As I write this, I am currently at the Center for Inquiry (CFI) Reason for Change conference, where on Friday Steve, Harriet, and I did a panel on—what else?—alternative medicine and how it’s become “integrative medicine.” As a result, I’ve been very busy, which means that parts (but by no means all) of this post will look familiar to those of you who follow me at my not-so-super-secret other blog. However, it occurred to me after we did our panel discussion that there are important things happening in California that we’ve only barely touched on here on this blog. I’m referring, of course, to a bill (SB 277) that’s wending its way through the California legislature. SB 277, if passed, would eliminate nonmedical exemptions to school vaccine mandates. That’s not to say we haven’t discussed the issue of nonmedical exemptions, of which there are two types: religious and personal belief exemptions (PBEs), which can all be simply described as PBEs. Both Steve Novella and I have addressed them on SBM. For example, when an earlier bill (AB 2109) was passed that mandated that parents seeking PBEs consult with a physician or other listed health care professionals (which, unfortunately, included naturopaths) before a PBE would be granted, I documented how the antivaccine movement strenuously objected even to this minor tweak in the law that would make PBEs slightly more difficult to obtain. Unfortunately, even though, against all expectations, the bill passed, Governor Jerry Brown sabotaged it with a signing statement that betrayed California children by reinstating, in essence, religious exemptions. Specifically, Gov. Brown ordered the California Department of Public Health to include a check box on the form that parents could check to say they have religious objections to vaccines. Parents who checked that box could thus bypass even the anemic requirement to consult with a pediatrician before being granted a PBE.

The problem with nonmedical exemptions to school vaccine mandates is that vaccine-averse and antivaccine parents tend to cluster mostly in areas where white, affluent people live, as demonstrated in California and my own state of Michigan. So, even though antivaccinationists frequently tout high statewide vaccination rates as evidence that the process for obtaining PBEs does not need to be tightened up, they are disingenuously using a straw man argument against vaccine mandates, because it’s the pockets of low vaccine uptake that compromise local herd immunity that are the problem. We see these in Oregon, California, Michigan, and many other states with PBEs, and we also know that ease of obtaining PBEs is correlated with more PBEs and more outbreaks of vaccine-preventable diseases.

All of this came to a head earlier this year with what is now known as the Disneyland measles outbreak, a large multistate outbreak originating at Disneyland and traced to unvaccinated children. This outbreak so shocked California that the unthinkable happened. The possibility of passing a law eliminating nonmedical exemptions to vaccine mandates, something virtually everyone would have considered as much a fantasy as many of the characters played by the recently deceased great Christopher Lee played during his career, suddenly became an attainable goal. Senators Richard Pan and Ben Allen introduced SB 277, which would eliminate the personal belief exemption for children attending state licensed schools, daycares, and nurseries in California.

The antivaccine movement strikes back

Given how vociferously and relentlessly the antivaccine contingent opposed AB 2109, it’s not surprising that SB 277 has resulted in a major pushback. Indeed, it was the anticipation of the resistance to the bill that led me to be rather pessimistic at first about its chances of becoming law. But then SB 277 passed the California State Senate three weeks ago, and the usual suspects just about lost it, with Barbara Loe Fisher likening it to medical blackmail and invoking Elie Wiesel, just in case you don’t get the message that she thinks we’re dealing with Nazi-like fascism. Along the way, antivaccine celebrities like Robert F. Kennedy, Jr. (who is also fond of Holocaust analogies) and Rob Schneider were trotted out with the same old pseudoscience and “health freedom” arguments, although RFK, Jr. might have done more harm to his cause than good when he explicitly likened the vaccine program to the Holocaust and was forced to apologize, although it was a classic “notpology”:

“I want to apologize to all whom I offended by my use of the word holocaust to describe the autism epidemic,” Kennedy said in a statement. “I employed the term during an impromptu speech as I struggled to find an expression to convey the catastrophic tragedy of autism which has now destroyed the lives of over 20 million children and shattered their families.”

