Anti vaxx movement - Effective and metastasizing

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25 May 2022, 10:33 am

The Anti-Vaccine Movement’s New Frontier

In his 14 years of practicing medicine in Littleton, a Denver suburb, Froehlke had seen parents decline their children’s vaccines for the sake of a more “natural” lifestyle. He had also seen parents, worried about overstressing their children’s bodies, request that vaccinations be given on different schedules. But until the past nine months or so, he had rarely seen parents with already vaccinated children refuse additional vaccines. Some of these parents were even rejecting boosters of the same shots they unquestioningly accepted for their children just a few years earlier.

Froehlke estimates that he has faced around 20 such parents, maybe more: a father who said he had done his own research and sent Froehlke a ream of printouts from right-wing and anti-vaccine websites to prove it; a mother (who is a nurse) who adamantly refused routine boosters for a kindergarten-age daughter — and then later, when the child got sick with Covid-19, asked Froehlke without success to give the deworming drug ivermectin to her. The overall number of these new doubters in his practice hasn’t been large, he says, but considering it was almost zero before the pandemic, the trend is both notable and worrisome.

These parents are not uneducated, Froehlke told me. Some of them are literally rocket scientists at the nearby Lockheed Martin facility. What has happened, he suspects, is that rampant misinformation related to the Covid-19 vaccines, and the fact that pundits like Tucker Carlson on Fox News have devoted a lot of time to bashing them — among other untruths, he has suggested that the vaccines make people more likely to contract Covid-19, not less — has begun to taint some people’s view of long-established vaccines. “I think we’re going to see more of this, more spillover of persons who had previously vaccinated their children and who are now not going to vaccinate,” he says.

Such doubt has been accompanied by, and may have been augmented by, an erosion of confidence in medical expertise generally. “We used to be able to persuade more, with our background and training,” he says. Parents trusted his advice because he was a doctor. Now, when he cites the Centers for Disease Control and Prevention or other official guidelines, skeptical parents sometimes accuse him of being a shill — of having been lied to and taken in by some vast conspiracy. “It’s very concerning, this lack of trust,” he says.

Southern California; Savannah, Ga.; rural Alabama; Houston — pediatricians in all these places told me about similar experiences with parents pushing back against routine vaccines. Jason Terk, a pediatrician in Keller, Texas, called the phenomenon “the other contagion” — a new hesitation or refusal by patients to take vaccines they previously accepted. Eric Ball, a pediatrician in Orange County, Calif., said the number of children in his practice who were fully vaccinated had declined by 5 percent, compared with before the pandemic. He has been hearing more questions about established childhood vaccines — How long has it been around? Why give it? — from parents who vaccinated older children without much hesitation but are now confronted with the prospect of vaccinating babies born during the pandemic. Some of these parents end up holding off, he says, telling him they want to do more research. “There’s a lot of misinformation about the Covid vaccines, and it just bleeds into everything,” he says. “These fake stories and bad information get stuck in people’s heads, and they understandably get confused.”

In another part of Orange County, Kate Williamson reports seeing more reluctance in her pediatric practice. Though she notes that vaccine hesitancy is not new — doctors in relatively conservative Orange County, in particular, have weathered earlier anti-vaccine flare-ups — the politicization of the issue seems different this time. “I have this worry in the back of my mind — that we’re up against something that we have never seen before,” she says. “To have something that could be anti-science as part of a political identity and culture is very concerning.”

In Savannah, according to a pediatrician named Ben Spitalnick, many first-time parents have been asking questions about vaccines that he had not heard in the past. Two years of seeing the doubts about Covid vaccines expressed on social media, he thinks, is causing parents to question other science as well. He and his colleagues — like Williamson and Ball — inform parents that they should find other doctors if they choose not to vaccinate their children. And, he told me, a number of patients have indeed left his practice.

If this dynamic continues, it could threaten decades of progress in controlling infectious disease. The C.D.C. has registered a 1 percentage point drop in childhood vaccinations since the pandemic began. Ninety-four percent of American kindergartners were up to date with their vaccines in the 2020-21 school year, compared with 95 percent the previous year, meaning that not only have vaccinations in this age group fallen below the C.D.C.’s 95 percent target, but also some 35,000 fewer children were vaccinated that year. Ball, Williamson and Spitalnick estimate that the volume of skeptical questions has increased by 5 to 10 percent over the past three years. “It doesn’t sound big,” Spitalnick says. “But it’s an awful lot of babies. That could also get you below herd immunity.”

