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Preventing Prevention: Vaccines in the Century of Choice

This year, the first vaccines licensed in the United States, those for rabies and typhoid, celebrated their centennial. The better half of the twentieth century was spent developing vaccines to prevent some of the most devastating epidemics in history. And the past century has seen extensive progress in the field of vaccinology — the widespread use of immunizations in the Western world is largely responsible for a significant increase in life expectancy. When the first rabies and typhoid vaccines were licensed in the United States, the life expectancy of the typical American was 56.8 years. Today, Americans can expect to live 78.8 years. Despite the irrefutable contribution widespread immunization has made to the quality of life we enjoy today, the twenty-first century has begun as one of contention between the medical community and a growing group of vaccination opponents. Public health experts like Paul Offit, an adviser at the Centers for Disease Control and Prevention (CDC) and a pediatric infectious disease specialist, maintain that vaccines are “without question, the safest, best-tested thing we put into our bodies.” But even so, extensive debate about the merits and effectiveness of immunization practices persist. If the twentieth century was that of the vaccine, the twenty-first century is shaping up to be that of the counter-vaccine movement.

Much of the controversy surrounding existing vaccine regimens in children is based on a study led by Dr. Andrew Wakefield in the United Kingdom and published in The Lancet in 1998. The study linked the measles, mumps and rubella (MMR) vaccine to the onset of autism. However, this study proved problematic. Other researchers were unable to reproduce Wakefield’s results, and in 2004 it was discovered that Wakefield had significant undisclosed conflicts of interest. Information surfaced that the parents of numerous children recruited for the study were plaintiffs in a lawsuit against MMR vaccine manufacturers. Attorneys representing the plaintiffs secured extensive public funding for research related to their anti-vaccine lawsuit. The British Legal Services Commission (now known as the Legal Aid Agency) provided $86,000 to the Royal Free Hospital to conduct the study on the link between the MMR vaccine and autism. They also gave Wakefield approximately $626,000 in personal funding. The total amount in British legal aid funds disbursed by the Legal Services Commission to researchers, including others beside Wakefield, totaled $5.3 million. While the lawsuit eventually failed, Britain’s legal aid fund — set up to increase access to legal representation for the poor — spent a total of $22 million in public money over the course of the entire MMR vaccine saga.

A number of participants in Wakefield’s study, along with his co-investigators and the administrative bodies overseeing his research, were largely unaware of the major financial conflicts of interest surrounding the study. After these disclosures resulted in scandal for an already methodologically dubious study, the General Medical Council, Britain’s physician licensing body, launched an investigation into Wakefield and his work. In 2010, investigators determined that Wakefield not only falsified conclusions in his published study, but also conducted a number of unapproved invasive procedures on developmentally challenged children as part of his research. Andrew Wakefield was barred from practicing medicine in the United Kingdom, and the article he published was retracted from The Lancet. Nonetheless, Wakefield’s study contributed to decreased vaccination rates in the United Kingdom and to increased fears about the safety of vaccines in the United States. And even as health care providers have tried to arm the public with truthful information about the merits of vaccines, media coverage of Wakefield’s study and its retraction from The Lancet only exacerbated public fears over the safety of immunizations. Wakefield’s study let the cat out of the bag — over a decade later the medical community has yet to regain control of it.

Enter Jenny McCarthy, a well-known acting and modeling personality. When her son was diagnosed with autism, McCarthy became adamant that vaccines are a major cause of autism in children and used her media presence to warn parents of the ‘dangers’ of immunizing their children. McCarthy has also remained a loyal Andrew Wakefield supporter. Indeed, she believes that vaccine-developing companies took down Wakefield and his study. If Wakefield’s dubious study is the cornerstone on which the anti-vaccine movement is based, Jenny McCarthy is the movement’s celebrity face. McCarthy is currently the president of Generation Rescue, Inc., a nonprofit that hopes to cure autism and reduce its toll on families. In addition to charitable and research work, Generation Rescue is also in the business of anti-vaccine advocacy. And much of that anti-vaccine advocacy is colored by the same questionable pseudoscience pushed forth by people like Wakefield. Recently, the organization self-published a “special report” suggesting that the vaccine schedule in the United States is too extensive since it asks that American parents immunize their children for a number of infections for which immunizations are not required in other nations. The paper suggests that the length of our vaccine schedule is a factor in the higher proportion of autism cases that exist in the United States compared to other nations. Questionable links like these, unsupported by extensive scholarly research on the effects of immunization, are at the centerpiece of the vaccine debate.

