How to Save Millions of Lives

If history and science have taught us anything, it’s a simple lesson: vaccines work. They’ve saved countless lives and allowed millions of children to grow up without fear of debilitating diseases. Because of vaccines, we’ve nearly eradicated several diseases that once posed significant danger to the public. 

In 1916, polio killed about six thousand people in the United States and left thousands more permanently paralyzed. There were nearly fifty-eight thousand cases in 1952. In the early 1960s, polio vaccines were licensed, and by 1994 polio was eradicated in the Americas. Other diseases that have dramatically decreased since the development of vaccines include Hepatitis A and B, chickenpox, measles, and whooping cough.

Nevertheless, preventable diseases remain a public health issue. In the first half of 2019, there were more measles cases reported worldwide than any year since 2006. Before the measles vaccine was developed, the US saw more than 400,000 reported cases each year. That number dropped almost to zero by 1992. However, in 2019 the disease re-emerged with 1,282 confirmed cases across thirty-one states—the second-largest outbreak since 2000. While this resurgence is nowhere close to measles’ peak, it’s still something to be concerned about. Measles is highly contagious, infecting up to 90 percent of those exposed prior to immunization. Over 140,000 people died of measles in 2018.

Whooping cough saw a similar global increase. Before the vaccine’s introduction in the 1940s, there were over one hundred thousand cases each year in the US. Cases dropped to fewer than ten thousand before rising again starting in 2003. 

In 2012, there were more than forty-eight thousand cases reported nationwide. Washington state declared an epidemic. In 2014, California followed suit after eight hundred cases emerged within two weeks; the number spiked to eight thousand by the end of the year. Though not as deadly as other infectious diseases, whooping cough is one of the most contagious, equivalent to measles. It’s especially dangerous for babies and those with weak immune systems—most who died from whooping cough in 2012 were less than three months old. 

Why have these diseases returned, especially in a medically advanced and developed country like the US? Much of the blame falls on the anti-vax movement, people and groups around the world who hold moral, religious, or philosophical beliefs against vaccination.

In developed nations, especially those in North America and Europe, distrust in vaccines is rising. Some cite religious reasons, as certain religious organizations—such as the Church of Christ, Scientist and the Dutch Reformed Church—discourage vaccination. To accomodate, forty-five US states allow religious exemptions from mandatory vaccination. 

Other people refuse to vaccinate because they distrust the pharmaceutical industry, citing the opioid epidemic as justification. This distrust also varies by race: the American Academy of Family Physicians found that 61 percent of African Americans agreed with anti-vax beliefs. This distrust is partially because medical professionals historically have harmed African Americans, as evidenced by the Tuskegee Experiment, in which several hundred black men with syphilis were promised free medical care, but unknowingly received placebo treatments. Even today, black women are two to six times more likely than white women to die from pregnancy complications, illustrating persistent racial disparities in the medical field. As such, it is no wonder African Americans are skeptical of the medical community and, by extension, vaccines. 

In contrast to those who distrust the medical system are those who only distrust vaccines. Many people lack a solid understanding of infectious diseases, vaccines, or epidemiology, and believe vaccines shouldn’t be trusted. In reality, the science is pretty simple. In 1796, Dr. Edward Jenner found that contracting cowpox prevents smallpox. All vaccine development stems from this discovery. Vaccines are weakened or inactive versions of the virus that don’t cause any actual harm. By exposing your body to the virus, your immune system learns how to recognize and fight it in the future. 

Still, vaccine development has caused public discomfort, hesitation, and even panic. Opposition existed from the start; clergy declared Jenner’s smallpox vaccine “unchristian” because it came from an animal. Furthermore, many parents were skeptical of the science and the method used to vaccinate—scoring the skin and inserting lymph (fluid containing white blood cells) from someone previously vaccinated.

