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Jonathan Berman’s new book Anti-vaxxers: How to Challenge a Misinformed Movement has two goals: to provide a complete picture of the anti-vaccine movement and to provide a counterpoint to some of the misinformation that has been circulating. It succeeds admirably on both counts.

In addition, it examines and critiques the strategies that have been used to dissuade people from their anti-vaccine beliefs. These fall into three broad categories:

  1. Reactive: engaging with anti-vaccine advocates with arguments and/or mockery
  2. Information-deficit strategies: making factual information available to the public
  3. Community-based strategies that take self-identity and values into consideration; the strategy most likely to succeed.

Anti-vaxxers come in many flavors, and there is often a disparity between belief and behavior. Berman reports that in France, 41% of people disagreed with the statement that vaccines are safe, but 96% vaccinated their children. Vaccination rates are generally high, but there are pockets of resistance that can lead to (and have caused) outbreaks of preventable diseases.

The history of vaccines and anti-vax attitudes

Berman starts by explaining what vaccines are and how they work. He provides an informative history of vaccines, pointing out that Jenner was not the first to vaccinate with cowpox: a farmer named Benjamin Jesty preceded him by two decades, using a darning needle to transfer pus from an infected cow to his wife and children.

Objections to vaccines were immediate, and the early anti-vaccine movement presaged today’s movement by ignoring the obvious success of vaccines and quibbling about scientific issues instead of addressing their real concerns such as individual rights, resistance to government mandates, the “natural order” of things, and social inequities.

In 1905, the US Supreme Court ruled that states could restrict individual liberties to avoid great dangers to public safety, that they could punish vaccine refusers with fines or imprisonment but could not forcibly vaccinate, and that they must allow medical exemptions.

To illustrate the success of smallpox vaccination, Berman says:

If you lined up all the people who have lived since 1980 because smallpox was eliminated and took one minute to greet each of them, you would spend the next 144 years meeting people who did not die of smallpox.

I didn’t check his math, but it’s undeniable that millions of people lived who would have died of smallpox if the vaccine did not exist.

Did you know Gandhi was originally an anti-vaxxer? He called vaccination “a violation of the dictates of religion and morality”. His concern was that an oppressive government was taking away the bodily autonomy of the people he was fighting for. He changed his mind after seeing unvaccinated children die of smallpox.

Vaccine injuries and laws

Berman doesn’t omit vaccine failures, like the two polio vaccines in the 1930s that killed six children and paralyzed ten, and the 1955 pharmaceutical accident when an improperly inactivated virus resulted in 250 cases of paralytic polio and 11 deaths. But he explains that safety precautions are now in place to prevent a recurrence of such disasters. He describes some of the many occasions around the world where vaccine fears led to a decrease in vaccination rates which then predictably led to a resurgence of disease – and where the disease promptly subsided when vaccination rates went back up.

He describes how lawsuits against vaccine manufacturers led to the National Childhood Vaccine Injury Act, which created the Special Masters court and provided compensation for patients who met certain criteria and protected the supply of necessary vaccines. The standard of evidence was a legal one, not scientific evidence that the vaccine had caused the injury (and this is still the case today).

Today’s anti-vaxxers love to cite reports of vaccine harms from the Vaccine Adverse Event Reporting System (VAERS). It was set up as an early warning system for identification of possible adverse events, but a report to VAERS does not establish that the vaccine caused the reported event. Dr. James Laidler vividly demonstrated the fallacy of relying on VAERS by reporting that the flu vaccine had turned him into the Incredible Hulk. The report was accepted, although he later withdrew it after he had made his point.

Doctors and others who encourage anti-vaxxers

He covers the Wakefield fiasco in detail (covered by SBM many times). Wakefield’s study was retracted, and he was stripped of his license to practice medicine; but meanwhile he had alarmed many parents who refused the MMR vaccine in the belief that it caused autism. Numerous studies have since shown no evidence that vaccines can cause autism, but many parents are still fearful.

