The rise of vaccine-preventable diseases hits close to home for me. I have a little boy in my life who was born at just 27 weeks, spent the first three months of his life in the neonatal intensive care unit (NICU) and has a rare disease called mast cell activation syndrome. Mast cells are master regulators of the immune system and this rare disease is caused when these cells become overactive.
Overactive mast cells can cause severe allergic reactions to triggers, including vaccines. Consequent to his disease, the two-dose measles, mumps, and rubella (MMR) vaccine was contraindicated, and he did not get vaccinated. But now, at age five, as a result of the measles outbreak in New York State, he is getting pre-medication in hopes of preventing an allergic reaction when he gets the vaccine. His parents fear a major setback from the tremendous progress made in managing his rare disease but understand that getting the measles would be far worse. Large scale vaccination campaigns are meant to protect children who can’t medically be vaccinated. And today, the loopholes in the system are failing them.
We can do more, as individuals and as a nation, to help protect children like this and improve public health. And we should.
It can no longer be disputed that measles, mumps, and rubella are spreading in the United States. In addition to New York, Washington state declared a state of emergency as measles cases climbed; spectators of the Detroit Auto Show may have been exposed to rubella; and the mumps virus has infected at least seven people at a U.S. Immigration and Customs Enforcement (ICE) facility in Houston. The cause for these outbreaks is undisputed: decreased vaccination rates across the country have greatly reduced the required proportion of immunized individuals needed to achieve herd or community immunity. Unless the proportion of people vaccinated increases, thus eliminating susceptibility, the spread of these diseases will continue. (The proportion of the population that needs to be immunized against measles is about 93–95 percent.)
For a country that declared measles eliminated in 2000 as the result of what the CDC calls a “highly effective measles vaccine, a strong vaccination program that achieves high coverage in children, and a strong public health system for detecting and responding to measles cases and outbreaks,” it is extremely regrettable that we’re seeing a resurgence in measles, mumps and rubella.
As an infectious disease epidemiologist, I’ve always marveled at the miracle wrought by modern science and medicine in developing and scaling the delivery of the MMR vaccine. Vaccines have widely been considered one of the greatest medical achievements in history—and yet in 2019 the World Health Organization (WHO) declared vaccine hesitancy (the delay in acceptance or outright refusal of vaccines) as one of the top 10 threats to global health.
Many have attempted to address this public health emergency by addressing the other “side” of this phenomenon. Despite suggestions to the contrary, the medical and scientific community are clear and unambiguous: vaccines are safe, effective, and not harmful.
As I have read and listened to accounts of anti-vaxxers and to those of young people who are now fact-checking their parents’ choice to not vaccinate, I have been struck by how little attention is given to how the public health and scientific communities are addressing the problem. It’s our job as trained experts to speak out against those who are harming the health of our children. However, it is well documented that simply repeating scientific facts and figures rarely impacts the decision processes of those who are vaccine-hesitant.
So how can the scientific community help the U.S overcome vaccine hesitancy? Ultimately, we should focus on what works. We need communication and policy approaches to address low vaccination rates, especially as rates of vaccine exemptions rise. The narrative and specific examples below are by no means exhaustive or comprehensive, but rather an attempt at sparking discussion, and ideally subsequent action, to combat this growing public health problem:
Stronger policies. While immunizations are required in most states for children to attend school, we should consider stronger policies requiring childhood vaccination, for both the safety of the child and for public health. This has precedent: since 2016, Australia has greatly improved vaccination rates through its “No Jab, No Pay” immunization policy, which withholds child benefits and enacts punitive financial measures for parents who do not vaccinate their children (parents of children with medical vaccine exemptions are not penalized). A similar policy U.S policy admittedly would be complicated to enact. For example, vaccine access and cost can be an issue for some families. In addition, such a policy could put pressure families who receive state or federal child benefits.
Public Education Campaigns. While policy change is slow and challenging, the public health community, advocates and government should work together more effectively on large-scale public education campaigns. Fear of autism and other side effects from vaccination can be traced to a now discredited and retracted 1998 paper in The Lancet, but it is time to reframe why and how vaccines are safe. The very successful Truth Initiative has worked to increase the nation’s understanding of the dangers of tobacco use among young people. Its innovation center is dedicated to designing, building, and implementing novel Web, text, TV, and mobile campaigns about the dangers of smoking (remember the shocking ads of people speaking through electrolarynx devices?) The same must be done regarding both the health benefits of vaccination and the health risks that come with a failure to vaccinate.
On-The-Ground Public Health Programs. Online campaigns can be powerful, but they must be done in conjunction with boots-on-the-ground public forums. Public health experts and advocates should consider engaging more frequently in honest dialogues—not one-sided lectures—about parents’ fear of vaccines. We would do well to communicate the dangers of not vaccinating face-to-face, and also explain the broader positive impacts vaccines have on cognitive development and health later in life. For example, most people are probably aware that measles is highly contagious, but how many realize that the virus can live for up to two hours in the air after an infected person has coughed or sneezed? Or that those infected with measles can spread it starting four days before and lasting until four days after the appearance of the illness’s hallmark rash? People who understand the risks shouldn’t alienate those who question vaccination but should instead openly discuss the science and data—while listening to the reasons why people have concerns.
It takes a lot of effort to keep trying to dispel scientific misunderstandings about vaccines, but we should strive to do so. Personal fears of vaccination should not automatically outweigh the decades of medical gains, reduced deaths, and improved health outcomes that vaccines have brought to our country, particularly children. In some areas of science and public health, differences of opinions can be enriching, even educational—but that’s not the case with discussions about vaccination.
Decades of objective scientific research, data and medical consensus have fully demonstrated the effectiveness of vaccines. it is time for policy, education campaigns, and boots on-the-ground public health campaigns to improve vaccination rates to protect the public.