Given the election of Donald Trump as President, there’s no doubt that antivaxers feel emboldened, and, when combined with other trends, there is reason for concern. Even now, fake news stories are circulating claiming that the FBI raided the CDC in the middle of the night using the “CDC whistleblower’s” charges as a pretext and that President Trump ordered all vaccine-related information off the CDC website by February 18 and enacted a 90-day ban on childhood vaccines. Meanwhile, health organizations are urging Trump to back vaccine science. That’s something that’s never been seen before, to my knowledge: The need to petition a sitting President to accept the science of vaccines. There’s good reason why some are now openly asking whether antivaxers are winning.
Peter Hotez, MD: When the next outbreaks occur, they’ll be in…Texas?
I started thinking about this topic in response to an op-ed published last week in the New York Times, by a pediatrician at Baylor College of Medicine and director of the Texas Children’s Hospital Center for Vaccine Development entitled “How the Anti-Vaxxers Are Winning.” Dr. Hotez, for those of you not familiar with him, is fast becoming the new Paul Offit in the eyes of the antivaccine movement. I mean that as a compliment, of course. If antivaxers view Paul Offit as Darth Vader, Lord Voldemort, and the Dark Lord Sauron all rolled up into one, they’re starting to view Dr. Hotez as Darth Vader, at least, thanks to his staunch advocacy for vaccines as the best means to protect children from deadly diseases. That’s a good thing, as is how much antivaccine activist J.B. Handley hates Dr. Hotez. I probably only qualify to them as one of Sauron’s orcs. (Meanwhile some antivaxers seem to think that Dr. Hotez is actually Dan Rather, something that amuses me to no end.) Dr. Hotez isn’t alone, either. Last month, Ford Vox wrote an editorial, “Under Trump, the anti-vaxxers might just win“, pointing to the antivaccine article published by the director of the Cleveland Clinic Wellness Institute as an example.
In his NYT op-ed, Dr. Hotez begins with this grim appraisal:
It’s looking as if 2017 could become the year when the anti-vaccination movement gains ascendancy in the United States and we begin to see a reversal of several decades in steady public health gains. The first blow will be measles outbreaks in America.
Measles is one of the most contagious and most lethal of all human diseases. A single person infected with the virus can infect more than a dozen unvaccinated people, typically infants too young to have received their first measles shot. Such high levels of transmissibility mean that when the percentage of children in a community who have received the measles vaccine falls below 90 percent to 95 percent, we can start to see major outbreaks, as in the 1950s when four million Americans a year were infected and 450 died. Worldwide, measles still kills around 100,000 children each year.
The myth that vaccines like the one that prevents measles are connected to autism has persisted despite rock-solid proof to the contrary. Donald Trump has given credence to such views in tweets and during a Republican debate, but as president he has said nothing to support vaccination opponents, so there is reason to hope that his views are changing.
Here’s where I’ll be more grim than Dr. Hotez. No, Donald Trump’s views are not changing. He’s been remarkably consistent in his view that vaccines cause autism at least since 2007, and, if there’s one thing we know about Donald Trump, once he’s latched on to a conspiracy theory, he doesn’t change his belief in it. My guess is that vaccine policy just isn’t a priority right now. We can only hope that his advisors manage to keep him distracted enough that he doesn’t turn his attention to it. Again, fortunately, vaccine policy is mostly made at the state level, with the CDC providing the recommendations that most states follow.
Dr. Hotez also notes a litany of other issues, such as Andrew Wakefield’s propaganda-film-disguised-as-a-documentary VAXXED and how President Trump might have proposed setting up a vaccine commission with RFK Jr. as the chair as reasons to be concerned, before launching into discussion of data concerning vaccine exemption rates in Texas that he wrote about in PLoS Medicine that was reported in December . In the past, Hotez has characterized Texas as the “center of the antivaxxer movement,” and his PLoS Medicine article shows why.
