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One of the stereotypes that I hear from time to time from fellow skeptics that really irritates me is the stereotype of antivaxers and being primarily hippie-dippy, granola-crunching left wingers. Sure, there is an element of that in the antivaccine movement, but in reality, as I’ve said many times before, antivaccine pseudoscience and conspiracy beliefs transcend political boundaries, and, yes, it’s true that areas with a lot of affluent people on the coasts where the politics tends to lean heavily liberal, have suffered outbreaks of vaccine-preventable illnesses. However, there is also a very strong strain of antivaccine views on the right as well, including General Bert Stubblebine III’s Natural Solutions Foundation, far right libertarians, and others who distrust the government, including government-recommended vaccine schedules.

An excellent example of how antivaxers have successfully co-opted the political zeitgeist of the moment by latching on to conservative or libertarian political rhetoric is in progress in the state of Texas. I’ve written about this several times on my not-so–secret other blog and once here about how antivaxers have attached their pseudoscience to small government, anti-regulation conservative rhetoric in my home state of Michigan and briefly alluded to it in a post about whether antivaxers are winning, but I haven’t much discussed it here. Recent events, however, have provided me the opportunity to remedy that oversight. Specifically, an antivaccine group known as Texans for Vaccine Choice is inserting itself into politics by backing candidates opposed to vaccine mandates and influencing the legislature. Before I discuss exactly what Texans for Vaccine Choice is doing, let’s take a look at this group and other antivaxers in Texas.

Antivaxers in Texas

Texas is home to many things, but, unfortunately for it and the nation as a whole, it is home to the most prominent antivaccine “scientist” of all, Andrew Wakefield, who lives in Austin. (Internet entrepreneur, quack, supplement hawker, and all around conspiracy crank Mike Adams also lives near Austin.) Looking back, I find it hard to believe that, as of last month, it’s been 20 years since Wakefield first published his now-retracted case series implying that the MMR vaccine is associated with autism in The Lancet, thus launching the modern iteration of the antivaccine movement. Whether these cranks inspired Texans for Vaccine Choice or not, I do not know, but I first took more than a passing notice of this group a little more than a year ago, when Science first reported how much the number of nonmedical exemptions in Texas had soared from 2003 to 2015. I discussed this problem before, but since the visual is striking, I’ll post the same graph again that I posted then:

There was a 19-fold increase in the number of nonmedical exemptions to school vaccine mandates, from 2,300 in 2003 to 45,000 in 2015. The graph included in the Texas Observer article I mentioned above shows that trend continuing alarmingly, with the total number of exemptions in 2016 surpassing 50,000. Yes, vaccination rates in Texas remain high overall, but this is a worrisome trend, and, as is usually the case, there are pockets of high rates of vaccine refusal throughout the state that can serve as niduses for outbreaks of vaccine-preventable diseases, with some schools having exemption rates in double digit percentages. If Texans for Vaccine Choice has its way, the rates of nonmedical exemptions will continue to climb, and more areas of the state will have vaccine uptake rates falling below the level needed for effective herd immunity.

Many states have groups like Texans for Vaccine Choice (my own state has at least one that I’m aware of), but, like Texas, Texans for Vaccine Choice is big, at least bigger and more active than most groups like it. They’re also trying to mobilize antivaxers to act to persuade the legislature to do what they want:

In San Antonio, 80 miles southwest of the state capital, Texans for Vaccine Choice convened a happy hour to encourage attendees to get more involved politically. The event was among dozens of outreach events the group has hosted across the state. The relatively new group has boosted its profile, aided by a savvy social-media strategy, and now leads a contentious fight over vaccines that is gearing up in the current legislative session.

If you wander over to the Texans for Vaccine Choice website, you’ll see that it’s pretty slick and that it also is full of the standard antivaccine talking points and misinformation. For instance, it proudly proclaims that this is about “freedom,” saying that “we promote the preservation of personal liberties and informed consent by opposing measures to limit vaccine choice rights or discriminate against those who exercise such rights.” Here’s an example on Twitter of the sort of rhetoric this group uses to disguise its antivaccine bent:

Of course, whenever an antivaxer says “freedom,” what he really means is the “freedom” to expose his child and community to potentially deadly infectious diseases and the “freedom” to use whatever quackery on his child that he so desires. Similarly, when an antivaxer says, “informed consent,” I like to go all Princess Bride on him, saying something like: “Informed. You keep using that word. I do not think it means what you think it means.” The reason, of course, is that the “informing” that antivaxers do and want is to vastly exaggerate the risks of vaccines, even attributing risks to them that are not supported by science, and to downplay the benefits of vaccines.

