The rise and rise of anti-vaccine agitators
There have always been people opposed to vaccination, but the new anti-vaccine lobby is different: 'meaner, cruder, more strident' and possessed of great celebrity clout.
Outbreaks of measles, mumps, whooping cough and Haemophilus influenzae type B (HiB) among children in the US have concentrated attention on the apparently growing influence of anti-vaccination campaigns. Popular anxieties about adverse effects of immunisation – resulting most notably from the long-running scare about alleged links with autism – have led to a decline in uptake of vaccines and the return of vaccine-preventable diseases. Both Paul Offit, Philadelphia paediatrician and leading vaccinologist, and Seth Mnookin, New York journalist, illustrate their challenges to the anti-vaccination campaigns with searing accounts of recent cases of children who suffered serious illness or death from HiB meningitis and whooping cough.
Offit’s latest book follows his studies of the good, the bad and the ugly aspects of the recent history of vaccination. In Vaccinated: One Man’s Quest To Defeat the World’s Deadliest Diseases, he told the story of Maurice Hilleman, one of the great vaccine pioneers of the twentieth century; in The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis, he studied the problem of adverse vaccine effects focusing on an outbreak of polio resulting from the vaccine introduced in the 1950s; in Autism’s False Prophets: Bad Science, Risky Medicine and the Search for a Cure, he exposed the quacks and charlatans promoting claims that autism is caused by MMR or vaccines containing the mercury-based preservative thimerosal. His new book, Deadly Choices: How The Anti-Vaccine Movement Threatens Us All, provides an authoritative account of the recent rise of anti-vaccination sentiment, particularly in the US, surveying both the medical and scientific aspects and the role of the courts and the media.
Offit notes how a ‘new breed of anti-vaccine activism’ has taken over from the movement against the whooping-cough vaccine that took off in the 1980s. As he observes, the campaigns claiming links between vaccines and autism that have emerged over the past decade have ‘a dramatically different style: meaner, cruder, more strident, and less professional’. Their most prominent personality is Jenny McCarthy, former Playboy model and film and TV actor, author of popular books on pregnancy and child-rearing and mother of Evan, whose autism and epilepsy she attributes to the MMR vaccine. McCarthy, who remains a loyal supporter of the disgraced British anti-MMR campaigner Andrew Wakefield, has become well known for her ill-informed diatribes against vaccination policy.
McCarthy is supported by the venture capitalist JB Handley and his Generation Rescue campaign, which focuses on alleged links between mercury-containing vaccines and autism and promotes chelation therapy for autism which it regards as a form of mercury poisoning. The new wave of anti-vaccine activism enjoys celebrity sponsorship – from figures such as Jim Carrey, Oprah Winfrey and Bill Maher – and enjoys ready access to TV and radio chat shows. As Offit illustrates, anybody, whether paediatrician, autism specialist, public health official, journalist or parent-blogger, who challenges the claims of the movement is likely to face intimidation, threats of litigation and ad hominem attacks. Though this is discreetly omitted from Deadly Choices, Offit himself has been the target of a scurrilous campaign of personal abuse by anti-vaccine campaigners.
So, what is to be done about the growing influence of anti-vaccine prejudices and the resulting decline in vaccine uptake? In his final chapter, Offit turns to the question of how to challenge a climate of opinion in which ‘children are suffering and dying because some parents are more frightened by vaccines than by the diseases they prevent’.
The first solution considered by Offit is that of compulsion: eliminating the exemptions from immunisation allowed by many US states on the grounds of ‘religious’ or ‘philosophical’ conviction. The former, Offit regards as ‘impossible’: he provides a list of deaths of children, whose Christian Scientist parents refused to allow them to have medical treatments, leading to the grim comment that ‘parents have been killing their children for decades’. The trend for parents to claim exemption because of their alternative health or New Age values has gathered momentum in recent years and Offit acknowledges that it would be difficult to reverse the tide of parental individualism. Though he is sympathetic to the suggestion by some public health authorities that bureaucratic measures could discourage parents from opting out, nobody believes that this would make much difference to uptake rates.
If compulsion seems impracticable, what about extending the policy of ‘mandatory’ vaccination? This means that the refusal of immunisation leads to the denial of some social privilege, such as attending school (as currently in the US) or receiving child benefits (as in France). This approach has been pursued in the US to encourage the uptake of the flu vaccine by hospital staff. Offit cites the example of a hospital in Philadelphia in which uptake languished at 35 per cent until the authorities last year offered staff who refused the jab two weeks of unpaid leave to think about it: ‘if they still refused they were fired.’ Uptake reached 99.9 per cent. In relation to childhood vaccines, Offit suggests a measure pursued by paediatricians in Pennsylvania: they refused to register children whose parents refuse to comply with the childhood immunisation programme. It seems doubtful whether this policy, which appears to discriminate against children because of their parents’ views, would be legal in the UK, where children are routinely registered with GPs rather than with paediatricians.
After this gloomy discussion of the scope for coercive measures, Offit finally turns to consider ways of restoring trust between parents and doctors and cultivating a more collective spirit of support for immunisation in society. He believes that if leading figures in public health and vaccine policy projected a more human face – even becoming known as public personalities – this might go some way towards challenging the prevailing cynicism and distrust of Big Pharma and Big Government and the anti-vaccination movement’s conspiracy theories. He invites parents who have experienced the benefits of vaccination – or the consequences of vaccine-preventable diseases – to play a more prominent role in challenging parent-activists who promote anti-vaccine scares. ‘Maybe the tide will only turn when parents start to speak up’, Offit writes in his epilogue, noting, ‘remarkably, that’s happening’ – in the response to the 2008 outbreak of measles in San Diego.
Though Offit has been a heroic champion of the cause of childhood immunisation – and a spirited defender of the families of children with autism who have suffered greatly as a consequence of irrational vaccine scares – he sometimes risks spoiling a good case by overstating it. For example, his claim that in 2000, as a result of Andrew Wakefield’s campaign linking MMR and autism, ‘outbreaks of measles swept across the UK and Ireland, causing hundreds of hospitalisations and four deaths’ is a considerable exaggeration. This an example of the attempt to combat one scare by promoting another and such attempts to use fear as an instrument of public health policy are likely to be counterproductive.
In The Panic Virus: A True Story of Medicine, Science and Fear, Seth Mnookin skilfully draws together many of the themes of anti-vaccination campaigns past and present that have been covered in Offit’s earlier books and in Arthur Allen’s Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver. He provides excellent accounts of key episodes in the ongoing vaccine-autism wars in the US – the Simpsonwood conference, the Omnibus Autism Proceedings, the controversies in Autism Speaks – and perceptive assessments of personalities such as Mark Geier, Arthur Krigsman, David Kirby, Jay Gordon and Bob Sears. It is ironic that he seeks some explanation for the influence of anti-vaccine sentiment in the speculative behavioural psychology of the very theorists of ‘nudge’ who are currently exerting such a baleful effect on British public health policy.
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