Monday, November 16, 2009

The Price of Fear: The Rise of Anti-Vaccination Movement and the Decline of Public Health

To vaccinate, or not to vaccinate? That seems to be the question. Growing numbers of concerned parents seem to be choosing the latter if the exceptionally low turnouts at New York City's free H1N1 vaccine clinics are any indicator of public opinion. In a city where free giveaways disappear in minutes, this is certainly surprising. Organizers are trying to determine if people are shying away due to assumptions about the populations the free clinics tend to serve, or if it's fear of the vaccine itself. They are hoping word of mouth will relay that the clinics are clean, safe, and FREE, and increase use in the coming weeks—lives may depend on it.

Last month, I discussed the panic surrounding the H1N1 virus and the anxiety about the vaccine. This month, Wired's feature, An Epidemic of Fear, traces the anti-vaccine movement and pediatrician Paul Offit's efforts to neutralize the propaganda spawned by the belief that vaccines can result in neurological impairments in children, including autism. As co-inventor of a rotavirus vaccine, Offit has been hyped as pharmaceutical spokesperson whose only objective is to have your child injected with as many vaccines as possible, so he and his pharmaceutical overlords can turn a profit. He has been called a "biostitute" by Robert F. Kennedy Jr. And countless other politicians and celebrities have joined in denouncing Offit publicly. [Image Left: H. Fred Clark and Paul Offit, the inventors of RotaTeq, a pentavalent rotavirus vaccine. Credit: The Children's Hospital of Philadelphia.]

Offit maintains that vaccines do not cause autism or any of the other conditions that have been attributed to them. He supports this claim with actual evidence—not pseudoscience, not half-truths, but evidence. While some claim that autism is the result of toxins that must be flushed out of the system or a vitamin D deficiency, the scientific community continues to find evidence that the autistic spectrum may be largely genetic:
Twelve epidemiological studies have found no data that links the MMR (measles/mumps/rubella) vaccine to autism; six studies have found no trace of an association between thimerosal (a preservative containing ethyl-mercury used in vaccines until 2001) and autism, and three other studies have found no indication that thimerosal causes even subtle neurological problems.
Vaccines and autism have been linked because the signs of autism and other neurological impairments begin to show at about 18 - 24 months—coincidentally, just about when children are getting multiple vaccines. Brandishing this correlation as proof, vaccination rates in certain parts of the United States have fallen so low that certain childhood diseases which had been eradicated are reappearing at pre-vaccine levels, as in the case with the recent outbreak of mumps in Brooklyn. And unfortunately, the non-vaccinated tend to cluster, so the risk of disease which increases the chances of an outbreak becomes greater in certain areas.

The anti-vaccine movement is not new. In the 19th-century, when Edward Jenner produced the vaccination for smallpox, people were hesitant to take it because they did not understand how it worked. (Jenner developed the vaccine in 1796, but it would take approximately 100 years for scientists to have the tools to understand how it worked, and even more time would have to pass before the right tools were available to understand the cause of smallpox.) Despite the institution of the Compulsory Vaccination Act in 1853, people still refused the vaccine, and thousands died. Smallpox broke out again in England and Wales. However, Ireland and Scotland, where there were high vaccination rates, did not suffer from this outbreak. A look at more recent events in the history of the anti-vaccine movement is available here. Despite this type of actual physical evidence, the question remains: why the fear? [Image Left: Edward Jenner.]

Offit maintains that the early anti-vaccine supporters were fantastic marketers. In 19th-century England, they were able to command the written word with spectacular flourish. It was a time when people hungered for information, which was disseminated via carefully constructed pamphlets, and the anti-vaccine proponents were professionals at utilizing this medium. Interestingly, communication and sharing information is also a reason that the anti-vaccine movement continues to survive today:
The Internet offers a treasure trove of undifferentiated data, research, speculation, half-truths, anecdotes, and conjecture about health and medicine. It is also a democratizing force that tends to undermine authority, cut out the middleman, and empower individuals ... Thanks to the Internet, everyone can be their own medical investigator.
Echoing recent discussions on this blog of late, it seems that the issues of authority and identity on the Internet are once again in question. The Internet has made it easy for everyone to market their ideas and causes. There are online communities and Facebook pages where you can go to get and share information, you can sign up to follow Tweets from "experts"—the point is that it is easier than ever to share information and to spread information. Social bookmarking tools mean that the click of a button can post a story on most major social sharing sites. This means that facts are stacked alongside half-baked theories.

