The New York Times - January 20, 2011
Why Parents Fear the Needle
A Century of Vaccine Scares
By MICHAEL WILLRICH
Michael Willrich, an associate professor of history at Brandeis University, is the author of the forthcoming “Pox: An American History.”
Wellesley, Mass.
DESPITE overwhelming evidence to the contrary, roughly one in five Americans believes that vaccines cause autism — a disturbing fact that will probably hold true even after the publication this month, in a British medical journal, of a report thoroughly debunking the 1998 paper that began the vaccine-autism scare.
That’s because the public’s underlying fear of vaccines goes much deeper than a single paper. Until officials realize that, and learn how to counter such deep-seated concerns, the paranoia — and the public-health risk it poses — will remain.
The evidence against the original article and its author, a British medical researcher named Andrew Wakefield, is damning. Among other things, he is said to have received payment for his research from a lawyer involved in a suit against a vaccine manufacturer; in response, Britain’s General Medical Council struck him from the medical register last May. As the journal’s editor put it, the assertion that the measles-mumps-rubella vaccine caused autism “was based not on bad science but on a deliberate fraud.”
But public fear of vaccines did not originate with Dr. Wakefield’s paper. Rather, his claims tapped into a reservoir of doubt and resentment toward this life-saving, but never risk-free, technology.
Vaccines have had to fight against public skepticism from the beginning. In 1802, after Edward Jenner published his first results claiming that scratching cowpox pus into the arms of healthy children could protect them against smallpox, a political cartoon appeared showing newly vaccinated people with hooves and horns.
Nevertheless, during the 19th century vaccines became central to public-health efforts in England, Europe and the Americas, and several countries began to require vaccinations.
Such a move didn’t sit comfortably with many people, who saw mandatory vaccinations as an invasion of their personal liberty. An antivaccine movement began to build and, though vilified by the mainstream medical profession, soon boasted a substantial popular base and several prominent supporters, including Frederick Douglass, Leo Tolstoy and George Bernard Shaw, who called vaccinations “a peculiarly filthy piece of witchcraft.”
In America, popular opposition peaked during the smallpox epidemic at the turn of the 20th century. Health officials ordered vaccinations in public schools, in factories and on the nation’s railroads; club-wielding New York City policemen enforced vaccinations in crowded immigrant tenements, while Texas Rangers and the United States Cavalry provided muscle for vaccinators along the Mexican border.
Public resistance was immediate, from riots and school strikes to lobbying and a groundswell of litigation that eventually reached the Supreme Court. Newspapers, notably this one, dismissed antivaccinationists as “benighted and deranged” and “hopeless cranks.”
But the opposition reflected complex attitudes toward medicine and the government. Many African-Americans, long neglected or mistreated by the white medical profession, doubted the vaccinators’ motives. Christian Scientists protested the laws as an assault on religious liberty. And workers feared, with good reason, that vaccines would inflame their arms and cost them several days’ wages.
Understandably, advocates for universal immunization then and now have tended to see only the harm done by their critics. But in retrospect, such wariness was justified: at the time, health officials ordered vaccinations without ensuring the vaccines were safe and effective.
Public confidence in vaccines collapsed in the fall of 1901 when newspapers linked the deaths of nine schoolchildren in Camden, N.J., to a commercial vaccine allegedly tainted with tetanus. In St. Louis, 13 more schoolchildren died of tetanus after treatment with the diphtheria antitoxin. It was decades before many Americans were willing to submit to public vaccination campaigns again.
Nevertheless, the vaccination controversy of the last century did leave a positive legacy. Seeking to restore confidence after the deaths in Camden and St. Louis, Congress enacted the Biologics Control Act of 1902, establishing the first federal regulation of the nation’s growing vaccine industry. Confronted with numerous antivaccination lawsuits, state and federal courts established new standards that balanced public health and civil liberties.
Most important, popular resistance taught government officials that when it comes to public health, education can be more effective than brute force. By midcentury, awareness efforts had proven critical to the polio and smallpox vaccination efforts, both of which were huge successes.
One would think such education efforts would no longer be necessary. After all, today’s vaccines are safer, subject to extensive regulatory controls. And shots are far more numerous: as of 2010, the Centers for Disease Control recommended that every child receive 10 different vaccines. For most Americans, vaccines are a fact of life.
