A Way Out of the Vaccine Wars

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from The Gray Area:

A common sense approach to the vaccines issue.

by Peter Coy, Parents who refuse to vaccinate their kids against diseases like measles put others at risk. But, shaming them isn’t the answer.

Parenting in America has long caused passionate debates, but rarely do they turn as vicious as they have since the outbreak of measles at California’s Disneyland. “Here’s hoping the anti-vaxxer movement will naturally deselect hipsters from the human race,” wrote one Twitter user. And another: “If I find out you’re an anti vaxxer I will kidnap your children and give them the shot myself.” One parent vowed that if her baby contracts measles, “I’m ripping an anti-vaxxer limb from limb.” And this, which boils the fear and hatred down to its essence: “Anti-vaxxer parents are the disease that must be wiped out.”

In January alone 102 people in 14 states were diagnosed with measles, a disease declared eliminated from the U.S. in 2000. It can lead to life-threatening pneumonia as well as deafness and swelling of the brain. Most vulnerable are infants, pregnant women, and people with compromised immune systems who can’t get the vaccine. The Centers for Disease Control estimates that 92 percent of the January cases can be traced to the outbreak in Southern California, which happens to be where some of the most fervent vaccine refuseniks reside.

These parents—who don’t vaccinate at all, or stretch out the schedule, or skip some vaccines—continue to say they’re just doing what’s right for their children. They rely on the small minority of physicians and others who tell them that the inoculations are more dangerous than the diseases they prevent. Their representative, the National Vaccine Information Center, decries “a massive Pharma-led lobby attempt to demonize and punish all Americans who defend the human right to exercise informed consent.”

The measles war is ugly and intense, with fear motivating both sides.

During the 20th century, the near-universal inoculation of children in developed countries all but eliminated the threat of such diseases as measles, mumps, and polio. Yet in the U.S., at least, federal law is silent on compulsory vaccination, leaving the matter to the states. The upshot is a muddled legal system in which all 50 states compel parents to vaccinate their children—but 48 of them (all but West Virginia and Mississippi) allow exemptions for religious objectors. Twenty more recognize personal or philosophical objections to vaccination.

There are strong social, medical, and moral arguments for limiting exemptions. If enough members of a population are vaccinated, there’s herd immunity: Even those who don’t get vaccinated are safe because the disease can’t reach them. Anti-vaxxers are free riders who get the benefit of vaccination programs without sharing the real or perceived burden. One study found that whooping cough is rarer in states that make it harder for people to obtain exemptions—for example, requiring parents to meet with a doctor who goes over the benefits and public policy purpose of vaccinations. Last year, California began requiring parents to produce a health-care practitioner’s note to claim a personal-belief exemption.

On the other hand, getting rid of exemptions entirely, even in the name of public safety, would be unwise.

If vaxxers can’t force people to get their shots, they can try shaming them into it. But vilification, however satisfying, doesn’t do much good.

Another thing that doesn’t work—and this is unfortunate—is distribution of reliable information.

… among parents who had the least favorable attitudes toward vaccines, refuting claims of a link between vaccines and autism actually decreased intent to vaccinate. “People are pretty good at coming up with reasons to continue to hold the beliefs they already hold,” says Nyhan.

What does work is to communicate through respected leaders. During the Ebola crisis in West Africa, village leaders played a crucial role. In the U.S. and Europe, teachers, pastors, and doctors can take the lead. Physicians can increase compliance by making clear that full and prompt vaccination is an expectation, not just an option, says Dr. Douglas Opel of the Treuman Katz Center for Pediatric Bioethics at Seattle Children’s Hospital. It’s important, though, to show respect for the parents’ opinions. “We, the public health community, should recognize that they’re starting from the right place,” agrees Emory’s Omer. “All parents want to see their kids healthy and are looking out for their welfare.”

One of the toughest calls for a pro­vaccine physician is what to do when a family rejects her or his counsel. Some parents and lawmakers have called on pediatricians to ban unvaccinated kids from their offices. But Omer says ditching an uncompliant family is a mistake. “You’re decreasing the possibility of changing their mind and pushing it toward zero,” he says. “A lot of these parents don’t refuse all vaccines. They still get some vaccines.”

As the number of measles cases in the U.S. rises, it might be tempting to stop with the exemptions and the counseling and just vaccinate everyone. But imagine the ugly scenes of children being torn from the arms of their howling parents; sieges; even shootouts. Mandatory vaccination might be justified in a made-for-Hollywood emergency, but we aren’t anywhere near that. The key is proportionality. As those Twitter tweets show, it’s not just the anti-vaxxers who come from a place of fear and anger. It’s the vaxxers, too. A democratic society must search for common ground. Let’s make this a time for healing. And not just from measles.

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