The fights against infectious disease and anti-vaxxers’ fears
VACCINES PREVENT a staggering two to three million deaths per year around the world, yet vocal groups in Australia and internationally continue to cast doubt on their effectiveness. Vaccine hesitancy ranks alongside climate change, pandemic flu and Ebola as one of the top ten threats to global health of 2019, according to the World Health Organisation.
Today, scientists are racing to develop new safe and effective vaccines against HIV, malaria, Ebola and tuberculosis. Meanwhile, public resistance to vaccines is growing around the world — from southern England to Afghanistan. Measles, once eliminated in North America, is making a comeback, and cases rose 700% across Africa in the first four months of this year.
For vaccination programs to work we all need to be willing to participate, to maintain herd immunity.
Given the importance of a coordinated, global effort in the fight against infectious diseases and vaccine hesitancy, we’ve put together a special newsletter outlining the evidence for the safety and efficacy of vaccines from around the globe, and how we can go about advocating for vaccines — which have saved more lives than any other medical intervention in history.
Measles: resurgence of a deadly virus
“When I started working on the virus in 1996, there were still over 500,000 children dying of measles each year worldwide.”
— Paul Duprex, Professor of Microbiology and Molecular Genetics, University of Pittsburgh
Measles is a highly contagious airborne disease. Symptoms include a high fever and a full-body rash, and sometimes the infection can be fatal. Measles was declared eliminated from the United States in 2000 and vaccination between 2000 and 2016 led to an 84% decrease in measles mortality globally. More than 20 million deaths were prevented.
Fast forward to April 2019, and the United States reported the most cases of measles — 704 across 22 states — in 25 years. Canada also reported 70 cases by June 2019. This resurgence across North America is dwarfed by measles outbreaks in Ukraine, Philippines, Madagascar, the Democratic Republic of Congo, Venezuela and Brazil.
• Why measles is so deadly, and why vaccination is so vital
—By Professor Paul Duprex. The Conversation, US.
• Road to measles elimination is predictable, but can be rocky
—By Assoc Professor Matthew Ferrari; Postdoc Fellow Amy Winter. The Conversation, US.
What’s up with those anti-vaxxers?
“Many ‘anti-vax’ parents see themselves as experts on their own children … and better qualified than health experts or public health agencies to decide what is best for their family.”
— Jennifer Reich, Professor of Sociology, University of Colorado Denver
The resurgence of measles is due in large part to growing vaccine hesitancy among parents. At least 96% of any given population must be vaccinated against measles for “herd immunity” to protect everyone. Mark Honigsbaum, a journalism lecturer at City, University of London, explains how distrust of vaccination is not limited by nationality, ethnicity, ideology or even economic circumstance:
Wealthy moms in Los Angeles are as likely to believe that the measles, mumps and rubella vaccine (MMR) causes autism (it doesn’t) as alternative types in Portland, Oregon.
Peter J. Hotez shares research from Baylor College of Medicine, in which a clear picture of vaccine hesitancy across the United States emerged. Vaccine exemptions in kindergarten are on the rise in 12 of the states investigated and they appear to be more of a western phenomenon, especially in the Pacific Northwest (Idaho, Oregon and Washington) and the American Southwest (Arizona, Missouri, Oklahoma, Texas and Utah).
While “anti-vax” parents are often vilified, Jennifer Reich of the University of Colorado, Denver, shows how they really aren’t that different to the 65% of Americans who don’t get a flu shot, and calls for a better understanding of what’s needed to protect society as a whole.
• Anti-vaxxers are just like the rest of us
—By Professor Jennifer Reich. The Conversation.
• What is herd immunity and how many people need to be vaccinated to protect a community?
—By Assoc Professor Hassan Vally, The Conversation.
Echo chambers of misinformation
“Social media has created echo chambers of misinformation and it is easy to fall into a circle of ‘virtual’ authorities that first create then build on misinformation.”
— Gregory C. Mason, Associate Professor of Economics, University of Manitoba
With the recommended double dose, the measles, mumps, rubella (MMR) vaccine is 97% effective against measles. And yet there are more than 200,000 unvaccinated children under the age of five in Canada. According to Gregory C. Mason of the University of Manitoba, this is an issue of flawed risk analysis:
- Parents are sleep deprived, giving them little time to fact-check so many rely on the advice of friends and doctors.
- Increasingly sophisticated internet-based advocacy against vaccination sows fear, uncertainty and doubt.
- The direct link between the MMR vaccine and autism has been laid to rest repeatedly and most recently using big data, but anti-vaxxers continue to circulate the weak association between aluminum and autism.
