The measles is back – everyone has probably heard of it. In recent years, people opposed to vaccination have managed to generate fear and have even had supporters elected to parliament in a number of countries. How did they do it?
Alternatives to vaccines? Working on emotions, bleach and natural food. Together with journalists from Poland’s Gazeta Wyborcza, France’s Le Figaro, Spain’s El Pais and Belgium’s Le Soir, we examine what the epidemiological situation in Europe looks like and who is inspiring the nonsense of anti-vaccination among us.
• Trust in vaccinations has decreased.
• Resistance levels in populations have fallen; diseases are coming back.
• The anti-vaccination crisis has to be passed through in the same way as a childhood disease.
Measles is an illness for which humanity has had an effective vaccine for five decades. But in 2018, nearly 9 million people developed measles world-wide, and 142,000 died. On average, almost 400 people die every day, most of them children. In a recent statement, the WHO warned that the number of cases will be three times higher this year. In Europe, 12,000 people fell ill in 2019. In most countries, the level of vaccination among children is below 95%, the level at which the safety limit has been set.
“False information disseminated through social media really affects parents’ decisions about whether they are going to vaccinate their children,” says Dr Kate O’Brien, director WHO vaccination, vaccines and biological medicines. The result, she adds, is that “children are suffering from measles and some of them are dying.”
Not just a rash. What is the danger from measles?
The disease begins with a high fever, runny nose and white spots on the mucosa. A few days later, a rash develops from the face and neck, which then gradually spreads downwards. A person who has not previously had measles and has not been vaccinated will be infected with a probability of about 98% if they come into contact with the virus, which spreads easily through the air.
Measles usually lasts 10-14 days. The list of complications includes blindness, oedema and encephalitis, severe diarrhoea, respiratory tract infections and pneumonia. WHO representatives emphasise that developing measles can harm the immune system’s memory for months or even years after the infection, which affects susceptibility to other serious illnesses.
It started with a scam.
In 1998, Andrew Wakefield published the results of his research on children in the medical journal The Lancet. Scientists usually study hundreds of thousands of cases but Wakefield examined only 12 of them. In eight of the cases he found a new syndrome combining colitis with autism. The children became ill because they were attacked by the measles virus from the MMR vaccine.
This had begun with the fact that in 1995, Andrew Wakefield of the Royal Free Medical School in London, then an unknown surgeon specialising in the digestive system and without a contract with any hospital, sought evidence to confirm his latest theory, the relationship between Crohn’s disease and the measles virus.
The presence of this germ in the intestinal walls or in body fluids (blood, lymph, spinal fluid) was supposed to be an important diagnostic test for Crohn’s disease. But where would the measles virus be found in the patient’s body? From the triple MMR vaccine. Wakefield theorised that this vaccine triggers the formation of a secretive protein in the gut that damages the brain, causing autism. No such protein has ever been discovered.
The previous year, JABS was established in the United Kingdom, an organisation created by a group of parents who believed that the MMR vaccine had caused brain damage in their children. After a few months of work, Andrew Wakefield made the worst possible choice – he started taking money from a lawyer who represented JABS.
Wakefield was to prove that the MMR vaccine did indeed harm their children. It was with JABS that Wakefield had the first of his patient, the famous Boy No. 2, who became the flagship example of the validity of his theory. The boy had autistic disorders and trouble with diarrhoea. The mother assumed that the child had been harmed by the vaccine he received at the age of six.
“My boy cried all night and banged his head, hitting the bed rungs. He didn’t do anything similar before vaccination,” the mother told reporters. At the time, however, she claimed that her son had started acting this way several months after vaccination.
So Wakefield was lying when he wrote in his Lancet article that all children who had the “new syndrome” had their first symptoms of the illness, not on average after a few months, but six days after vaccination.
There turned out to be other, similar, distortions. Nine out of the twelve children were supposed to have symptoms of regressive autism, but only one of them was definitely ill. Wakefield claimed that each of the children before the vaccine was “normal”. But patients identified as Number 4 and Number 8 had neurological problems causing developmental delays which had already been confirmed by doctors. In addition, one boy (Number 4) was given the MMR vaccine, unlike the usual toddler of around 15-18 months, only at the age of four. The doctors treating him were worried about the child’s appearance (facial deformity), recurrent diarrhoea and speech disorders. Altogether five children of the twelve had not developed normally before vaccination.
There was money in the background. Wakefield wanted to make money from Crohn’s tests, based on detecting the presence of the measles virus.
There were many more links with non-transparent financing and the sponsors of Wakefield’s research. Money for research from a JABS lawyer was passed through charity “Special Trustees” and returned to Wakefield in the shape of a grant of GBP 50,000.
When a media storm broke and the results of the study were questioned, Wakefield still defended himself and said that the triple vaccine should be abandoned in favour of a single measles preparation which he himself would produce.
