The Skeptics Society & Skeptic magazine

Engaging the Anti-vaxxers

a book review by Christian Orlic

On May 14, 1796, Edward Jenner developed and tested the first vaccine. He was able to protect people from smallpox by inoculating them with cowpox. Two centuries later vaccines have eradicated diseases and are often described as one of public health’s greatest achievements. According to the CDC vaccines have been highly successful and by 1996 there was 97.8% decrease in the incidence of rubella, diphtheria, haemophilus influenza type b, measles, mumps, pertussis, polio and tetanus (20).

Nevertheless, American parents appear to be more anxious than ever about vaccinating their children. Currently, American children receive at least 36 vaccinations before their sixth birthday. Some vaccines protect children and people against devastating communicable diseases that if when left unvaccinated would result in epidemics within communities. Nowadays about 40% of American parents chose to delay or refuse vaccinations for their children (15). Most of the children who have received no vaccines have slipped through the cracks: they are poor and have no insurance (20–40% of unvaccinated children). About 11.5% of American parents have “consciously refused” vaccines recommended by pediatricians, and about 23% have delayed some vaccines (32). Currently, all U.S. states allow vaccine exemptions for medical reasons, 48 states also allow children to be exempt for religious reasons, and some have even begun accepting philosophical objections.

Mark A. Largent is a historian of biology and director of Science, Technology, Environment, Public Policy (STEPPS) at Michigan State University. Largent’s previous book, Breeding Contempt, deals with the history of coerced sterilization in the United States. In Vaccine: The Debate in Modern America, Largent couples historical scholarship, keen cultural observations, and personal experiences in order to explore the American debate surrounding vaccination. Largent’s provocative but compelling argument suggests that the debate about the science, safety and efficacy of vaccination is a proxy for a set of unaddressed underlying anxieties regarding vaccines; therefore, science is not enough to resolve it, “no scientific finding and no agreement among physicians and scientists can possibly bring it [the debate] to an end” (173).

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The book sets out to explore these anxieties and understand where and how they originated. Largent’s insightful observations provide ways in which the debate can be moved forward by addressing the anxieties parents have directly, rather than bickering about “simplistic stand-ins” (1). The anxieties that motivate the debate are over the number of vaccinations required, the diseases for which we vaccinate, the contents of vaccines, a perception that pharmaceutical companies care more about profits than safety, recent public health emergencies, fears over the long term effects of vaccinations, a belief that natural is better, as well as an overall frustration with the state of medical care. These underlying anxieties, Largent argues, must be addressed in order to continue enjoying high levels of vaccine compliance: “our continuing success in vaccinating children depends on whether the public has confidence in the scientists, doctors, and policy makers (including industry) who shape these programs” (136).

The current debate surrounding vaccinations is bipartisan, and those who oppose vaccines use both liberal and conservative arguments. The anti-vaccine movement was influenced by alternative medicine and recent events. For example, when AIDS was first described, Eva Lee Snead claimed it was linked to the polio vaccine (52). Some concerns about vaccines are and have been legitimate. When polio vaccines were first developed, kidney tissue from chimpanzees was used. In fact, this process was unsafe, and tens of millions of people were unintentionally infected with SV40 (53). The fears expressed by Snead were thus not unwarranted; if one virus could make the cross-species jump, others could too. Since then, however, studies have disproven the link between the polio inoculations and HIV. Likewise, the alleged link between Gulf War Syndrome and vaccines given to soldiers is now debunked. Largent concludes that both of these public health emergencies fed suspicions about the safety of vaccines.

The claim that vaccines were linked to autism emerged at the same time in the U.S. and in the UK. These claims could only emerge because “modern concerns about vaccines were already in place” (67). Largent may come off as too sympathetic to Dr. Wakefield and Jenny McCarthy, “the iconic vaccine-anxious parent” (139); however, I submit, that this is required for both good history and understanding. By at least momentarily embracing the views of those who opposed vaccination, we come to understand why they hold these views and how they developed them. Chapter 3 and 4 of Largent’s book explore how Wakefield and McCarthy came to believe that vaccines cause autism and how they became spokespeople for an already anxious community. Their rapid rise to celebrity within their community supports the assertion that British and American parents were already anxious. Therefore, it should not surprise observers “how easily they adopted an explanation that was critical of the modern vaccine schedule” (73). The alleged link between thimerosal and autism, as well as that of the MMR vaccine with digestive problems resulting in developmental problems, provided “a ready-made venue for discussing their concerns about vaccines within a group of like-minded advocates”(12). While Largent recognizes that there is no evidence to support either Wakefield or McCarthy claims, he thinks that their outright dismissal is detrimental to maintaining high levels of vaccine compliance.

Largent argues that by ignoring the underlying anxieties, public health officials and vaccine advocates have misconstrued the reasons parents chose not to vaccinate, or to delay vaccination. Secondly, public health officials prefer to discuss the efficacy and safety of vaccines because this is within their professional realm. Vaccine advocates often claim that ignorance is one of the reasons parents are anxious about vaccinating their children. They claim that this refusal to vaccinate is predicated by an ignorance of the severity of the diseases for which vaccines protect. Whereas, data demonstrates that the more educated parents are the more likely they are to have reservations about the recommended vaccine schedule (34). These parents for the most part are making conscious, non-religious, decisions to refuse or delay vaccinating their children. Further antagonizing them rather than addressing underlying anxieties is likely to reduce vaccine compliance.

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One of the most important observations made by Largent is that not all vaccines are the same. Some vaccines protect against devastating diseases (MMR, DPT), others protect against dangerous ones (Hep A, Hep B, Hib, rotavirus, PCV) but the likelihood that an infant may be exposed to these is low, and other vaccinations provide protection against diseases with extremely low mortality rates (chickenpox). The distinction between the diseases each vaccine protects from are often forgotten. For example, Largent argues that some of the diseases we vaccinate newly born babies against may be unnecessary, such as HepB, a disease that an infant could only “contract by having sex with an infected person or by sharing contaminated needles with an infected drug addict” could wait (2). Public health officials should keep in mind that it is preferable for children to be under vaccinated than not vaccinated at all. Unfortunately, the vaccine debate is polarized. Amanda Peet, who supports vaccination, referred to the parents of unvaccinated children as “parasites” (she later apologized). Recognizing that not all vaccines are equal could sooth the rhetoric of the debate and allow for a more fruitful discussion. Otherwise, parents who are anxious about the amount of vaccines or one specific vaccine may be pushed not to vaccinate at all. Failing to recognize the differences between different inoculations results in an all or nothing approach (167).