In fairness, the article does note that currently Texas still has one of the highest rates of vaccine uptake overall, but as I try to pound home time and time again every time I write about nonmedical exemptions to school vaccine mandates, it’s not just statewide uptake rates that matter. It’s local pockets of low vaccine uptake that lead to declining herd immunity or community immunity. Whatever you want to call the phenomenon of high vaccine uptake protecting even those who can’t be vaccinated or won’t vaccinate, we’re starting to see a situation in Texas that is worrisome and possibly outright alarming: skyrocketing rates of personal belief exemptions, from 2,300 in the whole state in 2003 to nearly 45,000 so far this year, more than a 19-fold increase. A graph from the PLoS Medicine article tells the tale:
Looking at that graph, I see little sign that it’s starting to plateau, and public health officials agree. The trend looks as though it will continue. If I were a public health official in Texas, I’d be alarmed, and they are. Of course, at the risk of being repetitive—but when did that ever stop me?—I have to emphasize that it’s not just raw numbers. After all, Texas is a big state. If those numbers were spread out, the trend would still be of concern, but not quite so alarming as it is. From the PLoS article by Peter Hotez:
Measles vaccination coverage in certain Texas counties is dangerously close to dropping below the 95% coverage rate necessary to ensure herd immunity and prevent measles outbreaks. For instance, in Gaines County in West Texas, the percentage of exemptions is now 4.83%, while in Briscoe County in the Texas Panhandle, the percentage is 3.55% (Table 1) . In the very large Austin Independent School District (Travis County), the exemption rate is at 2.02% . Especially troubling are many of the private schools, mostly in Travis County—the Austin, Texas area—where exemption rates often exceed 20%, including more than 40% of the Austin Waldorf School . The rising numbers of nonmedical immunization exemptions across the state in combination with pockets of very low coverage in vulnerable populations is extremely troubling.
Now, I know what antivaccine apologists will say here. They’ll say that those rates are still high. Yes, that is true, but the trend is in the wrong direction. As noted by Hotez, in some counties MMR uptake is falling close to the range where herd immunity will start to waver. It’s not there yet, but it’s trending that way, which is why Hotez is concerned that by next winter there could be outbreaks. Then, of course, there are the private schools, such as the Waldorf Schools (schools I like to refer to as disease vectors because of the Waldorf philosophy that discourages vaccination), much like the case in California. These schools almost always have very high personal belief exemption rates and low vaccine uptake rates.
It’s not as though Texas hasn’t had outbreaks yet, either. For instance, in 2013 there was a measles outbreak centered at a Texas megachurch. The outbreak started when a person who contracted measles overseas visited Eagle Mountain International Church in Newark, located about 20 miles north of Fort Worth, Texas. This particular church is part of Kenneth Copeland Ministries. (Terri Pearsons is Kenneth Copeland’s daughter.) Kenneth Copeland and Terri Pearson promote all sorts of “natural healing” woo that you could easily find at Joe Mercola’s website, and, as is so common with believers in “natural healing,” they are (or at least were) antivaccine. In the wake of the outbreak, Terri Pearsons actually encouraged those who haven’t been vaccinated to do so, adding that the Old Testament is “full of precautionary measures.” Sadly, this is a common theme. Antivaccine warriors remain stubbornly antivaccine until the consequences of not vaccinating hit home.
There’s another thing Texas has that contributes to measles outbreaks, unfortunately, and that’s Andrew Wakefield:
But Hotez believes the situation in the Lone Star State is more perilous. One factor is the arrival of Wakefield, widely seen as the father of the modern antivaccine movement. Wakefield published a paper in The Lancet in 1998 that alleged a link between the MMR vaccine (which combines shots against measles, mumps, and rubella) and autism. Several large studies have failed to find the link, Wakefield’s paper was retracted in 2010, and he was disbarred as a physician after the U.K. General Medical Council found him guilty of dishonesty and endangering children. Wakefield has appeared at screenings of his film Vaxxed, released in April, all over Texas and has testified at many city councils, Dragsbaek says. “He is definitely a major influencer.”
