What’s new in the vaccine wars

Paul A. Offit, MD

Tina Q. Tan, MD

Resistance to vaccines is not new. Starting with the first vaccine developed in the late 1700s/early 1800s for smallpox through current times, people have resisted vaccines.

“What we are looking at today is not new,” said Paul A. Offit, MD, director of the Vaccine Education Center and attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia, Pennsylvania. “It is historic, but the good news is that I think there is a path forward.”

The path forward he suggests lies in understanding the historical resistance to vaccines and the reasons behind the resistance. Calling this a “war on vaccines,” Offit described a number of issues related to the fight around vaccines such as the whooping cough vaccine and measles/mumps/rubella vaccine. These issues inform what is going on today, he said.

Offit spoke during a session at the American Academy of Pediatrics (AAP) 2019 National Conference and Exhibit ion in New Orleans, Louisiana, on Sunday, October 27, titled “Communicating the science of vaccines to parents, the public, and the media.” The bulk of his talk centered on the current resistance to vaccines. He underscored 2 groups of people who primarily make up the resistance: vaccine-hesitant parents and antivaccine parents or conspiracy theorists.

Underlying the resistance in both groups, he said, is fear. “People are compelled by fear more than reason,” he emphasized. “I don’t think people fear the diseases anymore and so they fear other things, such as misconceptions about vaccines.”

As an example, Offit pointed to the lack of resistance to the polio vaccine despite the real tragedy that occurred in 1955: Using a bad batch of the vaccine, 120,000 children inadvertently were inoculated with a live polio virus that caused short-lived polio in 40,000 children, permanent paralysis in 164, and death in 10. “When you fear the disease more than the vaccine, you are willing to accept the safety issues,” Offit said.

Fear of vaccine-preventable diseases no longer motivates people. “People don’t fear diseases such as flu and human papillomavirus (HPV), but they are wrong not to fear them,” he said, pointing out that the flu has killed more people than all other vaccine-preventable diseases combined.

The fear motivating the 2 groups of people he sees as the main resistors to current vaccines he suggests is different. For the first group, the vaccine-hesitant parents, he emphasized their true hesitancy about the vaccines because they are not as compelled and fearful of the diseases themselves. Social media plays a role in spreading bad information that is quick and easy to access.

Underlying the fear of the antivaccine group, Offit said, is conspiratorial thinking. “They believe there is a conspiracy to hide the truth and that the pharmaceutical industry is behind the conspiracy.”

Although he said that there is little one can do to convince the antivaccine people of the value of vaccines, Offit underscored the need for compassionate and compelling education of the vaccine-hesitant group. “I think information is of value to people who are receptive to information,” he said.

COMMENTARY

Even though resistance to vaccines has been present since the first vaccine was developed in the late 1700s, over the last decade the antivaccine movement has grown exponentially. The proponents have become well organized, very vocal, and brash. They have flooded all forms of media, especially social media and the Internet, with their messages of misinformation about vaccines, distrust, conspiracy theory beliefs, and “fear,” much of which has a major negative impact on many parents seeking information on vaccinating their infants and children.

Additionally, the antivaccine group is incredibly well funded allowing them to continue to engage in their fight. This has all led to a growing number of significant outbreaks of vaccine-preventable diseases.

Dr. Paul Offit’s session “Communicating the science of vaccines to parents, the public, and the media” at the AAP 2019 National Conference provided a very insightful and comprehensive look into the current underlying reasons that drive the antivaccine movement, with “fear” rising to the top as being the most compelling factor leading to vaccine rejection.

Dr. Offit emphasized that people who are antivaccine or vaccine hesitant are compelled by different types of “fear” and that reasoning and logic play a little role in the decision to vaccinate. He pointed out that there is not much that can be done to convince true antivaccine people about the value of vaccines. However, he strongly stressed the need for practitioners to be understanding and provide guidance and education to the vaccine-hesitant group, who, in the vast majority of cases, are receptive to information and ultimately understand the value that vaccines provide.

The runaway train of the antivaccine movement has continued to rapidly gain momentum and we as a society are in grave danger of derailing much of the progress that has been made in the control of vaccine-preventable diseases. We as pediatric healthcare providers need to remain staunch advocates for the value and importance of vaccines. By providing understanding, information, and education, we can slow this movement and provide important protection to our patients.

Tina Q. Tan, MD, is professor of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and Infectious Diseases attending, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois.