1980s. Paradigm Shift

If you ask a parent of an autistic child if they want the measles or the autism, we will stand in line for the f*cking measles.

–Jenny McCarthy, anti-vaccine activist 

1900s: Disease Eradication

1980s: Paradigm Shift

2000: Measles Elimination

2014: Disneyland Outbreak

2015: California SB 277

2015: Current Climate

Historically, the relationship between scientific advancement and public opinion has maintained a predictable cycle; new innovation spurs a frenzy of excitement and for a time the lay public is so enamored with the technology that they remain credulous and unquestioning – but only for a time.  As the shininess of the new toy wears off, skepticism – that may or may not have already existed in the scientific community – encroaches upon members of the public and mistrusting dissenters create backlash against advancements.  No different is this narrative of vaccination.

Historical Precedence of Vaccine Safety Skepticism

MAY 25 1970, JUN 24 1970 Geraldine Rozales, Elmwood School Fifth Grader, Grimaces For Injection Dr. O. G. Stonington shoots measles vaccine under skin of almost-painless jet blast. Credit: Denver Post, Inc.
MAY 25 1970, JUN 24 1970 Geraldine Rozales, Elmwood School Fifth Grader, Grimaces For Dr. O. G. Stonington shoots measles vaccine under skin of almost-painless jet blast. : Denver Post, Inc.
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Virologist John Enders led the research team that discovered the measles vaccine.

The turn of the 19th century in the United States gave rise to the creation of vaccines.  Though infections like measles, smallpox, and mumps had for centuries already been documented and categorized, no preventative medical solutions had been invented until Edward Jenner created the first smallpox vaccine in 1778.  Immunization programs were difficult to implement in that time, and yet the first immunization mandate was issued by 1809.  For the first half of the 19th century vaccination became widely accepted and incidence of smallpox dropped dramatically; however, in the 1850s some physicians and alternative healers lead a movement against vaccination, claiming it was a foreign agent to the body, illness-inducing, and unsafe. And in turn, smallpox witnessed a large resurgence in the 1870s.

Likewise, the creation of the polio vaccine by Jonas Salk in 1952 and the measles vaccine by John Enders in 1963 were hailed as remarkable discoveries – as the American public that lived in fear of the measles rash and witnessed the plight of their polio-stricken president, Franklin D. Roosevelt, embraced and sought out mass vaccination for themselves and their children. But while polio escaped the cycle of mistrusting backlash, the 1980s witnessed the trajectory of the measles narrative down that very path.


Glorified to Guilty: the Rise of the Antivaccination Movement in the United States

Vaccinations in America immediately following the invention of the vaccine were administered at incredibly high frequency.  This mass immunization of the public drove a plummet in the incidence of measles – initially.  However, grassroots movements against the vaccine arose within a few generations, as the historical trend of excitation to skepticism would predict, and this movement adopted many rationales for their aversion to immunization.

As infectious disease epidemics across the board waned and the fear of disability or death attributable to these infectious diseases digressed, the public could focus less on the disease and more on other societal problems, fiscal and political implications of vaccination programs, and the potential risks of the vaccine.  In a large way, the effectiveness of the vaccine in allowing people to be healthy enough to think of a multitude of broad scope issues and not just worry about infection-induced morbidity ironically produced a backlash of skepticism against the vaccine itself.

For example, when an individual meets essential health needs, he can pay attention and become informed of other issues such as tax policies, wars, elections, etc. that are issues that would pale in comparison on a daily basis to worrying about contracting and treating infectious disease.  The last 30 years of the 20th century, post introduction of the measles vaccine, saw the images (5)skyrocketing of government spending as the national debt increased threefold from 1980-89, the end of the Vietnam War, the invasion of Panama and Persian Gulf War, etc.  So what do these events have to do with immunization? The attention of the public eye toward negatively perceived events and actions of the government resulted in a mistrust of the government that pervaded daily life and impacted decision-making – i.e. whether to trust government-sponsored immunization programs.  This mistrust crept even further into the fiscal sphere and the public was wary of the intentions and incentives of pharmacological companies and associations, especially keeping in mind that during these decades the United States was pushing capitalism above all else in the face of communist competition with the Soviet Union, China, and South America.  While government mistrust has been an ever-present theme in US history, these sentiments – conscious or perhaps subconscious – contributed to the push back against immunization programs in this era.

Likely the most influential contribution to the rise of the antivaccination movement was the shift in concern from risk of disease to risks conferred by the vaccine itself – which is a result of the accomplishments of the vaccine in decreasing the disparity between the perceived threats of these two risks.  This phenomena in public health is called the “paradox of success;” it purports that the achievements made by a vaccine invoke strong enough feelings of protection from the severity of consequences of the disease that the risks conferred by the vaccine itself seem more pressing.  This is in part a product of lack of exposure to the disease because of the decline of incidence due to immunization.  Nonetheless, the concerns over vaccine safety would be little appeased as global problems with compromised patient safety fed the fears of many in the United States.

 

Shot Heard Around the World: Global Complications Destabilize Vaccine Approval

The push for a mass immunization plan across the United States came in 1978 with the aim of eliminating measles from within the country by 1982.  Although this goal was not met, the efforts began very promising; in 1981, cases of measles in the US had dropped by more than 80% in just one year.  So why, over 1989 to 1991, were 55,622 cases of measles reported in America alone, killing 123 individuals, 90% of which had never been vaccinated?

vaccine-japan-dropped-fb

Antivaccination movements and further testing on vaccines administered in the US were further encouraged by the witnessing of other similarly developed nations that had severe complications with adverse vaccine reactions.  In the early 1970s Sweden and Japan had complications with their use of DTP vaccine (diphtheria, tetanus, and pertussis); it was found to be ineffective – conferring a higher risk of side effects and safety risks than immunity to the infections and by 1975 this version of the vaccine was nearly obsolete.  The US caught wind of the problems occurring globally with this vaccine and in 1978 the FDA funded a study at UCLA to test the safety of the DTP vaccine – the results of which would come to degrade the confidence of the American public in vaccines.

