Hiltzik: The coming toll in vaccine-preventable diseases

Forecasting the future is difficult. But here’s an easy prediction: The anti-vaccination movement in the U.S. and globally is going to result in the deaths of more children.

This grim portent comes to us courtesy of UNICEF, which is reporting that 30,601 confirmed cases of measles have been reported in Europe and Central Asia this year through Dec.5.

That’s up from 909 cases in those regions in 2022, or an increase of 3,266%.

There is no clearer sign of a breakdown in immunization coverage than an increase in cases of measles.

— Regina De Dominicis, UNICEF

UNICEF expects the final annual tally to be considerably higher, because the measles rate nearly doubled in October and November, marking a longer-term surge.

“There is no clearer sign of a breakdown in immunization coverage than an increase in cases of measles,” says Regina De Dominicis, UNICEF’s regional director for Europe and Central Asia.

In the United States, measles has remained more or less under control since the 2019 spike to 1,274 cases: 41 cases reported so far this year, down from 121 in 2022.

The 2019 surge was attributed to pockets of unvaccinated people spreading the virus. A spike also appeared in 2014, when more than half the 667 cases were attributed to unvaccinated Amish communities in Ohio.

That epidemiological pattern is what should give you qualms about what lies ahead for the U.S. That’s because the anti-vaccine movement is in full cry across the country, fueled by right-wing ideology and the presidential campaign, such as it is, of prominent anti-vaccine agitator Robert F. Kennedy Jr.

This 2014 map showed the surging incidence across the world of measles (red), whooping cough (green), mumps (brown), rubella (blue), polio (orange) and “other” (yellow). In the developed world, the cause was anti-vaccine sentiment; in the Third World, it was the unavailability of vaccines.

(Council on Foreign Relations)

One factor spurring the spread of anti-vaccine propaganda is the politicization of the COVID-19 vaccines. One leading public health advocate has called that phenomenon an “accelerant” for the anti-vaccine movement, which likens it to a can of gasoline in the hands of an arsonist.

For anti-vaxxers, it has been only a short step from opposition to COVID vaccine mandates to opposition to all childhood immunization mandates. This has often borne the banner of “health freedom,” the idea being that individuals should have the untrammeled right to decide for themselves what to put or not put in their bodies.

That may be marginally defensible when it concerns individuals’ decisions to eat or drink themselves to death, but obviously vaccination is in a different category: A vaccine defends not only patients themselves, but everyone around them — fellow pupils, teachers, family members, strangers with whom they come into contact.

Vaccination works best when it reaches coverage of about 95% of a population, producing what is sometimes described as “herd immunity,” in which a disease is so well suppressed that even the few unvaccinated members are protected.

It doesn’t take a very large decline in vaccine coverage to spur a surge in disease incidence. Consider the record in Britain. Through 1997, about 91% of British schoolchildren had received the measles/mumps/rubella (MMR) vaccine.

In 1998, the Lancet, a then-respected British medical journal, published a notorious article claiming a link between the MMR vaccine and autism, and by 2004 the vaccine uptake had fallen to 80%. Measles cases soon surged from an average of about 100 a year through 2005 to 1,280 in 2008 and 1,920 in 2012. By then the vaccination rate had begun to recover, but as of last year it was still below 90%.

That article, by the way, was fully retracted by the Lancet in 2010 and its principal author, Andrew Wakefield, stripped of his medical license. He has since surfaced in the U.S. as a star of the domestic anti-vaccine movement, rubbing shoulders with Kennedy and his gang.

Kennedy’s entry into the political fray poses a particular peril to public health because political reporters, who may be tasked with interviewing him on policy, may be ill-equipped to challenge the fire hose of misinformation and disinformation he dispenses with cocksure certainty.

When a reporter gets it right, compliments are warranted, so let’s examine an interview that CNN’s Kasie Hunt conducted with Kennedy on Dec. 15. Hunt came armed. When she quoted Kennedy as saying “there is no vaccine that is, you know, safe and effective,” he responded, “I never said that.”

Hunt cut Kennedy off on the spot, and ran a clip from an interview in which he said, yep: “There is no vaccine that is, you know, safe and effective.”

Kennedy mumbled and bumbled for a moment or two, then confessed to a “bad choice of words” and eventually retreated to his oft-repeated assertion that none of the vaccines currently recommended for children “have ever been tested in a pre-licensing safety study.”