In 2010, Wakefield was struck off the medical register and stripped of the right to practice for the rest of his life.
But the rumours about the association of autism disorders with vaccinations spread around the world, causing the development of anti-vaccination movements.
Although Louis Pasteur, the father of the rabies vaccine, was French, his is one of the countries where people are most suspicious of vaccinations. A study conducted in June 2019 found that one of every three people in France thought vaccines were unsafe.
The anti-vaccine arguments in France are based on several well-known themes repeated in many languages around the world. First, it is believed that the progress of hygiene is sufficient to eliminate disease, and the likelihood of contracting viral diseases is very low compared to the risks of vaccination. As everywhere, opponents of vaccination ignore the data that shows the very opposite. In 2008–14, 23,000 cases of measles were recorded in France, resulting in more than 30 cases of encephalitis and 10 deaths. Anti-vaxxers also warn that too much strain is harmful to children’s immune system, and that the innate immune system is sufficient for protection. They do not mention, however, that antibodies transmitted through breastfeeding are insufficient to protect against diseases such as whooping cough or measles. In addition, they only work in the first weeks of feeding an infant.
Another argument – vaccines can cause sudden infant death. The sudden death of babies, or cot death, remains a very mysterious phenomenon without identifiable causes. The reduction of risk can be affected by proper positioning of children going to sleep and not smoking cigarettes around them. And in France, they have also not forgotten about The Lancet article and link vaccination with autism. What is left unsaid, however, is that 10 out of 12 authors withdrew their signature in 2004, arguing that the data was insufficient to prove anything. And in 2010, it turned out that the head of the study had received money from lawyers engaged in litigation with the manufacturers of the vaccine.
In an interview with Le Figaro, Jocelyn Raude, a French sociologist who has studied anti-vaccine movements, discerns three main currents: those related to the extreme-right and extreme-left political movements, which are close to conspiracy theories, and supporters of alternative therapies.
Lucie Guimier, who wrote a dissertation on the geographical aspects of reluctance to vaccinate, explains that, for example, in Ardèche, in the south of France, the reluctance to vaccinate is associated with history. Resistance was an important element in local history: first with the movement to Protestantism in the sixteenth century, and then with the partisan movement during World War Two. In addition, many people escaped there from a consumer society in the 1960s.
What do parents do to avoid vaccinating their children:
– Some people want to postpone vaccinations until the children reach two years of age, so they delay visits to doctors, or deliberately forget to bring the child’s health booklet;
– Others find amenable doctors who agree to sign a contra-indication certificate. This course should be reserved for highly specific cases, for example severe allergies and auto-immune diseases. This dodge can, however, end tragically. In 2015, a boy who had been issued with a false certificate by a doctor fell ill with tetanus. The doctor was struck off.
– There are also parents who choose home education to avoid questions being asked about vaccinating their children.
In France, seven vaccines for ten different diseases are compulsory for children born after January 1, 2018.
Vaccination certificates, recorded in the health booklet, which each child receives after birth, must be presented when parents want to register their children in school or nursery school. If children are not vaccinated, they can be admitted, but vaccines must be brought up to date within three months.
These regulations stirred up anti-vaxxer movements and led to another mobilisation through social media in early 2018. To counteract this movement, the Ministry of Health launched a campaign of its own. It reiterates that vaccines are safe and that other individuals, people who cannot be vaccinated (children under 3 months, sick children …), have to be protected and epidemics which were once quite deadly have to be stopped.
In Belgium, the “Initiative Citoyenne” civic movement, formed during the A/H1N1 influenza pandemic, has been operating for ten years. This virus is a mutated version of the swine flu. The epidemic began in April 2009 in Mexico, and in June the WHO declared the highest level of epidemiological risk for the whole world. As many as 400,000 people could have died directly from the virus people, and tens of thousands more die from complications.
One of IC’s successes is the detection of an agreement between the Belgian Government and the pharmaceutical company GSK to purchase 12 million doses of the A/H1N1 virus vaccine for EUR 110 million without a public tender.
In Belgium, only the polio vaccine is compulsory. Recent debates on vaccination have focused, as elsewhere, on measles and its complete elimination in the country by 2020. In 2019, Belgium had 257 cases of measles, three times more than in 2018.
The coordinator of the Aviq (Walloon Agency for Quality of Life) cell for surveillance of infectious diseases, Dr Carole Schirvel, estimates that anti-vaccination movements are “marginal” in Belgium and says “our vaccination programmes work quite well”. Dr Schirvel adds that the lowest immunity rates are found among young adults aged between the ages of thirty and forty – these are people who did not benefit from the vaccination programmes introduced in 1985. The coverage of the first dose of measles vaccine is 96%.
For the second dose, the rate is lower in Brussels and Wallonia, at 75%, while in Flanders it is 90%. Flemish people are much more influenced by preventive messages than French-speaking Belgians.
