Vaccination: Definitely Worth a Shot

In 2010, a seven-year-old child who had returned from Sweden was diagnosed with measles. According to Sascha Garrey, this child was intentionally left unvaccinated which led to an outbreak in San Diego, California. As a consequence, over 800 people were found exposed and 11 had contracted the disease. The CDC placed an alert across seven states with reasonable doubt that the infection had already spread to these states. This is one case of many; in each case people who choose to avoid vaccinations put the lives of others in danger. The ideas of anti-vaccination have been gaining traction over the last decade and in turn more and more people have been exposed to diseases that countries have almost eradicated completely. Misinformation and ideas regarding anti vaccination must be stopped from spreading by whatever means necessary.

To understand why these ideas must be prevented from spreading, the severity of the situation must be analyzed. Why are vaccination rates so important? Vaccination rates determine the strength of herd immunity. Herd immunity is the immunity of an entire population by preventing viral outbreaks because the disease cannot be spread by vaccinated people. According to Helft and Willingham, the immunity threshold is considered to be at a safe level at 95% for measles but this can differ depending on the contagiousness of the disease. If the percentage of the vaccinated population drops below this threshold percentage, the entire population is at risk especially those who cannot receive vaccinations. Even though the percentage in San Diego was still quite high, the preventable disease spread rapidly endangering those who could not receive vaccines.

Herd Immunity

Fig. 1: A simple demonstration of how vaccinated individuals contribute towards herd immunity thereby inhibiting disease transmission

In a more recent case, a measles outbreak occurred at the Disneyland Resort in 2014. Crowded places like theme parks such as Disneyland serve as optimal conditions for these viruses which explains why the outbreak had escalated so quickly. “In the latest outbreak, sparked at Disneyland Resort, 11 of the 113 cases, or 10 percent, were children younger than 1 year old” (Chandler) Measles, an already dangerous disease, is even more so for children under the age of 12 months. This is because children under this age simply cannot receive these vaccinations. A vaccination is a weakened live virus which is injected into the body so the immune system can learn to identify it as a threat if encountered later on. However, a baby of under 12 months still has the inherited antibodies from the mother. Chandler cites Dr. Mark Sawyer, a pediatric infectious disease specialist at Rady Children’s Hospital in San Diego who stated that “They [the antibodies] stick to the virus and prevent it from doing what it needs to do; they react as if they’re seeing natural measles. They attack it and try to eliminate it.” The mother’s antibodies fight off the infection too quickly for the baby’s immune system to recognize and remember it. At 12 months, the baby can be vaccinated as the mother’s antibodies are too few in number to perform their duty effectively and completely. However, this means that an unweakened, resilient virus can wreak havoc on these children because the mother’s antibodies may not be strong enough to fight the virus by itself as the baby’s still developing immune system has not identified the threat. If a child under 12 contracts measles, there is not much that can be done even if rushed to a hospital. A child this young cannot take most strong medications that would aid in treating measles. In fact, the CDC states that “1 or 2 out of every 1,000 people with measles will die, even with the best care” and “1 out of every 1,000 people with measles will develop brain swelling which may lead to brain damage.” (“Year in Review: Measles Linked to Disneyland”) If more of the population had received vaccinations, then those 11 newborns would not be in a situation where they are helplessly at risk; where even medication cannot do much for them, where another individual’s actions can indirectly end a life just as it started to bloom.

These life-threatening beliefs have resulted in more and more measles cases in the United States in the last decade. With an increasing amount of “anti vaxxers” as they are informally known, the country has attempted to educate the people more to be rid of the misinformation. However, it seems this information falls on deaf ears in some states. Texas is one of nine states where “less than two thirds of children 19 to 35 months old have received a widely used seven-part vaccination.” (Hotez)