Still, according to a 2010 C.D.C. report, 40 percent of American parents with young children have delayed or refused one or more vaccines for their child. That’s in part because vaccines have been so successful that any risk associated with their use, however statistically small, takes on an elevated significance.
It also doesn’t help that, thanks to the Internet, a bottomless archive of misinformation, including Dr. Wakefield’s debunked work, is just a few keystrokes away. All of which means the public health community must work even harder to spread the positive news about vaccines.
Health officials often get frustrated with public misconceptions about vaccines; at the turn of the last century, one frustrated Kentucky health officer pined for the arrival of “the fool-killer” — an outbreak of smallpox devastating enough to convince his skeptical rural constituency of the value of vaccination.
But that’s no way to run a health system. Our public health leaders would do far better to adopt the strategy used by one forward-thinking federal health official from the early 20th century, C. P. Wertenbaker of the Public Health and Marine-Hospital Service.
As smallpox raged across the American South, Wertenbaker journeyed to small communities and delivered speech after speech on vaccinations before swelling audiences of townsfolk, farmers and families. He listened and replied to people’s fears. He told them about the horrors of smallpox. He candidly presented the latest scientific information about the benefits and risks of vaccination. And he urged his audiences to protect themselves and one another by taking the vaccine. By the time he was done, many of his listeners were already rolling up their sleeves.
America’s public health leaders need to do the same, to reclaim the town square with a candid national conversation about the real risks of vaccines, which are minuscule compared with their benefits. Why waste another breath vilifying the antivaccination minority when steps can be taken to expand the pro-vaccine majority?
Obstetricians, midwives and pediatricians should present the facts about vaccines and the nasty diseases they prevent early and often to expectant parents. Health agencies should mobilize local parents’ organizations to publicize, in realistic terms, the hazards that unvaccinated children can pose to everyone else in their communities. And health officials must redouble their efforts to harness the power of the Internet and spread the good word about vaccines.
You can bet that Wertenbaker would have done the same thing.
This article was found at:
http://www.nytimes.com/2011/01/21/opinion/21willrich.html
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Prosecutor to parents: Mailing chickenpox illegal
ReplyDeleteBy ERIK SCHELZIG, AP – November 4, 2011
NASHVILLE, Tenn. (AP) — Parents fearful of vaccinations are being warned by a federal prosecutor that making a deal with a stranger who promises to mail them lollipops licked by children with chickenpox isn't just a bad idea, it's against the law. Jerry Martin, U.S. attorney for the Middle District of Tennessee, said he was spurred by reports this week by KPHO-TV in Phoenix and WSMV-TV in Nashville about people turning to Facebook to find lollipops, spit or other items from children who have chickenpox.
"Can you imagine getting a package in the mail from this complete stranger that you know from Facebook because you joined a group, and say here, drink this purported spit from some other kid?" Martin told The Associated Press.
Isaac Thomsen, a specialist in pediatric infectious diseases at Vanderbilt Children's Hospital, said it's unlikely the items will succeed in giving other children chickenpox.
"If there's a very high load on the virus and shipped very quickly, it's theoretically possible," he said. "But it's probably not an effective way to transmit it. It typically has to be inhaled."
But Thomsen warned the lollipops could carry more dangerous viruses, including hepatitis.
Martin said it is a federal crime to send diseases or viruses across state lines, whether through the U.S. Postal Service or private services like FedEx or UPS. Sending the lollipops would be illegal under the same law that makes it illegal to mail contagions like anthrax. He said a conviction could lead to a sentence from less than a year to 20 years in prison. Martin said the items are sought by parents who don't want to give their children vaccines. He said he could neither confirm nor deny that his office is investigating or seeking charges against anyone.
According to the TV reports, parents have turned to a Facebook group called "Find a Pox Party in Your Area" to link up people looking to share the virus. One of the Facebook postings from Wendy Werkit of Nashville offered a "fresh batch of pox in Nashville shipping of suckers, spit and Q-tips available tomorrow 50 dollars via PayPal."