While there is a lack of data about how widespread this newfound intransigence toward vaccines is, the possibility that it may be spreading worries nearly every expert I queried. The anti-vaccine movement is “so strong, so well organized, so well funded, I doubt it will stop at Covid-19 vaccines,” says Peter Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine. “I think it’s going to extend to childhood vaccinations.”

Political affiliation may be an important factor behind what Froehlke and others are experiencing.

David Broniatowski, an associate professor at George Washington University who studies online misinformation, says that because Covid vaccines have become so charged politically, one of the largest groups in the country, white conservatives, may have also become the most susceptible to the skulduggery swirling around vaccines. “To my mind, they are a vulnerable audience that is targeted for manipulation by a pretty small number of grifters,” Broniatowski says. “It’s a crazy scenario where a dominant demographic in the country may be the most vulnerable population right now.”

In 2019, even before the pandemic struck, the World Health Organization listed growing vaccine hesitancy as one of its top 10 threats to global health. W.H.O. officials often refer to the contagion of misinformation that foments vaccine hesitancy as an “infodemic”:

Now the pandemic has given anti-vaccine advocates an opportunity to field-test a variety of messages and find new recruits. And one message in particular seems to be resonating widely: Vaccines and vaccine mandates are an attack on freedom.

Although it is convenient to refer to anti-vaccine efforts as a “movement,” there really is no single movement. Rather, disparate interests are converging on a single issue. Many reject the “anti-vaccine” label altogether, claiming instead to be “pro-vaccine choice,” “pro-safe vaccine” or “vaccine skeptical.” For some, there may be a way to make money by pushing the notion that vaccines are dangerous. For politicians and commentators, the “tyranny” of vaccine mandates can offer a political rallying cry. For states like Russia, which has disseminated both pro- and anti-vaccine messages on social media in other countries, vaccines are another target for informational warfare. For conspiracy-minded private citizens, vaccine misinformation can be a way to make sense of the world, even if the explanations they arrive at are often nightmarish and bizarre.

“This is a deadly movement,” Peter Hotez told me. “With things like terrorism and nuclear proliferation, we have lots of infrastructure. For this, we don’t have anything.”

In 1904 the U.S. Supreme Court heard the case of Henning Jacobson, a Swedish immigrant and minister who refused to comply with a vaccine mandate in Massachusetts. He had been fined $5, equivalent to about $170 today. At issue was how much control states had over residents’ bodies. It was part of a fight that stretches back to the very first vaccine mandates, in the 19th century, and the backlashes they inspired. The arguments against mandatory vaccination then were similar to those we hear now: Vaccines are dangerous; they kill children; they infringe on personal freedom. The remarkable constancy of these claims over time is due, in part, to the fact that vaccines raise legitimately complicated and enduring questions about how much autonomy any individual should surrender for the greater good and how to apportion risk between individuals and society. In Jacobson’s case, the court ultimately ruled that states did have the power to mandate vaccination when public safety was threatened — but not if individuals could show that the vaccine would harm or kill them.

In the early 20th century, as improvements in sanitation blunted the spread of many diseases, public-health authorities moved away from outright mandates to policies of persuasion. Vaccine science accelerated, too.

But that very triumph has, paradoxically, hindered the effort to counter vaccine skepticism. In the developed world, only a small portion of the population has seen the death and suffering caused by the diseases of eras past; vaccines, in the minds of many, have come to pose a greater threat than the diseases that they have helped nearly vanquish. In a sense, vaccines have become victims of their own success.