Vaccination Rates

Fig. 2: Vaccination rates of children from 19-35 month old in America

Dr. Peter J. Hotez is a pediatrician at Baylor College of Medicine and the director of the Texas Children’s Hospital Center for Vaccine Development. Dr. Hotez suggests that Texas may be the first state to see breakouts. A Texan political action committee has “been raising money to protect a “conscientious exemption” loophole” to allow more and more parents to file against vaccination of their own children. As a result, many public schools in Texas “are dangerously close to the threshold where measles outbreaks can be expected, and a third of students at some private schools are unvaccinated.” (Hotez) Densely populated states, like Texas, can spread the breakout rapidly with such low percentages of vaccination. The breakout can then spread to other states and cause more breakouts similar to the case of the Disneyland Resort in California. At this rate, a breakout is not only inevitable but can occur tomorrow. If anti vaccination ideals are not stopped or even slowed, a widescale outbreak that can span states and entire countries is just around the corner.

To formulate a better answer on how these ideas of anti-vaccination can be stopped from spreading, the how and why they spread must be studied first. Although it has traces that date back to the 1800’s when vaccination was introduced to the public, the anti-vaccination movement as it is seen today only began to shape itself in 1998. “In 1998, Andrew Wakefield and 12 of his colleagues published a case series in the Lancet, which suggested that the measles, mumps, and rubella (Sathyanarayana Rao and Andrade) vaccine may predispose to behavioral regression and pervasive developmental disorder in children.” (Sathyanarayana Rao and Andrade) The controversial findings of the study gained traction rapidly and “MMR vaccination rates began to drop because parents were concerned about the risk of autism after vaccination.” Immediately afterwards, studies were conducted to test the validity of Wakefield’s study and none had been able to confirm his results. The Lancet eventually retracted the Wakefield paper, admitting “that several elements in the paper were incorrect, contrary to the findings of the earlier investigation.” (Sathyanarayana Rao and Andrade) Although the Lancet had retracted Wakefield’s case study once it was proven fraudulent, the controversy that arose from the retraction only aided in providing the case study with exposure. Donning their tinfoil hats, many believed that the paper was retracted because the medical industry would lose large sums of money if the public had found out about the “money making scandal” called vaccines. Wakefield and his associates were found “guilty of deliberate fraud” which “picked and chose data that suited their case; they falsified facts.” (Sathyanarayana Rao and Andrade) Andrew Wakefield was “portrayed as a martyr, enduring “character assassination and professional shunning”.” (Kata)

Although there is a heavy correlation between anti-vaccination and anti-establishmentarian ideas, there is no concrete evidence to suggest this is the primary reason for belief in anti-vaccination. There have been suggestions that say distrust in government has fueled the spread of anti-vaccinations ideas. This distrust dates back to the very introduction of vaccination. Vaccination began in the 1800’s following Edward Jenner’s breakthrough in his experiments with live cowpox. Jenner successfully demonstrated “that he could protect a child from smallpox if he infected him or her with lymph from a cowpox blister.” (“History of Anti-vaccination Movements”) Jenner’s brilliant idea was immediately met with criticism that included “sanitary, religious, scientific, and political objections.” (“History of Anti-vaccination Movements”) Some parents were scared of the vaccine itself which involved “scoring the flesh on a child’s arm, and inserting lymph from the blister of a person who had been vaccinated about a week earlier” while some parents “believed that the vaccine was “unchristian” because it came from an animal.” (“History of Anti-vaccination Movements”) Others simply believed it violated their personal liberty; this ideology gained traction after the government introduced mandatory vaccine policies in 1853 under the Vaccination Act of 1853. Interestingly, most anti-vaxxer’s discontent with the smallpox vaccine “reflected their general distrust in medicine and in Jenner’s ideas about disease spread.” (“History of Anti-vaccination Movements”) The ideas of civil liberties infringement, conspiracy theories, religious opposition, anti-establishmentarian ideology, and parental autonomy that originated with the birth of vaccination itself. The aforementioned ideologies had been slowly gathering followers and the movement had been shaping itself with more incorrect information and confirmation biases until the invention of the Internet. With the rapid spread of information and a simple distrust in establishment, the anti-vaccination movement became the movement that is seen in today’s society.

