Dani Garavelli: Battle for herd immunity to anti-vax lies

It was reading Philip Roth’s Nemesis a couple of years ago that first got me thinking about polio epidemics. I am old enough to remember the boy-in-calipers donation boxes that used to stand outside chemists and to have been freaked out by pictures of children trapped in iron lungs. But by the time I was born, the oral polio vaccine had already been commercially available for six years. The best thing about the vaccine was that it was dispensed on sugar cubes, a rare treat for a child of the early 70s. The last polio outbreak in the UK was later that decade and the last recorded naturally occurring case in 1984.

A polio vaccination in 1959, before the introduction of the oral vaccine in 1962. Picture: M McKeown/Express/Getty
A polio vaccination in 1959, before the introduction of the oral vaccine in 1962. Picture: M McKeown/Express/Getty

Roth, however, does a brilliant job of summoning up the terror that grips Newark one summer as the disease sweeps through its streets, picking off victims. No-one is sure how it is spread, so no-one knows what precautions to take. They scrub their houses and stop their children from going to the swimming pool. Roth evokes the heat, the fear and the impotence of finding yourself at the centre of an epidemic that shows no signs of abating.

There are just three countries left with polio: Afghanistan, Nigeria and Pakistan.

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In Pakistan, health officials have been carrying out a mass vaccination programme for many years, but have met with fierce opposition. The number of cases has been dramatically reduced – from a 21st century peak in 2014 to fewer than 10 in 2018, but this is no thanks to Islamic militants, who spread false propaganda, claiming the programmes are a plot to sterilise their children or a cover for a western spying operation.

The latter claim is based on a truth; in 2011, the CIA used a vaccination programme to try to secure information on Osama bin Laden’s whereabouts. It was a damaging move. Even so, the current scaremongering is far out of proportion to that one-off incident and is generating mass hysteria. A fortnight ago, 25,000 children were rushed to hospital after a video falsely claimed a dodgy batch of the vaccine had led to fainting and vomiting.

The anti-vaxxers haven’t confined themselves to fake news either. Since 2012, 95 polio workers have been killed, with three shot dead last week alone. Most now have police protection as they carry out their work.

Risking the resurgence of a disease that could easily be wiped out in order to perpetuate anti-western sentiment is utterly reprehensible. But such zealotry is not confined to Pakistan.

Both the US and the UK have their own bands of science-resistant MMR anti-vaxxers who spread scare stories about immunisation, impervious to the potential consequences. Their campaign, which has been going on for the best part of 20 years, has caused a widespread outbreak of measles in the United States and elsewhere. Last week, the US Centers for Disease Control and Prevention confirmed 626 individual cases of measles in 22 states, the highest number since the World Health Organisation declared the disease eliminated in the country in 2000.

The number of cases in the UK last year was 966. With half a million unvaccinated children here, health officials are warning it is only a matter of time until we too face an epidemic.

As has been oft reported, the catalyst for widespread scepticism about the safety of the vaccinations was doctor Andrew Wakefield’s “research” into the supposed links between the MMR and autism. Given his work was published in The Lancet, those who failed to immunise their children at the tail-end of the 90s had a bona fide reason to be wary. But Wakefield’s work was discredited long ago. Nowadays, those who refuse to vaccinate tend to be Trumpian types who believe they are being lied to.

Perhaps they tell themselves measles is innocuous. Certainly, it is not like polio; the majority of children do make a full recovery. But for a handful, it’s a serious condition. In the very young, the rash itself will be debilitating. And those under one or with a weakened immune system can develop complications, such as hepatitis, meningitis, encephalitis, loss of hearing or loss of vision. Contracting it while pregnant may lead to miscarriage or stillbirth.

The worst aspect of the anti-vaxxers’ campaign is that if affects even those who are passionate advocates of immunisation. So long as 95 per cent of the population is vaccinated, a community will have “herd” immunity, but the level in the UK is lower. That means those too young to have received their two doses (given at one month and three years, four months) – along with those whose parents disapprove of immunisation – are being put at risk. Last week, one mother told how her baby girl’s eyes had become so swollen, she couldn’t open them; the infant had to spend eight days in hospital.

Across the West, patience is running out with the anti-vaxxers. Why should the well-being of the many be threatened by the reckless obstinacy of the few?

In Australia, politicians have introduced a No Jab, No Pay policy which involves withholding benefits from parents who refuse to have their children vaccinated. And in Italy and parts of Spain, unvaccinated children under the age of six are being banned from schools, nurseries and day care centres.

In Pakistan, the authorities have been even more confrontational. In 2015, they arrested more than 500 parents, letting them go when they agreed to allow vaccination to proceed.

Such punitive policies are not ideal; first of all, withholding benefits or nursery places further impacts on the children, who shouldn’t suffer for the sins of their parents. Secondly, if anti-vaxxers refuse to have their children immunised because they don’t trust the state, then this aggressive approach is likely to make them more rather than less hostile.

One way to try to counter the anti-vaccine narrative has been to convince Facebook to crack down on fake posts. The social media platform has agreed to ban advertisements that include misinformation about vaccines and to diminish the reach of groups and pages that spread anti-vaccine misinformation.

It is too early to know if this will have any impact; some fear trying to silence anti-vax voices could have the opposite effect and amplify them. But at least it’s a serious attempt to change hearts and minds. With 110,000 cases of measles worldwide since 1 January and the World Health Organisation describing anti-vaccine campaigners as in the top 10 global health threats, we are on the brink of a crisis.

Unless we find some way to win back trust in mainstream medicine – to shame those parents who refuse to 
have their children immunised and to force them to take responsibility – it seems once-vanquished diseases will start claiming lives again. What would those helpless parents before the discovery of vaccination who mourned the deaths of their children make of this generation tossing away all the medical advances that could have saved their babies? It’s a slight on their suffering and on all the scientists who worked tirelessly to find a safe and effective means of prevention.