Deadly Choices: How the Anti-Vaccine Movement Threatens Us All (2 page)
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Authors: Paul A. Offit M.D.
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The Indiana outbreak was a frightening reminder of our past. Before 1963, when a vaccine was first available, measles was a common cause of suffering and death. Although most parents know that measles virus causes a rash, few know that it can also travel to the lungs and cause pneumonia or to the brain and cause inflammation (a condition called encephalitis), often resulting in seizures and brain damage. Worst of all, measles virus causes a rare disease called SSPE (subacute sclerosing panencephalitis), whereby children become progressively less able to walk, talk, or stand. Invariably they develop seizures, lapse into a coma, and die; despite heroic supportive measures, no child has ever survived SSPE. Before the vaccine, measles infected as many as four million American children, causing a hundred thousand to be hospitalized and five hundred to die every year.
Following the measles outbreak in Indiana, health officials at the CDC did everything they could to warn parents about the seriousness of the disease. They issued media alerts, health advisories, talking points, and educational materials, all with the hope that the alarm sounded in Indiana would be heard. But their warnings were ignored.
On January 13, 2008, a seven-year-old unvaccinated boy flew back to his home in San Diego after a family vacation in Switzerland. Nine days later he developed cough and a runny nose. His parents, who thought he had only a cold, sent him to school. But his illness worsened. The next day, the mother brought the boy to the doctor’s office, where he sat in the waiting room with other children. The doctor, unsure of the diagnosis, sent the child to a testing laboratory at a local hospital. Later that day, the boy was taken to the hospital’s emergency room with a fever of 104 degrees and a worsening rash. Because none of the attending doctors had considered measles, isolation precautions were never used in the doctor’s office, the testing laboratory, or the hospital.
Between January 31 and February 19 of that year, other children started getting sick: the boy’s two siblings, several of his classmates, and three children who had been sitting in the doctor’s waiting room. Again, the measles virus showed its remarkable ability to find susceptible children. Every child infected by the boy was unvaccinated. Of the three children who caught measles in the doctor’s waiting room, all were too young to have been vaccinated; one was hospitalized with severe dehydration; another traveled by plane to Hawaii while contagious. The measles outbreak in California shouldn’t have been surprising. In 2008, the parents of ten thousand California kindergarteners chose not to vaccinate their children.
California wasn’t the only state to suffer a measles outbreak. Thirteen other states—Illinois, Washington, Arizona, Hawaii, Wisconsin, Michigan, Arkansas, Georgia, Louisiana, Missouri, New Mexico, Pennsylvania, and Virginia—as well as the District of Columbia succumbed. When it was over, 140 children, almost all of them unvaccinated, had been infected; 20 were hospitalized. It was the largest single measles outbreak in the United States in more than a decade.
The Indiana and nationwide outbreaks shared one important feature: in both cases, the first infection occurred outside the United States. This isn’t unusual. Every year about sixty people traveling from countries where immunization rates are lower, such as Switzerland, Austria, Ireland, Israel, the Netherlands, Japan, and the United Kingdom, enter the United States with measles. Indeed, all of these countries continue to suffer measles outbreaks. But the situation in 2008 was different; this time measles spread from one unvaccinated American child to another to another. The problem wasn’t that national immunization rates were low; they were actually quite high. The problem was that certain communities had so many unvaccinated children that infections could spread unchecked.
Perhaps most disturbing was an outbreak of mumps among Hasidic Jews in New York and New Jersey—an outbreak that showed just how much we depend on one another for protection.
In June 2009, an eleven-year-old boy traveled to England and caught the mumps. At the time, thousands of British children were infected with mumps, primarily because their parents were afraid that the measles-mumps-rubella (MMR) vaccine caused autism. On June 17, the boy flew back to New York, attended a summer camp for Hasidic Jews, and started a massive epidemic. By October, two hundred people had been infected; by November, five hundred; and by January 2010, fifteen hundred. When it was over, mumps was found to have caused pancreatitis, meningitis, deafness, facial paralysis, or inflammation of the ovaries in sixty-five people; nineteen were hospitalized.
The mumps outbreak in 2009 showed that even vaccinated people are at risk. In order to stop the spread of infections, a certain percentage of the population needs to be vaccinated, a phenomenon known as population or herd immunity. People who aren’t vaccinated or who can’t be vaccinated will be protected when surrounded by a highly vaccinated group, much like a moat safeguards a castle. The fraction of the population that needs to be vaccinated to provide herd immunity depends on the contagiousness of the infection. For highly contagious infections—such as measles or pertussis—the immunization rate needs to be about 95 percent. For somewhat less contagious infections—like mumps and rubella—herd immunity can be achieved with immunization rates around 85 percent. Although 70 percent of the Hasidic Jews in the mumps outbreak of 2009 were vaccinated, the proportion of those protected was actually lower. That’s because no vaccine is 100 percent effective. For mumps, about 88 percent are protected after two doses. Therefore, although 70 percent were immunized, only 62 percent were protected, well below the rate needed to stop the spread of mumps.
