Tuesday, February 3, 2015

Some Thoughts on the Antivaxxer Movement

As in all things, the best way to speak to antivaxxers is respectfully and in detail, taking time to listen to the concerns of each of the various schools of thought that reside under the antivaxxing umbrella and to address each of these specific concerns individually. The only way to have a substantive discussion and to perform that rarest of all miracles, changing someone’s mind, is to talk to antivaxxers, not at them, and to demonstrate as best we can why we are so committed to the notion that their objection to vaccination does not outweigh the benefits to society or to them personally when mass vaccination becomes the societal norm.

It is sometimes exasperating for people frustrated with antivaxxers’ intransigence on this issue to talk to them, precisely because so much is at stake, so the name-calling begins pretty quickly. The issue is too big and too important and we must come to better unity on this because disease prevention is one of the great achievements of science and medicine, and as a species we ought to leverage it to our greatest benefit. The science is too good, too consistent and too well supported by decades of real world testing to resort to a hostility that is going to add an even greater defensive posture to persons resistant to vaccinating their children.

Nobody wants harm to come to their children, and if it indeed exists at all, there is an infinitesimally small percentage of parents for whom society’s greater good does not figure at least somewhat into their thinking and their decision-making. These objections to vaccination then are born of love, not malice, and that is the spirit in which our discussion should be held. The antivaxxer community wants a healthy life for their children as much as that vast majority of people who are vaccinating their children do. They are concerned about the rise in autism and other early onset childhood diseases, and their ascription by at least one published study and by religious and thought leaders within other disciplines to vaccination as a source of these conditions is what is driving some of their objections.

The first piece in attempting to dismantle this way of looking at vaccination is to inform people that the one study that linked the measles, mumps and rubella (MMR) vaccine to autism has been debunked and proven false on numerous technical fronts. It is utterly discredited and is not taken seriously by any major research hospital in the world, nor has another come to supplant it with similar results and better credibility. Its author has been linked to a conflict of interest scandal and early proponents of the study have since disavowed it.

The 1998 study by Dr. Andrew Wakefield was published in the British Medical Journal, The Lancet, and suggested that the measles, mumps and rubella (MMR) vaccine may cause autism. By 2001, the study was being decimated by the medical community and has undergone more than 100 peer reviews since then with complete disavowal of the study’s findings. Nonetheless, the damage was done, and the residual effects of the Wakefield farce are still being felt today.  If an unawareness of the rebuke of that one junk article is still standing between someone and their decision to vaccinate, then it is incumbent on media outlets to be transparent about the Wakefield study’s bogus nature.

Another part of the problem stems from ethnocentricity. We have a lack of awareness of the dramatic benefit vaccination programs provide. Worldwide, when a disease becomes eradicated in a particular geographic area, the population very quickly grasps the true miracle of preventative medicine. Of all of the aid assistance the United States provides other nations of the world, there is none more gratefully received than vaccination efforts. But not only are we ethnocentric, we are also what you might call chronocentric, that is to say, unaware of any time apart from our own.

Society’s temporal distance from times when communicable diseases were scourges of the United States is at the heart of this new rise in unvaccinated children. The first of a series of waves of polio gripped the United States in the late 1800s. By the late 1940s to the early 1950s, when the epidemic was cresting, polio crippled an average of more than 35,000 people in the United States each year; parents across the United States would swoon with each summer cold their child would contract, with each allergic reaction to the spring bloom, dreading the worst, dreading polio. 

Death, paralysis, iron lungs and wheelchairs were the fates of many. The lucky ones got crutches. In a plea that boosted the research community in much the same way Kennedy’s words hurried space exploration, FDR begged the scientific community in 1944 to throw its vast imagination and deep body of knowledge toward the eradication of the scourge that put him in a wheelchair: “The dread disease that we battle at home, like the enemy we oppose abroad, shows no concern, no pity for the young. It strikes—with its most frequent and devastating force—against children. And that is why much of the future strength of America depends upon the success that we achieve in combating this disease.”

If you want to hear a song that captures with the typical stoicism of the greatest generation the experience of living with polio, listen to the lyrics of Save the Last Dance For Me in the knowledge that its author, Doc Pomus, had been felled by polio and wrote the lyrics watching his wife dance with others on their wedding night from his wheelchair. I work with a man whose father was a farmer and one of polio’s victims. He sometimes tells stories about his father, and occasionally a recollection of him swinging an uncooperative leg through a chicken coop door or some such detail will find its way into the story, and the wince that comes to this man’s face in those tellings is moving indeed.

In the United States, we are polio-free, and we are polio free thanks to Jonas Salk and the polio vaccine, which was aggressively promoted beginning in the 1950s. Because of the social contract most Americans seemed to agree to, the United States quickly reached the “herd immunity” threshold. Herd immunity is a critical point past which a disease circulating through a society experiences a diminishment in instances of contraction because of so many potential hosts being immune. That diminishment spirals further down more quickly the larger the percentage of the population that is vaccinated until, if a sufficient percentage of the population is vaccinated, the pathogen cannot reproduce and effectively dies. Most young parents do not have a direct connection to polio, there having been an entire generation inserted into the history, and this social contract is not being adhered to at the level it once was.

The recent uptick in instances of measles is largely attributed to children whose parents have elected not to vaccinate them. For these parents, their error is plain, and hopefully they understand that now. In that there are certain percentages of the population who cannot be vaccinated including infants, pregnant women and some other categories, these populations are put at risk through no oversight or fault of their own. For this reason, I believe that refusing to immunize one’s child is an immoral act that is, perhaps saddest of all, born of good intentions that are driven by bad information. Roald Dahl’s letter imploring the world to vaccinate following the death of his daughter to measles is essential reading for anyone still resistant to vaccinating his or her children. Absent a preponderance of the population participating in vaccination, these diseases will come roaring back.

There is a percentage of antivaxxers who come to their decisions from a mistrust of government, both from a left perspective politically and a right perspective. Antivaxxers who come at it from a left perspective and additionally chastise Republican politicians for ignoring climate science are displaying egregious intellectual inconsistency. Those people need to reconcile those two issues to themselves because they are fruit from the same tree and their simultaneous endorsement reveals a lack of seriousness with regard to a serious issue. That disposition is truly a shame and there’s not much more to be said about that.

Government conspiracy theorists who believe mass vaccinations to be susceptible to governmental incursion for microchipping, for hotshot vaccines that make the population more docile and other such outside suggestions, I just have to say that whatever you imagine the government to be doing, they are doing worse, but they are not f***ing with your vaccines. They have bigger fish to fry and better pans to do it with. Antivaxxers from the right and left who additionally allege money collusion have to understand that big pharma and big medicine in general make a lot more treating disease than they do vaccinating against it.

Vaccines have staved off invasive and sometimes fatal illnesses in America for generations, and it is to our shame to allow our lack of continued vigilance in this area make this current era in United States history one that allows these devastating childhood diseases to come back with their former vigor. We have the technology; let’s use it. It is incumbent upon all of us to do our share and to reach and sustain herd immunity. Say it with me now, “Moo!”

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