different forms of cancer in the 1960s.
Researchers from the University of California Davis's MIND Institute in Sacramento began the Autism Phenome Project in 2006. They have been studying the brain growth, environmental exposure and genetic make-up of 350 children aged between 2 and 3 1/2 years, and have so far found two biologically distinct subtypes of autistic brain development.
One group of children - all boys - had enlarged brains and most had regressed into autism after 18 months of age; another group appeared to have immune systems that were not functioning properly.
Psychiatry professor David Amaral, who led the MIND Institute's longitudinal study, said the findings could lead to more individualised treatment. "The ultimate goal is when a child comes into the clinic, rather than saying you just have autism, to be able to say you have autism type A, or type B, or type C," Dr Amaral said.
Bruce Tonge, emeritus psychiatry professor at Monash University, agreed that many subtypes of autism were likely to emerge.
Currently, a number of people are also looking for other possible environmental contributing factors, and the interaction between the environment and a person's immune system might be an interesting possibility there."
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Environment
Immune system
Brain - Inflammatory markers
CSF - Inflammatory markers
...all found in autism
I don't see what your point is here. What did Dr. Aaby have to say about vaccines and autism- did he notice an association between autism and vaccination in the children of Ginnea Bissau?
It also clearly shows robust evidence of the immune system and autism particularly around the time the vaccine schedule is heaviest on the infant body.
This would underline the biological plausability of some sort of association and even causation between the two elements ie vaccines and autism as a Non Specific Event.
Which we now know occur and that our lack of understanding of these and the underlying mechanism is unknown at this stage.
I think it would also be of interest to medical authorities that there may be a large population cohort that has a significant immune system dysfunction that needs to be considered in the administration of vaccines.
...and finally one should be aware of the connection between Johns Hopkins research previously by the Neuroimmunology department that revealed inflammation in the brains and CSF of autistic patients.
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* "The high-titre measles vaccine (HTMV) was protective against measles
but associated with two fold increased mortality for girls.
* Hence, such non-specific immune stimulatory effects can be very important for child survival.
* However, the research community did not pursue these observations, but instead searched for a new and better measles vaccines.
* However, if a licensed vaccine could have such dramatic effect it can probably happen again unless we understand the specific immunological mechanisms.
* We have therefore aimed to document the importance of non-specific effects not only for measles vaccine but for all of the routine vaccines."
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Safe and efficacious medicine isn't that we all want. It may be a "Nirvana" but it is those ideals and beliefs that move us forward.
No system is perfect and without criticism ... it those unwilling to change, that bring criticism on themselves for they show that they are prejudiced and dogmatic.
One important thing to keep in mind about Guinnea-Bissou is that it has the 2nd largest under-5 mortality rate as of 2009 (193 per 1,000) between Chad (212) and Sierra Leone (192). It also has a nearly 40 per 1,000 spread between the sexes (212 males per 1,000 173 females per 1,000) It is possible (likely) that some of these deaths had to do with factors other than vaccination such as malnourishment, malaria, cholera, HIV making it tough to predict what the numbers mean.
http://apps.who.int/ghodata/?vid=180
So that makes you and fellow posters the 'gatekeepers' of all knowledge does it ?
There are other view points that are just as legitimate and come from a variety of perspectives.
"I have only now seen you admit that vaccines are a good thing and that they save lives"
You've only been blogging on Huffpost on this subject for a couple of weeks. You've made inaccurate and prejudiced assumptions, that's for you to address not me. You should have asked.
"I'm sure most people reading these comments would think you provided further encouragemÂent not to have their children vaccinatedÂ."
Why because people like yourself characterise those people as such ... ? I've made complete and open statements on my position several times.
"One important thing to keep in mind about Guinnea-BiÂssou"
Is that Aaby's work has been primarily replicated in other countries and with other demographics by other researchers ... that is why it is such a powerful message in regards to what our current knowledge of vaccines is.
That is also why an international team of scientists is being formed to investigate these matters.
