Sunday, July 13, 2014

Anti-vaccination movement: Nothing new

PHIL Image 14538I've always thought of the anti-vaccination movement as beginning in the aftermath of the bogus (not to mention fraudulent and retracted) 1998 paper associating vaccines with autism. Recently I've become more interested in the movement and have begun reviewing the associated literature. Perhaps what I've found shouldn't surprise me, but in reality I'm astonished: Notions against vaccination have existed for a long time, and date back to at least the British compulsory vaccination laws of the 19th Century.

Jeffrey Baker describes the history of anti-vaccine movements in a very informative paper on the pertussis vaccine controversy in Great Britain in the late 1970s and early 1980s. His study recounts and analyzes how a 1974 series of case reports describing alleged diphtheria–tetanus–pertussis (DTP) vaccine adverse reactions led to plummeting vaccination rates and a resurgence in disease. The study describes many dynamics taking place then that resonate with events surrounding the MMR vaccine recently. For example,
  • Reports of supposed vaccine injuries were published
  • Vaccine victim/anti-vaccine advocacy groups were formed
  • A number of physicians recommending against vaccination emerged as a group
These and other forces led to a sharp decline in public acceptance of the DTP vaccine then in use and an increased incidence of pertussis, the likes of which had not been observed for 20 years (which is another similarity with the current outbreaks of vaccine preventable disease in the United States).

Importantly, Baker hypothesizes that, although the press played a role in initiating the anti-DTP vaccine movement and attendant epidemics, it was not the only factor. He points out that the British medical profession was deeply divided, "reflecting quite real uncertainties surrounding the safety and efficacy of the vaccine in the 1970s." (Note that although the medical profession isn't presently divided on the issue of the MMR vaccine, there is some reason to think that younger doctors are less likely to believe that vaccines are efficacious and safe than more senior doctors are.) Moreover, he notes that
Parents in vaccine victim advocacy groups played an additional important role in sustaining the crisis. The ambivalence of both public and medical profession . . . are best understood against the background of Britain’s long history of skepticism regarding many vaccines dating back to smallpox.
Here, Baker alludes to the controversy surrounding compulsory smallpox vaccination in the late-19th century in the UK, noting that mandatory vaccination against smallpox virus
. . . represented one of the first intrusions of state public health policy into personal life, and consequently provoked considerable libertarian opposition.
Recent studies by Anna Kata of the tactics and tropes used online by the anti-vaccination movement at present, and of anti-vaccination misinformation on the Internet, reflect many facets of the anti-DTP vaccine movement nearly 40 years ago.

How could ideas opposing vaccination have persisted for well over a century? The phenomenon of groups of people opposing the best public health guidance is not limited to vaccination; other examples include the raw milk movement (which refuses to acknowledge the risk posed by bacterial contamination of raw milk and related products) and the anti-fluoridation movement (which questions the safety of fluoridating public water supplies). As I've mentioned before in this blog, it's critically important to understand such groups and how they make behavioral decisions. It may or not be possible to change their outlooks given such knowledge, but it's hard to imagine doing so without it.

(image source: CDC PHIL image ID#14538)

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