by GMU Biodefense grad Ryan Gearheart
So where does this hostility and fear come from? From a historical perspective, anti-vaccination groups have existed since the start of state endorsed vaccination programs, and while the basic arguments are the same, the explosion of the Internet and increasing use of scientific jargon have allowed anti-vaccination groups to garner credibility and reach wider audiences. Today’s anti-vaccination groups and parents have been extremely vocal about what they perceive to be unsafe vaccines and vaccines’ correlation with increasing autism rates. Much of their anger can be traced back to the original Wakefield et al. (1998) article – now retracted – suggesting a link between enterocolitis infection, measles-mumps-rubella (MMR) vaccinations, and subsequent increases in autism in the observed children.[1] Indeed, many of the parents suspecting a link between the MMR vaccines and the onset of autism funneled their cases to Dr. Wakefield over the course of several years, thereby affecting the scientific body of knowledge (Moore & Stilgoe, 2009, p. 668). Despite several major studies disproving the link between vaccinations containing the preservative thimerosal[2] and autism, as well as discrediting MMR vaccination-linked autism (MMR vaccines did not and do not contain thimerosal), enlivened parents continue to voice their opposition and seek legal compensation.
According to an article by Harris and O’Connor (2005): “Parents have filed more than 4,800 lawsuits – 200 from February to April alone – pushed for state and federal legislation banning thimerosal and taken out full-page advertisements in major newspapers.” Because of the National Childhood Vaccine Injury Act of 1986 – created with the goal of preventing vaccine manufacturers from being sued out of business – all lawsuits regarding possible vaccine injuries must go through a special vaccines court, as opposed to civil court, thereby preventing class-action lawsuits from being filed (Kirkland, 2012, p. 238). Running from 2002 through 2010, Anna Kirkland (2012) cites the unusual nature of the vaccine-autism cases: “Because holding so many hearings was untenable, the cases were consolidated into the Omnibus Autism Proceeding (OAP) so that the causation issues could be tried in six test cases” (p. 238). With so much on the line for everyone involved in these cases, both sides undertook immense boundary work to discredit the other party and establish their own credibility zones.[3] How is it possible that such a resounding scientific consensus has failed to establish consensus in the overall public? Kirkland’s 2012 study, “Credibility Battles in the Autism Litigation,” does much to elaborate on how the petitioners – parents with autistic children – perceived the OAP as a “stacked deck” with the sole intent of protecting national vaccination campaigns (p. 254). Alternatively, Kirkland (2012) goes on to note that the “special masters” presiding over the hearing felt that they had done everything in their power to give the petitioners a chance to build the best case possible (p. 255). Of course, reaching an outcome agreeable to both sides was impossible from the start: “One significant schism in credibility zones in the OAP…lay between the mainstream toxicology and medical communities and the alternative autism community, with different labs, tests, standards, practices, and foundational assumptions for each” (Kirkland, 2012, p. 243). Without an agreed to set of facts, or even “foundational assumptions” to work from, the OAP’s attempt to reconcile the emotionally charged vaccine-autism issue was likely to fail from the start.
Continued anti-vaccination opposition reinforces the fact that the scientific community and the United States Government have been unable to establish cognitive authority because of some parents’ contextualization and, ultimately, rejection of mainstream scientific authority. Donald MacKenzie (1990) notes that these disputes are only natural when one considers that: “Knowledge is indeed a network wherein different kinds of test are performed against differently constructed backgrounds, with no one test – not even “use” – and no one background being accepted by all as the ultimate arbiter” (p. 378). As Stephen Turner (2001) notes:
What counts as “expert” is conventional, mutable and shifting, and that people are persuaded of claims to expertise through mutable, shifting conventions does not make the decisions to accept or reject the authority of experts less than reasonable in the sense appropriate to liberal discussion. To grant a role to expert knowledge does not require us to accept the immaculate conception of expertise (p. 146).
Wynne’s (1991) theory regarding society’s contextualization of scientific information holds particularly true here when considering the proximity of childhood vaccinations (one to two years of age) and the general timeframe for diagnosing autism in children (three to four years of age). It is not hard to understand why a parent would link childhood vaccinations to autism under these circumstances, even if scientific studies demonstrate no causal link between them.
Similar to the HCWs’ concerns described in the previous subsection, the overwhelming boundary-work undertaken to dismiss Wakefield’s work as ‘not-science’ has been insufficient to reassure parents with autistic children.
Additionally, parents with these concerns may be even less likely to give their children a live vaccine based on fears of their children actually contracting influenza – a fear likely to be higher than seen with the standard, inactivated vaccines – and compound fears regarding potential neurological disorders. This would mean that mass vaccination programs focusing on children are even more likely to encounter fierce opposition from anti-vaccination groups and concerned parents. Adverse events are an especially salient concern considering the recent Finnish study linking the 2009-2010 Pandemrix vaccine, produced by GlaxoSmithKline (GSK), to narcolepsy in children (Pohjanpalo, 2011). The damage to vaccination programs should be even greater given that Helsinki is establishing a pooled fund to pay for the children’s medical costs, in addition to the ongoing fallout from the Wakefield et al. (1998) article. Given previous and ongoing concerns about vaccines’ links to autism and various other neurological disorders, healthcare and scientific personnel are going to be hard pressed to maintain what social and cognitive authority they still possess. As such, it will be increasingly important that the United States Government undertake a public relations campaign – using (generally) trusted sources such as the CDC and trusted, local healthcare providers – to accurately convey the risks and costs associated with influenza, as well as the community-wide benefits which can be achieved through mass-vaccinations of school-aged children.