An analysis of Internet traffic and websites by Anna Kata details the ease of access of information regarding anti-vaccination. According to Kata, “approximately 74% of Americans and 72% of Canadians are online. An estimated 75–80% of users search for health information online. Of these users, 70% say the information they encounter online influences their treatment decisions.” (Kata) Anna sets up the argument providing data of the sheer number of users who turn to the Internet for help regarding their treatments. Astoundingly, “over half (52%) of users believe “almost all” or “most” information on health websites is credible.” (Kata) The Internet allows any and all opinions to spread almost instantaneously with people from across the planet. The Internet allows “individuals and groups to gain exposure online without being filtered or reviewed – and anti-vaccination advocates have taken advantage of this fact.” (Kata) Unsurprisingly, “anti-vaccination messages are more common on the Internet than in other forms of media.” (Kata) This goes to demonstrate the importance of understanding what these messages are saying and how they say it. Kata’s analysis shows that website that spread ideas of anti-vaccination attribute vaccines to illnesses such as “AIDS, asthma, autism, cancers, diabetes, fibromyalgia, leukemia, lupus, Sudden Infant Death Syndrome, and many more.” (Kata) To an uninformed parent, such statements alongside embellished rhetoric is enough to cause them to reconsider vaccinating their children. Kata then shifts to talk about how these websites appeal to the audience. Of the few analyzed anti-vaccination websites, the following methods and ideas have appeared multiple times suggesting that they appeal to broad audiences and that too, effectively.

Figure 4

Fig. 3: Percentage of anti-vaccination websites analyzed with content and design attributes present

 

A quarter of websites analyzed by Kata argued that vaccines were against their religion stating that “being created in God’s image means receiving God’s perfect immune system” meaning receiving a vaccine would be akin to insulting God. (Kata) About 88% of websites referenced emotional appeals from parents who believed their children had been damaged by vaccines. These stories usually “included the notion of “us versus them”, where concerned parents and vaccine objectors were portrayed as battling physicians, governments, corporations, or the scientific establishment.” (Kata) Many anti-vaccination websites (88%) proposed alternate treatments such as “herbalism, homeopathy, chiropractics, naturopathy, and acupuncture” over vaccinations. With some overlap, many websites (75%) suggest anti-establishment ideals such as “No one has the moral or ethical right to compel parents to vaccinate their children against the parents’ wishes – not the doctors, not the schools, not the government at any level.” (Kata) 63% of these websites had gone further to make accusation of totalitarianism. Three quarters of all anti-vaccinations ideals purport anti-establishment conspiracy theories that governing bodies have hidden information about vaccines that they hide from the public while other conspiracies suggest the vaccinations are placebos that are “motivated solely by a quest for profit.” (Kata) Evidently, the very ideas that opposed Jenner have grown with the evolution of modern science yet they remain the same at the core. The Internet has simply given the movement a voice, accounting for the exponential growth of this movement in the last thirty years.

