Voice

The World’s Many Measles Conspiracies Are All the Same

The deadly disease is spreading rapidly around the globe, fueled by a cratering of social trust.

A nurse administers a measles vaccine to a boy in the school of Lapaivka village near the western Ukrainian city of Lviv on Feb. 21, 2019. (Yuri Dyachyshyn/AFP/Getty Images)
A nurse administers a measles vaccine to a boy in the school of Lapaivka village near the western Ukrainian city of Lviv on Feb. 21, 2019. (Yuri Dyachyshyn/AFP/Getty Images)

A French family traveled to Costa Rica for a tropical holiday, arriving on Feb. 18. Within days, the couple’s 5-year-old son had a high fever, and his body was covered in a rash of red splotches characteristic of measles. The Costa Rican Ministry of Health went into overdrive. Passengers from the family’s flight were tracked down and examined, the child and his parents were placed in quarantine for seven days, and alerts were issued to physicians and the national population warning them to watch for symptoms akin to measles to ensure that the French child’s illness did not endanger the lives of anyone else.

It was a national emergency—and an entirely unnecessary one. Measles is remarkably contagious—at least 8 times more so than, for example, the flu. Individuals can carry and spread measles without showing any symptoms of illness, and most people don’t develop a rash, run a fever or cough, or have a sore throat until they’ve been infected for two weeks, thanks to a long measles incubation period. But, without exception, rates of measles contraction have plummeted worldwide whenever an appropriate vaccine has been put to use.

The unvaccinated French travelers, however, reflect a growing trend across Europe, where refusing immunization has become mainstream. As a result, last year Europe recorded more cases of measles than at any time in the last 20 years, with nearly 83,000 confirmed cases and 72 deaths. Worldwide measles incidence jumped 50 percent in 2018, according to the World Health Organization (WHO), prompting the agency to declare vaccine refusal one of the 10 greatest challenges to global health in 2019.

But it’s not just Europe. Measles is surging, crossing borders all over the world, as immunization rates drop. And the reason why is simple to sum up: trust—or rather, a lack of it. Overall in 2017, the most recent year for which global death tolls are tallied, more than 109,000 people died of measles, most having either never been vaccinated or only received their first shots, not their boosters. Measles has become the barometer of trust, or the lack thereof, in the post-truth world.

Vaccination isn’t just an individual choice; it’s a social contract entered into by the public and its government. The public trusts that the government will provide vaccines, render them affordable to the entire population, ensure their safety and efficacy, and promote their use. In return, the government trusts that the citizenry and medical providers will comply and get immunized properly not only to protect themselves and their children but for the sake of the entire society and the herd immunity that prevents diseases from spreading.

When governments fail to fulfill their side of the social contract, not providing vaccines to the population in an appropriate and affordable manner, outbreaks soon follow. Since September 2018, for example, Madagascar has had an out-of-control measles epidemic, causing nearly 83,000 cases and almost 1,000 deaths. The government has never provided equitable access to vaccines, which are unaffordable to its largely poor population, and it has had its hands full with other disasters over the last 12 months, including a plague epidemic, two major cyclones that destroyed the homes of 70,000 people, and a prolonged drought that has nearly half a million people living without safe water, sanitation, or washing facilities. A weak and contested government has struggled to meet population needs, across the board.

Another government failing to hold up its end of the social contract is Venezuela, which, under the leadership of President Nicolás Maduro, has spiraled into economic and political chaos. Measles was the first health indicator signaling that the nation’s public health system had collapsed, as cases and deaths began surging in 2017, reaching 6,500 diagnosed cases and an estimated total of nearly 10,000 by the end of February 2019. This was closely followed by rising malaria and diphtheria, which totaled 238 deaths by the end of 2018. Careful retrospective analysis found that Venezuela’s infant mortality rate started climbing in 2016 and now has fully reversed gains made in the 21st century.

