This article was written by one of our contributors; doctor and researcher in women’s health Fredrika Asenius.
‘I am a yoga teacher, and so I have decided not to have myself or my children vaccinated’
A pregnant woman said this to me a few years ago, when I had just started working as a Research Doctor in the antenatal department in a London hospital. I felt too junior and too unprepared to say anything to the contrary, like being a yoga teacher myself and having had all my vaccinations, or even asking why she felt that one precluded the other. But now I read about the rise in measles outbreaks, about the Italian child whose immune system was weakened by chemotherapy and was unable to attend school out of fear of being infected with life-threatening disease from his unvaccinated classmates. And I realise that 20 years after Andrew Wakefield claimed that there might be a link between the Measles, Mumps and Rubella (MMR) vaccine and the development of autism (a claim that has since been repeatedly refuted in large scale studies (1), the conversation about the benefits and importance of vaccinations continues.
Recent figures paint a worrying picture about vaccine uptake and accompanying rates in infectious diseases across high-income countries. In the UK, uptake of the MMR vaccine is now at the lowest it has been for almost a decade, which has left more than half a million British children unvaccinated against measles, and explains why the number of measles cases almost quadrupled in England between 2017 and 2018 (2). Worldwide, between January and March this year, more than 110,000 measles cases were reported- an increase of almost 300 per cent compared to the same period last year. An estimated 110,000 people, most of them children, died from measles in 2017, a 22 per cent increase from the year before (3). It is clear that if we are to stem the ongoing rise in preventable infectious diseases, we need to act quickly.
A term you might come across in this context is herd immunity, which describes how if a high enough proportion of individuals are vaccinated against a particular disease, the disease pathogen (e.g. a virus or bacteria) will not be able to spread, effectively making the population as a whole protected from the disease. Measles, being one of the most contagious diseases known, requires a herd immunity of 89-94% (4). If measles immunisation rates fall below this number, which it is dangerously close to right now, the virus can spread rapidly, causing harm or even death in particular to those with a weak immune system, such as young babies or individuals going through cancer treatment.
The anti-vaccine movement has seen a powerful surge with the rise of social media, where unverified claims about vaccine side effects coupled with vaccine-sceptic statements from high-profile individuals, including the US president, have made it difficult to navigate through conflicting information. It is obvious that while there is widespread consensus regarding the importance and safety of vaccines within the medical and scientific community, there have been flaws in our communicating with the wider public. Perhaps the fact that we live in a world where we have little first-hand experience of the perils and pains of diseases such as tetanus and rubella has made us doctors complacent about how important it is to keep discussing the benefits and importance of vaccines. If so, we need to change that now.
Coming back to the pregnant woman I spoke to in the antenatal department, what I think she meant by choosing not to vaccinate because of being a yoga teacher, was that she was used to taking decisions about health into her own hands. That she had a more ‘holistic’ understanding of health, and was perhaps sceptical towards a healthcare system where too little emphasis is placed on lifestyle measures such as diet, exercise and stress management. If so, I could not agree more, and think this approach should, to a large extent, be celebrated. But how should I, as a health care professional, encourage this autonomy and self-care, while also advocate for vaccinations, which help to save countless lives every year?
Thus, I could not help but wonder what, if anything, would have made her reconsider?
Would it have made a difference had I gone through the science behind and the evidence for vaccines?
Would it have made a difference had I told her that if I had children, I would not hesitate to vaccinate them?
Would it have made a difference had we walked two floors up, to the neonatal unit, to see the newborns struggling for their lives in their fight against infections similar to (and sometimes the same as) those that we can vaccinate against?
Or could it simply have made a difference if I had taken the time to listen to her concerns and tried to find some common ground?
In ‘The Righteous Mind: Why Good People Are Divided by Politics and Religion’, Jonathan Haidt argues that the last option would have been the best starting point (5). That there would have been little point in me discussing figures and science before finding a human connection. Of course, vaccine sceptics are not ‘bad people’, nor do they deserve to be treated with anything but respect by the medical community. We, as healthcare professionals, need to recognise how difficult it can be to know which evidence to trust, especially when it comes to emotive topics such as caring for our children.
We, as healthcare professionals, medical researchers and well-informed citizens, also need to be present at platforms where misinformation is spread, including social media. We need to step out of our respective echo chambers and restart the conversation from a place of understanding, curiosity and respect. And let us keep our focus on the longer-term goal: the aim is to protect vulnerable individuals from catching disease that can cause severe disability or even death, not to win the odd argument.
Lastly, let us imagine the alternative headlines to those about the rise in measles outbreaks. Those that could have been had we managed to make a concerted effort to share high-quality information about the importance of immmunisations in a non-confrontational, constructive manner. ‘Measles Completely Eradicated’, ‘Massive Drop in Cases of Cervical Cancer’, and ‘Polio- a Disease of the Past’ and are not outlandish, Theranos-style ideas, but real possibilities. Let us work towards those goals. And let us make sure that as few babies as possible need to spend their first days on the neonatal unit, fighting against infections that we have every possibility to prevent.
1) Hviid A, Hansen JV, Frisch M, Melbye M. Measles, Mumps, Rubella Vaccination and Autism A Nationwide Cohort Study. Annals of Internal Medicine. 2019;170(8):513-+.
2) Public Health England. Press release: Measles outbreaks across England [Press release]. United Kingdom: Public Health England; 2019 [Available from: https://www.gov.uk/government/news/measles-outbreaks-across-england.
3) Unicef. Press Release: Over 20 million children worldwide missed out on measles vaccine annually in past 8 years, creating a pathway to current global outbreaks – UNICEF United Kingdom: Unicef; 2019 [15 May 2019]. Available from: https://www.unicef.org.uk/press-releases/over-20-million-children-worldwide-missed-out-on-measles-vaccine-annually-in-past-8-years-creating-a-pathway-to-current-global-outbreaks-unicef/.
4) World Health Organization. Measles vaccines: WHO position paper Geneva: WHO; April 2017 [15 May 2019]. Available from: https://apps.who.int/iris/bitstream/handle/10665/255149/WER9217.pdf
5) jsessionid=360E301B3B00AC22018527DA15D2469F?sequence=1.5. Haidt J. The Righteous Mind: Why Good People Are Divided by Politics and Religion: Penguin; 2012.
feature image: element 5 digital via Unsplash