An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All | Magazine

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This isn’t a religious dispute, like the debate over creationism and intelligent design. It’s a challenge to traditional science that crosses party, class, and religious lines. It is partly a reaction to Big Pharma’s blunders and PR missteps, from Vioxx to illegal marketing ploys, which have encouraged a distrust of experts. It is also, ironically, a product of the era of instant communication and easy access to information. The doubters and deniers are empowered by the Internet (online, nobody knows you’re not a doctor) and helped by the mainstream media, which has an interest in pumping up bad science to create a “debate” where there should be none.

In the center of the fray is Paul Offit. “People describe me as a vaccine advocate,” he says. “I see myself as a science advocate.” But in this battle — and make no mistake, he says, it’s a pitched and heated battle — “science alone isn’t enough … People are getting hurt. The parent who reads what Jenny McCarthy says and thinks, ‘Well, maybe I shouldn’t get this vaccine,’ and their child dies of Hib meningitis,” he says, shaking his head. “It’s such a fundamental failure on our part that we haven’t convinced that parent.”

Consider: In certain parts of the US, vaccination rates have dropped so low that occurrences of some children’s diseases are approaching pre-vaccine levels for the first time ever. And the number of people who choose not to vaccinate their children (so-called philosophical exemptions are available in about 20 states, including Pennsylvania, Texas, and much of the West) continues to rise. In states where such opting out is allowed, 2.6 percent of parents did so last year, up from 1 percent in 1991, according to the CDC. In some communities, like California’s affluent Marin County, just north of San Francisco, non-vaccination rates are approaching 6 percent (counterintuitively, higher rates of non-vaccination often correspond with higher levels of education and wealth).

That may not sound like much, but a recent study by the Los Angeles Times indicates that the impact can be devastating. The Times found that even though only about 2 percent of California’s kindergartners are unvaccinated (10,000 kids, or about twice the number as in 1997), they tend to be clustered, disproportionately increasing the risk of an outbreak of such largely eradicated diseases as measles, mumps, and pertussis (whooping cough). The clustering means almost 10 percent of elementary schools statewide may already be at risk.

The rejection of hard-won knowledge is by no means a new phenomenon. In 1905, French mathematician and scientist Henri Poincaré said that the willingness to embrace pseudo-science flourished because people “know how cruel the truth often is, and we wonder whether illusion is not more consoling.” Decades later, the astronomer Carl Sagan reached a similar conclusion: Science loses ground to pseudo-science because the latter seems to offer more comfort. “A great many of these belief systems address real human needs that are not being met by our society,” Sagan wrote of certain Americans’ embrace of reincarnation, channeling, and extraterrestrials. “There are unsatisfied medical needs, spiritual needs, and needs for communion with the rest of the human community.”

Looking back over human history, rationality has been the anomaly. Being rational takes work, education, and a sober determination to avoid making hasty inferences, even when they appear to make perfect sense. Much like infectious diseases themselves — beaten back by decades of effort to vaccinate the populace — the irrational lingers just below the surface, waiting for us to let down our guard.

Before smallpox was eradicated with a vaccine, it killed an estimated 500 million people. And just 60 years ago, polio paralyzed 16,000 Americans every year, while rubella caused birth defects and mental retardation in as many as 20,000 newborns. Measles infected 4 million children, killing 3,000 annually, and a bacterium called Haemophilus influenzae type b caused Hib meningitis in more than 15,000 children, leaving many with permanent brain damage. Infant mortality and abbreviated life spans — now regarded as a third world problem — were a first world reality.

Today, because the looming risk of childhood death is out of sight, it is also largely out of mind, leading a growing number of Americans to worry about what is in fact a much lesser risk: the ill effects of vaccines. If your newborn gets pertussis, for example, there is a 1 percent chance that the baby will die of pulmonary hypertension or other complications. The risk of dying from the pertussis vaccine, by contrast, is practically nonexistent — in fact, no study has linked DTaP (the three-in-one immunization that protects against diphtheria, tetanus, and pertussis) to death in children. Nobody in the pro-vaccine camp asserts that vaccines are risk-free, but the risks are minute in comparison to the alternative.

But the underlying argument has not changed: Vaccines harm America’s children, and doctors like Paul Offit are paid shills of the drug industry.

To be clear, there is no credible evidence to indicate that any of this is true. None. Twelve epidemiological studies have found no data that links the MMR (measles/mumps/rubella) vaccine to autism; six studies have found no trace of an association between thimerosal (a preservative containing ethylmercury that has largely been removed from vaccines since 20011) and autism, and three other studies have found no indication that thimerosal causes even subtle neurological problems. The so-called epidemic, researchers assert, is the result of improved diagnosis, which has identified as autistic many kids who once might have been labeled mentally retarded or just plain slow. In fact, the growing body of science indicates that the autistic spectrum — which may well turn out to encompass several discrete conditions — may largely be genetic in origin. In April, the journal Nature published two studies that analyzed the genes of almost 10,000 people and identified a common genetic variant present in approximately 65 percent of autistic children.

But that hasn’t stopped as many as one in four Americans from believing vaccines can poison kids, according to a 2008 survey. And outreach by grassroots organizations like Autism One is a big reason why.

