The question confounds Jaeger, who still shudders when recalling the single measles case she encountered when she was a pediatric intern at Yale University and who considers vaccines that prevent childhood diseases among medicine’s greatest accomplishments. For Jaeger and her colleagues, there is no debate. With childhood immunizations, she says, “we pediatricians are actively trying to put ourselves out of business.”
Yet from parents’ point of view, whether to vaccinate or not may seem to be the greatest debate in public health, one they’ve likely heard argued everywhere from parenting blogs and classes to Oprah’s TV show to the pages of celebrity magazines, which have lately pitted two points of view against each other as though they’re competing teams on Dancing with the Stars. On one side, we have Charlie Sheen, Jim Carrey, and Jenny McCarthy, the former Playboy playmate who contends that the so-called MMR vaccine—a three-in-one shot against measles, mumps, and rubella—caused her six-year-old son Evan’s autism. On the other side are Salma Hayek, Kerri Russell, and Jennifer Garner, who have campaigned for shots to wipe out tetanus, pertussis, and influenza, respectively. Joining their ranks is Amanda Peet, representing Every Child By Two, an immunization advocacy campaign. She recently used the word parasite to describe those parents who reject vaccines for their own children while benefiting from the so-called “community immunity” created by the vast majority of families who follow a recommended immunization schedule. Her apology for that unfortunate choice of words was printed in gossip columns everywhere.
Normally, physicians would not feel the need to know the public health stances taken by the celebrities appearing in their waiting-room magazines, but these are unusual times. Scientific evidence is increasingly dismissed as mere opinion (see also global warming and evolution), while intuition is conflated with intelligence. In fact, when Oprah asked McCarthy—who concedes she researched autism at the “University of Google”—what to make of the fact that scientists have found no credible evidence that vaccines cause autism, McCarthy replied, “My science is Evan, and he’s at home.” The audience cheered in support.It’s against this drumbeat of doubt that pediatricians and public health officials now find themselves making the case for immunizations. “We used to be able to point to the science and just rest on our laurels,” Jaeger says, pointing to vaccines’ success in eradicating polio in the Americas, nearly erasing measles, and making chicken pox seem sooo last century. “Unfortunately, that message isn’t working the way it used to.”When I had my first child in 2002, I was one of those parents waving my hand with questions about vaccines. What worried me most was a 1998 study in The Lancet, a British medical journal, suggesting a link between the measles component of the MMR vaccine and autism. The media frenzy surrounding that report led to a drop in immunization rates across the UK and was soon followed by a movement to remove the mercury-containing preservative thimerosal from vaccines as a precaution (even though the MMR vaccine in question did not contain thimerosal).
When thimerosal was removed from most shots (it is still found in some forms of inactivated influenza vaccine), the autism rate did not decline. What’s more, in 2004 The Lancet’s editors retracted the study’s findings after learning that its lead author, Andrew Wakefield, had allowed lawyers hoping to sue vaccine manufacturers to recruit some of his test subjects. (In other celebrity news, Wakefield, who’s still under investigation by British medical authorities, has opened an autism clinic in Texas, where two of the Dixie Chicks serve on his board.) Meanwhile, no subsequent research has duplicated his findings or found a link between vaccines and autism, the cause of which is still unknown.
In the absence of a reliable explanation, many people have held tight to the notion that vaccines are to blame. Last fall, a survey by the Florida Institute of Technology of 1,000 adults found that one in four believed that “because vaccines may cause autism, it’s safer not to have a child vaccinated at all.” Even parents who understand the research are not entirely reassured. “As each concern is ruled out, they move on to a new concern,” says Jaeger. For instance, parents now ask about the presence of aluminum salts (used in vaccines since the 1920s) or express concern about whether their child’s immune system is ready for multiple shots, raising the “too many, too soon” argument favored by McCarthy and her allies.
“The Internet has a critical role in this,” says Patsy Stinchfield, director of infectious disease immunology and infection prevention at Children’s Hospitals and Clinics of Minnesota, who says many parents are coming to appointments with articles they’ve found online. “The information is at everyone’s fingertips, but, unfortunately, it’s not always accurate.”