In other words, the “vaccine-induced autism epidemic” is as bad as the Holocaust, but I won’t use the word anymore because it offends people who know what a real Holocaust is. Of course, this is not the first time RFK, Jr. has used Holocaust analogies with respect to vaccines. He did it two years ago and, for all I know, has been using such offensive analogies for much longer. Unfortunately, RFK, Jr.’s not the only one who likes Holocaust analogies. For example, Heather Barajas caught some justified flak for photographing herself and her child wearing badges shaped like a syringe juxtaposed with photos of Jews in Nazi Germany forced to wear yellow Stars of David:

Heather Barajas likening herself to Jews during the Holocaust.

Heather Barajas likening herself to Jews during the Holocaust.

Yes, because under SB 277 nonvaccinating parents will be treated exactly like Jews during the Holocaust. And she was surprised that the uproar was so great that she was forced to take it down!

Unfortunately, not all opponents to SB 277 are quite so…unrestrained. (Co-opting the Holocaust, the Tuskegee syphilis experiment, and other horrors generally reveals them to be fringe cranks.) The more “mainstream” antivaccine movement has learned to leverage social media. I remember back in 2005, before SBM was even an action potential in one of Steve Novella’s neurons, I did pay attention to the antivaccine movement, but initially it wasn’t one of my highest priorities when it comes to promoting science-based medicine. That all changed when Robert F. Kennedy published his incredibly conspiracy-packed black whole of antivaccine pseudoscience entitled “Deadly Immunity“. Sadly, almost exactly ten years later, Robert F. Kennedy, Jr. hasn’t changed. He’s still spewing the same nonsense with no sign of letting up. In contrast, the social media landscape has changed quite a bit. Back when I first started blogging, pretty much all that was available were websites and blogs. On the antivaccine side, there were pretty much websites, most of them not particularly well-designed or attractive, and some of the “big name” blogs that served as amplifiers of the antivaccine message, such as Age of Autism, didn’t even exist yet. Jenny McCarthy was still into “Indigo Child” woo and had not become an antivaccine celebrity. Overall, the antivaccine movement wasn’t particularly good at leveraging these tools.

Over the years, different forms of social media proliferated. There came Twitter, Facebook, YouTube, Instagram, Tumblr, and who knows what else. Yet, for a while, the antivaccine movement was fairly slow to adopt these new tools. Truth be told, so were skeptics, but that is changing. In fact, arguably, last year was the year the antivaccine movement discovered Twitter. I noted it myself when I was fairly dismissive of the inept attempts of antivaccinationists to use Twitter to capitalize on the “CDC whistleblower” scandal, that fake scandal based on a hapless CDC psychologist flirting with antivaccinationists and misinterpretation of a major study that failed to find a link between the MMR vaccine and autism.

Unfortunately, since their first attempts at using Twitter to get the attention of news reporters and legislators, antivaccinationists have turned their attention to defeating California SB 277. In addition to the offensive Holocaust imagery that backfires on them, they’ve started to successfully co-opt the language of “health freedom” to portray their opposition as an issue of “personal choice,” “parental rights,” and other antivaccine dogwhistles that resonate with conservative and libertarian politics, including a subset of the white, affluent parents who make up the bulk of the antivaccine movement.

It turns out that I’m not the only one who’s noticed these changes, either. Just last week, an excellent article by Renee Diresta and Gilad Lotan appeared on Wired entitled “Anti-Vaxxers Are Using Twitter to Manipulate a Vaccine Bill“:

But a small group of vocal anti-vaxxers is fighting hard to keep it from passing. This group, which leverages the power of social media, has launched a full-scale attack on the bill as it travels through the legislature. Each day, leaders craft tweets and instruct followers to disseminate them. Several senators who voted in favor of the California legislation have found themselves receiving extensive attention from the group—one, Senator Hannah Beth Jackson, has been @-mentioned (often unfavorably) in a particular Twitter hashtag more than 2,000 times since casting her vote in favor of the legislation.