Of course, Jackie Schlegel, founder of Texans for Vaccine Choice, and its executive director, strenuously denies that she or the group is antivaccine:

Schlegel is irritated when people refer to her or her group as “anti-vaccine.” She’s not against vaccines, she says. She believes in “parental choice,” “medical privacy” and “liberty” — powerful conjuring words in Texas politics. Mandatory vaccinations are lawmakers “reaching their hands into our homes and taking our rights,” Schlegel said.

That’s how antivaxers make allies of and appeal to conservatives and libertarians, by invoking the magic words of “parental choice” and “liberty.” They argue that it’s not about vaccines but rather about “FREEDOM!” from evil government mandates. Make no mistake, however. Schlegel and Texans for Vaccine Choice are antivaccine. For example, on their website, you can find blog posts misrepresenting herd immunity by citing antivaxers like Dr. Kelly Brogan (yes, the same Kelly Brogan who recently was a keynote speaker at Gwyneth Paltrow’s In Goop Health wellness expo) and standard antivaccine talking points about vaccine “failure,” posts exaggerating the risks of vaccines and downplaying the benefits, conspiracy mongering rants about big pharma, and basically every antivaccine trope you can think of. Texans for Vaccine Choice deny that the group is antivaccine. That is false, either a lie or a delusion. I know antivaccine when I see it, and Texans for Vaccine Choice is about as antivaccine as they come. That is not surprising. Jackie Schlegel, founder of the group, has a 16-year-old daughter with autism and believes vaccines caused it and likes to refer to pro-vaccine advocates the “Pro-Grab-Them-and-Stab-Them-at-any-Cost Camp.”

Unfortunately, she and her group have been very effective, as you will see.

Texans for Vaccine Choice is targeting pro-vaccine state representatives

Last week, I came across a story in the Texas Observer by Sophie Novack entitled “How Anti-Vaxxers are Injecting Themselves into the Texas Republican Primaries.” (I know, I know. “Injecting.” the headline is a bit of an old vaccine trope.) The article itself, however, should be reason for concern.

By way of background, you should know a couple of things. First, in 2015 State Representative Jason Villalba (R-Dallas) introduced a bill into the Texas House that, if passed, would have eliminated nonmedical exemptions to school vaccine mandates in the same manner that SB 277 did in California that same year. Second, State Representative Sarah Davis (R-West University Place) is a vocal supporter of vaccines. Acting on her beliefs, she introduced multiple pro-vaccine bills last year: a bill that’s a lot like what Michigan requires in that it would have required parents to review educational material about vaccines before claiming personal belief exemption to school vaccine mandates; a bill that would have required reporting human papilloma virus (HPV) immunization rates; a bill allowing minors to consent to HPV vaccination; and a bill that would have changed the state law to redefine opt-out decisions as “non-medical,” deleting reasons “of conscience, including a religious belief.”. None of those bills passed; they didn’t even make it out of committee.

Because they are in districts that lean heavily Republican, for these two Representatives the most important race is the Republican primary tomorrow (with a run-off on May 22 if needed), and they are being targeted by antivaxers in that primary:

A measles outbreak in Ellis County last month. A surge in mumps cases in 2017 that led to the highest annual total in Texas in 23 years. Skyrocketing vaccine exemptions among kids. Public health experts warn Texas is on the precipice of a major disease outbreak, and point to the growing anti-vaccine movement in the state as the main culprit. But Texans for Vaccine Choice, which began as a group of “mad moms in minivans” and quickly grew into an influential political group, is more determined than ever to fight for what they say is their right to “medical freedom,” and unseat their enemies in the Republican primary.

“This is a human rights issue,” said Jackie Schlegel, the group’s executive director, in a Facebook Live video last month. Schlegel, who insists her group is not anti-vaccine, but rather “pro-vaccine choice,” lamented what she says is uncivil treatment from doctors and lawmakers opposed to their mission. “There is a war on women, and it starts with a war on mothers,” she said.

A single mom who says one of her kids was injured by vaccines, Schlegel started Texans for Vaccine Choice in response to a 2015 bill by state Representative Jason Villalba, R-Dallas, that would have eliminated non-medical “conscience” exemptions for vaccines at public schools. Exemptions are a matter of “liberty,” “parental choice” and “privacy,” says Schlegel, who did not respond to requests for an interview.