I’d be somewhat cautious about this assessment, though. Andrew Wakefield has lived in Texas for well over a decade, basically having fled his home in England after having sparked an antivaccine panic there. I have no doubt that Wakefield is a major influencer. Also, in 2016 he’s been more active than ever, having released an antivaccine propaganda film, VAXXED, that peddles the conspiracy theory that is the “CDC whistleblower” and promotes VAXXED, his “documentary” that peddles pretty much every common antivaccine lie known to the antivaccine fringe. I just want to emphasize, though, that this goes way beyond just Wakefield:
Meanwhile, a PAC named Texans for Vaccine Choice has sprung up after state Representative Jason Villalba, a Republican lawyer from Dallas, proposed scrapping nonmedical exemptions last year. (The Texas House of Representatives voted down the bill.) “While they do not have a whole lot of money, they have a lot of people that they can deploy to interfere in primary campaigns,” Dragsbaek says. “They made Villalba’s primary campaign very, very difficult.” Rebecca Hardy, director of state policies at Texans for Vaccine Choice, says the group is not trying to convince parents that vaccines are dangerous, but fighting for their right not to immunize their children. (It’s also helping them apply for exemptions.)
We have our own version of this PAC in Michigan, but fortunately it seems not to have anywhere near the influence. The Texas PAC is more active, including its online presence. It peddles the usual antivaccine myths, with articles resenting being called out for pseudoscientific beliefs that endanger children and instead trying to peddle the risible narrative that these parents have made a “thoughtful decision to selectively, delay, or decline vaccines in the state of Texas.” I like to call such decisions pseudo-thoughtful. They appear thoughtful to parents because the parents actually do think a lot about their decisions, but they aren’t really thoughtful in that the parents’ thought is wasted because it’s based on misinformation, pseudoscience, and conspiracy theories.
It’s a common misconception that antivaccine views and vaccine-hesitancy are primarily the provenance of crunchy coastal liberals. They’re not. As I point out frequently, antivaccine views are the pseudoscience that transcends political views. Unfortunately, we very well might be seeing evidence of that in Texas when the next measles outbreaks happen there. Donald Trump’s antivaccine views could well resonate in a bipartisan fashion, should he choose to indulge them.
Just as antivaccine views transcend political boundaries, so does support for vaccines
In considering whether in 2017 antivaxers are “winning” or not, it’s important to note that, just as antivaccine views transcend partisan boundaries, so, too, do views supporting vaccines. Steve Novella discussed a recent Pew Research Center survey on whether Americans support a school-based vaccine requirement, concluding that there was good news and bad news there. The good news was that the Pew Research Center found broad support for school vaccine mandates. The bad news was that there was enough opposition to be concerned. And, of course, another finding was the same one that I tend to belabor if only because it goes contrary to the common belief that antivaccine views are the province of crunchy, hippy dippy liberals on the coasts, namely that antivaccine views and fear of vaccines are prevalent in both liberals and conservatives.
On the other hand, there is a significant difference in how conservatives and liberals perceive school vaccine mandates:
Conservatives (25%) are a bit more likely than either moderates (15%) or liberals (9%) to say that parents should be able to decide not to have their children vaccinated even if that creates health risks for others. At least seven-in-ten of all three ideology groups say that the MMR vaccine should be required for healthy schoolchildren, however. There are no significant differences in views about this issue by political party in this survey.
Even with a margin of error of 4%, I’m hard pressed to look at figures that show 25% of conservatives believe that parents should be able to decide not to vaccinate their children even if that may create health risks for others while only 9% of liberals do to be a “bit more likely.” That’s almost three times as likely. If these figures are reasonably accurate and generalizable to the population at large, this would definitely explain why otherwise moderate Republicans like Chris Christie would pander to the antivaccine movement during the run-up to the Republican primaries in 2015. It’s why antivaccine dog whistles have become more prominent on the right than on the left. Heck, my very own state senator panders to antivaxers.