In the Philippines, the government of Rodrigo Duterte is struggling to control a measles epidemic that has sickened more than 15,000 people this year, killing 238. Measles vaccination rates have plummeted, to just 55 percent, leaving 2.5 million children unprotected, thanks to loss of trust in the government’s services in the wake of an experimental dengue vaccine scandal in 2017. The dengue vaccine, Dengvaxia, manufactured by the French pharmaceutical company Sanofi, was used widely and heavily promoted by the government but blamed for the deaths of at least three children. The Duterte government denounced Sanofi and demanded restitution for lives lost, but the damage to trust has been irreparable, as Filipinos now widely believe all vaccines to be dangerous.

Most vaccine refusal worldwide goes hand in hand with public distrust in government. The nature of the anti-vaccination fury differs from one place to another and even within communities. False rumors that pig tissues might have been used in the production of a vaccine are enough to bring parental acceptance to a halt in Muslim countries. Since 2001, the rate of vaccine refusal in the United States has climbed fourfold. Declining to vaccinate their children, parents cite everything from excessive drug company profits and hidden mercury contamination to fear of their youngsters developing autism and general opposition to being told by the government to have their children poked with needles. Some dog owners even refuse to have their pets vaccinated, fearing they will have an autistic pooch on their hands.

Since the earliest 18th-century days of smallpox vacuolization—a crude form of immunization that preceded vaccine invention—there have been opponents and refuseniks. Many religious groups in the United States, such as the Amish, some Orthodox Jewish sects, and Christian Scientists, have long opposed vaccination. New York is currently in the grips of a measles outbreak, now totaling 133 cases, spreading primarily within a Hassidic Jewish community that rejects vaccines. Japan is also battling a measles epidemic, with 167 cases as of Feb. 10; nearly a third of those cases stemmed from the Miroku Community Kyusei Shinkyo, a religious group that opposed many aspects of modern medicine. (The group has issued an apology, vowing to cease opposition to vaccination.)

But the global anti-vaccination movement that predominantly confronts public health advocates today is dominated by highly educated, typically well-heeled individuals, such as the wealthiest residents of posh West Los Angeles communities like Santa Monica, Brentwood, and Beverly Hills, where rates of child vaccination are as low as those seen in civil war-torn South Sudan. Or consider the residents of Clark County, Washington, where only 78 percent of children are fully immunized. Thousands of parents have taken advantage of a state law allowing “philosophical or personal objection to the immunization of the child.” Clark County has had 70 confirmed measles cases this year, prompting the governor of Washington to declare a public health emergency and the state legislature to now consider a bill that would eliminate philosophical objections as grounds for refusing vaccination.

Among the affluent and poorly vaccinated Silicon Valley crowd, an absolutely false myth keeps employees of Amazon, Microsoft, Google, and the like from immunizing their children: that the measles vaccine causes autism. A newly published study of 657,461 children born in Denmark from 1999 to 2010, with follow-up through late 2013, found that the vaccine “does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination.” The Danish study is merely the latest of a long list of research efforts that, according to the American Academy of Pediatrics, “find vaccines to be a safe and effective way to prevent serious disease.”

Meanwhile, in Portland, Oregon, the Russian émigré community exhibits a high level of vaccine skepticism. According to the American Public Health Association (APHA), Russian-language media and social media trolls operating out of Russia actively promote hysterical claims about contamination and harm from vaccines. The APHA study found that Russian trolls recognized that vaccine concerns offered a wedge issue that could be exploited to sow anti-government feelings, concluding, “Whereas bots that spread malware and unsolicited content disseminated antivaccine messages, Russian trolls promoted discord. Accounts masquerading as legitimate users create false equivalency, eroding public consensus on vaccination.” Some of the trolls have found their way into Facebook, Pinterest, Amazon, Instagram, and Reddit discussions in the United States. A recent survey in the United Kingdom found that half of all new parents had visited online anti-vaccination websites.