Unfortunately, at that point, Kennedy had Hunt at a disadvantage. His assertion was carefully phrased to sound as though the Food and Drug Administration waved through all the childhood vaccines without a second thought. In other statements, Kennedy has made clear that he means that the vaccines have not been subjected to placebo-controlled randomized, double-blinded trials. This is the core of Kennedy’s claim that he’s not “anti-vaccine,” but merely an advocate for “vaccine safety.”

As I’ve written before, this is misleading to the point of being a flagrant lie.

The truth is that the FDA doesn’t allow vaccines on the market unless they’ve been safety-tested. When a vaccine is introduced as a treatment for a disease for which no safe and effective vaccine exists, it’s subjected to one of those randomized, placebo-controlled trials.

Once it’s approved, however, that standard for later generations of the same vaccine is different. As explained by vaccine specialist Paul Offit of Children’s Hospital of Philadelphia, subjecting those vaccines to placebo-controlled testing, say by injecting them with water or a saline solution instead of the vaccine, would be unethical, because it would require depriving half of the subjects of a known treatment.

The vaccines currently recommended for children are later-generation versions of shots that were placebo-tested. So are the COVID-19 vaccine boosters on the market today.

Offit points to what may be the most famous randomized trial in history, the 1954 test of Jonas Salk’s polio vaccine, in which about 200,000 first- and second-graders got the vaccine and 200,000 got salt water. Offit tells us that Salk didn’t want to structure the trial that way because polio was paralyzing 50,000 American kids a year and killing 1,500, and he felt it was wrong to deprive 200,000 of protection.

In the event, 16 of the child subjects died of polio during the study, all in the placebo group, and 36 were paralyzed, 34 of them in the placebo group. They gave their lives and health for nothing. Even today, when a clinical trial establishes that a treatment is safe and effective, it’s often halted early, so the placebo patients can get the treatment without waiting.

Hunt let this claim by Kennedy slide, perhaps because she couldn’t be prepared in advance for all the lies he was ready to spin out. But the claim was part of his known arsenal, so perhaps she should have been ready.

“With RFK Jr. running for President,” says veteran pseudoscience debunker David Gorski, “being ready with clips to bring home the evidence are not enough.” Reporters on the Kennedy beat must develop “a deep knowledge of the antivaccine claims that he’s been making since at least 2005 and then using that knowledge every time he tries to deny being antivaccine.” By his recknoning, “Kasie Hunt did way better than average with RFK Jr., but journalists need to do better still.”

Fighting back against the anti-vaccine propaganda spewed out by Kennedy and his cohort has never been as desperately crucial as it is today.

Thanks to the sustained assault on vaccination and science waged by right-wingers devoted to burnishing their own partisan bona fides rather than working in the public interest, vaccine coverage of kindergarten children has been declining since 2019 and remains well below the 95% target, according to the Centers for Disease Control and Prevention.

The share of children with a non-medical exemption from vaccination, such as a parent’s purported religious or moral objections, reached 3% in the 2022-23 school year, “the highest exemption rate ever reported in the United States,” the CDC reports.

In Florida, that hotbed of anti-science folderol purveyed by Republican Gov. Ron DeSantis and his handpicked surgeon general, the anti-vaccine charlatan Joseph Ladapo, school vaccine rates for non-COVID diseases fell in 2022 to the lowest level in 10 years. Its rate fell again this year, by an appalling 0.6 percentage points to 4.5%, the 12th worst in the nation.

States with responsible leaders respond to trends that threaten public health to that degree. After California’s 2010 outbreak of whooping cough (pertussis) — 9,120 cases, the most since 1947, the majority among unvaccinated children — the Legislature eliminated almost all non-medical exemptions for childhood immunization. California’s exemption rate of 0.2% in 2022-23 was the third best in the nation, after West Virginia and New York.

Can vaccine-resisters be reached with a rational counter-argument? One would think so. They tend not to be low-income, low-information residents — two of the most-vaccinated states are West Virginia and Mississippi.

Rather, they tend to come from more affluent, educated families, the sort of people who think they’re so smart they can decide healthcare policies for themselves, no matter how complex the issue.

In this respect, however, they’re just being stupid — and irresponsible. They should be receptive to reason. Let’s hope that it doesn’t take outbreaks of dangerous diseases like measles in their school districts to open their eyes.

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