The vaccination debate has always been heated. Does that help or hurt the issue?
Professor of Journalism Elena Conis wrote a book on the history of vaccines. She says, since we’ve had vaccinations in this country, we’ve had opposition to them.
"We tend to talk about vaccination as if it's a strictly medical issue. But the second we use the force of law to require vaccines we make it a political issue."
Measles has been popping up again across the country, in the biggest numbers we’ve seen since 2000. So far, nine Bay Area residents have contracted the highly contagious disease this year. That’s got people talking again about vaccinations. California has one of the strictest immunization laws in the country. School children have to be vaccinated and parents can’t opt out for religious or personal beliefs, only medical reasons. A new bill in the state senate would strengthen the regulations around those medical exemptions and make them harder to get. Should parents have a right to choose whether to vaccinate their kids or should be it mandated for the common good?
To get a historical perspective on the vaccination debate, KALW’s science reporter Marissa Ortega-Welch sat down with Dr. Elena Conis, a professor of Journalism at UC Berkeley who studies the history of medicine and wrote the book “Vaccine Nation.” Here are a few excerpts of the interview that have been edited for length and clarity.
Q: As someone who's studied the history of vaccinations, what are you thinking about when you read the latest headlines and hear this news about measles?
CONIS: From the very early history of vaccination, really from the first time we developed an effective vaccine against a specific infection — namely smallpox, we have seen people nervous, hesitant, resistant to vaccination. We’ve also seen a lot of objection when vaccination has been made compulsory in particular. We tend to talk about vaccination as if it's a strictly medical issue. The second we use the force of law to require vaccines we make it a political issue, so our politics are going to figure into how we think about the necessity of vaccines and how they should be used.
Measles has persistently thwarted our best efforts to keep it under control since we began vaccinating against measles in the early 1960s. It's an extraordinarily contagious disease. It still circulates beyond our borders even when we get it down to really low levels here in the U.S. And so it keeps coming back again and again because it's so infectious, so contagious; because it takes such high levels of vaccination to keep it at bay. We seem to keep coming back to these moments where measles is once again threatening us.
Q: The term “anti-vaxxer” seems to have become a bad term. It's almost akin to calling someone a climate change denier or “flat-earther.” How did we get here?
"Quite frankly, I'd love to just get rid of the term anti vaxxer ... because there are way more people who are nervous or unsure or hesitant about one of the many vaccines that we require for children and not all of them. If we can understand or at least have a little bit of empathy ... for some of those hesitations around individual vaccines, we'll see that people are actually more on board with vaccination than we tend to talk about it ... in the media."
It doesn't really stay true to the historical meaning of the word. Anti-vaccination was a term that was coined in the middle of the 19th century by individuals who were opposed to the one vaccine then available: the smallpox vaccine. Their main opposition was to mandatory smallpox vaccine vaccination, so not vaccination itself necessarily but to efforts to use the force of law to require people to get vaccinated.
There was a lot of overlap, incidentally, between anti-vaccinationism in the 19th century and the movements for vegetarianism, the protection of children and animals, abolition — a whole bunch of social reform movements.
Quite frankly, I'd love to just get rid of the term anti-vaxxer and stop using it. There are way more people who are nervous or unsure or hesitant about one of the many vaccines that we require for children and not all of them.
If we can understand, or at least have a little bit of empathy or compassion for some of those hesitations around individual vaccines, we'll see that people are actually more on board with vaccination than we tend to talk about it or describe it in the media.
Q: There has been bad science that has led people to be against vaccinations. Most notably there was the Lancet study in the 90s, a British Medical Journal, that linked vaccines to autism. That study was totally debunked. It turns out the guy was being paid to come out against vaccines. How do we think about this with more nuance but also not spread misinformation?
One thing that I look at in my research is where “bad science” comes from. If you look at that 1998 study in the Lancet that purported to show a link between measles and autism, and yes, was later retracted, what you'll see is that that study didn't come out of thin air. It came from parents claiming that they were seeing a connection between vaccines and their children's health
Autism was one of several concerns that parents were voicing concerns about in the 70s and 80s, Wakefield was one of several scientists who were responsive to that, and he was one of, I think, very few scientists who made some really questionable ethical choices about how to conduct that science. Lancet chose to publish that study; that study passed peer review. It spoke to concerns that were widely circulating at the time. I think it's important to think about how bad science can sometimes be a result of simmering concerns.
Q: The San Francisco Chronicle reported that there were seven Bay Area schools where more than half of the kids there were unvaccinated. What do you think of when you see a headline like that?
Those schools tend to be really small. One of these schools, I think, has just 20 kids in it. You can imagine that if ten of those kids are missing at least one vaccine then suddenly that school gets described in the press as having half of its kids unvaccinated. When you look at it very close, very few of those kids are missing all vaccines. Just because they're missing one vaccine doesn't necessarily mean that they're missing all the vaccines.
We need to talk about this with a little bit more nuance and I think it would do us all a whole lot of good to let go of this idea of controversy and start to understand which particular vaccines parents are avoiding, why they're avoiding them, and what it would take to make them feel a little bit more comfortable getting those vaccines when required.
Q: When the media reports that maybe more kids are unvaccinated than there actually are or they're not exactly representing the data accurately, why is that a problem?
One reason I think that's a problem is because we end up with headlines that say ‘X number of kids are not vaccinated at all’ and that gets some members of the public to think, “Oh my gosh, there are these people out there who think that they are exempt from all of our vaccine laws.” That can feed people's nervousness or anxiety and sort of amplifies the problem or amplifies the perception of a problem and makes more parents nervous.
The way that we've reported on vaccination in recent years we have focused a lot on people who are not getting vaccinated or who are filing vaccine exemptions based on personal beliefs. We’re focusing most intently on the concentration of those personal belief exemptions in wealthier and largely liberal communities. We're forgetting that there are also people who are not vaccinated because of lack of privilege. We are forgetting that there are people who are not vaccinated also for medical reasons and for religious reasons.
We're also kind of overstating in my view — and this is probably going to come across as somewhat controversial but — overstating the extent of the problem because we say ‘unvaccinated’ any time an individual child has a vaccine exemption on file. And that child may [be] missing the hepatitis B or the chickenpox vaccine; they're not missing the MMR vaccine, for instance.
What we’re seeing is this selective acceptance. So still, full-on across the board anti-vaccinationism is still rare. Anti-vaccinationism is something that we have always lived with in the modern era of vaccination. Quite frankly, I don't see going away anytime soon.
The good news is that you can still achieve herd immunity even with two percent of your population as staunch anti-vaccinationists. It's the people who make selective decisions that complicate the whole issue.