The recent measles outbreak has a lot of people thinking about how to get more people vaccinated. In at least 10 states, lawmakers, both Republican and Democrat, have introduced legislation tightening restrictions on who can opt out of vaccinating their children.
So far more than 150 people have been infected with measles in 17 states. And while neighboring Illinois, with 15 measles cases, is second only to California, where the outbreak originated and which has had 133 cases, Wisconsin hasn’t been affected — yet.
One of 20 states that allow opt-outs on both religious and philosophical grounds, the Badger State is ripe for infection. The state, at 4.8 percent, has the nation’s sixth-highest rate of unvaccinated kindergartners. A quarter of the state’s schools are below a recommended 90-percent vaccination level. In Madison, Marquette Elementary School on the near east side leads the district, with 13.8 percent of its students opting out on personal conviction waivers.
Alta Charo, a professor of law and bioethics at UW-Madison, said the “anti-vaxxer” movement has a long history in the U.S., stretching back 200 years.
“Since the founding of this country there’s been resistance to vaccines from some people who don’t trust them and don’t trust people who are experts in the field of medicine or public health,” she says. “Instead they want to decide for themselves.”
Charo has served on a long list of panels and committees dealing with bioethics and public health, advising the administrations of Republican President George W. Bush and Democratic Presidents Barack Obama and Bill Clinton. Among the agencies and organizations for which she’s consulted are the National Institutes of Health, the National Academy of Science, the U.S. Department of Human Services and the U.S. Food and Drug Administration.
The U.S. declared victory in the war on measles in 2000, proclaiming the disease eliminated. Why has the threat resurfaced?
The uptick now I think has been spurred by a combination of two things: One is our increased ability to prevent a wider range of diseases through vaccination, meaning that more vaccinations are being given. And second, the reverberating horrific effect of a fraudulent, devastating paper written (in 1998) by Andrew Wakefield that purported to show a causal relationship between the MMR vaccine, which is the one that includes the measles, and the onset of autism in children. That paper was fraudulent. It was been criticized since the first moment it was published. It has since been retracted by the journal that had published it. And even Autism Speaks is telling people to get the vaccine. Despite that, that paper not only set off a panic about MMR, but it also set off a panic that spread to all vaccines.
Why is the growing number of vaccines such an issue?
Just the feeling that it’s too much and "I don’t understand it and it seems like it’s overwhelming and when I go to the doctor my kid is always getting multiple shots." They’ve absorbed this fear of vaccines, or a fear of too many vaccines, from all this bad information. You couple that with the phenomenal success of vaccines at removing these diseases from daily life and the absence of fear of these diseases and you get what we now have. You have people who don’t feel like the diseases are likely to hit their kid, and even if they do they don’t think the diseases are all that serious because they don’t remember when those diseases were prevalent.
It seems like resistance to vaccinations is a phenomenon of both the far left and the far right.
It’s fascinating, isn’t it, that this is where far left and far right meet. It meets because of a common set of distrusts, although they distrust different things. The left often will distrust anything that’s associated with the for-profit markets. Vaccines are made by pharmaceutical companies so they can’t really trust them. And on the far right, the government says the vaccines are safe, and they don’t trust the government.
There seems to be a general vilification, verging on ridicule, of the anti-vaxxers in the media. Is that productive?
Probably not. Although straight talk is not vilification, and I do think we need straight talk. I don’t think you should hold back when explaining that vaccines are incredibly safe and incredibly effective, that these diseases that they guard against can be devastating, that some number of people will in fact get very, very sick, will be hospitalized and may very well die. That to me is not vilification.
The term “anti-vaxxer” has emerged as a standard label for those who forgo vaccinations. It seems to imply that there’s an organized movement, but you’ve described several different reasons people have for not vaccinating.
I don’t use that phraseology. I talk about parents who are vaccine-hesitant or vaccine-refusing. The phraseology I’m using is not that uncommon in many public health circles. And they use it partly to make distinctions. You’ve got parents who are what we call vaccine-hesitant. They’re often not necessarily against the vaccines, but they’re uncomfortable with how many vaccines we’re getting, how closely in time, and how young they’re starting.
And “vaccine-hesitant” parents are more likely to be convinced to get their children vaccinated?
They are people who really need to have an opportunity for a good conversation with their pediatrician about which vaccines really need to be given at certain ages.
And the vaccine refusers?
One of the things you hear from people who are refusing the vaccines is, “I’d rather my child got immune from having the disease.” I even saw a reference, although this is anecdotal so it’s not evidence, that there are some parents who are forming so-called “measles parties,” so that their kids can all get the measles and get sick and get it over with. This is entirely the result of people not having enough experience with the disease because the vaccinations have been working since the 1950s, and they’ve forgotten that measles can actually be dangerous.
It wasn’t that long ago that Wisconsin was ground zero for whooping cough, another disease that can be vaccinated against. But that didn’t generate near the scare as the current measles outbreak. Why?
Partly I think it’s because measles is so much more contagious. Partly I think it was because the whole (measles) thing started at Disneyland. There’s kind of a serendipitous catchy headline issue here about what actually penetrates the noise in the news world. We’ve actually had these outbreaks, we’ve had these warning before, it’s just that we’re now finally getting kind of a mass popular reaction to it.
Schools would seem to be a prime breeding ground for the spread of measles, especially schools like Marquette Elementary, where there’s a high rate of unvaccinated kids. What should schools do about it?
One thing that can be done is to make sure that every school educates every class about the importance of vaccines and gets the kids to think of it as a normal part of life. With regard to the parents, there’s another thing that could easily be done in states that allow parents to opt out for any particular reason, religious or philosophical. Right now they just sign their name and opt out in most cases, whereas if you’re going to allow your kid to get the vaccine you have to read through pages of information that spell out the benefits and the rare side effects and then sign that you understand all this. Why should it be harder to give the vaccine to your kid than to refuse the vaccine? Why shouldn’t we have symmetry here? Accepting the vaccine means that you have a great deal of protection for a tiny amount of risk. Refusing the vaccine means that you are forgoing protection and accepting a fair amount of risk. But why don’t we require informed refusal as well as informed consent?