Going Behind ‘The Vaccine War’

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FRONTLINE extensively covered the immunization controversy with “The Vaccine War” in 2010, and many of its findings are just as relevant in 2012. This week, we spoke with Jon Palfreman, the documentary’s producer, to learn what he discovered while making the documentary, and how it applies to the current debate.

First, a clip from the FRONTLINE show:

Theresa Riley: How long did it take to make “The Vaccine War” and what inspired you to make it?

Jon Palfreman: It took about six months to put together. There was an article in Wired magazine that let us know there were a lot of sparks around it. Then the Centers for Disease Control (CDC) identified three areas — Ashland, Oregon was one of them — where the uptake of vaccines was particularly low. So that seemed to suggest it was worth some new reporting to see whether the problem had gotten worse in the age of the Internet.

Riley: Are you saying that the internet has fueled the issue?

It’s certainly grown because of the Internet because it starts with the ability of people to find others on the Internet and to find sources of information. If you’re particularly linked to a group of people who have children with autism, you have all kinds of alternative support groups and sources of information online which are set up as a kind of competition to official sources like the Centers for Disease Control and the National Institutes of Health, and I think that is new and different. The internet is a wonderful tool, a wonderful source of information and way for people to meet people, but it can provide a type of alternate reality, as well.

Riley: What was your perspective on the issue when you started production? Did making the documentary change your perspective at all?

Palfreman: I’m a science journalist. I had the viewpoint that vaccines were one of the few things in medicine that have made more difference than anything. That didn’t change, but I think [my perspective] did in terms of understanding just how serious an issue it is and just how many people worry about it. I think that vaccines for young parents have always presented a bit of a challenge — the idea that your child, right from the moment they’re born, is given these injections. And the number of them has grown and grown.

I think the worry has always been there, but I do think it’s much worse now because of the capacity to organize and to tell a different narrative. Independent of the internet, I think there is a genuine anxiety that a lot of young parents have and I found it was very common among the young women, even the women working on the project with me. There was a general worry about this, particularly when people were claiming associations with things like autism. What really impressed me most were meeting young mothers in their 20s and 30s who were very intelligent and knew everything about the science who were still anxious when it came to their child. And it seemed to me that that’s the sharp edge here — when it’s your child, your fears might just override your logic at certain points. You’re watching your child develop and change, and there’s so much going on. It doesn’t take much to hear these stories and have them have some sort of impact on a lot of people, regardless of their knowledge.

Riley: What are some other factors that affect the debate?

Palfreman: I think we’re way beyond the situation where you just trust your pediatricians. I mean, pediatricians still hold the line in this. Pediatricians are the main reason that compliance is the way it is. Pediatricians as a group really believe in vaccines and push them very, very strongly, and I think that’s the main reason that uptake is as high it is. But you find that it’s quite patchy in some areas, like Ashland, Oregon, and you find that in certain schools, like Waldorf schools, the compliance rate drops quite significantly.

Riley: Are there other similarities amongst the communities of parents who object to vaccines?

Palfreman: Yes. You find highly educated populations and an association with alternative lifestyles, beliefs in alternative medicine, yoga, environmentally conscious groups that believe they can take ownership of their own health — and the reasoning is interesting.

The number of vaccines is much higher now, and the number of doses, too. It adds up to 35 doses in different inoculations. Some of them are packaged together. But the number of separate doses in the first six years of life is now 35. And some people feel that’s a lot. Certainly for young parents, there are definitely more now than what they got. So one argument involving diseases that are milder is that they are just traditional things you get when you grow up. You know, I had chicken pox, and that’s what you get while you grow up. It’s not pleasant to have — you’ve got a lot of lost days of school and your parents have to take off work, but it’s not in the same category as polio or diphtheria.

The second argument is that many of these diseases are now effectively banished from the world and the arguments for [vaccinating against them] has now changed. I think you’re on shakier ground there because the only infectious disease that has been eradicated completely is smallpox. They did have hopes that measles would be eradicated and they are quite close to eradicating polio, but there are several countries in Africa where you still have it. The Gates Foundation is involved in a big thrust to make polio the second disease to be eradicated. But it’s very difficult to eradicate an infectious disease from the planet, and if it’s not eradicated that means that it’s there. It’s a plane ride away.

Part of the reason that people are so complacent now is that vaccines have been so effective, but [the diseases] are not eradicated from the world and so everyone is dependent on this concept of herd immunity.

Riley: Can you explain herd immunity?

Palfreman: The truth is that you’re never going to reach everybody when you vaccinate. Some children who are immune-compromised — very ill or have cancer — can’t be vaccinated, so there’s always a certain group who remain unvaccinated. Herd immunity is a concept that if you reach a certain percentage of the population where the organism is unable to propagate, than essentially the entire group is protected. Some diseases like pertussis (whooping cough) are so infectious they have a higher threshold in terms of the percentage, like 93 percent. Others are less virulent and you can get away with a lower rate. But basically, everybody benefits from living in a country where it’s the common thing to have vaccinations. We all benefit from being part of a herd that’s been vaccinated.

So then in these “low exemption” areas, the people who are not vaccinating are benefiting from the protection given by the rest of them. It’s difficult because when you raise this argument with them they realize they are being called selfish and they get very upset and very angry about it. There is a direct clash between what they feel is their individual rights to do what they want with their own children and the responsibilities to the communities they live in.

The biggest issue within this whole thing is autism. If you have a child with autism and you’ve got a potential cause, there’s hope for a potential cure. One [anti-immunization] group is much more impassioned than any other group and they’re fairly resistant to evidence. In “The Vaccine War,” we profile this doctor in England, Dr. Wakefield, who studied 8-10 cases [and argues that vaccines may cause autism], but he became discredited. Nobody could repeat the experiments. And when you compare this with the mass epidemiology done around the globe — like the one in Denmark where entire populations, something like 500,000 children, are on the registry — the evidence is overwhelming.

Riley: One related issue that didn’t come up in your report, but we’ve noticed in several articles within the past year, focuses on pediatricians firing families for refusing immunization shots. Is that a new trend?

Palfreman: Yes, that’s something new. I don’t know what I think about it. In a sense, it’s very tough, I guess you have to see this from the pediatrician’s point of view. The doctor is trying to do their best and must get very frustrated if somebody comes in and says “I’m not vaccinating my children,” or “I’m only choosing some” or “I want to change the schedule.” I would guess it’s likely to become more common. This is something that they feel very strongly about. I think that if you were a pediatrician and you had the capacity to protect babies from 14 different life-threatening diseases, you wouldn’t be in much mind to negotiate.

EXTRA: New England Journal of Medicine: Read a pediatrician’s perspective on why stressing community responsibility is not a strong approach to dealing with parents worried about vaccinations»

But it’s very difficult to explain when a very rare event happens. You know, you had that case with the woman who claimed she could only walk backward [after having a flu shot] and people were asking their pediatricians about it in a very concerned way. It’s not very likely to be true, but it goes viral very quickly and plays into our fears.

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