Deadly Choices: How the Anti-Vaccine Movement Threatens Us All (23 page)
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Authors: Paul A. Offit M.D.
BOOK: Deadly Choices: How the Anti-Vaccine Movement Threatens Us All
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Religious exemptions opened the door to philosophical exemptions. A critical ruling in the late 1980s involved two Northport, New York, couples: the Sherrs and the Levys. Alan Sherr, a chiropractor, argued that his religion—a mail-order church in Sarasota, Florida, called the Missionary Temple at Large of the Universal Religious Brotherhood, Inc.—believed that vaccines represented an unwanted intrusion into the body. However, because Sherr had circumcised his son and allowed dentists to fill his son’s cavities, the intrusion argument didn’t hold. The Levys, on the other hand, were more compelling. Louis Levy argued that the state should not be allowed to force his daughter, Sandra, to be vaccinated because “We feel that any introduction into the process of a foreign element outside the normal processes of the body is going to affect the body adversely and, therefore, we feel it is a violation in a sense of our nature—physical, spiritual, religious nature.” The judge ruled in Levy’s favor, stating that vaccine exemptions could be granted if “beliefs [were] held with the strength of religious convictions,” even if parents weren’t members of a religious group. By 2010, twenty-one states allowed philosophical exemptions to vaccination.
By the late 1890s, the anti-vaccine movement in England had spawned the Anti-Compulsory Vaccination Act. If citizens didn’t want to be vaccinated, they could obtain a certificate of conscientious objection. As more and more citizens opted out, England became the United Kingdom’s epicenter of smallpox disease. By the early twenty-first century, American anti-vaccine activists—through passages of religious and philosophical exemptions—had also impacted the public’s health. Between 1999 and 2009, four studies examined whether the freedom to avoid vaccines also meant the freedom to catch and transmit infections.
In 1999, Daniel Salmon and co-workers from the Johns Hopkins School of Public Health found that the risk of contracting measles in five- to nine-year-olds whose parents had chosen not to vaccinate them was one hundred and seventy times greater than for vaccinated children.
In 2000, Daniel Feikin and his colleagues from the Respiratory Diseases Branch at the CDC found that three- to ten-year-olds in Colorado whose parents had chosen not to vaccinate them were sixty-two times more likely to catch measles and sixteen times more likely to catch whooping cough. They also found that measles outbreaks were more common in schools with greater numbers of unvaccinated children.
In 2006, Saad Omer and his colleagues, also from the Johns Hopkins School of Public Health, examined the impact of philosophical exemptions. Between 1991 and 2004, the number of unvaccinated children in states with philosophical exemptions more than doubled. Children in states with easy-to-obtain exemptions (granted by the simple signing of a form) were almost twice as likely to suffer outbreaks of whooping cough.
In 2009, Jason Glanz and his co-workers from the Institute for Health Research in Denver—confirming previous studies—found that unvaccinated children in Colorado were twenty-three times more likely to suffer whooping cough.
The impact of anti-vaccine activism hasn’t been limited to England and the United States. Studies have shown that the risk of whooping cough was ten to a hundred times greater in countries where immunization had been disrupted by anti-vaccine movements (such as Sweden, Japan, the Russian Federation, Ireland, Italy, and Australia) than in countries that had maintained high vaccination rates (such as Hungary and Poland).
The results were in. A choice not to get a vaccine was a choice to increase the risk of suffering and possibly dying from an infectious disease. Worse still, it was a choice to put one’s neighbor at greater risk. So why are more and more parents choosing not to vaccinate their children? The answer can be found in part in the writings of a professor of biology at the University of California at Santa Barbara who has explained why, under certain circumstances, a choice not to get a vaccine is far more rational than a choice to get one.
In 1968, Garrett Hardin published an essay in the journal
Science
called “The Tragedy of the Commons.” Hardin was interested in the problem of population control, but his observations can easily be applied to the problem of vaccine refusal. “Picture a pasture open to all,” he wrote. “It is to be expected that each herdsman will try to keep as many cattle as possible on the commons. As a rational being, each herdsman seeks to maximize his gain. He asks, ‘What is the utility
to me
of adding one more animal to my herd?’ The utility has one negative and one positive component.”
Science
called “The Tragedy of the Commons.” Hardin was interested in the problem of population control, but his observations can easily be applied to the problem of vaccine refusal. “Picture a pasture open to all,” he wrote. “It is to be expected that each herdsman will try to keep as many cattle as possible on the commons. As a rational being, each herdsman seeks to maximize his gain. He asks, ‘What is the utility
to me
of adding one more animal to my herd?’ The utility has one negative and one positive component.”
Hardin continued: “The positive component is a function of the increment of one animal. Since the herdsman receives all the proceeds from the sale of the additional animal, the positive utility is nearly +1. The negative component is a function of the additional overgrazing created by one more animal. Since, however, the effects of overgrazing are shared by all the herdsmen, the negative utility for any particular decision-making herdsman is only a fraction of -1.”