What else does this study show us? First, most Americans support a school-based vaccine requirement:
An overwhelming majority of Americans (82%) support having a school-based requirement that healthy children be vaccinated for measles, mumps and rubella. Older adults, ages 65 and older, are especially strong in their support for requiring the MMR vaccine.
Seniors, ages 65 and older, support a school-based requirement for the MMR vaccine by a margin of 90% to 8% who say that parents should be able to decide this. Smaller majorities of younger age groups support a school requirement for the MMR vaccine.
That’s not to say that there isn’t somewhat concerning information in this poll. Take a look at this graph:
As you can see, the overwhelming majority of adults support school vaccine mandates, but there are disturbing differences in the level of support based on age and whether or not the adults have young children. For example, only 8% of adults 65 and 14% of adults aged 50-64 and older say that parents should be able to decide not to vaccinate their children even if that may create health risks for others, 21% of adults under 50 say this. Even worse, 22% of parents of children age 0-4 years say this, compared to only 15% of parents with no children under 18.
There’s also an unsurprising result in the survey. While 88% of respondents agreed that the benefits of the MMR vaccine outweigh the risks, which is good, there are definite disparities in this belief based on science knowledge. Worse, the numbers of people who believe that the MMR is risky are concerningly high. (Thanks, Andrew Wakefield!) Basically, those with a high knowledge of science accept that the benefits of the MMR outweigh any risks, while those with low science knowledge are far less likely to accept that the benefits of the MMR outweigh the risks:
On the other hand, contrary to the commonly held stereotype that it is affluent (usually liberal) white people who distrust vaccines the most, the higher the income, the more the trust in the MMR vaccine, with the lowest percentage of people believing that the benefits of the MMR outweigh the risks belonging to the group making less than $30,000 a year. Similarly, in the graph above that looked at how people with young children view the MMR vaccine, you’ll see that significantly fewer African-Americans and Hispanics reported that the benefits of the MMR outweigh the risks.
As the Pew Research survey report puts it:
Reports that affluent communities have lower vaccination rates lead some to speculate that people with higher incomes hold more concerns about the safety of the MMR vaccine. The Pew Research Center survey finds, however, that people with higher family incomes tend to rate the risk of side effects from the MMR vaccine as low. Those with higher family incomes are especially strong in their support for a requirement that all children be required to be vaccinated against MMR in order to attend public schools.
I think I might be able to reconcile these two disparate observations, although I admit that my explanation is speculative, albeit speculative based on my 12+ years of observations. It might well be that affluent parents have a greater tendency to accept the benefits of vaccines and support school vaccine mandates. It may well also be that more education correlates with greater support for the MMR. However, there appears to be a subset of these parents who, highly educated and full of the Dunning-Kruger effect, tend to cluster together into communities that self-reinforce antivaccine views. In other words, there is another factor that, when added to high education and high income, promotes antivaccine views. More importantly, for purposes of promoting antivaccine views and persuading others that vaccines are dangerous, these highly educated, largely white, affluent people are much more talented at using social media and their connections to promote antivaccine pseudoscience than, say lower income people and minorities.
Whether my speculations are on the money or way off, I don’t know.
The bottom line is that hard-core antivaxers are a minority. They are and remain cranks. Moreover, for the most part they are marginalized, which is as it should be. Unfortunately, they have an outsized influence on reasonable parents who just don’t have the scientific background to recognize their misinformation and pseudoscience for what they are, contributing to vaccine hesitancy. A President who shares their fears and has no problem spouting off on Twitter or using the tools of the Presidency to spread whatever message pops into his head at any given time could easily increase that influence. But what can President Trump do?
