It’s easy to make fun of the anti-vaccination lobby, writes Alastair McAlpine, in his Digital Clubbing column on MedicalBrief. But the anti-vaxxers, with the help of medical colleagues – such as Professor Tim Noakes – celebrities and politicians who promote their bizarre theories, are beginning to cause real damage.
“It’s easy to make fun of the anti-vaccination lobby (‘anti-vaxxers’). Their science is so poor, their hysterical warnings so overblown, their conspiracy theories so theatrically kooky, that most in the medical fraternity simply ignore or blow them off. But the truth is that anti-vaxxers, through a concerted social media campaign, and with the help of medical colleagues, celebrities and politicians who promote their bizarre theories, are beginning to cause real damage. Vaccination rates world-wide have stagnated, and in some countries even regressed, with a predictable rise in preventable diseases. Children are getting sick and dying. We need to stop being so aloof and get the pro-vaccine message out to the public, because staying out of this battle is not doing our patients any good.
“For as long as there have been vaccines, there have been anti-vaxxers. When Edward Jenner first suggested that injecting people with the relatively benign cowpox could prevent the deadly smallpox, he was met with widespread resistance. Over 100,000 people in Leicester marched against mandatory smallpox vaccinations in 1855, and while smallpox was eventually eradicated, the antivaxx movement arguably caused millions of deaths by delaying its administration.
“Fast forward 150 years, and the vaccines have changed, but the concerted effort against them has not. It is perhaps worthwhile to note that by almost any reasonable estimation, vaccines are one of the greatest health interventions in human history. The World Health Organisation (WHO) estimates that the diphtheria, pertussis, tetanus and measles vaccines save 2-3m lives per year. The Global Vaccine Alliance estimates that the schedule of paediatric vaccines given to a hypothetical cohort of 4m children born in 2009 will prevent approximately 20m illnesses and 42,000 deaths over that cohort’s life time. For the economically inclined among us, that works out to over $850bn saved for an investment of $32bn.
“There is still work to be done, however: the WHO estimates that an additional 1.5m deaths could be avoided if global vaccination coverage improves.
“Opposition to vaccines tends to be regional and is often heavily shaped by religious and cultural beliefs. In 2003, there was widespread opposition to the polio vaccine in some states in Nigeria. The overwhelming feeling was that this vaccine had been contaminated with anti-fertility agents and the human immunodeficiency virus (HIV). It is worth noting that the predominant opposition came from Muslim scholars, who were heavily influenced by the US and its war against Iraq, and thus had an intrinsic suspicion of the ‘West’ and its motives.
“The results were predictable: by 2006, the cases of polio in the region had doubled, and made up nearly 80% of the world’s polio burden.
“In 1998, Andrew Wakefield published his now infamous ‘study’ in the Lancet, purporting to show a link between the measles, mumps and rubella (MMR) vaccine, and autism. Although the study was later retracted, Wakefield stripped of his medical license, and evidence provided that Wakefield’s results were not just incorrect, but outright falsified, the damage was done. To this day, the pervasive belief persists in the minds of some of the general public that there is a connection.
“Although the anti-vaccination lobby remains relatively small, the damage they wreak is substantial: in Europe last year, measles cases spiked to 21,315, up alarmingly from 5,273 in 2016. The US has had sporadic outbreaks in the past few years, usually in un-vaccinated children. Given the excellent healthcare access in these areas, the anti-vaxx movement is almost certainly the culprit.
“The question then is, given the mountains of evidence that show vaccines to be effective and generally safe,[2,3] and the widespread support they enjoy among the medical fraternity,[4,5] why are there still people out there who campaign so vociferously against their use? And how do we counter them?
“Social media, for anyone acquainted with it, is a hive of pseudoscience and quackery, especially when it comes to vaccines. Facebook groups abound with parents sharing fake news and horror stories of children with ‘vaccine injuries’. YouTube videos are distributed uncritically of tearful parents berating the evil doctors and scientists of ‘Big Pharma’ for the ‘toxins’ introduced into their children. One of the most pernicious local examples of these is the Vaccine Awareness South Africa (VASA) page, which sports an impressive membership of approximately 5,000 people. If I didn’t know better, I’d suspect it was satirical, so indescribably loony are the ideas propagated. Childhood vaccines apparently contain ‘fetal parts’ and ‘thimerosal’ (they contain neither). The group even advocates against the vitamin K injection at birth. Clearly, they have never watched an infant bleed to death, and been helpless to stop it, as I have.
“It’s also worsened when respected scientists and nutritionists use public platforms to disparage vaccine use or cast doubt on their efficacy. Professor Tim Noakes – an A rated scientist – stated in an interview with Gareth Cliff on the 29th of November 2017 that there is ‘evidence’ that Jenny McCarthy is right in her assertion that vaccines cause autism. He also stated that vaccines are being ‘overprescribed’ and ‘overused’, without elaborating on which vaccines he was referring to. VASA (remember them?) immediately linked to the interview and wrote, ‘Thank you for being brave enough, Professor Noakes, to venture into the contentious issue of vaccination too!’ The damage was done. Noakes had provided legitimacy to the anti-vaxxers.
“He has also posted links to discredited studies on his Twitter account that purport to show a connection between the MMR vaccine and autism. Noakes is very respected by many in South Africa, and when he, and other doctors, use their considerable authority to spread misinformation, the battle against preventable diseases is set back considerably.