This anti-vax activity might seem like low-stakes, juvenile propaganda. But social networking has the potential to significantly impact public perception of events—and the power to influence opinions increasingly lies with those who can most widely and effectively disseminate a message. One small, vocal group can have a disproportionate impact on public sentiment and legislation. Welcome to “Anti-Vax Twitter.”

So far, you might ask yourself: So what? How is this different from any other interest group trying to harness the power of social media to get its message heard? To some extent, it’s not, but one thing Diresta and Lotan note as distinguishing this effort from those of other interest groups is just how much Twitter is used to attack and bully legislators who voted for the bill and prominent supporters of the bill. Antivaccine activists are particularly ruthless about going after these people:

“Tweetiatrician” doctors, lawyers, and pro-vaccine parents often do attempt to join the conversation around the antivax hashtags. Unfortunately, many of the most active accounts experience the same attention received by the legislators: They become the target of harassment that includes phone calls to their places of employment, tweets posting identifying information or photos of their children, or warnings that they are being watched. Pro-vaccine activists and legislators alike often encounter paranoia when they attempt to engage the anti-vax community. They face accusations of being shills paid by Big Pharma to sway the narrative and keep “vaccine choice” activists from spreading The Truth.

Yes, this is typical behavior for the antivaccine movement, and I’ve been at its receiving end more than I can recall, beginning within a year after I started blogging. The most “spectacular”—if you can call it that—example occurred a few years ago, when our old buddy Jake Crosby wrote a post accusing me of a major undisclosed conflict of interest, resulting in a campaign on the part of antivaccinationists to contact my Dean, my department chair, and the board of governors of my university demanding an investigation and my firing. Fortunately, I work for a university, and the tradition of academic freedom at universities is such that such campaigns almost always fail, with the administration politely listening and then ignoring the cranks. At a private company, I might not have been so lucky. I might have been fired, or the company might have ordered me to stop blogging, and there would have been little or nothing I could do about it. This is how antivaccinationists silence their critics.

So far, so good. Diresta and Lotan’s article rings true, but it doesn’t tell those of us who try to counter the antivaccine movement anything we haven’t already known for a long time. What Diresta and Lotan did that was interesting (to me, at least) was to look at how the hashtags associated with Tweets in opposition to SB 277 were clustered. Basically, they analyzed hashtags used by people in Twitter, generating images in which circular nodes are Twitter handles and large nodes indicate accounts with more followers, making their Tweets more likely to be seen (“high centrality”). Lines between the nodes represent follower relationships, and different colors represent communities sharing similar messages, with the distance between regions based on common ties: The more common ties, the closer one group is to another, the more shared connections they have, and the more likely information is to spread among them.

First, Diresta and Lotan note the “Twitter party” that I made fun of back in August, particularly the instructions given by more “experienced” antivaccine Twitter users to all the newbies they were trying to recruit. In the end, Lotan and Diresta found one thing that I thought to be true without quantifying last year: Large numbers of these Tweets came from a few accounts. Indeed, 63,555 of these Tweets came from 10 prominent anti-vax accounts, such as @tannersdad and @ThinkerMichelle (yes, one of the “not-so-Thinking Moms’ Revolution“).

The second thing Diresta and Lotan did was to analyze these clusters with reference to the #SB277 hashtag to look at trends over time, specifically at how the antivaccine Twitter community, the autism Twitter community, and conservatives, many of whom use popular Tea Party hashtags, interact. Remember how I’ve discussed how antivaccinationists have of late been aligning themselves with more conservative talking points? Well, take a look at these results.

In the first graph, the conservative Twittersphere is pretty separate from the antivaccine Twittersphere, which has some overlap with the autism Twittersphere. At that intersection are some names you’re probably familiar with, such as @AgeofAutism, @The_Refusers, @TannersDad, and others. But the second network graph for SB277:

But as you look at this second network graph, you can see how antivax political strategy has shifted. A new group emerges in the space between “Antivax Twitter” and “Conservative Twitter”—we call it “vaccine choice” Twitter. The tweeters are the same individuals who have long been active in the autism-vaccine #cdcwhistleblower network. And originally, much of the content shared in #sb277 focused on the same anti-vax pseudoscience underlying #cdcwhistleblower. However, as bad science and conspiracies repeatedly lost in legislative votes, anti-vaxxers updated their marketing: They are now “pro-SAFE vaccine” parental rights advocates. Instructions to the group now focus on hammering home traditionally conservative “parental choice” and “health freedom” messaging rather than tweeting about autism and toxins.