Here is the video referred to above:

Notice how Schlegel is using a time-dishonored antivaccine technique of labeling criticism of their pseudoscientific views as “bullying” or hatred and contempt for mothers and women in general, even co-opting the “war on women” as applying to mothers refusing to vaccinate their children. I wanted to gag when these two started likening the antivaccine movement to the civil rights movement in the 1950s and 1960s.

There was also an excellent report on HBO’s Vice News showing the scope of the problem of antivaccine sentiment in Texas and how it is fusing with anti-government conservative movements:

If antivaxers are successful in targeting pro-vaccine legislators, the problem of lower vaccine coverage will only continue:

This primary cycle is a continuation of a grudge match between Villalba and the anti-vaxxers, who also campaigned against the Dallas Republican in 2016. Texans for Vaccine Choice designated his [Villaba’s] primary challenger, interior design firm owner Lisa Luby Ryan, as a “priority campaign,” and Schlegel has blockwalked with Ryan, who also picked up a batch of endorsements from other far-right groups including Empower Texans, on multiple occasions.

Not surprisingly, I had never heard of Lisa Luby Ryan before; so I did a bit of Googling. It turns out that she’s a far right wing fundamentalist Christian, which is not at all unusual in Texas, and has appeared in a film in which she confessed all her past sins and how she came to God. Interestingly enough, there is not a single word about vaccines on her website that I could find, and I searched using Google Advanced Search. Similarly, there’s nothing on her Twitter feed about vaccines (advanced search again). It’s almost as though she’s a stealth antivaxer.

Susanna Dokupil, a lawyer and a board member of the Seasteading Institute, seems to be keeping her antivaccine beliefs on the down-low as well:

Texans for Vaccine Choice picked the wrong race to target, said Davis, whose district includes the Texas Medical Center, the world’s largest medical complex. Peter Hotez, a leading expert on vaccines and director of the Texas Children’s Center for Vaccine Development at the center, has taken to social media to warn about Texans for Vaccine Choice, which he calls an “anti-science hate group.” It “has somehow convinced [lawmakers] this is a political issue, not a health issue,” Hotez told the Observer. “It’s very nefarious what they’re doing.”

Davis says she’s glad to talk about vaccines in her race, but is taking the involvement of Texans for Vaccine Choice seriously. “If I were to somehow lose this primary and they take credit for defeating a vaccine advocate, then their strength would grow because they would feel empowered,” she told the Observer. “And other members would probably think twice about wanting to get involved in advancing good, sound public policy dealing with vaccines. I think the ramifications are big.”

As for her denials that she is antivaccine and her statement that all of her children and she are “fully vaccinated,” let’s just put it this way. If Texans for Vaccine Choice is donating heavily to your campaign, blockwalking with you, and calling you their “MVP” and top priority to get elected, those are some really good indications that you are probably antivaccine or at least functionally no different from an antivaxer in that your agenda with respect to vaccines aligns closely with that of antivaxers. The latter possibility is quite possible, because Dokupil is a libertarian seasteading advocate who is basically opposed to most government regulations with respect to “choice.” When it comes to vaccine mandates, it doesn’t really matter if Dokupil is antivaccine or not. Her vote will be the same as any antivaxer’s, against vaccine mandates.

So it looks very unlikely that Dokupil will unseat Davis. Personally, I’d love to have seen the reactions to Dokupil’s supporters who belong to Texans for Vaccine Choice by health care professionals in Davis’ district. On the other hand, maybe, just like Dokupil herself, Texans for Vaccine Choice don’t even mention her stance of vaccines when campaigning for her. Similarly Villaba is not particularly worried about Ryan’s challenge. Unfortunately, that’s not the only way Texans for Vaccine Choice is flexing its muscle:

“It’s really scary how impactful they are,” Davis said of Texans for Vaccine Choice. “Last session, I couldn’t even get any hearings on my pro-vaccine bills. They really have been able to bully and intimidate a lot of members. And they’ve made vaccines controversial, which makes members nervous. … It really shouldn’t be controversial.”

From July to January, Texans for Vaccine Choice’s political action committee, or PAC, has raised about $56,000 in political contributions, largely from small donors. Of the more than $60,000 the group has spent during that time period, about two-thirds has gone to its own nonprofit arm, with the remainder directed to a handful of Republican candidates, according to campaign finance data. Though the anti-vaxxers’ fundraising is modest, they are able to mobilize grassroots support for candidates through blockwalking, phone banking and online messaging. Schlegel posts daily videos on Facebook from campaign events and is shown shaking Abbott’s hand in his new ad from a rally for Dokupil in the Houston area last week.

