It has been 21 years since the British doctor Andrew Wakefield published a paper in the Lancet proposing a connection between the measles, mumps and rubella (MMR) vaccine and autism, and nine since he was struck off the UK medical register, but his discredited research is still bearing poisonous fruit. With hundreds of cases in 24 states, the US is experiencing its worst measles outbreak since 1994. Even Donald Trump, no stranger to half-assed anti-vaccine messaging, has said that children “have to get their shots”. The world’s leading measles hot spots are as far afield as Ukraine, Brazil and the Philippines, while other preventable diseases, such as polio, are resurgent elsewhere, leading the World Health Organisation to include “vaccine hesitancy” in its ten greatest threats to global health for 2019. That’s one hell of a legacy.
Opposition to vaccines is perhaps the emblematic conspiracy theory of our times. As soon as the scientific consensus refused to legitimise the “debate”, campaigners began framing themselves as heroic truth-tellers fighting to save children from a deceitful medical establishment in cahoots with Big Pharma. It is a short ride from “just asking questions” to Cranktown. After Wakefield was struck off, he headlined a rally called “The Masterplan: The Hidden Agenda for a Global Scientific Dictatorship” and built a new career fuelled by martyrdom and fear. His 2016 documentary Vaxxed: From Cover-Up to Catastrophe carried the tag-line: “the film they don’t want you to see”.
Resistance to vaccines cuts across political lines and takes root in diverse communities. US outbreaks in recent years have afflicted Orthodox Jews in Brooklyn, Somali-Americans in Minnesota, the Amish in Ohio and Russian immigrants in Washington State: all tight-knit, self-reinforcing communities that are suspicious of the state and vulnerable to groupthink. “Being a religious Jew, you get used to having a minority viewpoint,” a representative of the Hasidic community told Vox. “So if something is not mainstream, it doesn’t take you away from believing it.” Vaccine hesitancy also thrives among affluent fans of alternative medicine, who pride themselves on bucking the consensus. In Europe, the cause has been taken up by far-right populists such as Italy’s Matteo Salvini, who has called vaccines “useless, and in many cases dangerous”. Katie Hopkins, a reliable barometer of market opportunities for far-right grifters, recently jumped aboard the anti-vaccine bandwagon by combining scientific illiteracy with fuck-you libertarianism: “You know what is best for your child. Your child is not an animal. The herd is not your concern.”
Hopkins was referring to herd immunity, which requires vaccination rates of 92 to 95 per cent to take effect. In some parts of the US, where vaccination is mandatory but exemptions for religious and personal beliefs proliferate, the rate among kindergarten pupils has fallen below 50 per cent. Unlike most conspiracy theories, this one can kill. “Measles may be the disease, but all too often the real infection is misinformation, mistrust and complacency,” Henrietta Fore, executive director of Unicef, has said.
An infection needs carriers. Wakefield’s past supporters included Melanie Phillips, Oprah Winfrey, Private Eye and Rolling Stone. Most of his mainstream defenders have since fallen quiet but the internet renders them unnecessary. Facebook and YouTube have long been riddled with anti-vaxxer propaganda and pseudo-science. In February, the Guardian found that the top 12 Facebook groups returned by a search for “vaccination” were all opposed to it. Under pressure from Adam Schiff, chair of the US House intelligence committee, Facebook, Google and Amazon have taken steps to cull misinformation, while Pinterest has blocked all searches for vaccine content.
However, tech companies can’t shut down an anti-vaccine industry that extends to hundreds of websites, as well as parent hotlines, books and documentaries. These networks purport simply to provide information but have been known to harass pro-vaccine doctors, journalists and even the parents of children who have died from preventable diseases. In April a polio vaccine drive in Pakistan was suspended after staff were murdered and a clinic burned.
The problem for public health officials is that the most effective remedies for misinformation are draconian, thus feeding the paranoid mindset. Persuasion is always preferable to coercion, but that’s easier said than done. Health officials need to prove that vaccines are completely safe and find an explanation for soaring rates of autism, whereas anti-vaccine campaigners need only raise doubts. Most parents who refuse to vaccinate their children are merely worried rather than convinced, but worry is enough. It leaves believers in free speech in a bind: every time the issue is presented as a valid debate in which people can make up their own minds, the anti-vaxxers win converts. The more converts they win, the more children suffer.
Now that the anti-vaccine movement is in the news again, its story feels archetypal, all too familiar. It demonstrated the contagiousness of misinformation long before it became commonplace to talk about post-truth or echo chambers. It remains perhaps the most extreme example, bringing preventable, life-threatening diseases back from the brink of extinction. You can argue over the strength of the impact of anti-Semitic tropes or Russian trolls, but a child with measles is an indisputable fact. The tenacity of the anti-vaxx delusion, despite the considerable efforts of governments, journalists and health-care professionals, shows how hard it is to get the genie of fear and mistrust back into the bottle. Whoever can find an effective antidote to the anti-vaxxer virus will not just solve a medical crisis but a political one too.
This article appears in the 29 May 2019 issue of the New Statesman, Theresa May’s toxic legacy