The modern iteration of the anti-vaccine movement is often traced to 1998. That February, a group of doctors and scientists held a news conference at the Royal Free Hospital in London. They had potentially incendiary findings to discuss, which were about to appear in The Lancet, a prestigious medical journal. Their paper speculatively proposed a link between the measles, mumps and rubella vaccine, the first dose of which is commonly given to children during their second year of life, and regressive autism, a mysterious condition whose prevalence seemed to be spreading. The single vaccine against the three viruses, the paper’s authors suggested, might cause an inflammatory disease of the gut, and the resulting intestinal dysfunction could affect the brain’s development. “I cannot support the continued use of the three vaccines given together,” Andrew Wakefield, the British gastroenterologist who had led the research, said. “My concerns are that one more case of this is too many.”

How did a paper with such a small sample size and an obviously weak design — a paper that was ultimately retracted — have such an outsize influence around the world? “He made news; he gave lots of press conferences,” Dorit Reiss, a professor at the University of California, Hastings College of Law, who studies vaccine policy, told me. “And the media was very supportive.” And research that could persuasively refute his contention was initially lacking, notes Daniel Salmon, the director of the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health. “It took a couple years to do studies showing that it wasn’t true,” Salmon says. “In those couple years, Wakefield traveled the world saying vaccines caused autism.”

Seven years after the notorious Lancet paper, Robert F. Kennedy Jr., son of the assassinated senator, jumped into the vaccine-autism fray. In 2005, Rolling Stone and Salon, an online publication, co-published an article by Kennedy in which he argued that thimerosal, the mercury-laden preservative used in some vaccines, was damaging children’s brains and could be driving what many had come to call the “autism epidemic.” Kennedy has said that his exploration of vaccine science that led to the article was spurred by a conversation with a mother of an autistic boy who, armed with stacks of scientific papers, persuaded him that the onset of her son’s autism coincided with his early-childhood vaccinations. He was already familiar with mercury’s toxicity from his work as an environmental lawyer.

But Kennedy’s current position has moved away from scientific claims toward an even more unsettling assertion. Vaccine mandates and government efforts to manage the pandemic, he argues, are a form of totalitarian oppression.

in2014, someone with measles, one of the most contagious viruses known to humanity, visited Disneyland in Orange County. Like the coronavirus, the measles virus spreads through the air we breathe. One hundred forty-seven people across the United States contracted the virus, some directly from that infected person, others from travelers who brought the disease home with them. (Additional cases linked to the California outbreak occurred in Canada and Mexico.) At least 45 percent were unvaccinated, according to the C.D.C.; another 43 percent had an unknown vaccination status — meaning many of them could have been unvaccinated as well. Although the available data is incomplete, as many as 20 percent of those who caught the measles ended up in the hospital.

Until then, California had allowed medical and “personal belief” exemptions to school vaccine mandates. But after what became known as the “Disneyland outbreak,” state legislators tried to address what they deemed was a source of the problem by passing a bill, called SB277, that did away with personal-belief exemptions.

That was when anti-vaccine rhetoric began to shift from the idea that vaccines harmed children toward what David Broniatowski of George Washington University calls the “don’t-tell-me-what-to-do freedom movement.” It represents the moment when what had been a mostly scientific and medical argument became a political one.

Around the same time, Renee DiResta, a researcher at the Stanford Internet Observatory, a cyber-policy center where she studies online anti-vaccine activity, started seeing what she describes as a “weird libertarian crossover”: vaccine opponents networking with Second Amendment and Tea Party activists.

These online groups, quite small in number, proved to be very adept at leveraging the viral potential of social media to make themselves seem large. Although surveys have repeatedly indicated that the great majority of parents support vaccination, these activists fostered, DiResta says, “a perception among the public that everyone was opposed to this policy.” To her dismay, some California Republican politicians adopted this new rhetoric of “parental choice,” despite the fact that SB277 had several Republican co-sponsors.

Richard Pan, a pediatrician and California state senator who was one of the two lead authors of SB277, confirms that until 2015, the discourse around vaccines was basically civil. But by the time SB277 was being debated in 2015, lawmakers began receiving death threats. Pan’s home address was posted online. Protesters showed up outside legislators’ offices. Some of them were closed when the staffs felt threatened by anti-vaccine protesters. And when Jerry Brown, then governor, signed the bill into law, the actor and comedian Jim Carrey tweeted, “This corporate fascist must be stopped.” (Carrey dated Jenny McCarthy for five years in the late 2000s.) “This is when things start getting less civil,” Pan told me.