Others saw vaccinations as a threat to personal liberty. Between 1840 and 1853, the British government passed acts that made vaccinations mandatory, giving rise to several anti-vaccine journals and groups. Opponents argued that mandatory vaccination infringed on personal choice and that the government had no right to compel them. As activism toward mandatory vaccination arose in the US at the end of the nineteenth century, the same rise in anti-vaccine groups occurred. They too cited personal freedom.

More recently, the public’s attention has shifted to potential side effects. The diphtheria, tetanus, and pertussis vaccine received controversy after a report alleged that three dozen children developed neurological conditions after receiving it. Moreover, in 1998, Andrew Wakefield published a paper claiming a link between autism and the measles, mumps, and rubella (MMR) vaccine. As the media spread his findings, the public grew more distrustful and hesitant toward vaccinating children.

However, Wakefield’s article was fraudulent. It involved a sample size of just twelve children. Because most children received the MMR vaccine, it was easy to find a dozen kids with autism who received it. Furthermore, the paper was a case study, which analyzed patients’ medical histories and involved no lab research. Consequently, the findings could not be replicated. An investigative journalist also found that Wakefield manipulated his data, only including cases that fit his hypothesis. He also shifted vaccination dates and fabricated the ages when behavioral symptoms emerged in order to make the connection more direct. Wakefield was stripped of his medical license and numerous studies discredited his findings.

Even so, Wakefield’s narrative persisted. A 2019 Gallup survey found that ten percent of American adults believe that vaccines cause autism, up from six percent in 2015; forty-six percent are unsure. Jenny McCarthy, a former Playboy model and MTV star, joined the anti-vax movement after her son was diagnosed with autism. In a 2009 interview promoting her book Healing and Preventing Autism, McCarthy claimed that the mercury, aluminum, and “other toxins” in vaccines—which act as preservatives and are not present in large enough amounts to be harmful—are at least partially responsible for many cases of autism. 

Anti-vaxxers point to the simultaneous increase in recommended vaccines and Autism Spectrum Disorder (ASD) diagnoses to justify Wakefield’s thesis. After all, if vaccines cause autism, then it makes sense that there’s a positive correlation between the two. Yet, correlation is not causation.

The rate of autism diagnoses has increased over the past two decades, from one in 150 children in 2000 to one in fifty-nine children in 2014. Two 2018 studies estimated the rate to be as high as one in forty. This increase isn’t because of vaccinations, but because doctors are identifying and diagnosing ASD earlier. Research shows that ASD can be reliably diagnosed as early as two years old; thus, doctors started screening for it earlier.

Doctors have also become better at identifying ASD in more diverse populations. Historically, ASD was most prevalent in white children. When doctors examined this race discrepancy, the rate of ASD diagnoses increased. Lastly, as doctors continue studying ASD, they discover how the disorder presents in different people. There are a wide range of symptoms, and no two autistic people’s experiences are the same. As doctors found more symptoms for ASD, diagnoses rose.

Autism diagnoses aren’t increasing because we’re injecting children with more vaccines. They’re increasing because we’re getting better at identifying and diagnosing it in younger children and in more diverse populations. Vaccines don’t cause autism, and using this false claim to justify not vaccinating children is horrifically ableist. In the previously mentioned interview, McCarthy stated that given the choice between autism and measles, parents of autistic children “will stand in line for the fucking measles.” She also argued that “it shouldn’t be polio versus autism”—as if a child with autism is equivalent to a child contracting polio and possibly becoming paralyzed for life.

Overall, anti-vax beliefs are misinformed, misguided, and dangerous. The World Health Organization named “vaccine hesitancy” as one of the top ten threats to global health in 2019. Only five US states have no vaccine exemptions. Fifteen allow philosophical exemptions; parents can opt out of vaccinating their children simply because they don’t want to. In states without personal belief exemptions, evidence suggests that parents make false claims about religious beliefs to avoid vaccination. 

