Why have parents stopped vaccinating their children?
‘Fake news’ is blamed for a surge in measles cases, but can health experts cut through the noise, asks Joe Shute
Click, click, click. That is all it takes to fall down the rabbit hole of the antivaccine movement that has taken root on social media.
Just a few taps on Instagram, for example, and one is taken far from the world of avocado brunches and deep into the realm of “anti-vax” conspiracies, ranging from pseudoscientific vindications for the disgraced British former doctor Andrew Wakefield’s bogus links between the MMR jab and autism in children, to hashtags such as #vaccineskill (with some 18,245 posts), to mocked up images of youngsters punctured by a barrage of needles.
This is viral content in the most literal sense. The World Health Organisation (WHO) has pinpointed “vaccine hesitancy” as one of the 10 biggest global health threats for 2019.
Earlier this month, Simon Stevens, the head of the NHS, blamed “fake news” by so-called anti-vaxxers on social media for fuelling a tripling in measles cases, with 913 infections recorded in England between January and October last year, compared with 259 in the whole of 2017.
Similarly, the number of measles infections across Europe tripled to 82,500 in 2018, compared to the previous year – a surge that killed 72 children and adults. And as of midnight last night, Rockland County in New York state took the “extremely unusual” step of banning non-vaccinated children from public places for 30 days to halt an outbreak of measles (declared eradicated from the USA in 2000), which has infected at least 153 people in the area since October.
Across the world, the anti-vaccine movement is drawing together disparate supporters from the US president, Donald Trump – who prior to his election scattergunned numerous anti-vaccine tweets – to Russian trolls; from Hollywood celebrities to hipster parents in the Home Counties and Orthodox Jews in London.
And the scare tactics appear to be registering: across Britain, the most recent NHS data shows the proportion of two-year-olds immunised against measles, mumps and rubella (MMR) fell for the fourth year in a row in 2017-18 to 91.2per cent (the WHO target is 95 per cent).
Dr Heidi Larson, director of the Vaccine Confidence Project, established 10 years ago at the London School of Hygiene and Tropical Medicine, calls it societal “hubris”, where as infectious diseases are brought under control, attention turns to the risk of the vaccine, even if minimal in comparison. In recent years, she says, the sheer scale of the anti-vaccine messages online have become far harder for health professionals to contest.
“These emotions and views don’t start with social media companies but are amplified by them,” she says.
“But as a society we need to think seriously about what we can do because something has broken in a big
way.” The decision to leave a child unvaccinated, she points out, is not just a threat to them, individually, but also the so-called “herd immunity” – the resistance among any given population to a disease.
“I think it is irresponsible to not vaccinate,” she says, given measles is deadly in one in every thousand cases, while infection can damage the entire immune system and lead to serious complications such as pneumonia and encephalitis (inflammation of the brain). Although Dr Larson admits Rockland County’s public ban is perhaps a step too far, she believes matters are reaching a point where the British government might need to reconsider its current position of leaving the choice down to parents.
“I wouldn’t wait until there is a crisis,” she says. “If I were in government I would seriously consider putting requirements in place. Going to school, I don’t think it’s unreasonable to say a child needs to be vaccinated because they put others at risk.”
There are pronounced regional variations for vaccine coverage in England. In the North East, 95.1per cent of children have been injected with so-called 5-in-1 jabs (which protect against diphtheria, tetanus, whooping cough, polio and Hib) by 12 months, while in London the rate is just 89.2per cent.
Religious beliefs are believed to play a role. The number of vaccinated children living in the ultra orthodox Charedi Jewish community in Stamford Hill in north London, for example, is estimated to be well under 80per cent, while Dr Larson says some Muslim communities have also raised concerns about gelatin in some vaccines.
But it is also in affluent areas where parents, inspired by the natural health movement, are choosing not to vaccinate their children. Rebecca Whitfield (not her real name) has just returned to the Hampshire home she shares with her partner and threeyear-old son from a five-week trip to Thailand (she eschewed travel jabs).
A therapist, Whitfield has decided not to vaccinate her son after seeing the children of friends react badly to jabs but also, she says, because he was born two months premature and she did not want to subject him to any more needles once he left hospital.
“The way we live our life is to stay well and really focus on being healthy,” she says. “There are vaccinations now for things that wouldn’t even make a child that ill. I don’t want him to suffer, obviously, but he never gets ill. I really don’t understand this need to protect ourselves from things that won’t do our child too much harm.”
Stressing she is “pro-choice rather than anti-vaccine”, she admits she has been criticised for her approach and lost one friend altogether. Another mother from an affluent area of south London (who also wishes to remain anonymous), says she, too, is wary of admitting that she hasn’t vaccinated her five-year-old daughter.
“There’s not enough information out there,” she says. “You’re just told, if you don’t vaccinate your kids they’ll get measles, and you’re a stupid hippy. You’re chastised by the health system if you don’t do things by the book, in the same way as if you don’t breastfeed. It’s really hard as a parent to navigate.”
Certainly, the public health community has little time for such arguments. According to Prof Helen Stokes-lampard, chairman of the Royal College of GPS, “one unvaccinated child is one too many” and recent measles outbreaks are a sharp reminder of how serious the disease can be.
“We need to cut through the fake news, with evidence-based, easy-tounderstand health advice for patients such as that provided by Public Health England,” she says. “They should feel equipped and confident to challenge any spurious claims they might encounter so that they can make sensible, informed decisions about the long-term health and well-being of their children.”
The spectre of British doctor Andrew Wakefield, drummed out of the British medical profession for his 1998 paper that made a link between MMR and autism, still looms large over the vaccine info-wars.
Twenty years on, he has rehabilitated his reputation in the US to such an extent that he is in a relationship with supermodel Elle Macpherson, and has amassed avowed supporters who fervently believe his (professionally) debunked claims.
Anna Merlan, a Us-based journalist and author of a forthcoming book,
Republic of Lies, on the rise of conspiracy theorists in America, has interviewed Wakefield, shadowed him giving talks on a cruise ship and attended a sell-out screening of his documentary, Vaxxed, in New York.
“He is very charismatic and feeds into long-standing suspicions [in the US],” she says. Whenever asked about his exile from Britain, she says he is “able to skilfully talk about it as a vendetta against him by a medical establishment who felt he was getting too close to the truth”.
Campaigners hope such voices will soon be muted. This week, Matt Hancock, the Health Secretary, called for new legislation forcing social media companies to remove content promoting false information about vaccines. Earlier this month, Facebook agreed to ban adverts with antivaccination content while Instagram says it will also introduce controls.
“There is a lack of information out there, apart from a few very vociferous people shouting loudly,” says Prof Arne Akbar, president of the British Society of Immunology. “People are being bamboozled and misled.”
‘It’s not unreasonable to say a child going to school needs to be vaccinated’