The debate has pitted scientific bodies like the Institute of Medicine (IOM) against organizations like Generation Rescue. It has become a battle between lab-coated physicians and anti-vaccine advocates with personal “horror-stories.” Elena Conis, Assistant Professor of History at Emory University and author of Vaccine Nation: America’s Changing Relationship with Immunization, suggests that the conflict between anti-vaccine advocates like McCarthy and the scientists that they debate is not a conflict between one idea and another. Rather, Conis believes that the conflict between pro- and anti-vaccine advocates is a “conflict of values” or a conflict between reason and emotion. McCarthy’s campaign, however unfounded, speaks to many parents throughout the country whose children have, or are at risk, for autism spectrum disorders. Despite a profound lack of scientific evidence linking vaccines with a heightened risk for autism, organizations like Generation Rescue continue to secure private funding. This funding allows these groups to conduct public relations acvaccinetivities that disseminate dubious claims in polished, palatable and clear ways that capture the eye of the public more effectively than the scientific community does.  Unsubstantiated claims aside, the anti-vaccination movement’s public relations success threatens to rollback immunization efforts within certain communities.

Even as the scientific  community attempts to make parents aware that evidence against vaccines is either questionable or often downright fraudulent, perceptions of vaccines have taken an insurmountable hit in the public eye. The success of the anti-vaccine movement has manifested itself with particular vigor in schools. Indeed, much of the rhetoric used by the anti-vaccine movement focuses on the rights of parents to prevent their children from being immunized, despite the success of child vaccination programs. While many school systems require that children be immunized for the most common vaccine-preventable illnesses, many parents actively seek exemptions for their children. One recent investigation by The Hollywood Observer found that parents in wealthy Los Angeles neighborhoods frequently exempted their children from mandatory immunization schedules. As a result of about 60 to 70 percent of parents filing “personal belief exemptions,” vaccination rates in some Los Angeles elementary schools are lower than child vaccination rates in South Sudan. As Olga Khazan argues in The Atlantic, parents who mindlessly excuse their children from being immunized put other children at risk, too. Increasing exemptions threaten to decrease the effectiveness of herd immunity, which protects entire communities when a certain threshold — around 90 percent of the population — is immunized.

While most states enforce vaccination as a prerequisite for children to attend public school — some states even extend this mandate to privately schooled and homeschooled children — parents are still able to exempt their children from obtaining certain immunizations by providing a legitimate reason. According to the National Vaccine Information Center, an anti-vaccine advocacy organization, parents can currently exempt their children from immunization for medical reasons in all 50 states, can seek religious exemption in 47 states and can conscientiously object to vaccinating their children in 18 states. Some vaccines, for example, are cultivated using eggs, and as a result children who are allergic to eggs can claim that they may experience adverse effects to immunization. Additionally, some families may have religious beliefs opposed to certain forms of medical prevention or intervention. While these are generally considered legitimate reasons to exempt children from immunization, when parents take advantage of these excuses to exempt their children they leave them unnecessarily vulnerable to a number of diseases. This growing culture, which holds that immunization is a choice rather than a responsibility, ignores the fact that communal spaces exist. People do not live in bubbles — we interact extensively with each other and exchange billions of infectious agents daily. Furthermore, vaccinations don’t just protect the immunized but other individuals who may be unable to receive vaccinations due to autoimmune diseases or allergies as well. Each immunized child is capable of protecting another vulnerable child, but this only works if we maintain the minimum level of immunization required for effective herd immunity.

In this century, where unsubstantiated claims can be easily published, and even more easily accessed on the Internet, parents come across questionable medical information more frequently than ever before. While it’s important to be critical of medical professionals and their interests, it’s also important to do so within reason. Despite numerous attempts, McCarthy and Wakefield’s claims have yet to be proven. Even so, the media’s attention to McCarthy’s staunch advocacy and her nonprofit organization have afforded the anti-vaccine movement more attention than the scientific community could ever hope to receive. As Gregory Poland and Robert Jacobson argued in a piece for the New England Journal of Medicine: “Society must recognize that science is not a democracy in which the side with the most votes or the loudest voices gets to decide what is right.” No matter how many glossy brochures and CNN appearances McCarthy and her organization secure, they do not impart scientific legitimacy. Whether her plight is rooted deeply in love and conviction for her son is irrelevant. Absolute truth, however boring or uncharismatic, is never up for debate. The centennial of the first licensed vaccines ought to be cause for celebration, but instead, easy access to false information may turn this century of choice into a century of reversal.

About the Author

Alejandro Victores '16 is a public health concentrator who enjoys long walks on the beach and reading The Economist.