In response, several American cities and states are moving toward mandatory vaccination. In 2019, Washington, Maine, and New York all removed some exemptions. New York Assemblyman Jeffrey Dinowitz noted that mandatory vaccination is “about health. It’s not about religion.” The ability of states to mandate vaccines goes back to 1905, when the Supreme Court ruled that states have the power to enforce mandatory vaccination to protect public health. Because certain individuals don’t consider the science when making decisions, these guidelines are essential.

Vaccines contribute to herd immunity—the more people immune to a disease, the less ability the disease has to travel between people, and the better protected the population is. Some people—including infants and those with autoimmune diseases or specific allergies—cannot receive certain vaccines. The best way to protect them is through herd immunity.

It’s equally important that we address the reach anti-vaxxers have in our culture. In 2019, anti-vaccine content from the three most popular creators of health misinformation generated over a million engagements online. As misinformation spreads from Facebook groups to YouTube videos, these beliefs become harder to combat. 

Many anti-vaxxers promote “natural” supplements and remedies as an alternative to vaccines and medical treatment. Commenters on a post in an anti-vax Facebook group encouraged one mother to treat the flu with breastmilk, thyme, and elderberry; no one recommended medical attention. Her son was eventually hospitalized and died a few days later. The family declined to comment on whether the child had received the flu vaccine. 

Like social media, traditional media sources play a role in spreading anti-vax sentiments.  Journalists have a habit of grabbing onto medical stories and running with them, regardless of how solid the science is. Reporters treated a story about an Italian researcher claiming to have cured his wife’s multiple sclerosis as a heartwarming love story, without reviewing the study’s merits. Upon closer inspection, the survey was badly designed, and its results could not be replicated

Everyone loves a feel-good story. But when media outlets publish stories about miracle cancer cures or red wine lowering the risk of heart disease, they misinform the public. The media was complicit in the spread of Wakefield’s fraudulent study connecting vaccines to autism. Reporters’ propensity for novelty over slow progress can give anti-vax movements an edge over scientific facts.

How do you fight a misinformed, dangerous movement that infected many areas of the internet and seeped into our daily lives? In short: well-researched, reliable information. Health researchers and doctors have fought misinformation for decades, and this fight must continue. Hilda Bastian, an Australian researcher, outlines several key lessons she and other medical professionals have learned: explain why you believe something, offer reliable and understandable information, and take emotions—not just statistics—into account. Responding to misinformation with hostility often doesn’t work. Moreover, Bastian emphasizes that it’s more effective to share correct information than criticize what’s incorrect.  

Being informed and knowing how to communicate information is key. Medical news can be scary—headlines that tell you vaccines are causing autism or that a disease outbreak is imminent tend to spread quicker than good news. Fear-mongering articles may lead to more shares if people quickly try to inform their inner circles about possible risks. Therefore, it’s up to consumers to treat medical news with scrutiny and search for additional sources. Doctors, researchers, and journalists need to be aware of how false news can spread and need to ensure that the information they provide is accurate. 

Countries should also consider adopting mandatory vaccination. Some countries already have restrictions to ensure that their citizens are vaccinated—Australia and Germany, for example, restrict access to school for unvaccinated children. For countries that can enforce mandatory vaccination, doing so could assure herd immunity. The pushback they’ll get can be overcome only by building trust between people and the medical systems that serve them. Communication will be critical. If medical professionals want the public to trust them, they have to participate in outreach and education.

Finally, many racial and ethnic groups have reasons not to trust the medical community, as they receive lower quality healthcare than white people. It’s up to experts and advocates to rectify this by building a culture where everyone trusts medicine. When people are informed about vaccines by advocates with similar backgrounds, it helps increase trust. A mother in Rio de Janeiro may not listen to an American doctor, but may listen to a member of her community.

Problem-solving, especially regarding divisive issues, begins by meeting people where they are. If we want to fight the anti-vax movement, it will require information, patience, and communication. The work will pay off and guide us toward a healthier world.

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