No funds if you use thimerosal : NPR

A health worker in Mali prepares a vaccine that protects against five diseases: diphtheria, tetanus, meningitis, whooping cough and hepatitis B. In vials like this, which contains several doses, thimerosal is used as a preservative that can prevent contamination.

Jürgen Bätz/Picture Alliance/via Getty Images

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Jürgen Bätz/Picture Alliance/via Getty Images

The U.S. government has issued an ultimatum to the international group that helps provide vaccines to children in the world’s poorest countries.

In a statement sent to NPR, the Department of Health and Human Services said Gavi, the Vaccine Alliance, must remove the thimerosal ingredient from its vaccines — or the United States will “withhold any new funding in the future.” The news was first reported by Reuters Wednesday.

At the heart of the US request is an unsubstantiated theory that mercury in thimerosal may be linked to autism. Thimerosal is a chemical compound added to vaccines as a preservative.

It’s the latest development in the evolving relationship between Gavi – which claims to have provided vaccines to 1.1 billion children in low-resource countries and averted 18 million deaths – and the United States, once a major funder of the vaccination group.

In June, the Trump administration cut more than a billion dollars previously promised to the group. At the time, HHS Secretary Robert F. Kennedy Jr. said Gavi “ignores the science” when it comes to vaccine safety.

Today, thimerosal has become a new sticking point in the relationship between the United States and Gavi.

Although thimerosal has been used safely in drugs and vaccines since the 1930s, it is also the subject of a long-running debate that reignited nationally last year. With this week’s request of HHS, the controversy becomes global. And, experts say, the potential impact is much greater abroad than in the United States. Indeed, this ingredient is essential to prevent contamination of vaccines contained in vials containing several doses, often used in countries in the South.

“The stakes are much higher in low-income countries,” says Dr. William Mossprofessor at the Johns Hopkins Bloomberg School of Public Health and executive director of the International Vaccine Access Center.

Here’s more on the debate and the potential consequences.

Why and where is thimerosal used?

Thimerosal has a particular antimicrobial property: it is very effective in preventing the growth of bacteria and fungi. So, for decades, it has been added to vaccines to avoid any contamination.

This is particularly important for multidose vials. For example, a vial may contain 10 doses of the given vaccine. When a syringe fits into a bottle to draw up liquid, there is a risk of introducing germs. The presence of thimerosal discourages the growth of any germs.

In the United States, the use of thimerosal has “decreased significantly,” according to at the FDA – partly because vaccines are now packaged in single-dose vials. Europe also relies heavily on single-dose vials.

However, in many Gavi-supported locations, multidose vials are regularly used.

“High-income countries can afford single-dose vials, which are more expensive – and more expensive to transport and store,” says Moss. “But low-income countries have to maintain a cold chain and they simply don’t have the refrigerator space to be able to store single-dose vials.”

It is common for low-income countries to use multidose vials for vaccination campaigns that last days or weeks, when large numbers of children are vaccinated. “It’s very effective and cost-effective to use these multidose vials as long as they’re not contaminated with bacteria or fungi – and that’s exactly what thimerosal does,” says Moss.

Indeed, approximately 14% of Gavi’s portfolio consists of thimerosal-containing vaccines in multidose vials, including the 5-in-1 vaccine. pentavalent vaccinethe DPT vaccine which protects against diphtheria, tetanus and whooping cough and the hepatitis B vaccine.

Why all this fuss?

Thimerosal contains approximately 50% mercury by weight.

This arouses suspicion in certain circles. “People think that the T-1000, Terminator 2 — liquid metal that will cause serious brain damage,” says Angela Rasmussenvirologist at the University of Saskatchewan and co-editor of the scientific journal Vaccine.

In reality, she said, the type of mercury it contains is ethylmercury which leaves the body quickly and is not harmful in the amounts found in vaccines. Methylmercury is a more dangerous type of mercury and can build up in the body when people are exposed to it in their environment or in certain foods, such as fish.

“The dangerous mercury that could be toxic from a single thimerosal-containing vaccine is less than what you would get from eating a tuna sandwich,” she explains.

Leading health institutions agree with Rasmussen: Thimerosal has the blessing of World Health Organizationwhose advisory committee found “there is no evidence of toxicity in infants, children, or adults exposed to thiomersal present in vaccines.”

Likewise, US federal agencies have deemed it safe. The Centers for Disease Control and Prevention states on their website that “research shows no link between thimerosal in vaccines and autism.” And the Food and Drug Administration has find that “scientific evidence collected over the past 20 years shows no evidence of harm.”

However, HHS Secretary Kennedy disagrees.

And the State Department told NPR that it’s RFK Jr. who’s taking the lead here. In a statement, he said: “President Trump has trusted Secretary Robert F. Kennedy Jr. to manage the U.S. government’s relationship with Gavi. »

Kennedy has long campaigned against thimerosal. In 2014, he published a book called Thimerosal: Let the science speak: the evidence supporting the immediate elimination of mercury – a known neurotoxin – from vaccines. This summer he said in a video that mercury found in thimerosal is a “very potent neurotoxin,” explaining his decision to order the removal of thimerosal from all flu vaccines in the United States

However, the decision did not have a huge impact because only about 6% of flu vaccines contained thimerosal.

In 2001, the United States removed thimerosal from almost all vaccines commonly given to children under 6 years of age as a precaution. The American Academy of Pediatrics explain that this decision was made because all the misleading claims about thimerosal were “eroding public confidence in the safety of vaccines”, and that she did not want to risk children not being vaccinated.

THE CDC website points out: “Even after thimerosal was removed from almost all childhood vaccines, autism rates continued to increase, which is the opposite of what would be expected if thimerosal caused autism. »

The status of the ultimatum

The United States is requesting from Gavi “a detailed action plan with a timeline for phasing out thimerosal-containing vaccines,” according to an HHS statement to NPR. The objective, indicates the press release, is to “bring the poorest countries into compliance with the standards of the United States, Canada, [and] most European countries, which have long since abandoned thimerosal-containing vaccines for children.“

Gavi, in a statement to NPR, said, “We remain in contact on this topic,” explaining that any changes “would require a decision by the Gavi board” and that it “would be guided by scientific consensus.”

“It’s basically extortion,” says Rasmussen of the University of Saskatchewan of the Trump administration’s demands on Gavi. “They say: Do the Trump things. Do the MAHAM things. Align with our policies – in the absence of evidence – and we won’t take all your money away.”

Potential implications of new US demand

Gavi has not indicated that it will comply with this request. The HHS statement said: “Gavi declined to expand on this [phase-out] “Nevertheless, vaccine experts are concerned about what could happen if Gavi agrees to remove thimerosal from its vaccines.

This would make “vaccines more expensive in developing countries, which means they would be accessible to fewer children,” says Dr. Paul Offitpediatrician and director of the Vaccine Education Center at Children’s Hospital of Philadelphia. The bottom line, he said, is clear: “Children will undoubtedly die because these vaccines are not available.”