Donald Trump versus vaccines
One of the retorts I heard when we at SBM expressed alarm about Robert F. Kennedy Jr. meeting with Donald Trump a week and a half ago was that the commission on vaccine safety and/or autism that he might or might not have been asked to chair, was that this wouldn’t matter. That federal vaccine policy is based in law and regulations, and that unless Trump spends political capital changing those we don’t have any reason to be worried. Of course, that’s partially true. Yes, Trump can’t just replace members of the Advisory Committee on Immunization Practices (ACIP) with Andrew Wakefield, Robert F. Kennedy, Jr., Barbara Loe Fisher, and a gaggle of other prominent antivaccine activists because there is a rigorous nominating process for membership and vacancies are staggered, so that it takes several years to turn the membership over. It’s also true that school vaccine mandates are a matter of state, not federal, law; Trump can’t change 50 state laws. On the other hand, as was noted on STAT News, Trump can appoint a CDC director and agency staffers who have antivaccine proclivities, and such a director could change CDC priorities and policies. If he’s willing to spend political capital, he could conceivably work with Congress to change or eliminate the Vaccine Court. He could cut back funding for the Vaccines For Children program or Section 317, a CDC-administered federal program that pays for vaccines, epidemiology, science, surveillance, the management of outbreaks, and more and has been called the “backbone of the US Immunization Program.”
So, what Trump can do to vaccine policy is limited, at least initially. However, that doesn’t mean he can’t still do enormous damage. There’s a reason why public health officials were appalled. That’s not even considering the Presidential bully pulpit. As Olga Khazan wrote a while back in The Atlantic, there is a shadow network of doctors who encourage vaccine hesitancy who could be empowered by a President who openly questions vaccine safety based on no evidence. For example, here’s what she wrote about the news about Trump’s meeting with RFK Jr.:
The Kennedy news sparked worries among some doctors that Trump will wrench responsibility for vaccines away from the CDC and hand the reigns to a pseudo-scientific panel, or that he will dismantle programs that protect vaccine makers from frivolous lawsuits.
In the meantime, he risks shaking the public’s trust in a vaccination schedule that has saved millions of lives and allowed Americans to live 30 years longer. As the recent wave of anti-vaccine alarm has shown, confidence in vaccines works similarly to herd immunity. It takes a universal acceptance of fact, and a rejection of conspiracy theories, to get every parent’s buy-in.
Last week, Kennedy told reporters, “Everybody ought to be able to be assured that the vaccines that we have … [are] as safe as they possibly can be.”
But doctors say even the hint that patients need such “assurance” is toxic. After all, people question vaccines because authority figures raise questions about them. Patients don’t question whether it’s the right choice to eat apples, because doctors and politicians have never suggested that the jury is still out on fruit.
Exactly. It is quite reasonable to fear that Donald Trump, just by questioning vaccine safety based on no good evidence and by cozying up to antivaccine activists prone to conspiracy theories (like RFK Jr.) will spread antivaccine ideas and give them the imprimatur of the President of the United States. He could accelerate a worrisome trend that has started to make school vaccine mandates into a partisan issue in which Republicans side with “parental choice” over public health. No wonder antivaccine parents are furiously working to get their message to Trump using anecdotes and pseudoscience. They see a kindred spirit in the White House, one with the power to give them at least some of what they want, fantasies that date back many years.
Will 2017 be the year of the antivaxer?
Normally, when I see the antivaccine movement apparently in ascendancy, as I double down my efforts to defend science, I can also reassure myself that the antivaccine movement is a fringe group and that, contrary to the case a decade ago, the press has for the most part learned not to fall into the false equivalency trap and instead to state consensus science correctly when doing stories about autism or vaccines. With the discrediting of Andrew Wakefield as a fraud my perception has been that, overall, science is slowly winning the battle over vaccine hesitancy. Sure, there have been bumps along the way, but my perception has been that the overall trend has been in the right direction, particularly given laws like SB 277 in California, which bans nonmedical exemptions to school vaccine mandates and how others states have been considering similar legislation. Now we have a President who says the same sorts of things that antivaccine activists do and has met with their heroes. We’re in uncharted territory, as far as I’m concerned, and I don’t know what will happen next.