In November 1981 Pediatrics published the conclusions of UCLA’s “Pertussis Vaccine Project: Rates, Nature, and Etiology of Adverse Reactions Associated with DPT Vaccines” which reported a greater frequency of harmful reactions to the DPT vaccine than reported in any other study. Subjects experienced in high incidence reactions of “persistent crying, episodes of convulsions, and collapse” after administration of the DPT vaccine; so harmful and severe were the effects of the vaccine that the study stopped testing on subjects after 17,000 individuals were tested, though their projected number of subjects was 50,000 individuals.

The results of the DPT complications globally resulted in a strong sentiment of mistrust among a public that had a decade before accepted vaccination with open and unquestioning arms.  To make matters worse, Japan had severe problems with their MMR (measles, mumps, and rubella) vaccine immediately after implementing a mandate for the vaccine in 1989.  Just four years later, after 1.8 million children were administered the vaccine, Japan banned the combination MMR vaccine and created three separate vaccines for measles, mumps, and rubella after the country saw rocketing cases of non-viral meningitis and even several cases of blindness, damaged hearing, and loss of control of limbs now known to be attributed to the Urabe Am9 strain of mumps used in the vaccine.

The US has yet to take the same action of separating the vaccines as the MMR vaccine used in the US uses the only strain of mumps out of four strains that does not have an established causal relationship between the strain and meningitis contraction.

Handbook on Vaccine Safety: What are the Risks?

The antivaccination movement from the turn of the 21st century to present day has very strong ties with the claims made in an article that was released in 1998 linking vaccines to autism.  Published in the British medical journal Lancet, the work of Andrew Wakefield – now touted as the figurehead of the modern antivaccination movement – proposed to find a causal relationship between vaccination and autism.  Though now disproven and retracted, this paper created an enormous fright response from the public, especially in those clusters that already were skeptical about vaccination.  Spurred by the universal access to the internet to disseminate information and the perceived ability of the lay public to find and interpret information, the modern antivaccination movement clings to these claims, despite Wakefield having had his license revoked.  For the record, the link between autism and vaccines is truly false.

Autism one

So just how safe is the MMR vaccine and how severe are the consequences of adverse reactions to immunization? Below the vaccination safety risks and side effects are reported.

What are the risks from MMR vaccine?

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions.  The risk of MMR vaccine causing serious harm, or death, is extremely small.  Getting MMR vaccine is much safer than getting measles, mumps or rubella.  Most people who get MMR vaccine do not have any serious problems with it. The American Academy of Pediatrics has published studies evaluating MMR safety: click here to read more.

Mild problems

  • Fever (up to 1 person out of 6)
  • Mild rash (about 1 person out of 20)
  • Swelling of glands in the cheeks or neck (about 1 person out of 75)

If these problems occur, it is usually within 6-14 days after the shot. They occur less often after the second dose.

Moderate problems

  • Seizure (jerking or staring) caused by fever (about 1 out of 3,000 doses)
  • Temporary pain and stiffness in the joints, mostly in teenage or adult women (up to 1 out of 4)
  • Temporary low platelet count, which can cause a bleeding disorder (about 1 out of 30,000 doses)

Severe problems (very rare)

  • Serious allergic reaction (less than 1 out of a million doses)
  • Several other severe problems have been reported after a child gets MMR vaccine, including:
    • Deafness
    • Long-term seizures, coma, or lowered consciousness
    • Permanent brain damage

These are so rare that it is hard to tell whether they are caused by the vaccine.

Move on in time to the next time period: 2000 Measles Elimination. Click Here.

 

References:

1. “Americans Want Vaccines Required amid Measles Outbreak – CNN.com.” CNN. Accessed May 16, 2015. http://www.cnn.com/2015/02/23/health/vaccine-poll/index.html.

2. “History of Vaccines — A Vaccine History Project of The College of Physicians of Philadelphia.” Accessed May 16, 2015. http://www.historyofvaccines.org/.

3. “Immunization and the Paradox of Success.” Accessed May 16, 2015. http://www.euro.who.int/en/media-centre/sections/press-releases/2008/04/immunization-and-the-paradox-of-success.

4. Omer, Saad B., Daniel A. Salmon, Walter A. Orenstein, M. Patricia deHart, and Neal Halsey. “Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases.” New England Journal of Medicine 360, no. 19 (May 7, 2009): 1981–88. doi:10.1056/NEJMsa0806477.

5. Parker, Laura, National Geographic PUBLISHED February 06, and 2015. “The Anti-Vaccine Generation: How Movement Against Shots Got Its Start.” National Geographic News. Accessed May 16, 2015. http://news.nationalgeographic.com/news/2015/02/150206-measles-vaccine-disney-outbreak-polio-health-science-infocus.

6. Poland, G. A., and R. M. Jacobson. “Understanding Those Who Do Not Understand: A Brief Review of the Anti-Vaccine Movement.” Vaccine 19, no. 17–19 (March 21, 2001): 2440–45.

7. “Why Japan Banned MMR Vaccine.” Mail Online. Accessed May 16, 2015. http://www.dailymail.co.uk/health/article-17509/Why-Japan-banned-MMR-vaccine.html.

8. “Why Japan Stopped Using MMR.” BBC, February 8, 2002, sec. Asia-Pacific. http://news.bbc.co.uk/2/hi/asia-pacific/1808316.stm.

 

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