“His ‘Real Meal Revolution’ co-author, nutritionist Sally-Ann Creed, with 26,000+ followers on her Facebook page, regularly posts anti-vaxx links. She posits that Vitamin C outperforms vaccines (it doesn’t), states that ‘400 scientific studies’ question the efficacy of vaccines (they don’t), and casts aspersions on the HPV vaccine. She, unfortunately, is not alone, and there are many nutritionists and in South Africa who are openly hostile to vaccines and modern medicine.
“Naturopaths, osteopaths, chiropractors and homeopaths vary in their views of vaccines. Many are supportive, but there are a substantial number out there who advocate ‘manipulations’ or ‘homeopathic vaccines’ instead of the routinely scheduled shots advocated by doctors.
“Journalists, too, are often responsible for whipping up unnecessary hysteria in their pursuit of headlines. Last year, in response to 2 unconfirmed reports of human papilloma virus (HPV) vaccine encephalopathy in Western Cape schoolgirls, the Cape Argus ran a breathless front-page article in which, without any evidence, it blamed the vaccine. Other articles followed this up. One of the journalists, Marchelle Abrahams, used, with a straight face, Britain’s right-wing, and deeply unscientific, Daily Mail newspaper as a source for potential side effects. The fact that 32,000 schoolgirls received the vaccine without incident and are now mostly protected against one of the nastier forms of cancer (cervical), was not mentioned.
“Side-effects to vaccines are real, and mostly minor.[6,7] Very few paediatricians have seen a true ‘severe vaccine injury’ (persistent encephalopathy, permanent neurodevelopmental regression, autism, etc.), but they are out there, and are acknowledged by the medical community. While it is possible that the HPV vaccine was responsible for the symptoms in the 2 affected girls mentioned above, it was by no means certain, and these isolated cases need to be reported responsibly, and the incidence placed in context of the number of lives likely to be saved. Instead, the beliefs of the parents were given uncritical prominence, while the experts and scientific studies relegated to the end of the article.
“Newspapers and websites often unwittingly contribute to anti-vaxx sentiment through their careless use of stock photographs. Images of screaming, hysterical children being injected with large volumes of scary-looking, luminous ‘science-juice’ via massive needles, are both inaccurate, and frightening.
“Politicians and celebrities are also not immune (pun intended) to anti-vaxx sentiment. Donald Trump is famously anti-vaxx and has publicly stated his belief that vaccines cause autism and that too many are given ‘too soon’. Jenny McCarthy, Robert DeNiro, Jim Carrey and a host of others often use their fame to promote their vaccine-scepticism and emphasise the dangers of vaccines.
“There are positives, however. For every VASA, there’s a ‘Pro-vax Posse’ – a glorious Facebook page where mothers discuss real concerns about vaccinations, and help each other with common side-effects, issues with delays, etc. For every doctor promoting vaccine nonsense on Twitter, there are 10 others, like @DocBastard, @gorskon and @kidoctr, who campaign tirelessly for the truth. For every Jenny McCarthy, there’s a Kristin Bell, Jennifer Garner, or Jennifer Lopez, willing to set a positive example.
“So how do we go about changing hearts and minds? Despite the overwhelming evidence, however, having debates or discussions with anti-vaxxers is often very difficult. Firstly, there is a huge spectrum of anti-vaccination sentiment. On the extreme end are those who reject all vaccines and view them as ‘toxins’. These individuals are usually cynical about modern medicine, and often embrace alternative or complementary treatments. Then there are the ‘vaccine hesitant’ – those who are not completely opposed but may have concerns about specific vaccines (MMR or polio). This group may also include those who believe in vaccines, but think children are exposed to ‘too many, too soon’, and like to ‘space out’ the schedule (there is no good evidence for this delay of vaccine administration).
“There is pretty good data that some hardened anti-vaxxers are simply not amenable to changing their minds. They are not persuaded by science or scientific studies (‘Corrupted by “Big Pharma”’, ‘Performed by shill scientists’, ‘Manipulated by governments’, etc.). They clam up when you get angry and call them ‘idiots’ or ‘uneducated’, mostly because this is untrue; they are educated, they have just unfortunately educated themselves incorrectly via some of the above sources.
“But all is not lost. A recent study by Zachary Horn and colleagues showed that while it may be indeed be impossible to change the minds of hardened anti-vaxxers, the so-called ‘vaccine hesitant’ are usually persuaded not by evidence showing why the vaccine is a good idea, but by data of the negative effects of not vaccinating. In this instance, for example, the possible severe consequences of a measles infection, (that it’s not just a ‘benign rash’, but can cause severe pneumonia, encephalopathy, etc.) should be emphasised.
“The anti-vaccine lobby is, mercifully, small. But its influence is growing, and as medical professionals, we need to get out of our ivory towers and start engaging with the public better, whether this is in the form of more information to our patients in our rooms, or active engagement with the public via social media. We need to remember that the best way to change minds is to patiently show both the benefits of vaccination, but also the negative consequences of failing to do so. Doctors who encourage anti-vaxx sentiment should be challenged and their views critically dissected; the days of giving professional courtesy to colleagues who endanger the lives of our children are over. Journalists and newspapers that promote damaging vaccine views should be brought to task, and the bizarre views of celebrities who promote nonsense should be ignored.
“We can turn the tide. But the gloves have to come off.”
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Copyright© 2009 by the Swedish Council on Health Technology Assessment: 2009