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SKEPTOID BLOG:

Paying The Toll For Anti-Vaccine Rhetoric

by Stephen Propatier

January 30, 2015

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Donate The anti-vaccination movement has run atwo-decade-long campaign of fear-mongering. It's a well-funded campaign with aprovocative narrative. They warnanyone whowill listenthat vaccines are dangerous, useless, and that they may cause autism. They spread propagandaoriginating from a fabricated 1998 study by ex-medical doctor Andrew Wakefield. It continues to be adifficult misinformation campaign to blunt. Wakefield's proposed autism-vaccine link is now completely debunked,yet theanti-vaccine movement finds new reasons to fight vaccinations. The movement has responded with disdain to themountain of evidence showing safety and efficacy. What began as fear surroundingautism has become a more generalized and less specific narrative. Whenever a specific objectionhas been disproven they changethe argument, consistently, ideologically, skewing or even replacing the facts to fit their preferrednarrative that vaccines and vaccination schedules are unnecessary and dangerous. Despite vitriolic rhetoric from the anti-vaccinecommunity, the science clearly shows thatvaccines arelow risk and high reward"a consensus shared by the vast majority of medical and public health organizations. Now, ameasles outbreakin the state of California presents ascenario that epidemiologists havefeared for years: the decline of herd immunity and the return of vaccine-preventable diseases with all their fury.

Vaccines have been, for the most part, a victim of their successes. 80 years ago diseases that are nowvaccine-preventable were common; birth defects, disfigurement, iron lung wards, and child fatalities were a part of daily life. There are still people walking around todaywith permanent disfigurement and paralysis from that era. Unfortunately, humans have a short memory for this type of tragedy. Iron lung wards and high infant mortality are now a thing of the past, in the developed world (for now). For vaccinatedgenerations theimmediacy and the fear of those diseases has waned. The security of modern medicineplus 20 years of unrelenting scaremongering and misinformation have caused a slow decline in vaccination rates.

There have always been fear-mongers related to vaccines. What changed for the Western world over the last 20 years was the absenceof the diseases. The children of the 1970s and 1980s for the most part had high vaccination rates. Anti-vaccine rhetoric didn't get much traction in that group because those parents lost childhood friends and siblings, saw the iron lung wards and spent summers unable to go in the pool due to polio. For them, vaccinating their children was no-brainer. Theirchildren, however, grew up never knowing a friend who died of polio, never saw a friend disfigured by smallpox, and never lost a baby brother to whooping cough. For the children-turned-parents of that generation the danger seemed faint and unreal, medical history rather thanreality.

In the 1990s, fears about autism and mercury made the danger of vaccinations seem much more real and palpable than the benefits, especiallyto those same disease-freechildren-turned-parents. No one at that time knew thatWakefield's paper was a fabrication,done so that he could market his own competing vaccine. In the wake ofhisforgery, anti-vaccine rhetoric gained traction: laws were changed, exemptions were given, misinformed parents refused vaccination. Whenthe medical community realized that the anti-vaccine rhetoric was gaining traction, the information push-back came late. It lacked the star-studded, well-funded polish of the anti-vaccine rhetoric. Those of us in the medical community have been trying to debunkthe rhetoric for years, butit has become a game ofwhack-a-mole nonsense. Knock down one ludicrous objection and another one arises. Everyone in the medical community and public health community knewthat that sooner or later the bill for this foolish ideology wouldcome due.

Now I believe we are seeing the first signs that vaccination rateshave reached a tipping point negatingherd immunity. Although herd immunity is called a myth by the anti-vax crowd it has been protecting the unvaccinated since their movement started. Nowthe informed are no longer numerous enough to protect the misinformed.

California is struggling withacontinuing measles epidemic and it is rapidly becoming a historic event. Disease investigators have yet to find "patient zero," or the person who triggered the outbreak. Officials at the California Department of Public Health said it was most likely an infected woman who visitedlocal theme parks. The illness was then spread to other visitors, many of whom were not vaccinated. Health officials have identified 73people in four states who have contracted measles. The vast majority of infections(35) are in California. Utah recorded two cases, while Colorado and Washington state each had one case. Most fell ill after visiting Disneyland or Disney California Adventure in December, while some were exposed to people who traveled to the theme parks. The incubation period for people exposed at Disney parks ended last week, and health officials are on the lookout for secondary infections. An NBC affiliate in the Bay Area reportedthat shoppers at aCostco and a nearby Walmart may have been exposed by an infected patron on January 18. The shopper may also have visited a nearby restaurant; however, the name of the restaurant has not been released.

California has long been a center of anti-vaccine successes. It has had a large increase in vaccine opt-out rates.To opt out, parents must file a personal belief exemption, or PBE, a signed statement avowing thatvaccines are against their personal beliefs. Most states have a medical exemption, but California is one of the biggest to have a personal belief exemption, and theirs is especially permissive. In the 2007-2008 school year, the statewide-PBE rate was 1.56 percent.By 2013-2014, the most recent year statistics are available, the rate had jumped to 3.15 percent. Adults are at fault, not only for not having their kids vaccinated, but also for not seeking vaccinations themselves, including those who have failed to get booster shots. Adults need vaccinations if:
  • Theywere never vaccinated as children

  • Newer vaccines were not available when theywere children

  • Immunity can fade over time

The facts of the outbreak have lit into the anti-vax community. There isno shortage of the usual platitudes from the anti-vax ideologues, mostly post-hoc contortions trying to blame this development on the use of vaccinations. It has taken an event of this magnitude to swing public opinion. National news outlets,previously friendly or acceptingto the anti-vaccine hysteria, are now beginning to turn on the anti-vax community. Some are rightly pointing out that the decline in California vaccinations is contributing to the uncontrolled spread of measles.

It is a sad commentary that return of preventable illness will probably be the only way to derail the anti-vaxnarrative forthe general public. I am just worried how many people will have to become ill, how many mighthave to die of preventable diseases, before we see the type of strong public health initiatives of the 1950s. No one can say with certainty,but many epidemiologists are surelyhoping that this outbreak mightswing public health policyin California. That state is especially at risk since it is very populous and hasa large immigrant and tourist population that is high risk for bringing active disease to the US, as here.

I fear that the final impact of reckless disinformation has yet to be felt in the world. Hopefully, it will not take bigger and more deadly epidemics to reversewhat has become a religious level ideology for some people. Maybe, just maybe, we can usethis relatively small event to turn the tide in California. Maybe it will spur a return to more sensible vaccination policies and inspire people to question the gutting of public health lawsand reverse the erosion ofthe protection that vaccine schedule provides.

This mayhappen, but only time will tell. I really just hope more people will not have to unnecessarily die before we have to rediscover the lesson that our grandparents learned at a young age. Vaccines are a medical wonder thatprotect usfromdisease; those diseases are not gone, they are waiting. Without vaccines, disease, disfigurement, and death are waiting for us to give them an opening. Do not givethem the chance to return"vaccinate. I don't just advise it, I live it and so does my family.

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If you would like to know more about Vaccines and Vaccination:

Anti-Vax to Pro-Vax parents

Voices For Vaccines

Centers Disease Control

Disclaimer: This post is my personal opinion, it is not a substitute for medical care. It is for informational purposes only. The information on Skeptoid blogis not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. This postdoes not reflect the opinion of my partners, professional affiliates, or academic affiliations. I have no financial conflicts of interest to disclose.

by Stephen Propatier

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