Yehuda Shoenfeld is a well-known immunologist with a long career. Formerly at Tel Aviv University in Israel, he now runs a center for autoimmune diseases at Sheba Medical Center, Israel’s largest hospital. He is editor-in-chief of both journals of the Israel Medical Association (IMA), serves on the editorial board of dozens of other journals, and was elected a member of the Israel Academy of Sciences and Humanities in June.
Yet a group of Israeli doctors says his ideas are a danger to public health.
Shoenfeld has long espoused theories popular among antivaccine advocates and spoken at their meetings, causing tensions with the Israeli medical community. The issue came to a boil in September, when Shoenfeld decided to publish a positive review of an anonymous antivaccine book in Harefuah, IMA’s Hebrew-language journal. The two reviewers, who did not have a medical background, wrote that the book “raises a strong suspicion that key aspects of vaccine safety have not been properly tested.”
The response was swift. Shmuel Rishpon, chair of Israel’s Advisory Committee on Infectious Diseases and Immunization, resigned as editor of Harefuah. Israel’s Association of Public Health Physicians called for an investigation and Shoenfeld’s resignation as editor-in-chief. The association is considering calling on authors and reviewers to boycott Harefuah, its chairman, Hagai Levine, tells Science.
Shoenfeld defends his decision and says the medical community is trying to silence vaccine critics. “If you write something about vaccines which doesn’t say that everything is OK … all the vultures are jumping on the one who writes it,” he says. IMA did not respond to Science’s questions.
Shoenfeld’s association with the antivaccine movement goes back many years. In a 2011 paper, he proposed that adjuvants, compounds such as aluminum added to vaccines to boost an immune reaction, can lead to a chronic activation of the immune system that he called autoimmune/inflammatory syndrome induced by adjuvants (ASIA). Shoenfeld has published many papers on the syndrome, which vaccine critics cite as a danger of vaccination.
Adjuvants’ side effects are a “valid issue,” says immunologist Ruth Arnon of the Weizmann Institute of Science in Rehovot. Although Arnon has not read the review, she says she considers Shoenfeld “one of the most prominent world experts on autoimmunity” and welcomes his election into the Israeli academy, of which she is a past president. The current president, Nili Cohen, a legal scholar, says Shoenfeld was “supported by the best scholars relevant to the field.” “Science is not necessarily based on consensus,” she wrote in an email. “Progress in science has been occasionally fueled by controversies.”
But ASIA is ill-defined, says pediatrician Paul Offit of the Children’s Hospital of Philadelphia in Pennsylvania. Symptoms are said to appear up to 2 decades after exposure to an adjuvant and include anything from dry mouth to memory loss. Nor do epidemiological studies support the idea, Offit says. A 2012 study analyzed data from more than 18,000 people who were given a high amount of aluminum under the skin, as part of an immunotherapy against allergies; as researchers pointed out in a 2017 paper, they had a lower rate of autoimmune disease than controls. “Shoenfeld continues to push this frankly ill-conceived and arguably disproven notion despite the evidence,” Offit says.
A 2016 study by Shoenfeld claimed to show abnormal behavior, caused by ASIA, in mice given the human papillomavirus vaccine or an aluminum adjuvant. The study was published in Vaccine, but later withdrawn. “Review by the Editor-in-Chief and evaluation by outside experts confirmed that the methodology is seriously flawed, and the claims that the article makes are unjustified,” a note on Vaccine’s website states. The paper was republished a few months later under almost the exact same title in Immunologic Research, where Shoenfeld is on the editorial board.
I write that vaccination is the most important invention in medicine in the last 300 years. So how can I be antivaccine?
In their review in Harefuah, the authors write that the anonymous book suggests vaccines’ benefits are exaggerated while health agencies “ignore the possible link between chronic diseases and vaccines.” Shoenfeld says immunologists declined to review the book, but the authors he selected, both criminologists, were “very knowledgeable on vaccines.” (The authors themselves say in the review that “we had no prior knowledge of the subject of vaccines and their safety.”) The letter by the Association of Public Health Physicians says Shoenfeld “acted unethically” by not consulting Rishpon or other editorial board members with relevant expertise and calls his behavior “reminiscent” of that of disgraced antivaccine doctor Andrew Wakefield.
Shoenfeld denies being opposed to vaccination: “I write that vaccination is the most important invention in medicine in the last 300 years. So how can I be antivaccine?” Asked about his appearance at an antivaccine conference in Jamaica in 2011, Shoenfeld says he went there “by mistake.” “I didn’t know where I was going.” Shoenfeld has spoken at several such conferences, however; in May, he was one of three “featured speakers” at the AutismOne conference in Rosemont, Illinois, a major gathering of people who believe vaccines cause autism. (Wakefield gave a talk as well.) Shoenfeld also served on the scientific advisory board of the Children’s Medical Safety Research Institute, an international antivaccine charity.
Shoenfeld also regularly appears as an expert witness for people claiming injury from a vaccine. Court records show that this year alone, he has claimed more than $46,000 in fees for testifying at the Office of Special Masters of the U.S. Court of Federal Claims, which adjudicates vaccine claims. Under U.S. law, plaintiffs must present a theory that explains how their symptoms are caused by a vaccine; Shoenfeld argues ASIA fits the bill.
The courts, so far, have rejected the theory. In a recent case, the judge found that ASIA “is not generally accepted in the medical community and its diagnostic criteria do not differentiate between healthy and ill people.” In another case, cross-examination suggested “biases” as well as “apparent misrepresentations” on Shoenfeld’s CV, according to the court. Although the judge did not find Shoenfeld unqualified to testify, he concluded that his “combative response to this questioning, coupled with outright evasiveness in responding to certain questions regarding his background, did reduce his overall credibility as a truthful witness.”
The World Health Organization recently named “vaccine hesitancy” one of the 10 health threats facing the world. His elevated position means Shoenfeld “has the potential to cause a lot of harm,” says Dorit Reiss, a law professor at the University of California’s Hastings College of the Law in San Francisco who works on legal issues around immunization and wrote a lengthy blog post about the case last month. “He’s well-connected and influential.”
Rishpon says Shoenfeld has refused to publish a letter in Harefuah criticizing the publication of the review. The letter was resubmitted yesterday for publication on the journal’s website, Rishpon says, cosigned by all members of Israel’s Advisory Committee on Infectious Diseases and Immunization. “The publication of the article is a serious failure of the editorial board and seriously damages public health,” they write. Rishpon says he expected IMA to fire Shoenfeld, but says he has seen no response at all.
Offit agrees that Shoenfeld should not lead medical journals. “What do you do when he becomes a public health hazard?” he asks. “I think you have to lessen his platform.”