Posters like yourself and Dyson are attempting to railroad real research that has the strong possibility of saving more lives potentially numbering in the millions.
http://www.bbc.co.uk/programmes/p00b1z4
http://www.bbc.co.uk/programmes/p00b6dt4
http://www.iom.edu/Reports/2011/Adverse-Effects-of-Vaccines-Evidence-and-Causality.aspx
"One of the most important findings was that a new measles vaccine used in low-income countries was associated with a two-fold increase in mortality among girls. This discovery led to the withdrawal of the vaccine. Had it not been withdrawn, it could have cost at least ½ million additional female deaths per year in Africa alone.
As illustrated by this example, it has been the experience that the most important health interventions, including vaccines and vitamin A supplementation, have non-specific and sex-differential effects."
Very interesting stuff here ...
http://www.bandim.org/index.php?background
I suggest you stick to the topic he raised and comment about the contents. If you prefer, rather than reading it all, you can skim the summary. If you wish to obsess at more length about the Bandim Health project I suggest you do it under one of the dozens of your old threads where you have been pimping the subject.
Your refusal to recognize vaccines while latching on to the vitamin A supplementation only discredits you. The Bandim project has made it pretty clear, as has the WHO, that vaccines save millions of lives a year.
The fear of being wrong may be the error preventing most new knowledge. Errors ought to be moments leading to new insight; instead they become dominated by fear of being wrong or of questioning institutional powers.
However, in the end, we will all be wrong, the real question being whether we were wrong in the right direction."
Peter Aaby Bandim Health Project
2004
doi:10.1016/S0140-6736(08)61345-8
http://www.vaccinestoday.eu/vaccines/eu-considers-%E2%80%98vaccination-passport%E2%80%99-for-kids/
If the EU - a group of 27 countries with separate vaccine schedules and a couple of dozen official languages - can look at this kind of option, surely the United States could do it very easily.
You mention the use of online vaccine records and smartphone apps, all of which are great for what they are worth. However, not everyone has a smartphone. Indeed, some of the highest risk groups are the least well-off.
http://www.vaccinestoday.eu/vaccines-for-me/new-electronic-vaccine-record-launched-in-switzerland/
Perhaps countries/states with electronic health records should integrate the vaccine record into this secure system, but that too will take time. http://www.vaccinestoday.eu/vaccines-for-me/vaccination-status-should-be-part-of-patient-records-says-mep/
Finally, although the term 'vaccine passport' is sometimes used (at least in Europe), it should be noted that there is nothing legally binding about this document. Your kids would not need it to move between countries. It's just an attempt to put a catchy name on something which is designed to facilitate mobility between European countries without disrupting the vaccination schedule.
500,000 lives a year ... saved.
mainly girls saved by a team of researchers who had a look without prejudice.
http://www.bandim.org/index.php?background
http://www.bandim.org/index.php?gallery
A 146 page booklet in PDF format is available from this link.
Bandim Health Project
Improving Child Survival
http://www.bandim.org/index.php?id=71,0,0,1,0,0
It does not include updated clinical research and controlled trial from 2010 and 2011 which have further evidenced the important work undertaken on the ground in Africa.
(I'm moving this up here)
You misunderstood my "interesting theory" about data manipulation. I said I trusted the pharmaceutical companies to post the results of their clinical trials without falsifying data. The data tweaking you're trying to rub in my face is something entirely different. Your article is about CeteroResearch, used by the drug companies to do early-phase contracted research. If you're so excited, here's another for you http://www.medscape.com/viewarticle/724381
I never said clinical data was never falsified; I said that drug makers wouldn't falsify the data on their trials or knowingly alter the results before going public. Sure, independent researchers/contractors have faked trials they were paid to do for pharmaco. Drug manufacturers get screwed over like everyone else. But they sure as hell didn't want that to happen; clearly you can tell the difference between Big Bad Pharma and Pharma the victim, can't you? If a company pays a contractor a substantial fee to do important work that needs to be done to specification, and instead that contractor just fakes the whole project and cashes the check it could end up costing them a fortune.
