On responding to anti-vaxxers
Today I saw two new articles on the issue of the measles epidemic in the USA which has been caused by the failure of parents, under the influence of anti-vaccine pseudo-science and ideology which feeds off a widely-discredited scare about the MMR (measles, mumps and rubella) vaccine and vaccines more generally. One is by Stephanie Nimmo whose daughter had a lifelong chronic illness that made it dangerous for her to receive live vaccines and is about the importance of the rest of us being vaccinated and making sure our children are. The other is in today’s Observer and is about how the contempt often shown to anti-vaxxers, including for these purposes parents who refuse vaccines for their own children, feeds populist right-wing politics (as it has in Italy) and causes the parents involved to dig in rather than to submit.
I grew up in the years before the MMR vaccine; when I was young, the major scare was about the whooping cough (pertussis) vaccine. Neither my sister nor I had it; both of us had the disease, and it got passed on to a friend’s child who also got it. We all survived. I also had the single measles vaccine that was available then (late 70s) and got measles, mildly, and passed it to my Dad, who had it severely (though without lasting effects). Steph Nimmo in her article speaks of her memories of having the disease, “of being terribly ill at home, in a darkened bedroom, unable to bear bright lights”, which is one of her strongest memories of early childhood. It left her deaf in one ear. My mother was not stupid; it was widely reported that the vaccine was linked to brain damage (as she told me) and she wanted to avoid causing her child lasting illness or disability. The same was true of many of the parents who refused the MMR vaccine in the early years of the scare. Neither she nor most of they were opposed to vaccines in general. Today, hard-set belief is more likely to be behind refusals.
Many of us now do not remember the days when measles was a severe illness that left people blind, deaf, brain-damaged or dead. We think of it as an illness that children got, and got over, that made them ill for a few weeks and gave them a rash. Many of us remember being a bit sick and having some time off school, maybe in bed, and having one of our parents or another adult to ourselves for a few days. So it is no surprise that when parents believe that a vaccine is linked to lasting damage, they would rather expose their child to the illness instead. The cure, they think, is probably worse than the disease. In the early years of the Wakefield MMR scare, readers may recall, the then prime minister Tony Blair refused to tell the public whether he had had his young son Leo given the MMR. This immediately gave the impression that the powerful, though they lectured the rest of us to trust the scientists and have our children vaccinated “their way”, did not do this themselves. I believed then, and do now, that the government should have made the single measles and rubella vaccines available free of charge to the public (the latter to pre-teen girls, to prevent congenital rubella syndrome in their children) as they had been pre-MMR.
A common term in the literature of vaccines is “herd immunity”, which is when the incidence of a disease is negligible because the vast majority of the population has been vaccinated. This is what people like Stephanie Nimmo’s daughter, Daisy, relied on to make sure they also will not get the diseases. When I mentioned this to an anti-vaxxer on Facebook a few years ago, however, she told me “and I’m not a heffer (sic) to be herded”. People do not like to be compared to livestock and when the likes of Tony Blair apparently refuse a controversial vaccine for their children, its message is that what’s good for “the herd” is not good for the shepherds. A few years ago Mitch Benn, the comedian who appears on BBC panel shows, did a song called “Vaccinate Your Kids” which called the Americans who resisted vaccination “bloody idiots” and also stressed the importance of “herd immunity”. It is unlikely to have changed many minds, however many laughs it got in the BBC studio; people know that politicians and the rich do not regard themselves as part of the ‘herd’.
What people often forget is that fears about vaccines are not just about the MMR and not just about autism. I know of a number of cases where people developed ME (myalgic encephalomyelitis), or a disease a lot like it, after being given routine vaccinations; the best-known case is that of Lynn Gilderdale, who developed it at 14 following the BCG vaccination (for tuberculosis) which was given routintely to teenagers at that time (the early 1990s) and became bedridden the following year, and remained so for the rest of her life. Some similar cases have been linked to the vaccinations for the human papillomavirus (HPV), a major cause of cervical cancer, which is also administered to girls at about the same age. These cases may be very rare but they are also extremely severe and consign a young person to a lifetime of extreme sickness and pain. I have heard theories about why people suffer extreme reactions to vaccines but I have not heard of any research being done into this and to what may be done to minimise the risk.
Neither public health authorities nor the medical profession should rely on their authority, and on the public’s acceptance of it, as a guarantee that people will take their advice and vaccinate during a scare. People know that doctors make mistakes and anyone with experience of chronic illness or disability will most likely have encountered an arrogant or callous doctor who thought they knew what was best when really they did not. People do not have to be prone to conspiracy theories to be suspicious of arrogant-sounding people telling them not to worry their little heads and just take the medicine. Similarly, there are common stereotypes about people in Pakistan and other places like it refusing vaccinations, leading to the return of diseases thought to have been eradicated, because they suspect that the vaccines have an ulterior motive, but a vaccination programme has been used for ‘intelligence’ purposes in the preparation for Osama bin Laden’s assassination. If the health authorities here and in the USA had been a bit more mindful of this in the early 2000s, the resulting epidemics could have been ameliorated significantly. When the aim is to protect health and prevent disease, arrogance in response to dissent can be counter-productive and doubly so if you are in the right.
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