Here’s one other example I like to give of the change since my early days as a blogger. Several years ago, I used to dread April, which is Autism Awareness Month, because I could, usually beginning on March 30 or 31, count on seeing Jenny McCarthy, J.B. Handley, and the other usual antivaccine suspects in the media touting the pseudoscience blaming autism on vaccines, largely because media outlets would do stories on autism for the month and inevitably feel the need to cover that angle. Over the last few years, I’ve noticed that these sorts of Autism Awareness Month stories have become rare to nonexistent. I often no longer notice when March 31 or April 1 rolls around. Not this year. I don’t think it’s a coincidence that antivaccine activists have planned a March on Washington called Revolution for Truth on March 31, 2017.
Here’s its “call to action.” Predictably, the webpage invokes our Founding Fathers and the Declaration of Independence. (Antivaxers do love doing that.) On their Facebook page, the organizers declare:
On Friday, March 31, 2017, concerned individuals from across America will join with health care professionals in Washington D.C. to defend parental rights and civil liberties, including freedom of thought, speech and conscience. We are uniting to call out the corporatized mainstream media for manufacturing “fake news” that distorts the truth about environmental toxins, unsafe food and vaccine risks, which endangers our right to know and freedom to choose how we protect our health.
We are Taking a Stand for Truth and Freedom in Washington D.C.
To protest the corporatized mainstream media’s biased coverage and demonization of anyone who advocates for safer vaccines or defends the legal right to make informed, voluntary vaccine choices.
To protest the exploitation of the people by the chemical and pharmaceutical industries that have poisoned our environment and compromised our health for profit.
To protest the liability shield that Congress has given to drug companies to protect them from accountability in a court of law when government mandated vaccines injure or kill us or our children.
We are calling on our elected representatives in state legislatures and in Congress to protect our parental rights and civil liberties and to restore Truth, Integrity, and Transparency in Government agencies responsible for ensuring the public health and safety in America.
Join us IF you believe that you – not Big Pharma or the government – should decide what is best for you and your children’s health.
Join us IF you recognize that the corporatized mainstream media is ignoring and withholding the truth when it comes to the evidence that our environment and our food and vaccine supplies have been seriously compromised.
The speakers there will include a veritable rogues’ gallery of antivaccine pseudoscience supporters, including Trump’s new BFF RFK Jr. giving the keynote address. Joining him will be Barbara Loe Fisher, Minister Tony Muhammad, Del Bigtree, Brian Hooker, Paul Thomas, Judy Mikovits, Toni Bark, Marcella Piper-Terry, Kent Heckenlively, Diane Hennacy Powell, Sheila Lewis Ealey, Ty Bollinger, Diane Hennacy Powell, Jennifer Margulis, and Robert Moxley.
Now, I know what you’re thinking. Antivaccine activists did the same thing nearly nine years ago, then led by Jenny McCarthy and Jim Carrey, with a march called Green Our Vaccines. Nothing came of it, even though Jim Carrey was a big star then and Jenny McCarthy was a C- to B-list celebrity. This year the biggest celebrity at the march will apparently be RFK Jr. On the other hand, back in 2008 antivaccine activists didn’t have someone sympathetic to their views, someone who speaks their language, in the White House. Vaccine mandates hadn’t become a partisan issue, with libertarian-leaning Republicans like Rand Paul insisting on “health freedom” and “parental choice”. Congress was a lot less likely to be receptive. It could well be that this demonstration fizzles too, just like its predecessor in 2008, but the wild card remains the occupant of the White House, coupled with the sea change in our politics during the intervening nine years.
To be honest, I don’t know whether antivaxers are “winning” or not. That might be a cop-out, but in my defense I can only point out that, even taking the long view as I have before, circumstances have never been as they are now. There are certainly reasons to be pessimistic, not the least of which is our President. However, not all the news is bad, and I know that vaccine science will be one of the top issues that scientists and science advocates will defend. I also know that Trump can’t wave a magic wand and impose his will on 50 diverse states.
What I do know is that 2017 will be a time of peril, given how energized the antivaccine movement has been by the election of President Trump. I also know that science advocates have to do everything in our power to defend and strengthen vaccination programs. After all, if antivaxers are winning, our children are losing.