By Jim Hyde
The headline in The Guardian on March 1 screamed: “ ‘God knows how I’m alive’:” How a teen defied his parents to get vaccinated. Driven by his own curiosity and facilitated by friends, Ethan Lindenberger turned 18 and asked, “Where do I go to get vaccinated?”
Most teens upon reaching the age of emancipation might look forward to a rite of passage such as voting or buying a beer. Ethan found a clinic and got his recommended vaccines.
He battled his mother for years about her refusal to have him immunized. According to her, vaccines were “some kind of government scheme backed by Big Pharma.” She knew this because of her reliance on Facebook for vaccine information. The State of Ohio further enabled her by allowing her to refuse vaccines for her kids for philosophical or religious reasons. (Vermont currently permits only medical or religious exemptions.) This story occurs against the back drop of 228 confirmed measles cases in the United States since January 1, the majority from five states.
Measles is highly contagious; a single infected person can transmit the disease to 12 to 18 others in an unvaccinated population. Nor is it trivial. Measles cannot only make someone very sick, it can lead to complications such as swelling of the brain, pneumonia and death. In 1968, I was a Peace Corps volunteer in Burkina Faso, and there was a measles outbreak in my village. In a single week three children under five died within sight of my house. The frustrating part is that in 2000 the U.S. was declared “measles free” by the U.S. Centers for Disease Control and Prevention due to the wide availability of a vaccine developed in the mid-60s and to laws and regulations requiring immunizations for all school-age children.
But vaccines don’t just protect the recipient, they break the chain of transmission of disease in a population. If there are no susceptible people, then transmission can’t take place. In short, people who are vaccinated shield other family members, neighbors and co-workers through so-called “herd immunity.” Different diseases require different percentages of the population to be immunized in order to avoid disease breakout—usually greater than 97 percent. As a consequence, small pockets of unvaccinated people can produce major disease clusters. It has been reported that in some of the affected areas with recent outbreaks immunization rates are as low as 70 percent.
So how did we reach this point less than 20 years after measles were declared eliminated?
Part of the answer is complacency; once diseases like measles and polio were eliminated, they fell off of people’s worry agenda. Also important is the re-emergence of the anti-vaccine movement in this country. (There has been some anti-vaccine sentiment ever since the time of Edward Jenner in the 1790s). But it was the long-debunked allegation by Dr. Andrew Wakefield in 1998 that the measles-mumps-rubella (MMR) vaccine was associated with an increased incidence of autism that caused the virulent re-emergence of anti-vaccination sentiment. Here it’s worth noting that a major new study published last week in the Annals of Internal Medicine, which followed 657,461 Danish children, found no increased risk for autism, no evidence of “triggering of autism” and no clustering of autism cases. (The story can be found in the March 6 issue of The New York Times.) This study simply re-affirms earlier results published in 2002 that found no greater incidence of autism in 537,303 children, some who were vaccinated and some who were not. All of this confirms what has been long been accepted by the scientific community.
But there is a war going on in the world today for our ears, eyes and minds. Data and facts have been hijacked, weaponized and delivered, using both social and traditional media. The word “fake” has entered into our lexicon with a vengeance and is now used universally to describe things one does not agree with regardless of the veracity or source. This has led to dismissing, devaluing and demonizing the work of even our most precious democratic institutions. Sadly, it has also undermined the credibility of public health agencies such as the CDC, the Food and Drug Administration and the Environmental Protection Agency.
As Ethan Lindenberger tells his story, it was his mother’s reliance on social media as her principal source of information that shaped and solidified her views. As a result of heightened scrutiny of social media platforms, it has been reported that Pinterest is now blocking all searches on vaccination, Facebook is considering removing anti-vaccination content, while YouTube is pulling ads from all anti-vaccine videos.
All of this is well and good, but it is crazy to suggest that censoring certain sites on certain platforms is a solution. For one, a strategy of curtailing access to information in an open society never has worked and never will work. (Clearly, there are some exceptions: child pornography, political dirty tricks, videos of journalist killings.) Who will be the gatekeeper, who gets to decide what information gets through and what does not? Do we set up and maintain information filters for every possible controversial subject from climate science to addiction?
It might be better to teach our kids to think critically about what they see and read.
A more effective and immediate strategy is simply to close the loopholes in existing state regulations. Every state accepts the fact that there are legitimate medical reasons that a child should not receive a particular vaccine. Some states, such as Vermont, have also eliminated the philosophical exemption that allowed parents to simply express their disagreement with the currently recommended CDC immunization guidelines; currently, 17 states permit these exemptions. States that have eliminated the philosophical exemption have seen an increase in immunization rates.
However, the elimination of the philosophical exemption has also led to an increase in requests for religious exemptions. For example, in Vermont, religious exemption requests jumped from 0.9 percent to 3.7 percent after the philosophical exemption was removed. Vermont H.238, currently under consideration in the Vermont Legislature, would close that loophole. In doing so, we would join California, Mississippi and West Virginia (17 other states are considering removing that loophole). In the case of California, removal of both religious and philosophical exemptions led to an increase of immunizations rates and a “precipitous” drop in measles cases.
No child should be denied access to these lifesaving and effective biologic agents no matter how well intentioned an adult caretaker may be. Neither should our greater society be denied the benefits that come from herd immunity. We live in a pluralistic society in which we are all required to make concessions from time to time for the benefit of all. With rare exceptions, vaccines have been shown to be safe, reliable and effective. Clearly, the state has a compelling interest to act in the best interest of not just the child but of us all.
Jim Hyde is professor emeritus of public health at the Tufts University School of Medicine. He lives in Charlotte.