Advertisement

Never mind the science: Anti-vaccine tide difficult to stem

A vial of measles, mumps and rubella vaccine and an information sheet is seen at Boston Children's Hospital in Boston, Massachusetts February 26, 2015. REUTERS/Brian Snyder (UNITED STATES - Tags: HEALTH)

Results of a very large study published this week in the Journal of the American Medical Association (JAMA) has found no association between autism spectrum disease and children who received the measles, mumps and rubella (MMR) vaccine.

The study, which analyzed health records of more than 95,000 children, should finally put to rest claims of a causal link between autism and vaccination.

But it won’t.

This is World Immunization Week (April 24-30), with the World Health Organization (WHO) hoping to close the immunization gap that sees one in five children (about 29 million) going unvaccinated, which the WHO says could potentially avert 1.5 million deaths of children from preventable illness.

Opponents of vaccination, whether it’s MMR or influenza, seem surprisingly resilient to scientific evidence refuting their claim that ingredients in the vaccines cause anything from autism to bowel disease, auto-immune disease and narcolepsy.

The phenomenon, especially prevalent in Europe and North America, frustrates the public-health community because it seems immune to scientific rebuttal.

“We’re in an interesting time when some of our most trusted sources of guidance are really being questioned,” Ian Culbert, executive-director of the Canadian Public Health Association, told Yahoo Canada News. “In an information age where Google puts a seemingly endless amount of information at people’s fingertips, people are questioning everything.”

A 2010 quote by WHO director general Margaret Chan that leads off the 2015 Vaccine Confidence Project report pretty much says it all.

“The days when health officials could issue advice, based on the very best medical and scientific data, and expect populations to comply, may be fading,” she wrote.

There’s no doubt some people suffer ill effects from a vaccination but advocates say the odds of that are infinitesimal compared with the benefits of protecting a child from potentially debilitating illness and conferring herd immunity on society at large.

“I’m not surprised the concern about vaccines and the hesitancy of some parents to have their children vaccinated continues despite a scientific study being debunked,” said Culbert.

The debunked British study that fuels the anti-vax movement

The study he’s referring to is the infamous 1998 article by Dr. A.J. Wakefield, published in the British medical journal The Lancet. Wakefield claimed to have found a dozen normal children suffered developmental regression (autism) and bowel problems after receiving the MMR vaccine.

Related stories:

Measles outbreak tied to Disneyland, Canadian travellers should be on alert

‘Vaccine-free’ daycare sign of Canada’s fraying immunization safety net

B.C. measles outbreak underscores continued battle over vaccination holdouts

The results sent vaccination rates Britain plunging but scientists found it impossible to replicate Wakefield’s findings. Later investigation found evidence of unethical practices, perhaps even fraud, in compiling the dozen case studies, along with Wakefield’s connection as paid consultant to a group suiting vaccine makers.

But the article, which The Lancet eventually retracted, remains ground zero for the 21st-century anti-vaccination movement and Wakefield, who lost his medical licence but never recanted his conclusions, is its revered figurehead.

The message was picked up by celebrities such as starlet Jenny McCarthy and flourishes via thousands of websites and social media groups.

Anti-vax proponents are predictably defensive about their views, which may explain a lack of success in getting comment from groups like the Vaccine Resistance Movement and the Facebook-based Vaccination Re-education Discussion Forum for this story.

Naturopaths have been criticized for suggesting alternative remedies in place of vaccination. Yahoo Canada News spoke to Edmonton naturopath Dr. Michael Mason-Wood, whose webpage on autism lists “vaccination stress” as a potential contributing lifestyle or environmental factor in autism.

After being sent the JAMA study, Mason-Wood refused to comment on its results.

“At this point in time with vaccines, it’s actually career suicide for me to say anything and so we’ve been guided by our association,” he said, before referring Yahoo to the College of Naturopathic Doctors of Alberta, which did not respond to a request for comment.

Mason-Wood wouldn’t explain why vaccine stress is listed as a potential autism factor, despite evidence to the contrary.

“I don’t want to tell you because I know it’s going to go in your report,” he said. “Because I get guys like you phoning me up and say why is it there, I should just take it out.

“But people are looking for autism help and it’s not doing them any justice by me taking it out.”

The vast majority of people in North America do heed the advice of health-care professionals and vaccinate their kids, said Culbert.

Poll shows most Canadians support vaccination

An Angus Reid poll, taken in February around the time of the measles outbreak in Canada and the U.S. – many cases linked to un-vaccinated kids visiting Disneyland, others to a Quebec religious group with low vaccination rates – indicated about three quarters of respondents considered those who wouldn’t immunize their kids to be irresponsible.

“It is a small proportion who don’t and the vast majority of those who don’t … are hesitant, they’re just not sure, maybe they’ll just delay the vaccine and wait and see,” Culbert said. “The true anti-vax community is pretty small but they believe what they believe.”

But that hard core seems well entrenched thanks to its Internet megaphone.