Imagine a herdsman as a parent choosing not to vaccinate a child. The great unsaid about vaccines is that if everyone in the world is vaccinated, it would make more sense for a parent not to vaccinate. This is true for two reasons. First: as more and more children are vaccinated it becomes less and less easy for viruses and bacteria to spread. Indeed, when enough people are vaccinated, these infections simply stop spreading. For example, when the polio vaccine was introduced in the United States in 1955, only 40 percent of the population was immunized, and, although the number of people paralyzed by polio declined, the virus continued to spread. However, after 70 percent of the population had been immunized, the virus stopped spreading and polio infections were eliminated from the United States. The same is true for measles. The only difference is that measles is much more contagious than polio, so a larger percentage of people (about 95 percent) needed to be immunized. After enough people are immunized, those who aren’t can hide in the herd, protected by those around them. Second: although vaccines are safe, they aren’t perfectly safe. All vaccines have side effects, mostly pain and tenderness at the site of injection; but some side effects, such as allergic reactions, can be quite severe. By choosing not to vaccinate, one can enjoy the benefits of hiding in the herd without risking such rare but real side effects. (This is true for all vaccine-preventable diseases save one: tetanus, which is acquired from the soil, not from another person. So, even if everyone in the world is vaccinated against tetanus except for one child, the risk to that child of acquiring tetanus is the same.)
Hardin continued his essay by explaining how a rational choice can become an irrational one: “The rational herdsman concludes that the only sensible course for him to pursue is to add another animal to the herd. And another; and another.... But this is the conclusion reached by each and every rational herdsman sharing the commons. Therein is the tragedy. Each man is locked into a system that compels him to increase the herd without limit—in a world that is limited. Ruin is the destination toward which all men rush, each pursuing his own best interest in a society that believes in the freedom of the commons. Freedom in a commons brings ruin to all.”
Such is the case with vaccines. As more and more people have chosen not to vaccinate, herd immunity has broken down. Now, a choice not to get a vaccine has the benefit of avoiding rare side effects, but not the benefit of herd immunity. The studies of Salmon, Feikin, Omer, and Glanz showed that the choice not to get measles or pertussis vaccine was a choice to risk infection because not enough people were getting vaccinated.
No one has been hit harder by the loss of an immunological commons than children who can’t be vaccinated.
On October 20, 2009, Stephanie Tatel, an elementary school reading specialist in Charlottesville, Virginia, published an article on
Slate.com
on her efforts to find a child-care center for her son. “Last year, while searching for child care for our 2-and-a-half-year-old son, my husband and I thought we had found the perfect arrangement,” she wrote, “an experienced home day care provider whose house was an inviting den of toddler industriousness. Under her magical hand, children drifted calmly and happily from the bubble station to the fairy garden to the bunnies and the trucks, an orchestrated preschool utopia. But when I asked, ‘Are any of the children here unvaccinated?’ the hope of my son’s perfect day care experience burnt to a little crisp. As it turned out, one child had a philosophical or religious exemption—a convenient cover-all exemption that many doctors grant, no questions asked, when a parent requests one. I still do not understand how the state can allow one to attribute his or her fear of vaccines and their unproven dangers to religion or philosophy. Ordinarily I wouldn’t question others’ parenting choices. But the problem is literally one of live or don’t live. While that parent chose not to vaccinate her child for what she likely considers well-founded reasons, she is putting other children at risk. In this instance, the child at risk was my son. He has leukemia.”
Slate.com
on her efforts to find a child-care center for her son. “Last year, while searching for child care for our 2-and-a-half-year-old son, my husband and I thought we had found the perfect arrangement,” she wrote, “an experienced home day care provider whose house was an inviting den of toddler industriousness. Under her magical hand, children drifted calmly and happily from the bubble station to the fairy garden to the bunnies and the trucks, an orchestrated preschool utopia. But when I asked, ‘Are any of the children here unvaccinated?’ the hope of my son’s perfect day care experience burnt to a little crisp. As it turned out, one child had a philosophical or religious exemption—a convenient cover-all exemption that many doctors grant, no questions asked, when a parent requests one. I still do not understand how the state can allow one to attribute his or her fear of vaccines and their unproven dangers to religion or philosophy. Ordinarily I wouldn’t question others’ parenting choices. But the problem is literally one of live or don’t live. While that parent chose not to vaccinate her child for what she likely considers well-founded reasons, she is putting other children at risk. In this instance, the child at risk was my son. He has leukemia.”
Tatel knew that the unvaccinated child posed a risk to her son. “I realize that anti-vaccine sentiment has been around as long as the vaccines themselves,” she wrote. “But I wonder whether they have fully considered that the herd immunity, of which they are taking advantage, is designed to protect those who cannot be vaccinated. For now, we will hire an at-home sitter for [our son]. When he is ready to go off to school, we will have to face this issue again. Because we want him to have as ‘normal’ a life as possible, we’ll likely send him off in the bright yellow school bus and cross our fingers that the kid sitting next to him didn’t just attend a ‘chickenpox party’ over the weekend. Because what’s ‘just a case of chickenpox’ for that kid could be a matter of life or death for mine.”
Like Stephanie Tatel’s son, hundreds of thousands of people in the United States cannot be vaccinated, forced to depend on those around them to be protected.
