Protests against anti-vaccination movement concept.

Pro-vaccination activists. Image credit: Russell Watkins / Department for International Development [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)]

Conspiracy theories – real and imagined – exert a virtually unparalleled grip on the public imagination. Many simply sell improbable books or over-hyped Netflix series. Anti-vaccination conspiracy theories, however, pose a threat to children and vulnerable adults around the world.

Speculation about nefarious plots veer from the plausible to the ridiculous, from the verified to the flatly false. Conspiracy theories do sometimes uncover real instances of wrongdoing and criminality such as the Watergate scandal. Other times, they have the potential to wreak real damage. In public health, perhaps nowhere is this truer than the anti-vaccination movement.

The roots of the modern anti-vaccination movement are well-established. They stem from a fraudulent research paper published by then-Dr Andrew Wakefield in The Lancet, in which he claimed there to be a link between the measles, mumps, and rubella (MMR) vaccine and autism.

Thanks to exhaustive investigations, most notably by Brian Deer, the paper’s findings were debunked; The Lancet retracted them; and Wakefield was investigated by the British General Medical Council (GMC) for unethical behaviour, ranging from dishonesty to the abuse of children with neurodevelopmental disorders (including performing unnecessary invasive medical procedures). The GMC stripped Wakefield of his medical license in 2010, having described him as “callous and misleading”. That should have put the matter to bed.

It did not.

“A common factor in many of these countries is an insurgent anti-vaccination movement, one whose public figureheads represent diverse fields ranging from entertainment to politics. These are influencing parents, in a far cry from the norms of the past.”

Image credit: WHO’s Global Health Observatory [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)]

The World Health Organization (WHO) this year found that measles cases had increased in every region of the world in the first three months of 2019, compared to the same timeframe last year. Overall, 170 countries reported 112,163 measles cases. Last year, the figure stood at just 28,124.

Measles can be prevented in 97 percent of cases with two doses of a vaccine; 93 percent of cases can be prevented with a single dose. Despite this, the disease is seeing a resurgence. This is not only limited to countries that may face gaps in healthcare infrastructure and difficulty reaching remote segments of the population. It is true of western nations too.

The United States is perhaps the most notable example of this, but it is far from an outlier. In the United Kingdom, uptake of the measles, mumps, and rubella (MMR) vaccine fell in England last year for the fourth year in a row. In Italy, the incumbent coalition government has enacted populist measures since coming to power, such as suspending a policy making vaccination compulsory for schoolchildren to proposing (the policy is now back in force).

A common factor in many of these countries is an insurgent anti-vaccination movement, one whose public figureheads represent diverse fields ranging from entertainment to politics. These are influencing parents, in a far cry from the norms of the past.

Image credit: Heidi J.Larson, PhD; Alexandre de Figueiredo, MSc; Zhao Xiahong, BSc; William S. Schulz, MSc; Pierre Verger, PhD; Iain G. Johnston, PhD; Alex R. Cook, PhD; Nick S. Jones, PhD [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)]

“No longer today is vaccination a matter of rote: it is now a battleground upon which the struggle between baseless conspiracy theories and legitimate scientific evidence is being fought. And it is causing human suffering and costing lives.”

“I remember my father (a practising physician) vaccinating me in our kitchen in the early 1960s,” Denise Gray-Felder, founder of the CFSC Consortium, recalled to me.” There was no debate about whether my brother and I would be vaccinated; our parents were card-carrying members of the ‘care-about-your-neighbour-as-much-as-you-do-yourself’ club. The message was simple: ‘roll up your sleeve.’” Grey-Felder is also part of Baird’s CMC, a sister company of Hyderus.

No longer today is vaccination a matter of rote: it is now a battleground upon which the struggle between baseless conspiracy theories and legitimate scientific evidence is being fought. And it is causing human suffering and costing lives.

“Today, I thank my parents for many normative behaviours they passed along,” Gray-Felder says. “Because of such upbringing, I, admittedly, find some behaviours of today’s anti-vaxxers perplexing, scary and unacceptable.” The consequence of such behaviours, she asserts, is that “we continue to fight battles that many of us assumed we had already won decades ago: wars against childhood diseases like measles and chickenpox…states’ mandatory childhood vaccinations have been remarkably effective; yet our herd immunity remains threatened.”

The numbers are frightening, as, Gray-Felder explains

“In the United States, there have been a total of 764 cases of measles reported to date this year, spread across 23 of the 50 states. [Since publication, the toll has increased to 880 cases across 24 states, between January 1st and May 17th]. Measles killed 72 children and adults in Europe in 2018; 82,596 people in 47 of the 53 countries in the World Health Organization European Region contracted measles in 2018, with more than sixty percent of people who reported having the measles hospitalised.”

Vaccine scepticism is not the sole reason behind outbreaks of diseases such as measles. As the WHO notes, “the reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy.” However, it still lists vaccine hesitancy as one of the ten major threats facing public health globally in 2019, stating that the phenomenon “threatens to reverse progress” and stymies further successes. “Vaccination…currently prevents 2-3 million deaths a year,” the WHO asserts. “A further 1.5 million could be avoided if global coverage of vaccinations improved.”

Children at a vaccination clinic near Sululta, Ethiopia. Image credit: Yasmin Abubeker/DFID [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)]

“The modern anti-vaccination movement…comes at a time when the cost-effectiveness of vaccination campaigns is widely understood and we have witnessed massive successes in the global eradication of smallpox and the near-eradication of polio. It also comes at a time when the media landscape has changed dramatically, allowing for medical conspiracy theories like the anti-vaccination movement to spread at an alarming clip.”

Vaccine scepticism has its roots all the way back in the early days of smallpox immunisation. The 18th century saw much religious opposition to variolation, the first attempt to immunise people against smallpox. Vaccine scepticism in Stockholm led to an epidemic of the disease there in the late 19th century. Forced smallpox vaccinations led to the so-called Vaccine Revolt in Rio de Janeiro in 1904.

The modern anti-vaccination movement, however, comes at a time when the cost-effectiveness of vaccination campaigns is widely understood and we have witnessed massive successes in the global eradication of smallpox and the near-eradication of polio. It also comes at a time when the media landscape has changed dramatically, allowing for medical conspiracy theories like the anti-vaccination movement to spread at an alarming clip.

“The anti-vaccination movement is not new, but it has leveraged new media to become extraordinarily strong and resonant with large numbers of well-meaning, uninformed and vulnerable young parents,” Baird’s CMC shareholder Kenneth Rabin told me. Baird’s CMC is a sister company of Hyderus.

Anti-vaccination activist Robert F. Kennedy, Jr.. Image credit: Daniel Schwen [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]

“These grim realities have not stopped a groundswell of support for the anti-vaccination movement, allowing the likes of Wakefield – a man, lest we forget, thoroughly discredited and struck off the British medical register – to be hosted at the White House, publish books and make films spreading his pseudoscientific propaganda.”

To be clear, no medical procedure is without risk: some vaccines can very occasionally cause serious complications. However, it is worth noting that this happens rarely and such complications are much less frequent than those which arise from the diseases which vaccines target. “If we do not do a more credible job of explaining the benefits of childhood vaccines to families and communities, at the grassroots level,” Rabin adds, “we risk seeing new epidemics of preventable infectious diseases that should have no place in the 21st century.”

These grim realities have not stopped a groundswell of support for the anti-vaccination movement, allowing the likes of Wakefield – a man, lest we forget, thoroughly discredited and struck off the British medical register – to be hosted at the White House, publish books and make films spreading his pseudoscientific propaganda.

A chorus of celebrities and public figures echo his misgivings about vaccines: Robert F. Kennedy, Jr. is one notable example. His vaccine scepticism goes back years. He has published books and articles questioning the safety of vaccines; chairs an anti-vaccination “think tank”; delivered public speeches on the subject; and blames them for rising rates of autism, which he likens to “a holocaust”. For a distinguished legal mind to peddle in such misinformation is disturbing, so much so that even his own family have reacted with despair. Kathleen Kennedy Townsend, Joseph P. Kennedy II, and Maeve Kennedy McKean wrote in Politico

“His and others’ work against vaccines is having heartbreaking consequences. The challenge for public health officials right now is that many people are more afraid of the vaccines than the diseases, because they’ve been lucky enough to have never seen the diseases and their devastating impact. But that’s not luck; it’s the result of concerted vaccination efforts over many years. We don’t need measles outbreaks to remind us of the value of vaccination”

Kennedy met with Donald Trump when the latter was President-elect, reportedly being asked to lead a government commission on vaccine safety. Kennedy has since complained that the White House is excluding him from the discussion about vaccines, but this is beside the point. For public figures to foist deadly scientific mistruths into the public sphere is dangerous enough. To be legitimised with potential government appointments is something else altogether.