But here's what happens when a company does fake the results of a clinical study http://www.justice.gov/opa/pr/2011/April/11-civ-475.html It's not really that harsh of a sentence, though to be fair, it was perfectly safe, it just didn't increase the survival rate enough to pass for efficacy.
The example of Dr Thorsen is a classic. He was a middle ranking researcher on a couple of trials about autism/vaccines. Sometime after the studies were published and well after the time he did any of the work he was accused of misappropriating some CDC funds. In the eyes of antivaxers, this fact alone is sufficient to blacken all official autism/vaccine research for evermore. This is despite the accusations having nothing to do with his vaccine study work, and despite no case against him being proven - so its not even as though he has been found guilty of anything, let alone any research manipulation.
Yet look at Wakefield - he committed financial transgressions and serious research failings, and was removed from the UK medical register for proven serious professional misconduct directly related to his research, which was also patently frudulent. Yet apparently in the eyes of antivaxers everywhere, this makes him a heroic martyr, and not a dishonest fraud. There is no reasoning to it, and no reasoning with them.
Have you read the revised National Vaccine Plan?
http://www.nap.edu/openbook.php?record_id=12796&page=79
Sources such as the World Wide Web, blogs, message boards, and organizations both supportive of and opposed to vaccination contribute to the public’s decision-making process Keelan et al. (2007) analyzed 153 immunization-related videos on the video-sharing website YouTube. They characterized 48 percent as positive, 32 percent as negative, and 20 percent as ambiguous in their perspective on immunization. Interestingly, they found that negative videos were more likely to receive a rating, had a higher mean star rating,7 and received more views.
Layered on top of this are issues of corporate governance and genuine and transparent oversight.
"The data tweaking you're trying to rub in my face is something entirely different."
I remind you that this was your 'theory' . I've made no allegation of 'data tweaking' as you call it. Because their is evidence that undermines your argument is not my error.
Blaming the messenger is not a robust defense.
I'm not blaming you for anything. You said you found evidence of a drug company tampering with the results of a trial, and I merely pointed out that it wasn't. Yes, the drug companies care about money. They need a whole lot of operating capital, and if they want to stay in business and not get bought up by a bigger fish, they have to have revenue.
That doesn't mean they don't give a crap about product safety or efficacy. To do well, they need a strong pipeline and a good reputation. What use would it be to have a product that looked good on paper but didn't actually help (or even worse harmed) the patient? Any drug pharma develops has to stay on the market for a while before they can even break even. Why would they want to finish developing something that would be pulled before they saw a return on their investment, and ruined their reputation in the process?
http://stm.sciencemag.org/content/3/90/90ps27.abstract
Guzman Sanchez-ScÂhmitz Children’s Hospital Boston
Ofer Levy Harvard Medical School
Vaccines for early-life immunizatiÂon are a crucial biomedical interventiÂon to reduce global morbidity and mortality, yet their developmenÂtal path has been largely ad hoc, empiric, and inconsisteÂnt.
Immune responses of human newborns and infants are distinct and cannot be predicted from those of human adults or animal models.
Therefore, understandÂing and modeling age-specifÂic human immune responses will be vital to the rational design and developmenÂt of safe and effective vaccines for newborns and infants.
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Transparent data release would enable better medical intervention that may reduce negative consequences , some not fully explored or understood at this time, but also enable safer and more efficient vaccines.
The Bandim Project , Guinea-Bissau has shown how important this type of data collection is and the very positive benefits it may have particularly in the developing world at this time.
It has the potential to save millions of lives and give better health outcomes to millions more not only for one generation but many more.
I'm surprised that their is a "politik" that wants this type of information to be controlled or suppressed by private business concerns like pharmaceutical companies that have a less than impeccable record in these types of matters.
What I find strange is that you think there is some cabal of political and pharmaceutical conspirators who wishes to suppress and control information about the Bandim Project findings or other scientific work on vaccines.
Seeing as how this information is widely available in numerous scientific publications and numerous other ubiquitous sources on the web, it would appear that any attempt at a "coverup" is particularly half-hearted and has been spectacularly unsuccessful.