In 2019, they got even worse. That year, the country experienced major measles outbreaks in under-vaccinated communities in Washington State, New York, California and elsewhere. The 1,282 documented cases were more than the C.D.C. had registered in a single year since 1992. The outbreaks were nearly enough to make the virus endemic again, meaning that after its eradication from the United States 19 years earlier, measles almost became re-established in the country.

In California, authorities had discovered that certain doctors were, in Pan’s words, “selling” vaccine exemptions — and they were making lots of money doing so. Pan sponsored a bill in response that would establish oversight of doctors who offered exemptions. Now what had been largely a campaign of online harassment started spilling into real life. He began hearing epithets with racial overtones — “Pol Pot,” “Chinese spy,” “Go home” — hurled his way. (Pan, who was born in the United States, is of Taiwanese descent.) Protesters shut down the Capitol building in Sacramento that September by screaming and chanting in the public gallery as the legislators debated the bill. Earlier the same week, while walking down the street, Pan was punched in the back by someone livestreaming the assault on Facebook. The bill was finally signed on Sept. 9, 2019, and a few days later, a woman threw a menstrual cup filled with what appeared to be blood on legislators, yelling “that’s for the dead babies!” According to Pan, in the entire history of the California Legislature — during which many contentious issues have been debated, from slavery to abortion to gun rights — no one had ever thrown anything at legislators. “So far, the only ones to do that are the antivaxers,” he says.

With Donald Trump’s arrival on the national political scene, the politicization of vaccines that was happening in California accelerated in the national arena. Figures like Wakefield and Kennedy reached new levels of visibility:

In January 2020, the Children’s Health Defense website received just under 84,000 monthly visits from the United States, according to the tracking firm Similarweb. As of this March, that number had reached more than 1.4 million monthly visits, a 17-fold increase in traffic. (Revenue, coming from donations and fund-raising events, was already surging before the pandemic, according to the group’s tax filings, to $6.8 million in 2020 from just under $1.1 million in 2018.)

By one measure, C.H.D.’s reach now occasionally outstrips that of bona fide news outlets.

Numerous experts told me that a good way to understand what motivates many players in the anti-vaccine movement is through the lens of profit. There are several levels of profiteering. The first involves social media companies. Historically, the algorithms that drive their platforms, some argue, have fed users more and more of what they respond to without regard for whether it’s true. “It’s not some sophisticated technology,” says Hany Farid, a professor at the University of California, Berkeley, who studies misinformation on social media. “It turns out we’re primitive jerks. And the most outrageous stuff, we click on it.”

Peter Hotez, of Baylor College of Medicine, points to the many anti-vaccine books sold on Amazon, some of them best sellers in their respective categories. Amazon, he says, is probably the largest purveyor of anti-vaccine books in the world.

picture of the world these professional vaccine agitators paint — full of conspiracies and cover-ups, with a dangerous medicine being forced on the populace — could be seen as a form of advertising. “I look at these companies and go, ‘Yeah, these are well-run marketing organizations,’” Ahmed told me. They often employ what he calls “a marketing funnel”: a net of interconnected websites that lead users down a rabbit hole until finally, somewhere, they are asked to buy something or donate money.

The movement also has mysterious benefactors. Bigtree’s Informed Consent Action Network has received significant funding from the Selz Foundation, which is controlled by the wealthy hedge-fund manager Bernard Selz and his wife, Lisa. The foundation gave ICAN nearly $1.8 million in 2018, more than two-thirds of the nonprofit’s revenue that year, according to tax filings. It’s unclear what the Selzes’ interests are — they didn’t respond to a request for comment — but through their foundation, they have also donated to a legal fund for Andrew Wakefield and to his autism-related charities.

There is no single, simple answer to why anti-vaccine rhetoric finds such fertile ground in the minds of so many. But one factor is that many vaccine-related conspiracy theories contain sprinklings of truth. The inclusion of such kernels of fact may constitute a deliberate strategy, Kolina Koltai, who studied vaccine-hesitancy as a postdoctoral researcher at the University of Washington, told me. They lend a sheen of legitimacy to the distortions around them. “Misinformation takes something that’s true and decontextualizes it,” she says. But in some cases, those kernels represent real problems that, in an ideal world, would be solved. One of these truths is that vaccines occasionally do cause frightful reactions in people.