Alongside the expansion of the anti-vaccination movement, the pro vaccination movement has also seen tremendous expansion. For reasons unknown, Australia’s anti-vaccination movement grew incredibly large in number very quickly. Anti-vaccination became large problem in the country and the government had had enough. Australia’s response to the anti-vaccination movement seemed to pay off as the movement has been throttled and even seems to be losing supporters. Australia saw a terrible year of outbreak in 2012. In 2012, Australia was hit with a pertussis epidemic and 168 cases of measles, a disease that was most eliminated through vaccinations. Australian government had decided to take action and began to work on a law to find a way to slow or hopefully reverse the effects of the anti-vaccination movement in the country. This saving grace came in the form of a policy called ‘No Jab, No Pay.’ The ‘No Jab, No Pay’ policy aims to “improve vaccination rates and reduce the spread of vaccine preventable diseases.” (Kimble) This “by hook or by crook” policy requires any and all “children under 20 to get all relevant vaccinations under the country’s National Immunization Program for parents to receive up to $11,000 in child care benefits, including the Australian Child Care Benefit, the Child Care Rebate and the Family Tax Benefit Part A.” (Kimble) The policy took effect on January 1, 2016. According to People’s author Lindsay Kimble, nearly 200,000 children who were not previously vaccinated were immunized in 2016. However, this policy still allows for medical and religious objections only. In just 1 year, the “number of fully vaccinated 5-year-olds…has increased from 92.59 percent to 93.19 percent.” (Kimble) The policy was incredibly effective and Australian Health Minister Greg Hunt states that “This data shows the policy is working.” (Kimble) The Australian government has not stopped there. The 2015-2016 Budget includes “$161.8 million over five years for new and amended listings to the National Immunization Program’s (NIP) schedule of free vaccines” and “$26.4 million over four years to improve immunization coverage rates, particularly in children and adolescents.” (Klapdor and Grove) On top of this, the Australian government intends to increase the effectivity of these installed policies by providing incentives to doctors who “identify a child who is overdue for vaccination and call them in for a catch up” and by funding awareness campaigns to promote the NIP’s activities and address parents’ concerns regarding immunization. Not only have vaccination rates increased, the country has seen a slowing of the spread of these life-threatening ideals. However, the government is not the only ones who are credited with this impressive turnaround. “The Nursing and Midwifery Board of Australia released the vaccination standards in response to what it described as a small number of nurses and midwives promoting anti-vaccination via social media.” (Davey) If the nurses and/or midwives are found promoting such messages, they may face prosecution by the Australian Health Practitioner Regulation Agency for “promoting false, misleading or deceptive information.” (Davey) Though it seems as if it is very harsh, it must be kept in mind that midwives and nurse are highly trusted and people take their advice very seriously concerning matter of health. If education, persuasion, and even piles of data cannot convince anti-vaxxers to reconsider their stance, the government must act on the behalf of the country.

Equipped with a history of the movement, information on how it spreads, evidence of successful counter movement, and an understanding of why people are persuaded by these arguments a theoretical solution can be proposed to attempt to inhibit the growth of the infection known as the anti-vaccination movement, pun intended. First and foremost, search engines and search results should be modified to filter out anti-vaccination websites and push them farther in the results that appear. This would be incredibly effective since “Google was chosen as most popular search engine, accounting for 73% of all Internet searches” using the terms ““vaccine”, “vaccination”, and “immunization OR immunisation”” in the study conducted by Ana Kata which included America and Canada. Pushing the results to page 5 for example would drastically decrease the chances of the article being read and therefore decreasing the chances of the spreading of this information. Although it may be considered censorship, the government limits First Amendment Rights in cases when certain actions create unnecessary panic which endangers lives such as the popular metaphor, “shouting fire in a crowded theater.” Next, the government should follow suit regarding Australia’s stance on anti-vaccination and lower tax benefits and welfare available to people who do not vaccinate their children. Not only will this force people to vaccinate their children, it will increase the overall vaccination percentages and contribute to strengthen herd immunity. The government in turn, saves hundreds of millions over a few years because less people will contract diseases and there will be no need to conduct expensive studies researching the link between vaccines and other diseases or conditions. As a result of increasing vaccination percentage, the lack of vaccinated people contracting diseases will prove that vaccines present no danger and this in turn will send vaccination rates into a feedback loop. Third, any and all people of influence cannot openly display their anti-vaccination beliefs. America is a massive consumerist country where people check out new fads and happening of celebrities and stars and catch up with news on what politicians have stated. Popular people, for lack of a better term, tend to have followers who will side with them on many things they say. For example, in a few months if Beyonce were to say she is not vaccinating her twins it would not be surprising for many to follow suit. Thousands across the country can instantly receive news on Beyonce and many do in fact look up to her. Her words and actions can strongly influence the opinions of her thousands of followers quite easily. Such influence can be dangerous if she had stated she was anti-vaccination. Politicians follow along the same line. Politicians are servants of the government and are representative of their constituents. If a member of government preaches that vaccines cause autism, there is not much the government can do without looking incredibly hypocritical.

