The Politics of Vaccination

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Authors’ note: When we wrote this nearly three years ago, we knew the vaccination controversy wasn’t going away, but we had no idea it would become such an issue in the already-bubbling (and babbling) 2016 presidential campaign. The measles outbreak that largely began at Disneyland (!) in mid-December has now led, as of the end of January, to more than 100 cases diagnosed in 14 states.

Both New Jersey’s Republican Gov.Chris Christie and Kentucky’s Republican Sen. Rand Paul landed in the thick of the fight this week with comments that suggested vaccination should be a matter of parental choice. Christie walked his words back; Paul at first seemed to double down, but then showed up at the US Capitol physician’s office for a booster shot and a photo op, proclaiming, “I think the science is clear that if you compare the risks of taking a vaccine to the ill effects of taking a vaccine, it’s overwhelming.”

As Jeremy W. Peters and Richard Perez-Pena wrote in The New York Times: “The politics of medicine, morality and free will have collided in an emotional debate over vaccines and the government’s place in requiring them, posing a challenge for Republicans who find themselves in the familiar but uncomfortable position of reconciling modern science with the skepticism of their core conservative voters.”

The efficacy of vaccines is past dispute, the theories linking vaccination to autism and other ills debunked. It’s important that our kids get the shots they need, not only for themselves but also for all the other children with whom they share classrooms, playgrounds and everything contagious that floats in the open air. While steadfastly maintaining our position of non-partisan progressivism, we agree with this tweet from Hillary Clinton: “The science is clear: The earth is round, the sky is blue, and #vaccineswork.”

Melinda Anderman of Duxbury holds her four and a half-year-old daughter, Margaret, as she gets an H1N1 vaccination during a flu clinic in Montpelier, Vermont, November 2009. (AP Photo/Toby Talbot, File)

Melinda Anderman of Duxbury holds her four and a half-year-old daughter, Margaret, as she gets an H1N1 vaccination during a flu clinic in Montpelier, Vermont, November 2009. (AP Photo/Toby Talbot, File)

We haven’t even turned the page on the controversy over contraceptives, health care and religious freedom when another thorny one arises involving personal conscience and public health. A flurry of stories over the past few days coincided with seeing a movie that inspires more than passing interest in their subject.

Steven Soderbergh’s film Contagion came out a few months ago and was inexplicably and completely frozen out of the Oscar nominations. But it is the most plausible experience of a global pandemic plague you’re likely to see until the real thing strikes. With outstanding performances from an ensemble cast that includes Matt Damon, Kate Winslet, Gwyneth Paltrow and Laurence Fishburne, Contagion is stark, beautiful in its own terrifying way, and all-too-believable. The story tracks the swift progress of a deadly airborne virus from Hong Kong to Minneapolis and Tokyo to London — from a handful of peanuts to a credit card to the cough of a stranger on a subway. Rarely does a film issue such an inescapable invitation to think: it could happen; that could be us. What would we do?

With Contagion making such a powerful impression, for several days news articles seemed to keep popping up about contagious disease and the conflict between religious beliefs and immunization. There was nothing new about the basics: All 50 states require some specific vaccinations for kids, yet all of them grant exemptions for medical reasons – say, for a child with cancer. Almost all of them grant religious exemptions. And 20 states allow exemptions for personal, moral, or other beliefs.

According to the Feb. 15 edition of The Wall Street Journal, a number of pediatricians are dropping families from their practices when the parents refuse immunization for their kids. “In a study of Connecticut pediatricians published last year,” the paper reported, “some 30 percent of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21 percent reported discharging families for the same reason.” They add:

“By comparison, in 2001 and 2006 about 6 percent of physicians said they ‘routinely’ stopped working with families due to parents’ continued vaccine refusal and 16 percent ‘sometimes’ dismissed them, according to surveys conducted then by the American Academy of Pediatrics.”

But some parents still fear a link between vaccinations and autism, a possibility science has largely debunked. Some parents just want to be in charge of what’s put into their children’s bodies, as one West Virginia politician puts it. And some parents just don’t trust science, period — a few have even been known to fake religion to avoid vaccinating their kids. So there are many loopholes. But now seven states are considering legislation to make it even easier for mothers and fathers to spare their children from vaccinations, especially on religious grounds.

In Oregon, according to a story by Jennifer Anderson in The Portland Tribune, the number of kindergartners with religious exemptions is up from 3.7 percent to 5.6 percent in just four years, and continuing to rise. This has public health officials clicking their calculators and keeping their eye on what’s called “herd immunity.” A certain number of any population group needs to have been vaccinated — 80 percent for most diseases, 92 percent for whooping cough – to maintain the ability of the whole population — “the herd” — to resist the spread of a disease.

Ms. Anderson offers the example of what used to be called “the German measles” – rubella. All it takes are five unvaccinated kids in a class of 25 for the herd immunity to break down, creating an opportunity for the disease to spread to younger siblings and other medically vulnerable people who can’t be vaccinated. If you were traveling to Europe between 2009 and 2011, you may remember warnings about the huge outbreak of measles there, brought on by a failure “to vaccinate susceptible populations.”

Here in the United States, several recent outbreaks of measles have been traced to pockets of unvaccinated children in states that allow personal belief exemptions. The Reuters news service recently reported 13 confirmed cases of measles in central Indiana. Two of them were people who showed up to party two days before the Super Bowl in Indianapolis. Patriots and Giants fans back east were alerted. So far, no news is good news.

But this is serious business, made more so by complacency. Older generations remember when measles killed up to 500 people a year before we started vaccinating against them in 1963. The great flu pandemic of 1918 killed ten times more Americans than died in the Great World War that ended that year and took the lives of as many as 40 million globally. Our generation was also stalked by small pox, polio, and whooping cough before there were vaccinations.

In a country where few remember those diseases, it’s easy to think, “What’s to worry?” But as the movie Contagion so forcefully and hauntingly reminds us, the earth is now flat. Seven billion people live on it, and our human herd moves on a conveyer belt of perpetual mobility, so that a virus can travel as swiftly as a voice from one cell phone to another.

When and if a contagion strikes, we can’t count on divine intervention to spare us. That’s when you want a darn good scientist in a research lab. We’ll need all the help we can get from knowledge and her offspring.

Watch a video version of this essay.

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