Psychologically speaking, however, adverse events loom large in the imagination of those already fearful of vaccines. Daniel Salmon of Johns Hopkins, who was also a former head of vaccine safety in the National Vaccine Program Office, says that we could learn about how to better manage this anxiety from the way the government handles commercial plane crashes. The National Transportation Safety Board quickly investigates aviation accidents. It’s nimble, independent and, maybe above all, trusted by the public. And it spares little expense to understand why accidents occur. In part that’s because if there is even the slightest inkling that your plane might go down — and that that risk is regarded as acceptable — people will stop flying altogether and the industry will collapse. “It’s not just about preventing rare accidents,” he says. “It’s about making the public confident that things are very safe.”

But instead of feeling confident about vaccines, a growing segment of the population may be primed to feel more anxious and doubtful about them, and that doubt may be seeping into their relationship with medical science — or governmental mandates — in general. Kate Williamson, one of the pediatricians I spoke to in Orange County, told me that because vaccine skepticism has become linked with patients’ political leanings, many doctor-patient conversations are now much harder. Merely bringing up “science” at all can be interpreted as a personal attack. “Politics for a lot of people, it is an identity,” she says. “It is a culture. I feel like if I talk about science, then I’m going against their political identity.”

Eric Ball, another pediatrician in Orange County, is vice chairman of the local American Academy of Pediatrics chapter. He told me that when California passed SB276 in 2019 — which tightened the oversight of exemptions — he and his colleagues felt emboldened to push for similar legislation in other states. Today, just three years later, these same doctors are embattled. “We’re completely on the defensive,” he said. “Now we just want to hold on to what we have. I worry about what’s going to happen in the next several years and that we’ll start seeing more kids with measles and whooping cough.”

On the ground, violence related to vaccines appears to be escalating. In December, an enraged man attacked workers at a mobile vaccine clinic in Tustin, in Orange County, calling them “murderers.” It took seven police officers with tasers, aided by workers and patients, to subdue him. Late last year, another man used his car to strike a vaccine worker in Los Angeles. In Colorado, unknown assailants have tossed firecrackers into mobile vaccine tents, forcing the companies in charge to hire security. Last spring, a woman plowed her minivan through a vaccine tent in Tennessee as she shouted, “No vaccine!”

Perhaps most ominous, from a public-health perspective, is that school mandates have started to come under attack in state legislatures. Numerous states have already passed laws restricting or prohibiting mandates for the Covid-19 vaccine. And in a few, including Ohio and Pennsylvania, bills have been proposed that would weaken school vaccine mandates or even prohibit them altogether. “

None of these legislative efforts have succeeded in becoming law yet, but they highlight a broader development that’s easy to overlook. “During the pandemic, the antivax movement was able to springboard to the mainstream,” Koltai says. “I don’t think it’s that taboo anymore to be vaccine-hesitant.”

Sean O’Leary, vice chairman of the Committee on Infectious Diseases at the American Academy of Pediatrics, suspects that, hesitancy aside, we are probably in for outbreaks of vaccine-preventable diseases in the near future. Young children are undervaccinated. Polio and measles are already flaring up in some parts of the developing world, where the pandemic has stymied vaccination efforts. He worries that one of those infections will hop to the United States, where it would now find a public-health infrastructure that is stretched very thin and a combustible population of under-vaccinated bodies to burn through. “We’re potentially staring at a huge problem in the coming months to years,” O’Leary says. “Now you add in potentially more people refusing vaccines — we’re setting ourselves up for really bad outbreaks here.”

As I mentioned in another thread the fact that there are widespread COVID outbreaks among the fully vaccinated and boosted has validated anti vaxxers and created “I did my part and got sick anyway, I’m done” sentiment. This after the government promised the vaccines would create herd immunity.

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DSM 5: Autism Spectrum Disorder, DSM IV: Aspergers Moderate Severity

“My autism is not a superpower. It also isn’t some kind of god-forsaken, endless fountain of suffering inflicted on my family. It’s just part of who I am as a person”. - Sara Luterman