Werkit told WSMV that the money was used to cover the shipping costs of the lollipops had been licked by her children. "They can't get (chickenpox) the normal way anymore of just naturally catching and just naturally getting the immunity for life," Werkit said.
Thomsen, the Vanderbilt physician, said he was even more concerned by a person in the KPHO report seeking items tainted with measles to avoid a school-required vaccination. Measles has a significant mortality rate, causes more complications and is very infectious compared with chickenpox, he said. And law enforcement won't take any such cases lightly, Martin said.
"If you are engaged in this type of behavior, you're not only potentially exposing innocent people to dangerous viruses and illnesses and diseases, you're also exposing yourself potentially to federal criminal prosecution," he said.
http://www.google.com/hostednews/ap/article/ALeqM5hZPTOwdahjYmdW-P5rzeiq5ErHww
Muslim doctors denounce anti-vaccination drive
ReplyDeleteby FARANAAZ PARKER - Mail & Guardian South Africa March 19 2012
A pamphlet circulating within the Jo'burg Muslim community that warns of the dangers of vaccination has been slammed by doctors and paediatricians, who say not vaccinating children puts them and the wider community at risk.
The pamphlet, titled "Islam, vaccines and health", argues that vaccines are harmful and contain haraam substances, which Muslims are not permitted to use. It claims that vaccination is ineffective and based on "a long discredited theory".
But local medical associations have warned that this type of information puts the most vulnerable in South Africa at risk.
The pamphlet in question has been printed and distributed by the Young Men's Muslim Association in Benoni, but its origin lies a continent away.
The very same article has been circulating online for the past five years, and is attributed to Dr Abdel Majid Katme, a British psychiatrist who affiliates himself with the Islamic Medical Association (UK).
Katme's tract first made the rounds in the UK in 2007. He urged Muslim parents to forgo vaccinations and to instead practise natural defences against disease. He suggested, among other things, frequent hand-washing, fasting, prayer and eating honey and black seed.
An internet search turned up a number of instances of Katme's article. But it takes quite a bit more digging to find the voices of those who oppose Katme's view.
An article in the British Medical Journal, which points out that the organisation Katme represents has no membership, staff or offices, and is only accessible to subscribers.
When the article was first published, Katme was criticised by the British Medical Association, the department of health, and Muslim groups in the UK who said his beliefs could lead to a rise in infectious diseases in Muslim communities.
The Islamic Medical Association of South Africa (IMA SA) has also spoken out against the information being put out. The organisation's president, Dr Ebrahim Khan, told the Mail & Guardian that the IMA did not endorse this or any other anti-vaccination campaign.
"The IMA distances itself from any of these campaigns that advise people not to vaccinate," he said. "The IMA position is that vaccination is an essential tool in the prevention of disease."
Khan pointed out that in some cases, the same parents who opted not to vaccinate their children received vaccinations themselves as this is mandated for pilgrims who travel to Saudi Arabia for haj.
He appealed to those handing out the information to "refrain from misguiding people".
Lobby groups simmer in South Africa
Vaccination became a cornerstone of modern medicine in the late 19th century. It has led to the eradication of the deadly smallpox virus and saved the lives of millions of children who in earlier times would have died or been permanently disabled as a result of complications from measles, whooping cough (pertussis) and polio.
Yet there is a small but vocal thread of dissent from people who choose not to vaccinate.
Some trace this anti-vaccination sentiment to the work of British surgeon and medical researcher Andrew Wakefield, who put forward the now-discredited theory that the MMR (measles, mumps and rubella) vaccine is linked to autism.
Wakefield's theory took off in the 1990s and there was a subsequent drop in the rate of vaccination and an increase in illness and death from measles, mumps and rubella.
It was later found that Wakefield had falsified his research and had sought to launch a business selling diagnostic kits to parents who feared an adverse reaction to the MMR. He has since been barred from practising medicine in the UK.
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ReplyDeleteYet Wakefield's influence lives on. Two years ago, a dangerous outbreak of whooping cough in the state of California in the US resulted in the deaths of ten newborns.
Polio, once on the verge of eradication, has also reared its head once more in Nigeria and Pakistan, where the edicts of religious leaders encouraged communities to refuse the polio vaccine.