Twitter activity around #sb277 is part of a multipronged strategy that takes place alongside phone, email, and fax campaigns, coordinated by well-funded groups including the Canary Party and the NVIC. The net effect is that legislators and staffers feel besieged on all fronts. In one unfortunate video, a movement leader encouraged supporters to use Twitter to harass and stalk a lobbyist, who has since filed police reports. In a very recent creation, that same leader excoriates her “Twitter army” for diluting the power of the #cdcwhistleblower movement by creating their own hashtags rather than using the ones they’ve been assigned. She also requests that the entire network tweet at Assembly representatives to inform them that their political careers will be over if they vote in favor of SB277. Much like Food Babe leverages her #foodbabearmy to flood corporations with demands for change, the goal of anti-vax twitter is to dominate the conversation and make it look as if all parents are vehemently opposed to the legislation.

It’s amazing how much what Diresta and Lotan have found resembles what I’ve been saying all along in other venues. Specifically, I’ve been pointing out for several months now how the antivaccine movement has been co-opting conservative rhetoric, to the point where some conservative politicians have found it worthwhile to pander to these kooks, as Rand Paul does and, unfortunately, my very own state senator. Yes, antivaccine beliefs are, as I’ve pointed out so many times before, the pseudoscience that transcends politics and party lines, but over the last year or so, the loudest voices in the antivaccine movement appear to be increasingly leaning conservative/libertarian, thanks to its intentional co-optation of “health freedom” rhetoric and messages based on distrust of the government and being against government regulations and mandates with respect to health. It’s a potent message that can appeal not just to conservatives, too.

And who opposes this on Twitter?

That’s the depressing thing. Diresta and Lotan note that, despite the vast majority of the population supporting vaccination, there is no pro-vaccine Twitter machine to speak of to oppose the antivaccine Twitter machine. That’s because most parents just vaccinate. They don’t organize into groups around the activity, or, as Diresta and Lotan put it, people “don’t organize in groups around everyday life-saving measures,” which is why there is no pro-seatbelt movement on Twitter. Worse, the goal of the antivaccine movement on social media like Twitter, its disingenuous claim to be “not antivaccine but ‘pro-safe vaccine'” notwithstanding, is to make new parents question everything about vaccines and erode confidence in vaccination.

SB 277 powers on

So as of last week, SB 277 had passed the California Senate, which still left the Assembly and the Governor as the two remaining hurdles. In the Assembly, there were two hurdles, first the Assembly Health Committee, after which the bill would go to the full Assembly for debate and a vote. Shockingly (in a good way), last week SB 277 cleared the Assembly Health Committee, and it wasn’t even a close vote:

California lawmakers on Tuesday approved a hotly contested bill that would impose one of the strictest vaccination laws in the country, after five hours of highly emotional testimony that brought hundreds of opponents to the Capitol.

SB277 is intended to boost vaccination rates after a measles outbreak at Disneyland that sickened more than 100 in the U.S. and Mexico. It has prompted the most contentious legislative debate of the year with thousands of opponents taking to social media and legislative hearings to protest the legislation.

The Assembly Health Committee approved the legislation 12-6 Tuesday evening with one lawmaker abstaining, sending it to the full Assembly for its final legislative hurdle.

If the bill becomes law, California would join Mississippi and West Virginia as the only states with such strict requirements.