The epidemic among Hasidic Jews wasn’t an isolated event. Three years earlier, in 2006, mumps had swept across the Midwest, infecting more than sixty-five hundred people, mostly college students.
The mumps epidemics of 2006 and 2009 proved that even vaccinated people might not be protected if vaccination rates aren’t high enough.
Outbreaks started by travel outside the United States won’t be limited to measles and mumps.
In 2003, rumors circulated in Nigeria that polio vaccine caused AIDS and made young girls infertile. Vaccination programs came to a halt. By 2006, polio originating in Nigeria had spread to twenty previously polio-free countries in Africa and Asia—more than five thousand people were severely and permanently paralyzed. “Such large-scale polio outbreaks haven’t been seen in quite a long time,” said Tammam Aloudat, a senior health official at the International Red Cross. Walter Orenstein, deputy director for the Gates Foundations’ Global Health Program, saw a parallel with the U.S. measles outbreaks of 2008. “Polio is only a plane ride away from the United States,” said Orenstein. “If we let our guard down, if our immunization coverage drops, there is certainly the possibility of a polio outbreak.” Orenstein doesn’t think it will end with polio: “Diphtheria could also come back. Any of them can. Because aside from smallpox, every other one of these infections is either in the United States or close to our borders.”
In the early 1900s, children routinely suffered and died from diseases now easily prevented by vaccines. Americans could expect that every year diphtheria would kill twelve thousand people, mostly young children; rubella (German measles) would cause as many as twenty thousand babies to be born blind, deaf, or mentally disabled; polio would permanently paralyze fifteen thousand children and kill a thousand; and mumps would be a common cause of deafness. Because of vaccines, all these diseases have been completely or virtually eliminated. But now, because more and more parents are choosing not to vaccinate their children, some of these diseases are coming back.
How did we get here? How did we come to believe that vaccines, rather than saving our lives, are something to fear? The answer to that question is rooted in one of the most powerful citizen activist groups in American history; founded in 1982, it is a group that, despite recent epidemics and deaths, has continued to gain followers in both the United States and the world.
CHAPTER 1
The Birth of Fear
If you say in the first chapter that there is a rifle hanging on the wall, in the second or third chapter it absolutely must go off.
—
S. SHCHUKIN,
MEMOIRS
(1911)
S. SHCHUKIN,
MEMOIRS
(1911)
F
rederick Wiseman was born on January 1, 1930. After graduating from Williams College and Yale University Law School, Wiseman became a law professor at Boston University. Then he decided to make movies. For the next thirty years Frederick Wiseman was the most inventive, most reviled, most controversial, and most influential documentary filmmaker in America.
rederick Wiseman was born on January 1, 1930. After graduating from Williams College and Yale University Law School, Wiseman became a law professor at Boston University. Then he decided to make movies. For the next thirty years Frederick Wiseman was the most inventive, most reviled, most controversial, and most influential documentary filmmaker in America.
Wiseman’s first film—released in 1967—was his most powerful. Called
Titicut Follies
, it was a stark depiction of life inside the walls of Bridgewater State Hospital for the Criminally Insane. Wiseman showed prisoners being hosed down, force-fed, and tortured by an indifferent, bullying staff. In one scene, a physician takes a long tube and inserts it into a prisoner’s nose. Then he attaches the tube to a funnel, fills it with thick, dark fluid, and stands precariously on a chair, a cigarette dangling from his mouth. A guard mockingly shouts, “Chew your food, Joey.” The viewer is at once sickened by the degradation of force-feeding and captivated by the cigarette ash dangling over the funnel.
Titicut Follies
, it was a stark depiction of life inside the walls of Bridgewater State Hospital for the Criminally Insane. Wiseman showed prisoners being hosed down, force-fed, and tortured by an indifferent, bullying staff. In one scene, a physician takes a long tube and inserts it into a prisoner’s nose. Then he attaches the tube to a funnel, fills it with thick, dark fluid, and stands precariously on a chair, a cigarette dangling from his mouth. A guard mockingly shouts, “Chew your food, Joey.” The viewer is at once sickened by the degradation of force-feeding and captivated by the cigarette ash dangling over the funnel.
Time
magazine called
Titicut Follies
a “relentless exposé of a present-day snake pit.” Vincent Canby of the
New York Times
wrote that the film made “
Marat/Sade
look like
Holiday on Ice
.” And one theatrical poster warned, “Don’t turn your back on this film ... if you value your mind or your life.”