“The mere fact of this being a controversy has become solidified,” said health-policy researcher Neil Seeman. “It’s an irrefutable fact there is no such controversy, at least within the scientific community.

“This then leads to a proliferation online of conspiracy-mongering and it’s fueled by supportive online influencers and prominent vaccine skeptics like Jenny McCarthy.”

Seeman, a senior fellow at the University of Toronto’s Massey College and CEO of RIWI, a global survey, technology and risk-measurement company, co-authored a 2010 article in Healthcare Quarterly on Canadian attitudes toward the safety of the H1N1 flu vaccine following the 2009 pandemic.

Results of an Internet survey by RIWI found less than a quarter of respondents considered the vaccine safe, while more than 40 per cent thought it was unsafe (the rest weren’t sure). Research also found anti-vaccine blogs and websites were popular during the pandemic.

Interestingly, the debate over getting an annual flu shot is less heated (though no less widespread) than the one over giving children the MMR vaccine.

“It’s a very much more passionate debate than typically you’ll find about the flu,” said Culbert, despite flu’s role in thousands of deaths each year, especially among the elderly and immune-compromised.

Most who eschew flu vaccination say they doubt its effectiveness, which varies from year to year depending on the flu strain, or that they’ve managed without it all this time. Some worry about catching the illness from the shot.

“We give anti-flu vaccine advocates a bit of an escape valve in part because there are sometimes arguments that can be made,” Seeman observed.

He doesn’t think that’s warranted, though, because flu shots do help most of the time.

Internet has helped entrench anti-vaccine viewpoints

Seeman says the climate vis-a-vis vaccines hasn’t changed much since the 2009 flu pandemic.

“What’s changed is simply the fact that these anti-vaccine voices on the web have become so entrenched and amplified and they’ve become cross-partisan,” he said.

A lot of it has to do with the rise of social media in the last decade just as the Wakefield study was being circulated on the web before being exposed as bogus, Seeman said.

“We had this societal change going on,” Culbert agreed. “That debunked study came out almost – I hate to say it – the perfect time to be picked up by a community that was ready to hear a message that was contrary to what the public health community was saying.”

In an era when conspiracy theories get a surprising amount of traction (Barack Obama is a secret Muslim, 9/11 was an inside job), were health authorities too slow to counter the anti-vax message?

“I think we took it very seriously,” Culbert responded. “Could we have projected the trickle-down impact? Probably not. But we’re not paid to look into the crystal ball. Our practice is always evolving.”

So the public health community finds itself on the defensive, needing to increase its outreach to target groups like parents of infant children and some private religious-based schools.

In his 2010 article, Seeman recommended a number of approaches to pushing back against the anti-vax message both online and offline.

One suggestion was what he calls “collaborative counter-marketing by trusted non-governmental third parties.” Groups and individuals would monitor the web and social media, ready to to challenge online “influencers’” claims. It’s similar, Seeman said, to the pre-Internet campaigns aimed at countering tobacco advertising.

Seeman would also like to see ways of ensuring web searches for information don’t always produce a flood of anti-vax material in the first couple of results pages, allowing “trusted third-party entities” like the U.S. Centers for Disease Control prominent positioning, too.

There also needs to be a better job done of measuring the degree of confidence in vaccines via the web and traditional survey tools, he said.

Doctors need to step up to stem anti-vaccine tide

But Seeman believes the most powerful changes should come outside cyberspace, in doctors’ offices.

“Clinicians need to confront head-on and have a duty to respond and challenge parents or other patients who express skepticism in the MMR vaccine,” he said.

“A lot of clinicians simply accommodate, for example, requests to delay the vaccine because they want to maintain trust in the doctor-patient relationship. But in my view that is in violation of the Hippocratic Oath.”

Seeman also sees a role for religious communities to engage their flocks.

“We saw that with great success in Nigeria during the ebola outbreak,” he said. “Mosques and churches, for example, were engaged to spread the message of the importance of going to local healthcare facilities.”

Culbert agreed new ways are needed to get the public to understand the importance of vaccination, especially since younger generations have no memory of what it was like before widespread vaccination largely wiped out diseases like measles and polio.

“The reality of recent outbreaks has brought back the spectre of these previously almost disappearing diseases in Canada; the measles outbreaks, the whooping cough outbreak, the Ottawa case of the mother of seven,” he said.

“It’s hard for parents to justify a very small risk today of a negative reaction to a vaccine versus some obscure long-term possibility that maybe their kid will get a disease. So bringing that reality of the disease into the present tense is a very powerful factor for people.”

Unpublished data from his 2010 survey bear that out, said Seeman. RIWI found awareness of public health measures such as hand-washing and vaccination much more prevalent in countries such as the Philippines and Mexico, where the odds of a deadly disease outbreak are higher.

“It’s not a surprise that in those countries and in many countries around the world that are very affected by outbreaks, there is mandatory, sometimes daily education at a young age about hand hygiene and the importance of vaccinations, whereas we’ve lost that in Canada,” he said.