Although seemingly centred in the US and UK, South Africa also has its share of parents who choose not to vaccinate.
Rosemary Burnett, a senior lecturer in epidemiology at the University of Limpopo at Medunsa, together with her colleagues, has recently started researching the phenomenon in South Africa.
"From anecdotal reports given to us by healthcare workers during the recent measles outbreak, it is clear that some parents are refusing to have their children vaccinated," she said.
Although her team has not yet built up a clear profile of the people who choose not to vaccinate, or quantified their impact on vaccination uptake, preliminary research suggests they are mainly educated and white.
This seems to mirror the situation in other countries, where people who choose not to vaccinate are predominantly educated and upper-class.
The case against vaccination
Shakirah Gathoo is a mother of three and a former paramedic who has chosen not to vaccinate her children.
"The human body has the innate ability to fight off infections and illness itself," she told the M&G. "I have a problem putting something that is basically impure into my body and the body of my children."
Gathoo believes that contracting an illness or not is down to fate, and said she tries to protect her children by ensuring that they have ideal nutrition and are in peak health. She's turned to alternative medicine in times of need and at one point nursed her toddler, who had contracted pneumonia, at home.
"It's not that I don't believe in medicine but as I've studied, I've realised the deficiencies in the conventional medical system," she said.
Gathoo said in an ideal world, vaccine and conventional medicine like antibiotics would not be needed, but admitted that fighting illness with alternative medicine requires patience and perseverance and said it's not something that would be right for everyone.
She said that in a country like South Africa, especially in informal settlements where nutrition, health, hygiene and sanitation isn't up to scratch, vaccination does help.
But she defended her choice saying: "Different people have different points of view and some people's views are stronger than others. They need to respect that as an individual it's my decision."
Her choice, she said, was informed and supported by her paediatrician.
Losing sight of the danger
But Dr Yaseen Joolay, a paediatrician at Groote Schuur Hospital in Cape Town, said many parents and even healthcare practitioners have lost sight of how dangerous infectious diseases, like measles, can be.
"Because we vaccinate and there's less infectious disease, and less severe cases of it, its kind of gone out of people's minds," he said.
In developing countries measles kills one in five infected children. Globally, it causes pneumonia in one in 20 children and encephalitis -- acute inflammation of the brain -- in one in 2 000.
"To not vaccinate is akin to child neglect," said Joolay.
Some children who are not vaccinated are spared childhood illnesses because their peers have been vaccinated against them. But Joolay warned that if vaccination rates continued to drop, this "herd immunity" will be eroded, allowing infectious diseases to gain a foothold in communities and spread.
"By not vaccinating, you're putting the entire society you're living in at risk," he said.
http://mg.co.za/article/2012-03-19-muslim-doctors-denounce-antivaccination-drive
High Court orders two sisters must receive MMR vaccine
ReplyDeleteBBC News October 11, 2013
A judge has ruled that sisters aged 15 and 11 must have the MMR vaccine even though they and their mother do not want it, BBC Newsnight has learned.
The High Court decision, made last month, came after the girls' father brought a case seeking vaccination.
The parents, now divorced, had agreed when married not to vaccinate the girls in the wake of the MMR controversy.
But the discrediting of concerns about an MMR autism link and recent measles outbreaks changed the father's view.
This is the third time this issue has come before the court.
In 2003 a mother was ordered to have her child immunised against measles, mumps and rubella after the court ruled the benefits of vaccination outweighed the risks. In 2011, children in care were ordered to have the MMR jab against the wishes of their parents.
'End of MMR debate'
When outlining her decision in the latest case, Mrs Justice Theis emphasised it was a specific case "only concerned with the welfare needs of these children", but lawyers say as one of a series it confirms there is no longer any debate about the benefits of the vaccine.
Measles is a highly contagious disease characterised by a high fever and a rash.
In one in 15 cases it can lead to severe complications, such as pneumonia, and in a very small number of cases it can cause encephalitis - inflammation of the brain - which can cause brain damage or even death.
MMR is a combined vaccine against measles, mumps and rubella, three common infectious diseases of childhood. It was introduced in the UK in 1988 to replace single vaccines for each disease.