Titicut Follies
was so hard to watch—so unblinking, so unsettling, so unfailingly detailed—that days before its debut at the New York Film Festival, Massachusetts Superior Court judge Harry Kalus ordered the state to seize all copies, writing: “No amount of rhetoric, no shibboleths of ‘free speech’ and the ‘right of the public to know’ can obscure or masquerade this pictorial performance for what it really is—a piece of abject commercialism, trafficking in the loneliness, on the human misery, degradation and sordidness in the lives of these unfortunate humans.” In 1968,
Titicut Follies
was the first and only film in the United States ever to be banned for reasons other than obscenity or national security. Twenty years would pass before the movie was shown to the American public.
magazine called
Titicut Follies
a “relentless exposé of a present-day snake pit.” Vincent Canby of the
New York Times
wrote that the film made “
Marat/Sade
look like
Holiday on Ice
.” And one theatrical poster warned, “Don’t turn your back on this film ... if you value your mind or your life.”
Titicut Follies
was so hard to watch—so unblinking, so unsettling, so unfailingly detailed—that days before its debut at the New York Film Festival, Massachusetts Superior Court judge Harry Kalus ordered the state to seize all copies, writing: “No amount of rhetoric, no shibboleths of ‘free speech’ and the ‘right of the public to know’ can obscure or masquerade this pictorial performance for what it really is—a piece of abject commercialism, trafficking in the loneliness, on the human misery, degradation and sordidness in the lives of these unfortunate humans.” In 1968,
Titicut Follies
was the first and only film in the United States ever to be banned for reasons other than obscenity or national security. Twenty years would pass before the movie was shown to the American public.
The modern American anti-vaccine movement was born on April 19, 1982, when WRC-TV, a local NBC affiliate in Washington, D.C., aired a one-hour documentary titled
DPT: Vaccine Roulette
. Although Frederick Wiseman wasn’t involved in a single aspect of the film, his influence on the writer and producer, Lea Thompson, was apparent.
Vaccine Roulette
contained the sad, haunting images of
Titicut Follies
, except that this time, instead of inmates degraded by prison guards, the camera focused on children—twisted, withered, disabled children—irreparably damaged by a vaccine. (Although Lea Thompson referred to the vaccine as DPT, doctors called it DTP because the vial read “diphtheria and tetanus toxoids and pertussis vaccine.”)
DPT: Vaccine Roulette
. Although Frederick Wiseman wasn’t involved in a single aspect of the film, his influence on the writer and producer, Lea Thompson, was apparent.
Vaccine Roulette
contained the sad, haunting images of
Titicut Follies
, except that this time, instead of inmates degraded by prison guards, the camera focused on children—twisted, withered, disabled children—irreparably damaged by a vaccine. (Although Lea Thompson referred to the vaccine as DPT, doctors called it DTP because the vial read “diphtheria and tetanus toxoids and pertussis vaccine.”)
Vaccine Roulette
opens with Lea Thompson standing in the middle of a newsroom, staring straight into the camera. Her tone is grim, her voice unwavering. “DPT,” she begins, “the initials stand for diphtheria, pertussis, tetanus: three diseases against which every child is vaccinated. For more than a year we have been investigating ‘P’: the pertussis portion of the vaccine. What we have found are serious questions about the safety and effectiveness of the shot. The overriding policy of the medical establishment has been to ag-gressively promote the use of the vaccine, but it has been anything but aggressive in dealing with the consequences. Our job in the next hour is to provide enough information so that there can be an informed discussion about this important subject. It affects every single family in America.”
opens with Lea Thompson standing in the middle of a newsroom, staring straight into the camera. Her tone is grim, her voice unwavering. “DPT,” she begins, “the initials stand for diphtheria, pertussis, tetanus: three diseases against which every child is vaccinated. For more than a year we have been investigating ‘P’: the pertussis portion of the vaccine. What we have found are serious questions about the safety and effectiveness of the shot. The overriding policy of the medical establishment has been to ag-gressively promote the use of the vaccine, but it has been anything but aggressive in dealing with the consequences. Our job in the next hour is to provide enough information so that there can be an informed discussion about this important subject. It affects every single family in America.”
DPT: Vaccine Roulette
, which aired on April 19, 1982, ignited America’s modern anti-vaccine movement. (Courtesy of WRC-TV/NBC News.)
, which aired on April 19, 1982, ignited America’s modern anti-vaccine movement. (Courtesy of WRC-TV/NBC News.)
The next image is that of a baby screaming: a needle jabbed into her arm. “It’s a fact of life,” says Thompson. “All children must get four DPT shots to go to school. Shots we are told will keep our children healthy. Shots we are told will protect every child from a dreaded disease: pertussis. But the DPT shot can also damage to a devastating degree.” To the sound of a beating heart, the screen fills with images of children with severe mental and physical handicaps, withered arms and legs, gazing at the ceiling, drooling, seizing. Then a vial of vaccine appears behind letters spelling out “D-P-T: V-a-c-c-i-n-e R-o-u-l-e-t-t-e,” each letter accompanied by a sharp, penetrating noise, like gunshots.
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