- In fact, the MMR vaccine does not contain aluminum salts. Aluminum is the third-most-abundant element after oxygen and silicon, and any vaccine is a minor source of this element for all of us.
The good news: research by Filippo Menczer and Pik-Mai Hui of Indiana University reveals that pro-vaccine information and activity is beginning to push back against, and even overtake, anti-vax disinformation online.
• Why are anti-vaxxers risking a public health crisis?
—By Assoc Professor Gregory C Mason. The Conversation.
• Anti-vaxxers appear ro be losing ground in the online vaccine debate
—By Professor Filippo Menczer: PhD Student Pik-Mai Hui. The Conversation.
Childhood vaccination: legal or moral obligation?
“In Asia, where we have been rolling out programmes to vaccinate against the mosquito-borne Japanese encephalitis virus, a lethal cause of brain swelling, families queue patiently for hours in the tropical sun to get their children inoculated. For them the attitudes of the Western anti-vaccinators are perplexing.”
— Tom Solomon, Professor of Neurology, University of Liverpool
Following a measles outbreak in Rockland County in New York State, authorities declared a state of emergency and banned unvaccinated children from public spaces. Should governments go further and make childhood vaccination mandatory?
Many would argue this to be an infringement of human rights. Tom Solomon, of the University of Liverpool, contends that there are precedents. One example is that proof of vaccination against yellow fever virus is required for many travellers arriving from countries in Africa and Latin America to prevent its spread. And think about car seat belts: they are compulsory in much of the world, even though a seat belt might cause harm by rupturing the spleen or damaging the spine.
For bioethicist Joel Michael Reynolds, of the University of Massachusetts Lowell, vaccination is a moral obligation, for three reasons:
- Public health is a public good (like roads and clean drinking water) that benefits everyone and we must all contribute to.
- By failing to vaccinate, we put the elderly, infants and people with weakened immune systems at risk.
- Anti-science attitudes are dangerous because they undermine our ability to make decisions together as a society.
• Should vaccinations be compulsory?
—By Professor Tom Solomon. The Conversation.
• Why parents need to get their children vaccinated
—By Asst Professor Joe Michael Reynolds. The Conversation.
A teenager’s consent is enough
“If a doctor, public health nurse or other health-care professional has reason to believe that an adolescent is a mature minor and has not been vaccinated, they should, in accordance with their legal and ethical responsibilities, provide the adolescent with information about vaccination.”
— Timothy Caulfield, Canada Research Chair in Health Law and Policy, University of Alberta
In the United States, Ohio teenager Ethan Lindenberger made headlines by going against his parent’s anti-vaccination views. He got immunized.
But why was this viewed as such an unusual act? At the time of his decision Ethan was 18 years old. In many countries around the world he would clearly be viewed as a legally competent adult, capable of making his own health-care decisions.
Timothy Caulfield of the University of Alberta argues that, legally, in Canada, an adolescent’s consent to vaccination is both necessary and sufficient. A parent or guardian need not be involved, and in most cases should only be involved after obtaining permission from the mature minor. Moreover, doctors and nurses are obliged to provide adolescents with information about vaccination.
• In Canada, many teenagers don’t need parental consent
—By Professor Timothy Caulfield. The Conversation.
Everyone can be an advocate
“Communication has enormous influence when it comes to the 43 % of parents who have some questions or concerns about vaccines.”
— Jessica Kaufman and Margie Danchin, Murdoch Children’s Research Institute
Many people struggle to discuss vaccination when confronted with a friend, relative or acquaintance who expresses hesitancy. Simply providing lots of facts or dismissing their views is not effective. Research shows that these strategies can help:
- Ask about, and listen to, people’s concerns: is it safety? Effectiveness? Side effects?
- Acknowledge their concerns: remember, everyone loves their children. This can go a long way in establishing trust.
- Provide information to respond to their concerns: share what you know, and try to provide reliable sources for your information. Don’t debunk myths too aggressively.
- Share personal stories: emotive stories tend to have more impact than facts.
- Don’t pass judgment: berating people won’t convince them to vaccinate, but it will convince them never to speak to you about vaccines again.
• How to be an effective advocate for vaccination
—By Postdoc researcher Jessica Kaufman; Snr Research Fellow Dr Margie Danchin. The Conversation.
• Are YOU up to date with your vaccinations? [Information for Australian readers.]
—By Dr Lucy Deng; Professor Kristine Macartney: Assoc Professor Nicholas Wood. The Conversation.