In the wake of the latest thimerosal studies, most of the anti-vaccination crowd — even Autism One, despite the ever-changing rhetoric on its Web site — has shifted their aim away from any particular vaccine to a broader, fuzzier target: the sheer number of vaccines that are recommended. It sounds, after all, like common sense. There must be something risky about giving too many vaccines to very young children in too short a time. Opponents argue that for some children the current vaccine schedule creates a “toxic overload.”

Paul Offit has a slightly nasal voice and a forceful delivery that conspire to make him sound remarkably like Hawkeye Pierce, the cantankerous doctor played by Alan Alda on the TV series M*A*S*H. As a young man, Offit was a big fan of the show (though he felt then, and does now, that Hawkeye was “much cooler than me”). Offit is quick-witted, funny, and — despite a generally mild-mannered mien — sometimes so assertive as to seem brash. “Scientists, bound only by reason, are society’s true anarchists,” he has written — and he clearly sees himself as one. “Kaflooey theories” make him crazy, especially if they catch on. Fisher, who has long been the media’s go-to interview for what some in the autism arena call “parents rights,” makes him particularly nuts, as in “You just want to scream.” The reason? “She lies,” he says flatly.

“Barbara Loe Fisher inflames people against me. And wrongly. I’m in this for the same reason she is. I care about kids. Does she think Merck is paying me to speak about vaccines? Is that the logic?” he asks, exasperated. (Merck is doing no such thing). But when it comes to mandating vaccinations, Offit says, Fisher is right about him: He is an adamant supporter.

“We have seat belt rules,” he says. “Seat belts save lives. There was never a question about that. The data was absolutely clear. But people didn’t use them until they were required to use them.” Furthermore, the decision not to buckle up endangers only you. “Unless you fly through the window and hit somebody else,” he adds. “I believe in mandates. I do.”

Despite his reputation, Offit has occasionally met a vaccine he doesn’t like. In 2002, when he was still a member of the CDC’s advisory committee, the Bush administration was lobbying for a program to give the smallpox vaccine to tens of thousands of Americans. Fear of bioterrorism was rampant, and everyone voted in favor — everyone except Offit. The reason: He feared people would die. And he didn’t keep quiet about his reservations, making appearances on 60 Minutes II and The NewsHour with Jim Lehrer.

The problem with the vaccine, he said, is that “one in every million people who gets it dies.” Moreover, he said, because smallpox is visible when its victims are contagious (it is marked by open sores), outbreaks — if there ever were any — could be quickly contained, and there would be plenty of time to begin vaccinations then. A preventive vaccine, he said, “was a greater risk than the risk of smallpox.”

Ah, risk. It is the idea that fuels the anti-vaccine movement — that parents should be allowed to opt out, because it is their right to evaluate risk for their own children. It is also the idea that underlies the CDC’s vaccination schedule — that the risk to public health is too great to allow individuals, one by one, to make decisions that will impact their communities. (The concept of herd immunity is key here: It holds that, in diseases passed from person to person, it is more difficult to maintain a chain of infection when large numbers of a population are immune.)

The Journal of Infectious Diseases, looking at 3,292 cases of measles in the Netherlands, found that the risk of contracting the disease was lower if you were completely unvaccinated and living in a highly vaccinated community than if you were completely vaccinated and living in a relatively unvaccinated community. Why? Because vaccines don’t always take. What does that mean? You can’t minimize your individual risk unless your herd, your friends and neighbors, also buy in.

A while back, Offit was asked to help put together a reference text on vaccines. Specifically, his colleagues wanted him to write a chapter that assessed the capacity of the human immune system. It was a hypothetical exercise: What was the maximum number of vaccines that a person could handle? The point was to arm doctors with information that could reassure parents. Offit set out to determine two factors: how many B cells, which make antibodies, a person has in a milliliter of blood and how many different epitopes, the part of a bacterium or virus that is recognized by the immune system, there are in a vaccine. Then, he came up with a rough estimate: a person could handle 100,000 vaccines — or up to 10,000 vaccines at once. Currently the most vaccines children receive at any one time is five.

He also published his findings in Pediatrics. Soon, the number was attached to Offit like a scarlet letter. “The 100,000 number makes me sound like a madman. Because that’s the image: 100,000 shots sticking out of you. It’s an awful image,” Offit says. “Many people — including people who are on my side — have criticized me for that. But I was naive. In that article, I was being asked the question and that is the answer to the question.”

In 19th-century England, he explains, Jenner’s smallpox vaccine was known to be effective. But despite the Compulsory Vaccination Act of 1853, many people still refused to take it, and thousands died unnecessarily. “That was the birth of the anti-vaccine movement,” he says, adding that then — as now — those at the forefront “were great at mass marketing. It was a print-oriented society. They were great pamphleteers. And by the 1890s, they had driven immunization rates down to the 20 percent range.”

Immediately, smallpox took off again in England and Wales, killing 1,455 in 1893. Ireland and Scotland, by contrast, “didn’t have any anti-vaccine movement and had very high immunization rates and very little incidence of smallpox disease and death,” he says, taking a breath. “You’d like to think we would learn.”

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