He covers Dr. Robert Sears’ spurious reasons for delaying vaccines, which have no basis in fact (covered here on SBM also); delaying vaccines only creates serious risks for children. An entire chapter is devoted to a devastating critique of the film Vaxxed (which we have done many times here). Another chapter addresses the misinformation promoted by Robert F. Kennedy in his article “Deadly Immunity” and elsewhere, stoking fears of thimerosal (which is essentially absent from the American pediatric vaccine schedule today anyway; addressed by David Gorski).

One chapter covers ineffective “alternatives'” to vaccination, including pox parties, breast-feeding, homeopathy, probiotics, vitamins, essential oils, chiropractic, Miracle Mineral Solution (MMS), hyperbaric oxygen, exorcisms, craniosacral therapy, and bogus autism cures including the “chemical castration” advocated by the Geiers.

Religion and other factors

He discusses placebo effects, fake news, social media, memes, and freedom of speech. A chapter on religions finds that nearly every major religion either encourages its members to vaccinate or is neutral on the subject. The so-called “religious exemption” does not reflect actual religious beliefs, but is a smokescreen that gives anti-vaxxers an excuse to bypass government regulations. It is a cynical ploy that exploits the privileged position of religion in society. Berman says:

Freedom of religious belief is not the same as freedom of action based on religious belief…In the rare case that religious beliefs do conflict with vaccination, the state’s interest in public health may outweigh religious privilege.

Anti-vaxxers would have you believe that Big Pharma is guilty of conspiracy and is lying to you for profit. Big Pharma is undoubtedly guilty of many sins, but that doesn’t mean vaccines are unsafe or ineffective.

Who are the anti-vaxxers?

Anti-vaxxers are not a homogeneous group. Some are activists who work to spread misinformation, others are merely vaccine-hesitant: they have heard things that worry them but haven’t entirely made up their minds. And some are willing to vaccinate but have not yet done so because of factors like financial barriers, poor access to medical care, or transportation difficulties. Those who don’t vaccinate tend to have:

a lower level of trust in health care professionals, a lower level of trust in government, a concern that a child’s immune system could be “weakened” by too many immunizations, a belief that immunization requirements abridged freedom of choice and that parents know what’s best for their own children, a greater level of trust in alternative health practitioners, and a past history of having sought information from sources on the internet or alternative health practitioners.

Anti-vaccine parents are deeply concerned with being good parents. They seek out information from sources they trust, like friends and family. They are more distrustful of people they don’t know personally. They are subject to the normal human tendencies, biases, and shortcuts of thinking. They distrust authorities and respond more favorably to stories than to statistics. They worry about chemicals with long names they don’t understand. They fear that putting things into our bodies that are not natural will make them impure.

Changing minds

People do change their minds, but we can’t do it for them. Perhaps a kind stranger answers their questions. Perhaps they connect with someone paralyzed by polio or blinded by measles. Perhaps an illness in their family prompts them to do more (and better) research.

Vaccination is a success story. We should tell that story and should “sing louder than those who sing out of key”. Anti-vaxxers are motivated by the same desires that motivate us all: the desire to be a good parent and do what is best for our children. We can help by understanding the kinds of anti-vaccine arguments and how they are involved with group identity.

Berman says, “We should learn how we can individually respond to the doubts of our friends, neighbors, and family members in a way that is compassionate, well-informed, and correct. Anti-vaccination activism is a local problem that demands local, personal solutions.”

Conclusion: Everything worth knowing about the subject

Berman’s book compiles everything worth knowing about the anti-vaccine movement into one convenient, well-referenced volume. It is well-written, concise (213 pages of text), and conveniently divided into 22 short, easily digested chapters. If you are anti-vaccine, you need to read this book but probably won’t. If you are pro-vaccine, it deserves a prominent place on your bookshelf among your reference books. It is a useful compendium that will help you respond appropriately when you encounter a victim of this misinformed movement. I urge everyone to read it. Even if you are as well-informed as I assumed I was, there is much more to learn and to think about.

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Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.