Anti-vaccination is an outdated ideology which should have been eradicated, with the very viruses and infections it indirectly supports, long ago. Though the anti-vaccination movement is gaining traction in the United States there are ways that it can be hindered if not completely dismantled. It is possible to begin to move the country forward towards a better future for the next generations and this was successfully carried out in Australia. If the United States were to follow, it would finally step entirely into the 21st Century. After all, it is rather sad that there are victims to 100% preventable diseases in today’s day and age.

Works Cited

Chandler, Jenna. “Why Can’t My Newborn Be Vaccinated? Infants and Measles: What Parents Need to Know.” The Orange County Register, The Orange County Register, 18 Feb. 2015. Web.

Davey, Melissa. “Australian Nurses Who Spread Anti-vaccination Messages Face Prosecution.” The Guardian. Guardian News and Media, 19 Oct. 2016. Web.

Fig. 1. A simple depiction of the herd immunity during an outbreak. Digital image. Brookings. The Brookings Press, n.d. Web.

Fig. 2. Missing Key Vaccines. Digital image. NY Times. NY Times, Centers for Disease Control and Prevention, n.d. Web.

Fig. 3. Kata, Anna. Statistics on themes present on anti-vaccination websites. Digital image. ScienceDirect. Elsevier, 30 Dec. 2009. Web.

Garrey, Sascha. “Opting-Out Of Vaccines; Dipping Below Herd Immunity.” CommonHealth, WBUR, 22 Aug. 2013. Web.

Helft, Laura, and Emily Willingham. “What is Herd Immunity?” Public Broadcasting Service, PBS, 5 Sept. 2014. Web.

“History of Anti-vaccination Movements.” The History of Vaccines, edited by Karie Youngdahl, The College of Physicians of Philadelphia, 15 Mar. 2017. Web. Apr. 15. 2017

The History of Vaccines is a non-profit organization established for educational purposes.  The website is run and edited by the qualified doctoral staff of The College of Physicians of Philadelphia. This article details the history of the anti-vaccination dating back to very beginning of vaccination itself. This article aids in allowing understanding of the roots of the anti-vaccination movement thereby explaining how it started to spread.

Hotez, Peter J. “How the Anti-Vaxxers Are Winning.” The New York Times. New York Times, 8 Feb. 2017. Web.

This article is an opinion piece by Peter J. Hotez published in the NY Times. Hotez is pediatrician at Baylor College of Medicine and the director of the Texas Children’s Hospital Center for Vaccine Development. Hotez states his worry for his state of Texas and describes how the ideas of anti-vaccination have gripped Texas. Texas is quite close to a measles outbreak and Hotez is able to use Texas as just one example of anti-vaccination effects in America. This article is useful for people who are looking for information on how the anti-vaccination movement operates in America.

Kata, Anna. “A postmodern Pandora’s box: Anti-vaccination misinformation on the Internet.” Elsevier 28 (2010). ScienceDirect. Web. Dec. 30. 2009

This scientific paper examines in detail the conspiracies and misinformation that can be found on the Internet. Kata, a professor of Anthropology at McMaster University, argues that the Internet plays a large role in spreading anti-vaccination ideals. This paper analyzes data from an Internet traffic sample while analyzing arguments from anti-vaccination websites and determining the degree of misinformation present. This paper is useful for anyone looking to learn how anti-vaccination ideals spread and why they spread so quickly.

Kimble, Lindsay. “Australia Sees Increase in Vaccinations After ‘No Jab, No Pay’ Policy Ties Tax Benefits to Immunizations.” People, Time Inc, 20 Feb. 2017. Web.

Klapdor, Michael, and Alex Grove. “‘No Jab No Pay’ and Other Immunisation Measures.” Parliament of Australia, Parliament of Australia, May 2015. Web.

Sathyanarayana Rao, T S., and Chittaranjan Andrade. “The MMR Vaccine and Autism: Sensation, Refutation, Retraction, and Fraud.” Indian Journal of Psychiatry, Medknow Publications, June 2011. Web.

“Year in Review: Measles Linked to Disneyland.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention. 2 Dec. 2015. Web.

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