In 1998, Hardin wrote another essay titled “Extension of ‘The Tragedy of the Commons.’” In the intervening thirty years, Hardin had witnessed increasing pollution of the air, seas, and land by “herdsmen” who had continued to “overgraze.” His summary of the situation was poignant. “Individualism is cherished because it produces freedom,” he wrote. “But the gift is conditional.”
CHAPTER 9
The Mean Season
You know, you remove certain medications off shelves because they’re deemed unsafe. Why not vaccines?
—JENNY MCCARTHY ON
LARRY KING LIVE
, APRIL 3, 2009
LARRY KING LIVE
, APRIL 3, 2009
T
he breakdown in herd immunity in the United States at the beginning of the twenty-first century hasn’t silenced anti-vaccine activists. Although Barbara Loe Fisher and her National Vaccine Information Center have been heard from less frequently, other groups have stepped in to take her place—specifically the Coalition for Vaccine Safety. Formed from a variety of groups that believe vaccines cause autism, this new breed of anti-vaccine activism has a dramatically different style: meaner, cruder, more strident, and less professional.
he breakdown in herd immunity in the United States at the beginning of the twenty-first century hasn’t silenced anti-vaccine activists. Although Barbara Loe Fisher and her National Vaccine Information Center have been heard from less frequently, other groups have stepped in to take her place—specifically the Coalition for Vaccine Safety. Formed from a variety of groups that believe vaccines cause autism, this new breed of anti-vaccine activism has a dramatically different style: meaner, cruder, more strident, and less professional.
Jenny McCarthy was born on November 1, 1972, in Chicago, Illinois. She attended St. Turibius Grade School on Chicago’s south side and Mother McAuley Liberal Arts High School. Later, she entered Southern Illinois University in Carbondale to study nursing. But her heart wasn’t in it; she wanted to be a model.
Her success was immediate. In October 1993, McCarthy was
Playboy
magazine’s Playmate of the Month; in 1994, she was Playmate of the Year. Her affiliation with
Playboy
didn’t end there. McCarthy hosted the
Playboy
television show
Hot Rocks
, which featured uncensored music videos, and the dating show
Singled Out
. In 1996, she landed a bit part in the comedy
The Stupids
. That same year,
People
magazine named her one of the fifty most beautiful people in the world.
Playboy
magazine’s Playmate of the Month; in 1994, she was Playmate of the Year. Her affiliation with
Playboy
didn’t end there. McCarthy hosted the
Playboy
television show
Hot Rocks
, which featured uncensored music videos, and the dating show
Singled Out
. In 1996, she landed a bit part in the comedy
The Stupids
. That same year,
People
magazine named her one of the fifty most beautiful people in the world.
McCarthy’s movie career wasn’t limited to
The Stupids
. In 1998, she had a small role in
BASEketball
and the following year in
Diamonds
, directed by John Asher, whom she married in September 1999. A few years later, on May 18, 2002, their only child, Evan, was born in Los Angeles. But all was not well. Following a chance encounter with a stranger, McCarthy knew that something was different about her son. “One night I reached over and grabbed my Archangel Oracle tarot cards and shuffled them and pulled out a card,” she wrote. “It was the same card I had picked over and over again the past few months. It was starting to drive me crazy. It said that I was to help teach the Indigo and Crystal children. [Later,] a woman approached Evan and me on the street and said, ‘Your son is a Crystal child,’ and then walked away. I remember thinking, ‘Okay, crazy lady,’ and then I stopped in my tracks. Holy shit, she just said ‘Crystal child,’ like on the tarot card.” McCarthy realized that she was an Indigo adult and Evan a Crystal child. Although Evan would soon be diagnosed with autism, McCarthy took heart in the fact that Crystal children were often mislabeled as autistic. According to Doreen Virtue, author of
The Care and Feeding of Indigo Children
, “Crystal Children don’t warrant a label of autism! They aren’t autistic, they’re AWE-tistic.”
The Stupids
. In 1998, she had a small role in
BASEketball
and the following year in
Diamonds
, directed by John Asher, whom she married in September 1999. A few years later, on May 18, 2002, their only child, Evan, was born in Los Angeles. But all was not well. Following a chance encounter with a stranger, McCarthy knew that something was different about her son. “One night I reached over and grabbed my Archangel Oracle tarot cards and shuffled them and pulled out a card,” she wrote. “It was the same card I had picked over and over again the past few months. It was starting to drive me crazy. It said that I was to help teach the Indigo and Crystal children. [Later,] a woman approached Evan and me on the street and said, ‘Your son is a Crystal child,’ and then walked away. I remember thinking, ‘Okay, crazy lady,’ and then I stopped in my tracks. Holy shit, she just said ‘Crystal child,’ like on the tarot card.” McCarthy realized that she was an Indigo adult and Evan a Crystal child. Although Evan would soon be diagnosed with autism, McCarthy took heart in the fact that Crystal children were often mislabeled as autistic. According to Doreen Virtue, author of
The Care and Feeding of Indigo Children
, “Crystal Children don’t warrant a label of autism! They aren’t autistic, they’re AWE-tistic.”
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