Published Winter 2015
For most Americans, vaccination is an ordinary and accepted part of medical care. Walk into any pediatrician’s office and you can witness the humdrum of checkups and the vaccines that come with them. Recently, however, a debate centered on some parents’ refusal to vaccinate their children has received wide public attention, as lower rates of vaccination coverage in certain communities have contributed to outbreaks of vaccine-preventable diseases, for instance of measles in California in late 2014 and early 2015. In this and similar outbreaks over the last several years, the vast majority of the infected people were unvaccinated or of unknown vaccination status.
The problem with low vaccination rates is that they disrupt herd immunity: vaccinating a sufficient number of individuals helps reduce the chances for a disease to spread through a population. This means that even people who are not immune to the infection — including those who are not vaccinated as well as those for whom vaccinations do not provide complete immunity — are less likely to be infected if those around them are protected. Poor vaccination rates, then, can affect other people than just unvaccinated children.
The heated responses from vaccine supporters and critics alike to news of disease outbreaks and low rates of vaccine coverage reflect the intensity of the conflict over the safety, efficacy, and necessity of the vaccines themselves. When the Los Angeles Times urged in an editorial on the California measles outbreak that the anti-vaccine movement “get over its ignorant and self-absorbed rejection of science,” prominent vaccine critic Barbara Loe Fisher responded, “Name-calling is a convenient way to deflect attention from inconvenient truths about vaccine failures and the dissolving myth of vaccine-acquired herd immunity.” Dr. Paul Offit, a professor of vaccinology and pediatrics at the University of Pennsylvania and a prominent vaccine supporter, has been told by vaccine critics that he has “blood on [his] hands” and is “directly responsible for the death and damage of hundreds of children.” Such exchanges do not bode well for the kind of education and persuasion that are needed to ensure vaccination coverage.
It is true that high vaccination rates are important for public health, and when people make false claims about the dangers of vaccines it is the responsibility of scientists, journalists, and politicians to criticize and refute them. But calls to ostracize and ridicule vaccine critics may be as likely to harden hearts as they are to persuade. For example, in a recent article in the journal Pediatrics, researchers studying the effects of different communication strategies reported, somewhat counterintuitively, that giving vaccine-hesitant parents more information about the safety of vaccines, or telling them about the risks of vaccine-preventable disease, whether through scientific information, dramatic narratives, or arresting images, were not effective at persuading them to vaccinate their children. And yet, another recent study in Pediatrics suggests that parents are less likely to vaccinate their children if physicians ask them what they want to do about vaccinations (as opposed to taking a presumptive approach and asserting that the children will receive their shots).
Given this impasse, where ought we to turn? Perhaps what is needed is a better understanding of the long history of vaccine critics’ objections, going back to the very origins of vaccination. This will help us not to bemoan, accuse, or fight but to educate, persuade, and vaccinate.