In 2016 a recent National Health Performance Authority report showed the region's average vaccination rate for 5 year olds was reportedly still the lowest in the country at 89.2%. The North Coast Assistant Public Health Director warned "Pockets of unvaccinated people in the region was the cause for the rise and fall in whooping cough cases... because we do not have herd immunity to the illness on the Northern Rivers". The Australian Vaccination-Skeptics Network believes that vaccines contain a variety of toxic ingredients that have no place in the human body. The group argues that these toxins can cause autism, ADHD, brain damage, and cancer, among other serious side effects. In response to medical and scientific research that shows few side effects to most vaccines, Dorey argues that doctors are very hesitant to report adverse reactions and thus the data is highly skewed. These claims are false: while minor side effects such as soreness, swelling, and fever are not uncommon, no large scale scientific study has found evidence of more serious reactions and the purported link to autism is refuted. Former president Meryl Dorey claimed that most doctors are not fully informed about vaccination research and that the medical community as a whole relies on "selective evidence" to back its argument. She says there is a "very, very strong effort" by the government and mainstream medical community to suppress any information that may cause parents to question the safety of vaccines. Consequently, Dorey argues, doctors often don't adequately warn patients of potential vaccination risks. Several critics have pointed out that AVN itself is guilty of ignoring evidence not favourable to the anti-vaccination point of view and the NSW Health Care Complaints Commission (HCCC) found that the AVN routinely ignore information that is not favourable to its anti-vaccination position. The HCCC accused the AVN of deceptively removing selected parts of stories when they report on them, and the misrepresentation of the conclusions of reliable studies. Dorey countered that she was not guilty of selective reporting, and that she "simply quoted the sections that [she] felt were important". In reality, doctors have access to extensive information on vaccine safety and the medical literature includes all known significant potential adverse reactions. The AVN has also questioned the effectiveness of vaccines. While admitting that infection rates dropped dramatically in the twentieth century, they argue that the change is due in large part to improved hygiene and living conditions. Dorey has argued that infection rates were already on the decline before vaccines were invented and that effectiveness has "never been scientifically tested."