The Texas Observer reported on how effective antivaxers, led by Texans for Vaccine Choice, have been in causing a legislative stalemate on any bills having to do with vaccines. They’ve also persuaded legislators to introduce lots of “vaccine choice” bills. Fortunately, none of them have gone anywhere—yet. For instance, only one of the six antivax bills introduced in the last session got a full committee hearing. Specifically, HB 1124, a bill authored by Matt Krause, a far-right member of the House Freedom Caucus from Fort Worth, would have made it easier for children to claim exemptions to immunization. Currently, a parent who wants a personal belief exemption for her child in public school must apply in writing for an exemption affidavit from the Department of State Health Services, which takes up to a week to process. HB 1124 would have eliminated the requirement for the written request by letting parents print out a blank exemption form from the health agency’s website.

Fighting Texas antivaccine pseudoscience

Sadly, at least thus far, it’s been an uphill fight for advocates of child health in Texas:

Peter Hotez, director of the Texas Children’s Hospital Center for Vaccine Development, predicts that 2017 could be the year the anti-vaccination movement gains ascendancy in the United States. Texas could lead the way, he said, because some public schools are dangerously close to the threshold at which measles outbreaks can be expected. A third of students at some private schools are unvaccinated.

“We’re losing the battle,” Hotez said.

Although the anti-vaccine movement has been strong in other states, including California, Oregon, Washington and Colorado, experts say the effort in Texas is among the most organized and politically active.

“It’s a great example of an issue that has a targeted, small minority but an intense minority who are willing to mobilize and engage in direct action,” said Mark Jones, a political science professor at Rice University in Houston.

Dr. Hotez is Texas’ answer to Paul Offit. He’s rapidly becoming one of the foremost vaccine advocates in the world. If you want to know more about him, he was recently profiled in Texas Monthly. Think of it this way. I pointed out the last time I wrote about Texas that, 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 or Sauron, 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.

In any case, pro-vaccine advocates are just plain outgunned by the antivaxers. Consider the story of Jinny Suh, who runs Immunize Texas, a group working to counter the antivaccine message of groups like Texans for Vaccine Choice. She’s fighting a brave battle, but is hopelessly outgunned by Texans for Vaccine Choice:

But immunization advocates like Suh say it’s hard to counter the passion of her opponents. Most people consider vaccinations to be such a basic part of life, like clean drinking water, that it’s hard to motivate them to take time to show up at lawmakers’ offices.

“We’re completely outgunned,” said Suh, adding there are only about a dozen members whom she can call on to show up for events. Immunize Texas is part of the Immunization Project.

Suh often writes emails and posts to the group’s Facebook account from her cellphone while caring for her two sons. She juggles her immunization advocacy, a mostly volunteer gig, with other businesses she runs from home.

Also, the message equating “vaccine choice” with “freedom” resonates very strongly in conservative Texas:

One particularly strong strain of anti-vaccine rhetoric in Texas is libertarian and anti-government. Texans for Vaccine Choice receives help and expertise from “friendly” lawmakers and groups such as Empower Texans, said Jonathan Stickland, a tea party Republican representative from Tarrant County and a key supporter. Political experts consider Empower Texans the state’s most sophisticated and influential conservative organization.

“Our message resonates with people,” said Schlegel, 37, in a brief interview after a day of meetings at the Capitol. “Texans value parental rights,” she said. “We have a message of liberty. We have a message of choice.”

As I’ve said more times than I can remember, antivaccine pseudoscience is an irrationality that appeals to both the right and the left, but for different reasons. On the left, it’s often due to a belief that “natural” is somehow better coupled with distrust of big business, especially big pharma, while on the right it’s “freedom” and anti-government rhetoric. Think of it this way. Political operatives know that people tend to be more passionate when they are against something rather than for something. It’s easier to get them to donate and do stuff to oppose a policy rather than to promote a policy. That was how the Tea Party got started, and we’re seeing a similar passion on the left in response to Donald Trump. So the antivaccine movement in Texas has slick, glossy literature, complete with red, white, and blue emblems to go along with the lies that vaccines aren’t tested adequately for safety and are full of “questionable ingredients” (a.k.a. “toxins”), while Suh doesn’t even have business cards.

They also have a message that resonates in a state like Texas, and knowledge doesn’t matter:

When the group recently sought volunteers on Facebook for “engagement days” at the state Capitol this month and in March, one woman said she wanted to help but was concerned she didn’t know enough about vaccines. Don’t worry, she was told. “Very little talk about vaccines and a LOT of talk about parental rights and CHOICE.”