Workshop Day | Wednesday, March 2, 2011
8:00 Registration and Morning Coffee
9:00 Understand the Changes in the National Vaccine Plan to Maximize Government Sponsored Funding and Avoid FDA Scrutiny
Part I National Vaccine Plan
10:30 30 Minute Morning Networking Break
11:00 Part II Public Health Emergency Medical Countermeasure Enterprise
12:30 Lunch for Workshop Participants
1:30 Explore Emerging Markets to Successfully Implement Your Vaccine Platform and Expand Your Global Footprint
Part I The View from Inside — Emerging Market Perspective
Subhash Kapre, Executive Director, SERUM INSTITUTE OF INDIA
3:00 30 Minute Networking and Refreshment Break
3:30 Part II The View from Outside — Developed Market Perspective
Regina Rabinovich, MD, Director, Infectious Diseases, Global Health Program, THE BILL AND MELINDA GATES FOUNDATION
End of Workshop Day
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Wonder what they meant by "Avoiding FDA scrutiny" ?
Isn't the FDA the regulatory body that undertakes medicine safety including vaccines ?
Exchanges, but there are inherent incompatibilities because of their differing structure and data ontologies. The link through the national system for electronic health records is vestigial at best. I am previously familiar with the DHCP (mainly via laboratory usage) which is quite common, but its limitations and ability to blend with other systems is suspect.
However there is clearly no civil liberty issue about having this vital vaccination information readily available. Not only will it help get crucial information quickly in any emergency situation (eg dates of tetanus booster, rubella immunization in a pregnant woman) but it would record medical exemptions and any core health reasons for this.
It will also be able to know how many people choose to leave their kids vulnerable to infection by not getting them vaccinated.
The data on vaccinations and specifically on the rate and reason for exemptions would be very helpful to those in public health and disease epidemiology. One could take this even further and use it to record vaccine reactions, something people who worry about this would welcome.
"I just want the statisticaÂl numbers anonymous."
What do you mean? Do you want patient information to be anonymous?
Which is something that seems to be in common with the current crop of 'experts' pushing medicines on infants and children when there is a growing body of evidence and real expert opinion that vaccines have serious Non Specific Effects.
There are enormous implications for vaccine progammes not only domestically but particularly in the developing world. Including child mortality.
http://wwwÂ.ncbi.nlm.Ânih.gov/puÂbmed/17484Â223
http://wwwÂ.ncbi.nlm.Ânih.gov/puÂbmed/21093Â496
http://wwwÂ.sciencediÂrect.com/sÂcience/artÂicle/pii/SÂ0264410X06Â01111X
Any reasonable person is concerned that we have a clear knowledge base on which to rely on when it comes to drugs and vaccines.
I would suggest that this includes the real and transparent release of all data surrounding such items as clinical drug trials and any other pertinent information to which an objective evidenced based decision may be made.
One could then begin the task of doing clear clinical research on Non Specific Effects as it pertains to the "Western world" and set up longitudinal studies on a range of vaccine issues.
Surely that is a better option than continuing to cry out "Wolf".
All that aside, I'm all for records keeping, clinical trials and publication of the data. You might find this website useful
http://www.clinicalstudyresults.org/search/
I did a search on measles, mumps & rubella; one on human papillomavirus vaccines; and one on pertussis, and they all came back with hits (including hits for vaccine trials). If you just scroll down to "vaccines" and search you get no hits, which is probably because of the current hysteria. I didn't read any of the results/reports on the clinical studies. I'll leave that up to you to read and get back to us on.
http://en.wikipedia.org/wiki/Bandim_Health_Project
The Nonspecific Effects of Vaccines and the Expanded Program on Immunization
http://jid.oxfordjournals.org/content/204/2/182.extract
"There is now clear evidence that the simplistic conventional model of immunization is invalid. We can no longer assume that a vaccine acts independently of other vaccines, or that it influences only infections caused by the target disease.
Randomized trials show that measles vaccine has strong nonspecific effects. Providing it is not given after vitamin A or followed by DTP, measles vaccine reduces mortality from diseases other than measles by 45% (95% confidence interval [CI], 14%–65%) when given at 4.5 months of age, and by 47% (95% CI, 23%–63%) when given to girls at 9 to 10 months of age .