Emily Martin (1998) proposes that the anti-vaccination movement may also be reflective of a new culture of health in the United States, wherein “…the very bodies of people are being categorized into two types: those that can survive the present intensely competitive environment and those that cannot” (p. 33). Martin (1998) takes her argument one step further and pushes the idea that the rigidity of scientific communication regarding vaccine safety has lost some of its purchase in the mainstream public because it is no longer culturally gripping – that is to say, a vaccine might be seen as “crudely bludgeoning the delicate adjustment of the finely tuned immune system at a time when there is no actual threat” and thereby “be seen as undermining health” (p. 33). If the United States Government and the scientific community are unable to convey that vaccines are a far cry from bludgeoning tools for the immune system, but are rather statistically safe and effective methods for molding it in advance of a life-threatening illness or pandemic, “good” science may gradually find itself unable to quickly achieve high vaccination rates prior to, and immediately after, the start of a pandemic. Therefore, it is absolutely essential for the United States Government and any other governments hoping to use and enforce a national vaccination campaign, to understand that opposition groups can use the government’s own findings and seemingly callous scientific communication as evidence of government conspiracies to promote vaccinations, while simultaneously downplaying and/or ignoring specific subsets of the population that may suffer elevated risks of adverse effects. Consequently, it is imperative for the United States Government to identify which credibility zones are most important to the survival of its vaccination campaigns and to focus its efforts there in the event of a pandemic.[4]
It will also be critical for the United States Government and mainstream healthcare community to address anti-vaccine groups on the Internet. Multiple studies have shown that user-generated information on the Internet, alternatively known as “Web 2.0”, supply large amounts of misinformation to users, often with the same themes: childhood diseases are not as severe as the public is led to believe; the threat from childhood diseases is either minimal or does not exist; vaccines are not safe; vaccines are not effective; vaccines contain poisons, such as ether, antifreeze, etc.; civil liberties infringement; that a government-biopharmaceutical conspiracy exists because vaccines are profitable; and the list goes on (Jacobson, Targonski, & Poland, 2007; Kata, 2010; Kata, 2012; Busse, Wilson, & Campbell, 2008; Keane et al., 2005; Betsch & Sacshe, 2012; Bean, 2011; Betsch et al., 2012; Manfredi et al., 2010; Downs, de Bruin, & Fischhoff, 2008; Spier, 2002; Leask & McIntyre, 2003; Witteman & Zikmund-Fisher, 2012; Poland & Jacobson, 2001; Poland, Jacobson, & Ovsyannikova, 2009; Leask, Chapman, & Robbins, 2010). However, any attempt to counteract the anti-vaccine movement online must understand that this issue cannot be “fixed” by an educational campaign – the anti-vaccine movement has found a niche in a “postmodern” society that places an emphasis on individuals’ values, “prioritizing risk over benefit,” and promotes “the well-informed patient” (Kata, 2010, p. 1714). In this postmodern society, anyone is free to challenge the expertise of established authorities and, in effect, to become “lay experts” – an oxymoronic term itself – capable of forming and following their own knowledge and judgments (Kata, 2012).
Moreover, the broad distrust of government and mainstream healthcare harbored by anti-vaccine groups means that no amount of epidemiological statistics, no matter how extensive the study or its statistical power, will be able to override personal experience and anecdotal evidence. Nevertheless, efforts must be taken to improve the number of “hits” government and mainstream healthcare websites receive on the first page of search results, given the high number of people seeking healthcare and vaccination information on the internet (Kata, 2010; Kata, 2012; Betsch & Sachse, 2012; Bean, 2011; Betsch et al., 2012; Witteman & Zikmund-Fisher, 2012; Leask, Chapman, & Robbins, 2010). This is a particularly important endeavor given that anti-vaccination websites like the NVIC portray themselves as neutral information providers, advocating safer vaccines and informed choice – inarguable points intended to draw in larger audiences – while putting out information that is almost entirely anti-vaccine. Furthermore, distrust and/or frustration with mainstream healthcare have led to a resurgence in the number of people seeking complementary and alternative healthcare (CAM) in the U.S (Ernst, 2002). For those parents of autistic children, suffering from an ill-defined disease with few, if any, treatment options according to mainstream healthcare, it is unsurprising that many would turn to alternative healthcare treatments to find hope and a potential cure for their children. Still, many within the CAM community – certified and uncertified practitioners alike – actively and/or passively dismiss vaccines as ineffective at best and harmful at worst. The United States Government and mainstream healthcare community cannot afford to lose a credibility battle in doctors’ offices because they have failed to provide hope to parents at the cost of vaccination rates.
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[1] Wakefield’s original article never explicitly stated a link between MMR vaccinations and autism, although the potential linkage could not be dismissed by the authors. As such, the original authors had called for further investigation. Nevertheless, the publicity surrounding this research led in no small part to significant decreases in MMR vaccination rates in the United Kingdom – predictably leading to upticks in measles outbreaks – and, to this day, continues to be cited by various anti-vaccination groups as evidence of a major government-biopharmaceutical conspiracy aimed at hiding any evidence of harm.
[2] Thimerosal is an organic ethyl mercury compound – approximately 50 percent ethyl mercury by weight – used as a preservative in many vaccines (Kirkland, 2012, p. 242). Although the toxic, neurological effects of methyl mercury – the type most commonly found in fish and the natural environment – are well documented, thimerosal never underwent the extensive safety testing of later preservatives, effectively having been “grandfathered” in prior to the creation of the Environmental Protection Agency.
[3] “Credibility zones are spaces of knowledge production for communities that have their own sources and forms of sustenance…” (Kirkland, 2012, p. 240).
[4] For an in-depth look at credibility zones and their impacts on mainstream consensus, see: Jasanoff, S. (2004). Sates of Knowledge: The Co-Production of Science and Social Order. New York: Routledge.
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