Measles and the anti-vaccine 'debate'

There should be no debate on the benefits of immunisation, writes the Washington Post's Alexandra Petri

An outbreak of measles in New York City that has spread to at least 20 people has added heat to the debate over the effectiveness of public awareness campaigns and whether the government should strengthen mandatory requirements for children.

Although the UK saw immunisation rates drop after a now discredited 1998 study by Dr Andrew Wakefield linking the MMR (measles-mumps-rubella) vaccine and autism, the US has not had a significant change.

At least not yet, warn some in the public health field.

There are pockets of lower immunisation that could widen, they caution, if autism activists like actresses Jenny McCarthy and Kristin Cavallari continue to push the notion that immunisation is dangerous.

"You don't need to get every listener to believe that vaccines are Actively Dangerous," writes Alexandra Petra in the Washington Post. "You just need to create an atmosphere that suggests there is Room For Doubt and Debate. Then sit back and watch the vaccination rates drop."

A New England paediatrician writing in the Daily Beast under the pseudonym Russell Saunders calls the situation "sheer lunacy".

"Just over a dozen years ago this illness was considered eliminated in our country, and this year people are being hospitalized for it," he writes. "All due to the hysteria about a safe, effective vaccine. All based on nothing."

Unvaccinated children should be prohibited from attending public schools unless they have a medical reason, writes Phil Plait in Slate.

He continues:

I do understand that people might have a religious belief against vaccinations. However, I think religious exemptions can and should only go so far. Certainly they stop dead when religion impinges on my rights to have my child attend a school that is safe. I have even less patience for the "personal belief" exemption because that strikes me as being aimed at people who are anti-vaccination. And they are most certainly wrong.

Jennifer Margulis, a fellow at the Schuster Institute at Brandeis University, counters that parents have valid reasons to stray from a government-recommended vaccination schedule.

"It is a news media-driven misperception that parents who claim philosophical or religious exemptions are uneducated or misinformed," she writes.

"Most parents who individualize the vaccine schedule are actively educating themselves, continually assessing their family's specific health needs, and doing everything they can to keep their children safe and healthy."

So is more money for education the answer? Maybe not. According to a study recently published in Pediatrics medical journal, the more people are warned about the lack of a link between MMR and autism, the more suspicious some parents become that there actually is a link.

Aaron Carroll, in the Incidental Economist blog, writes:

When they gave evidence that vaccines aren't linked to autism, that actually made parents who were already skittish about vaccines less likely to get their child one in the future. When they showed images of sick children to parents it increased their belief that vaccines caused autism. When they told a dramatic story about an infant in danger because he wasn't immunized, it increased parents' beliefs that vaccines had serious side effects.

"Basically," he says, "it was all depressing. Nothing was effective."

Attempts to educate the public are not "futile", according to Dan Kahan of Yale Law School's the Cultural Cognition Project. The information produced by public health groups has to be carefully crafted, however.

"It is a bad idea to flood public discourse in a blunderbuss fashion with communications that state or imply that there is a 'growing crisis of confidence' in vaccines that is 'eroding' immunization rates," he writes.

"It's a good idea instead to use valid empirical means to formulate targeted and effective vaccine-safety communication strategies."

He also warns that comparing the anti-vaccination movement to other controversial topics is particularly counterproductive. Citing a Yale study, he writes:

The equation of "vaccine hesitancy" with disbelief in evolution and skepticism about climate change - another popular trope - can create cultural polarization over vaccine safety among diverse people who otherwise all agree that vaccine benefits are high and their risks low.

Could the immunisation issue really be in danger of becoming another political football? There's a lot wrong with the current US political climate, but at least it hasn't been responsible for an entirely preventable measles epidemic. It would be nice to keep it that way.