I also remind you of a speech given by Del Bigtree in Michigan last year:

Del Bigtree, as you might remember, produced the antivaccine propaganda film VAXXED, which was directed by Andrew Wakefield. You might also remember that he spent most of his time framing vaccine mandates as an issue of “freedom” and concluded thusly:

If we do not fight now, then there will be nothing left to fight for. And I think that is where everyone in this room, I pray you realize how important you are in this historic moment. We will never be stronger than we are right now. We will never be healthier than we are right now. Our children are looking like this, a generation of children, as we’ve said on The Doctors television show this is the first generation of children that will not live to be as old as their parents. Are we going to stand…are we going to sit down and take it? Or are we going to stand up and say: This is a historic moment, that my forefathers, those from Jefferson all the way to Martin Luther King, the moments where people stood up and something inside of them said I’m going to stand for freedom and I’m going to stand for it now. That is in our DNA. It is pumping through me, and I pray that you feel it pumping through you, because we must look back. Our grandchildren will look back and thank us for having stood up one more time and been the generation that said, “We the People of the United States of America stood for freedom, stand for freedom. We will die for freedom today.”

Histrionic? Yes. Overwrought? Definitely. Grandiose? Well, it is Del Bigtree. Even so, it’s not hard to see how this can be a very effective message among libertarian and government-distrusting conservatives. Also think of Rand Paul’s now-infamous quote: “The state doesn’t own the children. Parents own the children, and it is an issue of freedom.” The antivaccine movement is full of this attitude, namely that parental “rights” trump any rights children might have as autonomous beings. The right of the child and any public health considerations are subsumed to parental “freedom to choose” and “parental rights,” with children viewed, in essence, as their parents’ property or an extension of the parents, to do with as they will, never mind what’s actually best for the child.

The politicization of school vaccine mandates

Here’s what worries me. Traditionally state vaccination policy and school vaccine mandates have been as close to a nonpartisan issue as we have in this country. There has usually been broad bipartisan support for such mandates and the idea that children should be vaccinated in order to attend school. It’s a consensus that has served the country well for many decades now. What I fear is that this consensus is breaking down, and—even worse—school vaccine policies are becoming a partisan issue, every bit as bitter and divided as many others.

I’m not the only one who’s had such fears, too. For instance, Saad Omer and Sarah Despres over at Politico expressed a fear that vaccine policy will become as politicized as climate science, noting:

Increased politicization of the vaccination issue would be deadly, because it could spawn new anti-vaccination converts and further insulate the debate from scientific research, potentially lowering immunization rates and increasing the risk of disease. The likelihood of infectious disease outbreaks increases substantially when there is a “critical mass” of unprotected individuals in a community. For most diseases against which we vaccinate, this critical mass is achieved when at least 10 percent-20 percent of the population is un-vaccinated. Therefore, even a 70 percent-30 percent split in public opinion in favor of vaccines could result in an unacceptably low immunization rate. This type of divide will inevitably lead to reduced immunization rates and disease outbreaks. Thousands of people could die. So as the country becomes increasingly divided, we must ensure that vaccine remains on the fringes of both parties.

There’s a bit of false equivalence in the article, such as neglecting to note that powerful mainstream conservative forces in Texas and elsewhere are behind groups like Texans for Vaccine Choice, while there is no equivalent support on the “other side” to match. In essence, Empower Texans is using antivaccine conspiracy theorists like those running Texans for Vaccine Choice as cannon fodder in a larger battle to decrease government regulation and promote far right wing causes. Indeed, that’s why I’m so concerned. What I’ve sensed watching the antivaccine movement over the last three or four years is a distinct rightward shift in its preferred politics. That’s not to say that left wingers don’t have antivaccine dog whistles of their own (I’m talking to you, Jill Stein), but by far the loudest and most active antivaccine voices appear to come from the right these days, and the most effective antivaccine dog whistles are linked to “freedom” and “parental rights.” This phenomenon predates Donald Trump as well. For example, Texans for Vaccine Choice sprang into being in 2015, when in the wake of the Disneyland measles outbreak, the state legislature considered bill like California SB 277, and that’s when I first started to notice the convergence of right wing politics and antivaccine beliefs to an extent far greater than I had ever seen before.

As I’ve said before on at least one occasion, unfortunately now that we’ve gone down this road, I don’t see a clear path to preventing the further politicization of school vaccine mandates and state vaccine policy. I fear that it might require much bigger outbreaks than we’ve seen thus far before we as a nation come to our senses again about vaccines. Texans for Vaccine Choice is but a symptom, and I fear that we’ll see more examples of antivaxers effectively entering politics before the fever breaks.

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Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.