From the measles outbreak in Williamsburg and Rockland County, New York, to a case of whooping cough in the Texas Capitol and Kentucky Gov. Matt Bevin’s public embrace of “pox parties,” vaccine-related news is everywhere. The stories are indeed alarming, with the resurgence of cases of vaccine-preventable illness and bona fide outbreaks, as in Williamsburg and Rockland County, highlighting the very real threat and public health challenge that can result from a drop in vaccination rates.
These stories are also alarming in another sense ― one that concerns the responses to vaccine refusal. Rockland County officials have declared a state of emergency and banned unvaccinated children under 18 from a slew of public spaces. New York City ordered mandatory measles vaccinations in four ZIP codes in Brooklyn. In a recent case in Arizona, armed police officers removed a sick child and his siblings from his parents’ home in the dead of night, because the unvaccinated child’s physician feared he might have meningitis.
One can argue the merits and necessity of the Williamsburg, Rockland County and Arizona interventions, and indeed of many others, from the standpoint of public health policy and practice. But the picture that emerges from these stories, and from the steady stream of editorials in various media, indicate how fraught this issue has become. Faced with an anti-vaxxer movement of Pizzagate-style conspiracy theories, social media manipulations and campaigns backed by Russian trolls, the full fury of the media, the medical establishment, local governments and even law enforcement is being unleashed on those who are not vaccinating their children.
Before I go any further, I need to make one thing clear: I am a pediatrician. I support vaccines. They are safe and effective. They prevent real disease. Everyone who can be vaccinated ought to be vaccinated. There are those who try, using false and misleading information, to convince people to fear vaccines. Such people are misguided at best, and malicious at worst.
My experience tells me we may not be addressing this public health challenge in the right way. At the very least, we ought to take a moment to ask ourselves what exactly is going on here.
But my experience tells me we may not be addressing this public health challenge in the right way. At the very least, we ought to take a moment to ask ourselves what exactly is going on here.
As a pediatrician who regularly cares for healthy kids, I encounter vaccine-hesitant parents all the time. Asking about vaccines is a routine part of most checkups and other medical visits. The reasons for not vaccinating vary from parent to parent, as does their resolve not to vaccinate.
Some parents remain concerned about supposed links to autism, although the original studies that claimed to prove that link were retracted and debunked years ago. Other parents worry about putting something into their children that is unnatural, or manufactured by pharmaceutical companies. Some have worries about vaccines replacing, and therefore weakening, their children’s immune systems. Others are concerned about side effects. These are all misconceptions that go against the facts, or at least misconstrue them. But I would argue that if we place dogma aside, they really aren’t so irrational.
Let’s take a look at a few standard anti-vaccination arguments. First, the supposed autism link. A 1998 study by British physician Andrew Wakefield, published originally in The Lancet, one of the world’s most highly regarded medical journals, purported to demonstrate a relationship between the measles-mumps-rubella vaccine and increased rates of autism in children who received it. The data was ultimately revealed to be unscientific, the study was retracted and Wakefield lost his medical license. But the idea took hold in the public imagination.
So, any parent who raises this particular concern to me will hear something like this response: “That study was a fraud, a sham. We know now that it’s not true. Vaccines don’t cause autism.” That’s all well and good, but it bears noting that the same medical establishment now telling parents over and over that vaccines don’t cause autism once produced a study in a prestigious journal stating the opposite. Is it any wonder at least some people aren’t sure what to believe?
How about not wanting to put chemicals into your child’s body? Is there any consumer of organic food ― or any person who “goes organic” once they have a child, as many of my friends have ― who can swiftly dismiss this instinct?
And mistrust of the pharmaceutical industry? The Vioxx scandal, and the opioid crisis that has harmed millions in America and beyond, were the direct results of deceit and disinformation perpetrated against the public by profit-driven pharmaceutical companies (Merck and Purdue Pharma, respectively).
Of course, vaccinating children doesn’t decrease their immunity; it enhances it. But it’s true that having an infection like chicken pox, which I had as a kid, will make you immune to it. And we’re learning more and more, when it comes to food allergies or diseases like asthma, that being exposed to irritants and allergens in the environment may help enhance the immune system and prevent disease. People who believe that exposing children to disease may help build their immunity might be drawing the wrong conclusion, but they aren’t inventing the concept out of whole cloth.
Vaccine side effects, though rare, are real. You need an understanding of probability, and of the risks of not vaccinating, to be able to make an educated decision that weighs the risks against the benefits. It only takes one scary true story to turn an already fearful, protective parent off vaccines.
It is crucial to realize one thing: Vaccine-hesitant parents do not set out to harm their children. A parent who brings their child to seek medical care is expressing concern for that child’s well-being, even if they’re opposed to vaccination. What’s more, parents who openly tell a physician that they are not planning to vaccinate are demonstrating no small measure of courage in admitting their attitudes about vaccination. They are usually well aware of the stigma and disapproval this may arouse in a health care provider. It’s OK to give them credit for that without endorsing their decision. Doing so may open space for conversation, and an opportunity to reach a better outcome.
Banning children from public spaces and sending armed police to their house, on the other hand, creates very little space for conversation. To take a less extreme example, overwhelming people with statistics and phrases like “evidence-based” and “risk-benefit” probably doesn’t create much room for conversation either.
There is no quick way out of this vaccine-hesitant moment. Public health authorities will do what they must. People need to be protected, after all. But I suspect those efforts will not amount to much unless they go the way of true engagement, on a human scale.
So what’s going on here? The world is awash in information, disinformation, competing narratives, agendas and forces, some of them malicious, many just plain ignorant. Yes, people are falling prey to them. But we also know more than ever about how the world works, and that means we know that bad things really are happening. Institutions and entities we were supposed to be able to trust have betrayed us. Let’s remember that the entire planet is quite literally in a state of existential crisis, and those with the power to do the most about it are blatantly denying it. (This is to say nothing of the fact that a planet destroyed by climate change is one where vaccinations probably wouldn’t be too helpful.)
People are reacting to this reality, and expressing their unwillingness to automatically trust figures of authority. Refusing to vaccinate, or asking questions before agreeing to do so, is in some ways a rational response to deeply confusing times. We in the medical establishment take our good intentions for granted, and so we are struggling with this state of affairs. We believe ourselves to be good, and we expect others to automatically believe the same.
The assumption that physicians are working in the best interest of patients may increasingly have to be earned, at least some of the time. I think this creates a key discomfort in physicians, and I say this because I have felt it myself, many times. “Why won’t they just listen to me?” goes the internal monologue. “I’m right! I know!” But the questions of parents, patients, society and the media are the new normal we must accept, and embrace.
There is no quick way out of this vaccine-hesitant moment. Public health authorities will do what they must. People need to be protected, after all. But I suspect those efforts will not amount to much unless they go the way of true engagement, on a human scale. I’m talking about asking simple questions nonjudgmentally, opening spaces for conversation, moving out of our defensive crouches and relinquishing some of our received ideas.
When everyone is yelling over one another, maybe the best way to be heard is just to speak calmly, human being to human being.
Samuel Freeman is a pediatrician in Montreal and for the Northern and Native Child Health Program at the Montreal Children’s Hospital.