The first MMR vaccine is given as a single injection to babies as part of their routine vaccination schedule, usually within a month of their first birthday, then a second injection of the vaccine, known as the MMR booster, is given before starting school.
The first gives about 95% protection against measles, while two doses give 99-100% protection.
Vegan concerns
In 1998, a study by Dr Andrew Wakefield was published in the respected medical journal The Lancet raising the possibility that the MMR jab was linked to autism and bowel disease.
The report and the media furore that followed prompted many parents to decide against having their children vaccinated with the three-in-one injection, including the parents of the two girls at the heart of this case.
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The elder daughter was given the first injection, but not the booster vaccine; the younger daughter did not receive any vaccinations at all - decisions made jointly by both parents at the time.
ReplyDeleteHowever, in 2010 Dr Wakefield's research was found by the General Medical Council to have been "dishonest" and has since been entirely dismissed.
The father of the two girls says that this change, combined with an outbreak of measles in Swansea late last year, changed his mind in January 2013 about whether his daughters should be given the MMR jab. He says he was worried these diseases could have serious consequences.
According to the text of the court decision, seen by BBC Newsnight, the father's solicitor wrote to the girls' mother in January seeking her agreement that they should now be vaccinated, and saying that if she did not agree he would take the matter to court.
The mother did not agree and the matter eventually came before the Family Division of the High Court.
'Children's understanding'
A court-appointed welfare officer who spoke extensively to the girls said that neither of them wanted the vaccination.
The children were particularly concerned about the ingredients in the vaccine, which include animal-based materials; one of the girls is a vegan.
However, the officer said that when she asked them what would happen if they became ill with measles, mumps or rubella and needed medicine, they clearly had not thought about what the ingredients in that medicine might be.
The welfare officer said both children had been strongly influenced by their mother, who was very anxious about the jab.
Mrs Justice Theis decided that it was in the best interests of the children that they were vaccinated.
"I am aware that this is against the girls' wishes but that that it is not the only factor," she wrote. "The court also has to consider their level of understanding of the issues involved and what factors have influenced their views. I do not consider there is a balanced level of understanding by them of the issues involved."
The mother's lawyer Philippa Dolan told Newsnight that the girls had not yet been vaccinated despite the deadline to do so having passed on Thursday.
She said: "There are practical difficulties in enforcing the order and that is at the moment an ongoing issue. There's not a legal deadline that's a serious issue the parents are in discussion and everyone hopes it will be resolved without any more litigation."
http://www.bbc.co.uk/news/health-24493422
Vaccine objectors rise as parents skirt no jab, no play law
ReplyDeleteby Cindy Ngo, Sydney Morning Herald January 11, 2014
Conscientious objection to childhood immunisation is on the rise as parents exploit a loophole in the new ''no jab, no play'' law that allows unvaccinated children to be enrolled in childcare centres.
The federal Health Department says 3910 parents across Australia lodged a conscientious objection form last year, the highest number recorded by the Australian Childhood Immunisation Register since 1999.
It takes the total number of conscientious objectors to 36,320, out of more than 2.2 million children on the register.
The highest number of objections came from NSW parents, who accounted for 9625 of the total number of conscientious objectors at the end of last year. That was 1102 more than at the end of 2012.
Under the ''no jab, no play'' law, the documents must be signed by a GP or medical practitioner. Doctors can only do so after explaining to parents the benefits and risks of immunising their children against vaccine-preventable diseases.
Childcare centre operators face fines of up to $4000 if they do not keep immunisation records up to date.
From January 1, children who have not been vaccinated cannot be enrolled in a childcare centre unless their parents lodge documents claiming they object on philosophical or moral grounds or giving medical reasons for their failure to immunise. Parents can also provide documents proving their child is on a catch-up schedule if not already fully immunised.
The director of All Star Early Learners in Botany, Michelle Bouabaid, said there was a trend towards conscientious objection in ''certain demographics''.
''I do a lot of networking with colleagues and I've heard that, in middle-income suburbs, there is a lot more support for conscientious objection because of the panic around [the effects of] vaccination,'' she said.
