The measles outbreak that began in Disneyland, and which has so far spread to 17 states with more than 120 people sickened by the highly contagious disease, has prompted moral outrage in the mainstream media and calls by policymakers for more aggressive requirements forcing parents to get their children vaccinated.
Nothing produces moral outrage like new converts.
It wasn’t too long ago that the media, and many policymakers, mostly shrugged off warnings of America’s diminishing ‘herd immunity’ caused by declining vaccination rates. Or worse, engaged in the false equivalency of suggesting that the highly theoretical risks of vaccine-induced disorders (e.g.,autism) deserved as much weight as the proven public health benefit of vaccines.
Some believe this latest outbreak has finally spawned an evidence-based quantum shift in the popular and media narrative on immunization – one that will stick.
Others aren’t so sure. And even some who think we have entered a new phase of heightened rational discourse on vaccines are concerned that this popular surge of outrage against the ‘anti-vaxxers’ could backfire.
“I do think this outbreak is different,” said Paul Offit, a pediatrician and probably the leading voice of pro-vaccine advocacy in the United States. This is not because people suddenly have become more rational, Offit said, so much as because the disease erupted in one of our nation’s holiest sites.
“Disneyland!” he exclaimed. The symbolic power of a disease our country had once completely vanquished coming back to threaten the entire country from out of the Magic Kingdom, he said, is ‘almost Biblical’ in its impact on the popular narrative.
“The public reaction this time is quite different,” he said.
As evidence, Offit noted that last year the U.S. experienced a much bigger measles outbreak of some 650 cases that sprang from an Amish community in Ohio. That got news coverage, he noted, but it was generally regarded as due to the special nature of this religious community (which, afterward, lined up by the thousands to get vaccinated).
“If these cases continue to spread and we get an even larger outbreak than last year’s, we could see some deaths,” Offit said. “People are really scared this time.”
Heidi Larson, an anthropologist at the London School of Hygiene & Tropical Medicine who studies public confidence in immunization, said it does appear that the measles outbreak spawned out of Disneyland has altered the public debate in the United States – much as a massive measles outbreak did for Britain.
“The tension between protecting the public’s health and personal choice has become very real, very tangible for people,” Larson said. “Most people support immunization as a benefit for themselves, their children and for the community in general. They are fed up with the anti-vaccine arguments.”
The pro-vaccine voices have certainly gotten louder and more visible, she said, which could eventually drive changes in public policy aimed at encouraging or requiring certain vaccinations.
The Bill and Melinda Gates Foundation, globally, has been one of the biggest advocates and funders of expanding childhood immunizations. The Seattle-based philanthropy has funded numerous advocacy groups, like the ONE Campaign, and media programs, such as this reporting trip by the UN Foundation, aimed at promoting the public health benefit of vaccines overseas.
Has having Bill Gates, as a celebrity, the world’s richest man and a leading philanthropist, strongly make the case for vaccination also helped change the public narrative in this country?
“It’s hard to say,” said Orin Levine, head of the vaccine delivery program at the Gates Foundation. “In many developing nations, we really don’t need to make the case. People there have daily, stark reminders of the danger from vaccine-preventable diseases.”
The challenge in the U.S., Levine said, is that the great success of widespread immunization has, ironically, made vaccines a harder sell. Why get your child vaccinated against a disease you never (or never used to) see?
The Gates Foundation has largely stayed out of the domestic debate over vaccination, Levine said, but has nevertheless had to deal with ‘outbreaks’ of fear and conspiracy theories often originating in the richer world that undermine public confidence in immunization in those poor countries that most need protection against these infectious diseases.
The global polio eradication campaign has continued to suffer setbacks due to public mistrust in some countries. Indian anti-vaccine advocates have now taken up the autism-vaccine link argument, which has lost its force in most Western countries once it was shown to be falsely advanced by the now-discredited British doctor Andrew Wakefield.
“With global media, and social media, there’s always the risk that misinformation in one location will jeopardize efforts elsewhere,” Levine said.
Bill Foege, former head of the US Centers for Disease Control under the Carter and Reagan Administrations and the physician widely credited for coming up with the strategy for eradicating smallpox through vaccination, said he’d urge caution before celebrating a shift in the popular narrative.
“The media narrative may have changed but that doesn’t mean public perception has changed,” Foege said. Parental philosophical exemptions from mandatory vaccinations are still on the increase in many parts of the country, he noted, and even if Wakefield’s theories have been soundly discredited there’s plenty of evidence to suggest many still have lingering if vague concerns about the risk of vaccines. Simply repeating the scientific evidence will not be enough, he said.
“What is really being debated here is the concept of the social contract,” Foege said. That is, he asked rhetorically, do most Americans believe they have a duty to the community that should sometimes trump their personal desires and freedoms?
“We used to believe in that and in the 1970s, more than 95 percent of children received the routine vaccinations,” Foege said. “I don’t think we really believe in the social contract anymore. And, until we do again, I’m not sure I think this outbreak is going to change anything.”
This outbreak and the current opprobrium leveled against parents who don’t vaccinate their children fully may prompt some changes in law, such as more mandatory vaccinations and less exemptions. But trying to change human behavior by force, Foege notes, is often less effective and sustainable than educating and encouraging such changes be taken by choice.
Will Disneyland make this measles outbreak the paradigm shifter? Will moral outrage create positive change, or just more polarization and recalcitrance?
Other vaccine-preventable disease outbreaks have been expected to improve public uptake of vaccination before, and have failed to do so. The media appears to have turned a corner, but the jury is out on if the public sentiment will be changed.