I can’t help but say again that this news amazed me—in a good way. I never thought that a bill that would eliminate religious and philosophic exemptions to school vaccine mandates would get anywhere near this far in a state with high concentrations of antivaccine belief and some of the most famous antivaccine pediatricians out there (e.g., Jay Gordon and Bob Sears, who are antivaccine although they swear otherwise), as well as a large Hollywood contingent of celebrity antivaccinationists like Rob Schneider. Yet now the bill has made it to the full Assembly, after the antivaccine movement failed spectacularly to prevent it from passing its major committee hurdle. I and other observers had been concerned that the vote would be close and that SB 277 might die in committee, but the Assembly Health Committee provided the antivaccinationists a resounding rebuke. This occurred despite their bringing in protesters, as well as antivaccine luminaries like Dr. Jay Gordon, who tried to argue that because the Disneyland measles outbreak didn’t occur in a school and SB 277 wouldn’t have prevented it then it’s not necessary, which is akin to arguing there’s no need to enforce a fire code at a warehouse because the last fire leveled a barn. Not surprisingly, Barbara Loe Fisher testified as well. It also probably didn’t help the antivaccine cause that in the lead up to the committee hearing the American Medical Association weighed in at its annual meeting as supporting the elimination of nonmedical exemptions, producing stories like this appearing on the morning of the hearing:

The American Medical Association, the country’s largest association of physicians, is weighing in on the vaccination debate by supporting the end of personal vaccination exemptions on both the state and federal levels.

At the group’s annual meeting in Chicago on Monday, members voted to mobilize the organization in order to persuade state legislatures to eliminate nonmedical reasons for exemption, such as religion, which are used to dodge crucial immunizations against diseases such as measles and whooping cough.

“As evident from the recent measles outbreak at Disneyland, protecting community health in today’s mobile society requires that policymakers not permit individuals from opting out of immunization solely as a matter of personal preference or convenience,” said board member Dr. Patrice Harris, according to Forbes. “When people are immunized they also help prevent the spread of disease to others.”

Exactly.

So what’s next? SB 277 will go in front of the full Assembly for debate and final vote. Look for the antivaccine Twittersphere and the antivaccine contingent to crank up the angry and offensive rhetoric to 11, even though arguably in a way they are their own worst enemies when they make threats against legislators and use full-blown conspiracy theories to justify their opposition. Unfortunately, that’s normal behavior in the antivaccine movement. The real question is: Will SB 277 pass? That, I don’t know, but it’s gotten further than I ever would have predicted, and its progress is starting to take on an air of inevitability, to the point where a guest blogger has posted a Resolution in Response to the California Democratic Party (CADEM) “Resolution in Support of Repealing California’s Personal Beliefs Exemption to Mandatory Vaccinations” in which she swears never to vote Democratic again. (In this case, most of the opposition to SB 277 comes from Republicans on the basis of “health freedom” and “parental rights” arguments.)

Meanwhile, as AoA regular Dan Olmsted uses his status as a gay man to draw parallels between how medicine used to view homosexuality and how now (in his view) it ignores “vaccine injury,” another AoA regular, Ginger Taylor, is now declaring that SB 277 is a “victory” for the antivaccine cause because its passage “advances our cause” because will let the antivaccine movement challenge the law in court. Given how previous challenges to various school vaccine mandate laws have generally been decided in the past (hint: not in favor of “vaccine freedom”), all I can say to Ms. Taylor is: “Good luck with that. You’ll need it. A lot of it.”

If SB 277 passes, though, I do worry about some things. Most importantly, I worry that Governor Jerry Brown will once again betray California children and sabotage the new law, as he did when AB 2109 passed, by adding a signing statement instructing the California Department of Public Health to allow a check box for a religious exemption on the form that needed to be signed, thus bypassing the requirement for consulting with a pediatrician or health care provider to learn the benefits and risks of vaccines. There was no provision for doing that in AB 2109, but that didn’t stop Brown from crippling the law. Given his deference to religion, I could easily see him doing that again. I could also see him putting pressure on the legislature not to eliminate religious exemptions, with the implicit threat of a veto if the legislature does not amend the bill. We shall see. It would be an amazing thing indeed if California were to pass SB 277 in its present form. If that were to happen, it might embolden other states to consider similar laws, or at least to make nonmedical exemptions harder to obtain.

We can hope, can’t we?

 

 

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.