It’s no coincidence that the largest European measles outbreaks today are in Ukraine and countries formerly part of the Warsaw Pact, including Romania and the Czech Republic. Last year, Ukraine had more than 54,000 diagnosed cases of measles, with 16 deaths; by Feb. 1, another 15,000 cases and seven deaths were reported, making the current epidemic the largest the country has experienced since the 1960s Soviet introduction of measles immunization. According to UNICEF, the Ukrainian outbreak is driven by false safety claims about vaccines, and Russian troll disinformation has played a role, in a country where ongoing military clashes between Moscow-aligned and Ukrainian forces has bankrupted public health services. In Eastern Europe, suspicions extend to doctors themselves—36 percent of general practitioners surveyed in the Czech Republic and 25 percent in Slovakia believe the measles vaccine is unsafe.

There is a strong link between the rise of populism and anti-vaccination sentiments. France’s National Rally party and Italy’s Five Star Movement-League coalition government both oppose vaccines. League leader Matteo Salvini, Italy’s interior minister, lifted all vaccine requirements last year, arguing that immunization was “useless and in many cases dangerous, if not harmful.” Walter Ricciardi resigned from his position as the head of Italy’s National Institute of Health in protest of Salvini’s policy. One study has shown that vaccine refusal started climbing following the 2010 financial crisis in Europe and imposition of austerity programs in Italy. Opposition was fueled by Five Star-League messaging, casting doubt on the authenticity of science, public health, and global forces such as WHO.

While Italy’s populist movement is most tightly linked to anti-vaccination sentiments, across Europe right-wing parties are exploiting popular suspicion of pharmaceutical profits and antipathy toward governments to sow discord. In the United States, Republican politicians, including President Donald Trump, have voiced opposition to mandatory vaccination and insisted that government agencies are hiding data that allegedly proves immunization causes such health issues as autism and brain damage.

There is no good reason that immunization should be a partisan issue, but in the United States, it increasingly is. For example, in Arizona, Republican state Rep. Kelly Townsend has tapped into widespread sentiments that the imposition of compulsory vaccination undermines liberty. Coupling this with her party’s new concerns about “socialism” in the Democratic Party, Townsend says the promotion of vaccination to attain herd immunity means forcing “someone to give up their liberty for the sake of the collective … [and that] is not based on American values but rather, communist.” Darla Shine, the wife of White House communications director Bill Shine, has repeatedly in recent weeks tweeted her belief that vaccines are dangerous and the diseases they aim to prevent are actually “healthy.” “Come breathe on me!” she wrote, claiming a case of measles could give a person lifelong protection against cancer. The alleged cancer curative role of measles is promoted all over the internet, falsely drawing from a Mayo Clinic study that used genetically altered measles viruses to carry treatment into cancer cells. In Texas, Republicans in the state legislature are trying to further ease the already lax vaccination rules for schoolchildren, taking cues from state Rep. Bill Zedler, who says there’s nothing to worry about if measles spreads—because “with antibiotics and that kind of stuff, they’re not dying in America.” (Antibiotics, of course, only treat bacterial infections, and measles is a virus.)

The stakes are rising, as anti-vaccination messaging reaches poorer parts of the world. A wealthy kid in Beverly Hills or Knightsbridge, London, may muddle through and survive life unvaccinated. But that youngster’s counterpart in Timbuktu, Mali, or Huehuetenango, Guatemala, faces a serious death risk if left unprotected against measles. While people in rich countries fret about so-called unsafe vaccines, vaccinators in many poor countries risk their lives to dodge Taliban assassins, Himalayan avalanches, guerrilla fighters in Central Africa, or Amazon floods to bring vaccines to the world’s remote poor. The anti-vaccination movement is, at its heart, based on privilege. As Texas state Rep. Zedler put it, “They want to say people are dying of measles. … Yeah, in Third World countries they’re dying of measles.” But not in the Lone Star State.

Unfortunately, there is no simple recipe for cooking up bonds of trust amid a broken social contract. Public health leaders and pediatricians are hard-pressed to counter anti-vaccination messaging that is tied to larger political, religious, and cultural divisions and suspicions. Once the obligations of herd immunity are cast aside, the individual trumps the needs of the community. And once the one is more important than the us or all, it’s very hard to reverse that equation.

Laurie Garrett is a former senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer.

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