The roots of the anti-vaccination movement in the conspiracy theory mindset are patent. What tends to unite conspiracy theories is the mistrust of governments and elites, cast in the role of a shadowy cabal working to advance their own interests no matter the human cost.

Copyright: netsay / 123RF Stock Photo

Eradication of polio would not have been possible without vaccination.

“Part of why Wakefield was discredited arose from the fact he did not declare pertinent conflicts of interest, such as from anti-vaccination lobbying groups and solicitors trying to litigate the cause. In his exposé, Brian Deer did an excellent job of outlining the extent to which profiteering was a key motivating factor in the anti-vax movement’s nascent stages – not only for Wakefield but also his partners.”

The anti-vaccine movement is no exception: so the argument often goes, the autism connection is debunked because of the profit-seeking behaviour of Big Pharma and governments who stand to gain from vaccine sales. Doctors are paid off to endorse vaccines and keep quiet about the risks to your children’s health. Anyone who disputes the claims of the anti-vaccination movement is in Big Pharma’s pocket. The likes of Wakefield are not proven liars and frauds; they are freedom fighters, bravely crusading to demolish what they want you to believe.

Conspiracy theories do not originate in a vacuum, including the anti-vaccination movement. As Anna Merlan writes in The Guardian

“Medical conspiracies aren’t irrational. They are based on frustration with what is seen as the opacity of the medical and pharmaceutical systems. They have taken root in the US, a country with profoundly expensive and dysfunctional healthcare – some adherents take untested cures because they can’t afford the real thing. And there is a long history around the world of doctors giving their approval to innovations – cigarettes, certain levels of radiation, thalidomide, mercury – that turn out to be anything but safe.”

This translates to a cottage industry of individuals who will stoke these fears, often for personal gain. Part of why Wakefield was discredited arose from the fact he did not declare pertinent conflicts of interest, such as from anti-vaccination lobbying groups and solicitors trying to litigate the cause. In his exposé, Brian Deer did an excellent job of outlining the extent to which profiteering was a key motivating factor in the anti-vax movement’s nascent stages – not only for Wakefield but also his partners. Others have profited in big ways. Alex Jones – the disreputable face of conspiracy theory hub InfoWars – profited significantly from promulgating medical conspiracy theories – and then marketing his own nutriceuticals and ‘life supplements’.

“We can ignore the reality of the profiteering public faces or the overwhelming scientific evidence dispelling their assertions or the consequences of their actions being seen in outbreaks of preventable diseases. We can ask one question: can it simply be an issue of parental choice enjoying primacy? “No.””

Nobody disputes that medicines should be safe, least of all the medical community. But to discount them all at once is dangerous, as the spate of measles outbreaks plaguing the globe shows. Even Donald Trump, who has a history of entertaining anti-vaccination conspiracies and their representatives in the public sphere, is now encouraging parents to vaccinate their children against measles in the face of outbreaks.

When it comes to the anti-vaccination movement, there is a final argument we can come to. We can ignore the reality of the profiteering public faces or the overwhelming scientific evidence dispelling their assertions or the consequences of their actions being seen in outbreaks of preventable diseases. We can ask one question: can it simply be an issue of parental choice enjoying primacy?

“No,” Denise Gray-Felder asserts. “Public health and safety regulations exist to protect the majority within societies. Think about lines painted on public streets throughout the world. These lines are universally understood to mean “stay on your side while driving.” Even in towns and villages without highway dividing lines, drivers know to drive on their side of the road. When it comes to keeping my town free from avoidable diseases, we should all “stay in our lane.”