...Aaby et al present further evidence, from Guinea-Bissau Low-birth-weight neonates were randomized to receive BCG at birth or via the routine immunization program at an older age (median, 7.7 weeks). The biological effects of BCG are shown by the outcome during the first 4 weeks after randomization, before children in either group had been given DTP and when few children in the control group had received BCG. In this period, BCG reduced mortality by 45% (95% CI, 11%–66%); there were fewer deaths from sepsis and acute respiratory infection, and no deaths from tuberculosis."
Did you read through the studies you linked?
The first study said that girls were more likely to die after polio vaccinatioÂn than boys.
Girls had similar mortality rates to boys after being vaccinated for measles and similar rates for polio vaccine if they were vaccinated for measles at 9 months.
girls who had already received all 3 doses of DTP vaccine had a lower mortality rate than girls who had not received all 3 doses of DTP (and therefore probably received the third dose after being vaccinated for measles and polio) but this was not true for boys
Girls had a lower mortality rate when the measles vaccine was the most recent given (rather than polio or DTP)
Second study
Adverse events were more common in the MV+DTP+OPV group vs. MV+OPV group
Girls in the DTP group were more likely to get diarrhea and need medication than girls in the non-DTP group. This was also true for febrile disease with vesicular rash and hospitalizÂation.
Girls in the DTP group grew less (in height, weight and upper arm circumfereÂnce) than girls in the non-DTP group, but the opposite was true for boys (who experienceÂd greater growth in the DTP group).
Or maybe you only want to restrict government access to private medical records when it doesn't directly benefit your beliefs about vaccines and autism?
Look under "validation" on my website. @ www.autismrawdata.net. Vaccines do cause autism in children who are predisposed. The question is, how many children and what causes the brain injury pattern. Lucky the CDC just announced they are launching a 5-year research agenda to answer those questions. Also the good scientists at UC Davis have been working on this for years and have made great strides in discovery.
The government doesn't have any right to my personal records. We the people are in charge here in the US. Our governments role is to protect our trade routes and borders and keep the machine being our Country going. They have no right to access my medical records! In the wrong hands it could bring terrible consequences for some.
However, I fail to see why anyone might wish to conceal medical records that could prove vital to someone's life.
My education is in radiation exposure and I have to say the Ottawa watch dial painters medical records are open for educational purposes. There are others, what I find interesting is when a child has a vaccine event they are put in the far corner in order to sustain the program. Like we cannot talk about adverse events like in radiation exposure, even-though we expose people with radiation everyday on purpose. This is arcane and should end.
There is a subset of the population that should not be vaccinated (my son). We should validate the injury, understand the pattern and spare the vulnerable!
I would also like to add that today my son is covered with a measles rash. His blood draw states that he has a virus. His dermatologist states there is nothing we can do about it, so does his developmental MD's. This is a pattern after is MMR.
continued
If a parent or patient would like to enter their medical records for scrutiny then so be it. It did that with my son's records with the CDC. I had to signs records for 2 months in order for the study to commence. I wanted to know what the CDC's epidemiologists had to say - my son is vaccine injured, confirmed (sadly)!
Occasional antibody tests might be appropriate. That way can see what diseases the person in fact needs immunization against. We are skipping some of my son's immunizations required for middle school because of the antibody levels. He does have to get the chickenpox vaccination.
I just got my shingles immunization since I did have chickenpox as a child. I also was immunized with a defective batch of early polio vaccine - it had unkilled polio virus in it and caused polio in some of its recipients. Vaccines are much safer now then they used to be.
For more information see: www.autismrawdata.net
"Also vaccine safety is unknown for long term use..."
That's not really a true statement. There are plenty of vaccines that have are demonstrably safe, and cause no ill health effects over long periods of time. There might be *some* vaccines where long term safety is not yet tested, but that's an entirely different statement.
You should learn how to make accurate statements, rather than broad, sweeping, inaccurate ones. It will go a long way towards helping your cause/argument.