Referencing the discussion on the management of knowledge by Cori Hayden's in When Nature Goes Public: The Making and Unmaking of Bioprospecting in Mexico, it's great that the Internet has provided people with the tools to access information and produce information based on their own evaluation of available material—information should not be owned and used solely for the purposes of big pharmaceutical companies. However, people should be accountable for the information they post. But I suppose this is only a stones-throw away from the type of policing Park Dae-Sung was subject to. The ways in which the Internet can be utilized ethically remains a gray area.

But that still leaves the question of why people continue to believe in the anti-vaccine movement despite the success of vaccines. Astronomer Carl Sagan suggested that belief in pseudoscience prevails because science can be cold and cruel and unyielding, whereas pseudoscience allows for hope. According to Sagan,
"There are unsatisfied medical needs, spiritual needs, and needs for communion with the rest of the human community."
That is, every parent wants to believe that a sick child can be healed, and it is easier to believe this if you can point a finger at something concrete as the underlying cause of the illness. Vaccines are an easy target. They work by introducing a foreign agent into the body, which the body attacks and remembers how to attack in the future. The foreign agent can be killed microorganisms (used in vaccinations against flu, cholera, bubonic plague, polio and hepatitis A); live, altered microorganisms (used in vaccinations against yellow fever, measles, rubella, tuberculosis, and mumps); toxic compounds as is the case with diphtheria and tetanus shots; protein subunits; conjugates; as well as a number of innovative agents. The thought of introducing anything foreign into your body, willingly, is frightening, granted. You essentially must infect yourself to protect yourself. Post-vaccination, you may feel effects of the foreign agent: the flu vaccine may leave you feeling achy, feverish—in essence, flu-ish. The vulnerability that people are subject to is unpleasant and undoubtedly unsettling. It is easy to lay blame at the feet of vulnerability—vaccines made you vulnerable, so they are responsible for the resulting ill consequences.

But there is something else beyond the discomfort, beyond the fear of the foreign agent—we've forgotten. Science has gotten so good at protecting us that we haven't really faced an epidemic recently, and the benefits of vaccines are fading from present day memory. Historian David M. Oshinsky, author of Polio: An American Story, provides the two following examples of the response to vaccination in the face of need:
In 1947, a man newly arrived in New York City from Mexico died of smallpox. The authorities “lined up the entire city” and vaccinated everyone, even those who had already been vaccinated.
Then there were the polio vaccine trials of 1954, in which parents volunteered more than a million children to receive either an experimental vaccine or a placebo.
According to Dr. Oshinsky, in the first example, the entire city was revaccinated, and without resistance because people seemed to understand that the risks associated with the vaccine were far less than the risks associated with getting sick. In the second example, epidemics were still a part of the recent collective memory, so people were aware of the risks again. In this age of information, we seem to have rationalized ourselves out of taking preventative measures to ensure that we remain healthy.

The anti-vaccine movement survives on the strength of network connections. We want to belong to the group, so when others in our community assume a cause, we are more likely to be sympathetic to that cause than others. We know the person promoting the cause—they're not "crazy" or misguided, after all. We know their story, their plight. In this case, we may have witnessed their pain and the struggles they have faced with their autistic child. And, as noted, the Internet means that these people can speak knowledgeably about their child's challenges—who can speak better about the subject of autism and the challenges of raising an autistic child than the parents of an autistic child? So others sympathize, and with that sympathy comes an inkling of fear for their own children. And perhaps some guilt. And maybe also a belief that their neighbors expect support. So the network propagates the belief that vaccines can be harmful.

But what of those who cannot be vaccinated for medical and health reasons? Children with cancer cannot be vaccinated—and it is not by choice. With the risk of death looming from preventable diseases, these children cannot afford to associate with those who can luxuriate in the choice of vaccination. They need us to be vaccinated in order to survive. Vaccines are not risk free, but they greatly reduce risks associated with facing certain diseases unarmed.

Is it there a disconnect between science and the general population? How is it that in spite of the wonders of the web, information is distorted?

For more information on vaccines, you may want to visit the CDC's FAQ on vaccines. And here is a list of myths versus facts concerning vaccinations.

You may be also be interested in viewing the responses to the Wired article here, but please feel free to chime in below.


  1. Excellent, calm, thoughtful post. Thank you.

  2. Thank you, Wendy. Help spread the word about vaccinations!