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A report from the National Health Performance Authority last year showed some of Australia's lowest immunisation rates were in Sydney's wealthier suburbs, including Mosman, Manly, the inner city and the eastern suburbs. Other areas where immunisation rates were 85 per cent or lower included the coastal areas of the Richmond Valley, such as Byron Bay and Lennox Head, the Richmond Valley hinterland, the south coast, the Blue Mountains and Kempsey-Nambucca.
ReplyDeleteIn Mount Victoria in the Blue Mountains, early childcare teacher Fenella Cios - who runs a family daycare program - said the new laws had prompted the parents of an unimmunised two-year-old girl to catch up on her vaccinations.
As a mother to a nine-week-old son, Ms Cios is wary of enrolling unvaccinated children, fearing that her own children may be infected when exposed. ''I am planning on not taking on kids that aren't vaccinated because I have a newborn,'' she said.
Nicholas Wood, a doctor at the Children's Hospital at Westmead and senior lecturer on paediatrics and child health at the University of Sydney, said adverse publicity surrounding childhood vaccinations in recent years partly explained higher rates of conscientious objection.
''The other thing to remember is that … as the population increases you're probably going to see the number of conscientious objectors will increase,'' he said.
''Herd immunity'' - where a significant proportion of the population is immunised against a contagious disease, thereby reducing the chances of an outbreak - was lowered when children were not vaccinated, Dr Wood said.
''At an individual level, that [unvaccinated] child is not protected,'' he said.
According to Christine Selvey, a medical epidemiologist at NSW Health, most children were vaccinated but the legislation was a ''prompt for parents to make sure that their children are vaccinated or up-to-date [with their vaccination schedules]''.
Under the law, doctors are not legally bound to sign conscientious objection forms if they conflict with their personal views.
Childcare facilities were previously required to request an immunisation statement from parents enrolling their child but those who failed to provide one faced no enrolment restrictions.
http://www.smh.com.au/national/health/vaccine-objectors-rise-as-parents-skirt-no-jab-no-play-law-20140110-30mi1.html
Colorado May Become The Latest State To Crack Down On Vaccine Denialism
ReplyDeleteBY TARA CULP-RESSLER ON, Think Progress JANUARY 6, 2014
Colorado officials are considering tightening the rules for vaccinations, and may make it more difficult for parents to claim religious exemptions for their kids.
Right now, opting out of inoculation is typically as easy as filling out a form. But if health officials approve the new policy, parents who want to exempt their kids from vaccine requirements for non-medical reasons will need to receive more education on the benefits and risks of vaccination first.
The state’s health department is considering the rule change in light of recent outbreaks of infectious diseases, like whooping cough and measles, that have been linked to vaccine denial. Federal officials have repeatedly warned parents that failing to vaccinate their kids leaves them vulnerable to contracting these illnesses, which have been on the rise lately. Nonetheless, as the Wall Street Journal reports, more than six percent of kindergartners in some states hadn’t gotten their shots last year:
Other states with high vaccination refusal rates, like Oregon and Washington, have also made it more difficult for parents to opt their kids out of vaccines.
Anti-vaccine beliefs can have serious public health consequences, since even a few unvaccinated people can allow deadly diseases to spread. For instance, a measles outbreak in Texas last year was traced to an evangelical megachurch whose pastor preached the widely-debunked myth that vaccines can lead to autism. A similar outbreak in the Netherlands originated from a pocket of the country’s fundamentalist Christians who don’t believe in inoculation.
Here in the U.S., many people who are skeptical about vaccines aren’t necessarily religious fundamentalists — and they don’t have to cite religious beliefs in order to opt out their kids. In 19 states, parents can claim a broad “philosophical” exemption to mandatory vaccinations. Since persistent vaccine misinformation has led some U.S. parents to believe it’s simply more natural to refrain from giving their kids too many shots, some of them use that loophole.
A recent survey published in the journal Pediatrics suggests that this issue can be corrected by removing the decision-making dynamic from the equation.
When vaccination is presented to parents as an option, they’re more likely to refuse it. But when doctors treat vaccines as a mandatory and routine aspect of medical care — rather than asking parents about their preference — parents are more likely to trust medical professionals’ opinions on the subject.
http://thinkprogress.org/health/2014/01/06/3123991/colorado-vaccine-exemptions/