Vaccines have done more than any other medical innovation to save lives and improve health. Yet the persistent and incorrect belief by a minority of parents that vaccines are more dangerous than beneficial is undermining those advances in the U.S. and parts of Europe. The challenge is how to protect communities against disease when some people won’t take part in public health measures that need everyone’s participation to be effective.
Preventable diseases are making a comeback in the U.S. and Europe. A vaccine eliminated measles from the U.S. in 2000, but there were 189 cases of the potentially deadly disease in 2015, after a peak of 644 cases a year earlier. The situation is worse in Europe, where nearly 4,000 people were stricken in 2015. Whooping cough, a lethal hazard to babies, has remained at elevated levels since 2012, when it killed 20 people in the U.S. and 10 in the U.K. In the U.S., disease outbreaks have been traced to individuals who weren’t vaccinated or were under-vaccinated and contracted the infection abroad. The number of unprotected children has grown amid an organized campaign to convince parents that vaccines have dangerous and common side effects, including autism. Because unvaccinated children often live in geographic clusters, their communities can lose herd immunity, which occurs when so many people are protected a pathogen can't take hold and dies out. Without herd immunity, those who can’t be vaccinated, for medical reasons or because they are too young, become vulnerable. In 2015, a Washington woman with a compromised immune system died from measles after she was likely exposed during an outbreak in Clallam County, where resistance to immunizations is high. Even those who are immunized are at risk, as no vaccine is perfectly effective. As many as 18 percent of the measles cases in a California outbreak that began at Disneyland in late 2014 were in vaccinated people.
The anti-vaccine movement took off after the medical journal The Lancet published what turned out to be a fraudulent study in 1998 linking the measles, mumps and rubella vaccine to autism. The Lancet retracted the study in 2010 and the U.K.’s General Medical Council stripped its author, Andrew Wakefield, of his medical license for “dishonest” and “irresponsible” work. By then many parents had latched on to the idea that vaccines were to blame for a rise in autism diagnoses, despite repeated studies debunking the connection. The myth expanded in 2005 with claims that the vaccine preservative thimerosal, which contains ethyl mercury, causes autism. U.S. authorities in 1999 urged vaccine makers to reduce or eliminate thimerosal as a precautionary measure, and today every vaccine recommended for young children is available without it. Only a few others contain trace amounts, and numerous studies have shown that thimerosal-containing vaccines are safe. Autism rates continued to rise and anti-vaccination activists continued to thrive, hyping reports of vaccine side effects and dismissing research documenting their benefits on balance.
Public health specialists disagree on the best way to deal with vaccine refusers. Some support eliminating the exemptions on the grounds of personal belief that 18 U.S. states offer to laws requiring childhood vaccines for school attendance. Some also would do away with religious waivers, as California has voted to do, joining Mississippi and West Virginia. In striking down the exemption, Mississippi's Supreme Court said the state had an “overriding and compelling public interest” in protecting children. U.S. courts have consistently upheld vaccine mandates. Other health advocates argue that making vaccination compulsory would harden the position of refusers. There are historical precedents. In Europe, the strongest anti-vaccination movements tend to be in countries that made vaccines mandatory in past centuries. A number of U.S. states have made vaccine exemptions harder to get. These changes have increased vaccination rates somewhat, probably by motivating parents who’d chosen exemptions out of convenience. Changing the attitudes of true vaccine refusers is much more difficult, research suggests. Australia stopped offering child-care benefits to such parents in 2016. Medical ethicist Art Caplan suggests that the parents of unvaccinated children who sicken others should be held legally liable for damages, including death.
The Reference Shelf
- The Council on Foreign Relations tracks outbreaks of vaccine-preventable diseases on this map.
- Comedy duo Penn and Teller demonstrate the value of vaccines in this video.
- The U.S. Institute of Medicine’s 2012 report provides evidence for actual vaccine side effects.
- This World Health Organization paper documents benefits of vaccination. This one gives the history of immunization.
- The National Conference of State Legislatures maps vaccination exemptions across the U.S.
First published Jan. 26, 2015
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