Among the most widely respected resources on the topic is immunize.org, a website run by the St. Paul–based nonprofit Immunization Action Coalition and recognized with awards from the Encyclopaedia Britannica, the National Science Teachers Association, and other groups. “We work very hard to make sure our site shows up near the top of any search,” says associate director Diane Peterson, who acknowledges that the IAC’s collection of dry-eyed epidemiological studies and peer-reviewed medical reports may be no match for the more emotional claims found elsewhere on the Internet. After all, the answers you find online often depend on where everyone else is searching.
For instance, when I searched vaccine recently, I came across several YouTube videos describing a “global vaccine conspiracy,” clips from the Big Pharma conspiracy flick The Constant Gardener, a page dedicated to vaccine injuries, and several sites advocating home schooling as a way to opt out of immunization. Then I found the listing for the World Health Organization and the Vaccine Education Center, a resource page run by the well-respected Children’s Hospital of Philadelphia. Narrowing the search to Minnesota, I was directed to the state health department and a nonprofit group called Vaccine Awareness Minnesota based in Crystal.
I called both numbers to see if I could verify a point I’d come across in Time saying that Minnesota and Colorado had the nation’s highest percentage of kindergartners—between 5 and 6 percent—exempted from vaccinations for religious or philosophical reasons. I talked to Kris Ehresmann, the state’s immunization chief, and Christina Abel, the founder and executive director of VAM, and they agreed that the Time report had overstated the actual number, which both estimated to be around 3 percent. But that may be one of the few things the two women agree on.
Abel, a nonpracticing licensed nurse, has made vaccines “an academic hobby” for nearly twenty years. Her website says its aim is to promote “informed decision-making regarding vaccinations and Minnesotan’s right to conscientious objection,” though she says, “My purpose is not to promote either way.” As for her own choice, the mother of nine says, “I don’t need to fix something that’s not broken. Besides, these vaccine-preventable diseases are not life threatening to most people anyway.”
Ehresmann disagrees and points out that the argument is common among a generation of parents with no memory of German measles and whose grandparents may not even remember that the 1946 state fair was cancelled because of polio fears. “Because we’re not seeing these diseases like we used to, the focus has shifted to adverse events,” she says, adding that some vaccine-preventable illnesses are staging comebacks. In the last decade, whooping cough has whipped through Boulder, Colorado, where pertussis vaccination rates are low. Measles—nearly wiped out eight years ago—saw a surprising resurgence in the United States last year, with 131 reported cases, more than 90 percent of them in individuals who, for religious or philosophical reasons, weren’t vaccinated, including twenty-five home-schooled kids in suburban Chicago.
It’s probably worth noting that media coverage, which tries to balance the views of a handful of worried parents against the voice of medical authority, may only further the impression that there’s a controversy about vaccines within the world of public health or that a critical mass of parents are rejecting vaccines for their children. There isn’t, and they aren’t.
While Jenny McCarthy may be appearing on the cover of US Weekly, the vast majority of parents—upwards of 90 percent—line up behind Amanda Peet and the advice of their own pediatricians. And while pediatricians may be spending a lot of office time explaining immunizations, Sharon Jaeger and her colleagues are also getting a surprising number of requests from parents who want their daughters to be given Gardasil, a vaccine to prevent four strains of the human papillomavirus linked to cervical cancer. I myself was enthusiastic about the new vaccine for rotavirus—a gastrointestinal bug that contributes to the death of more than 500,000 children every year—after one of my kids was hospitalized with a severe case.
In fact, it’s the community aspect of immunity—because our children bring us into contact with everyone else’s children—that public health experts believe they must emphasize if the established science isn’t moving parents like it used to. “People think it’s more passive, or less risky, to opt out [of vaccinations], but you don’t know when measles are coming to your community,” says Patsy Stinchfield. While most of us are lucky enough to have no memory of the childhood diseases prevented by vaccines, she says, we need to remember that “to do nothing is actually a risk.”
Stinchfield was making this case to a new mother who had recently arrived from Somalia, explaining through an interpreter why she was recommending vaccinations for the fifteen-month-old child in the woman’s lap. Halfway through the doctor’s speech, the mother held up her hand. “I thought, ‘Oh, no—what now?’” Stinchfield recalls. But the woman simply wanted to explain that her baby had been born with a twin who died of measles in a refugee camp in Kenya. “That mother,” Stinchfield says, “she wanted that shot.”
Appeared in Mpls/St. Paul Magazine, 2009