Initiative Citoyenne relies on voluntary donations from its supporters. It has 3,600 users on Facebook and is followed by 377 people on Twitter.
Research conducted in 2015 shows that Spanish parents who do not vaccinating their children explain this is for fear of side effects, autism and the fact that pharmaceutical businesses promote unnecessary treatments only for profit. As an alternative, they support the body with homeopathy and acupuncture and natural food.
The most active anti-vaccination movement in Spain is Discovery Salud, which it has 36,000 users on Facebook. The organisation publishes a magazine in which primarily recommends alternative methods of treatment. In the December issue, for example, it tells readers that malignant tumours can be cured by diet, and, in the November issue, recommended saffron as an effective remedy for cancer. Josep Pàmies, a gardener and phytotherapist who is fighting to include alternative medicine in the public health service frequently figures in the magazine. Other actors on this stage are Andreas Kalcker, who claims to be a biologist and promotes the use of Chlorine Dioxide, industrial bleach and disinfectant as a medicine.
A very fashionable trend in Spain recently has been the so-called “Bioneuroemoción” theory of Enrico Corbera, according to which diseases have nothing to do with infections or pathogens, but rather with emotions. Treatment consists of pseudo-psychological sessions. Corbera takes charges EUR 90 for a ninety-minute session.
The presence of anti-vaccination movements in the Spanish media is, however, slight. Since the Socialist Party came to power in 2018, it has launched intense awareness campaigns against pseudo-therapies, including anti-vaxxer arguments. The Ministry of Health, Consumer Affairs and Social Welfare announced a campaign in April 2019, with the slogan “Vaccine V” (“vida” is the Spanish word for “life”). The aim was to provide information on the benefits of vaccines and to respond to misinformation on this topic.
The flagship organisation fighting for voluntary vaccinations in Poland is STOP NOP. They do not let themselves be called “anti-vaccination”, they are officially called the National Association for the Knowledge of Vaccination.
STOP NOP drew attention to itself in October 2019 because of an appeal case in which they suggested that doctors kill patients in intensive care units by giving them morphine. The Ministry of Health notified the prosecutor’s office of a suspected crime. Justyna Socha, the head of the association, has already lost two cases regarding the defamation of doctors.
Meanwhile, STOP NOP is again encouraging the collection of signatures for a draft bill on “safe vaccination” on its website. Another of their bills submitted to the lower house of parliament, the Sejm, in the previous parliamentary term was rejected. At that time they did even have a parliamentary team which represented their interests, but there is no such team now. Nor did any of the anti-vaccine activists whom politicians from the nationalist “Confederation” group included on their party’s electoral lists get elected to the Sejm. In order for their bill to be submitted to the Sejm, they must collect 100,000 supporting signatures.
Local authorities see the problem. The Warsaw authorities, for example, recently decided that only vaccinated children could be admitted to public nurseries. A similar proposal has been made in Wrocław and Poznań is also trying to do the same. STOP NOP has over 133,000 followers on Facebook.
Vaccination history and the background of vaccination movements
Vaccination history begins with seeking protection for smallpox. In the tenth century (AD/CE), scabs of patients suffering from black pox were rubbed into the mucus, and in India clothes were worn after the sick, and so the pathogens were given in small doses. In the seventeenth century, the Turks learned varialisation from the Chinese. In the Ottoman Empire, it was no longer rubbing, but secretion from smallpox blisters. Earlier, however, the dose with the viruses was weakened – a container with warm oil was worn under clothing, thanks to which some of the viruses were lost. Today, the method is attenuation, and the virulence of the vaccine decreases, regulating the rate of multiplication of pathogens.
Mary Montagu brought the idea of protection through contact with the virus to Europe. The brother of this English aristocrat died of smallpox, and she was disfigured by illness.
In 1718, Montagu accompanied her husband on a mission to Constantinople. The embassy surgeon gave her son smallpox pus to scratchy skin, the child had a fever but healed and never had smallpox. After returning to London, the Montagu family propagated variolation. Her younger daughter also got the vaccine, the first person in the Kingdom of Great Britain to do so.
The British were not ready, however, for such oriental prophylactics. Infected oil was, for example, tested on prisoners awaiting executions in Newgate, all survived and were pardoned. In 1721, William Douglass, a member of the Royal Society, opposed vaccinations. It was probably then that prophylactic vaccinations were called a “medical experiment” for the first time. Douglass invoked arguments such as – first, do no harm, and that Jesus said, “Not the healthy need a doctor, but the sick.” A year later, however, Douglass admitted that vaccinations were safer and more effective than he thought and had vaccinated himself.
In 1796, Edward Jenner, an English doctor, proved that the smallpox virus do not need to be applied and instead the safe cowpox can be used. This discovery paved the way for a wide use of vaccines also for other diseases. Anti-vaxxers then used pictures of humans with cow heads to frighten people. In 1885, 100,000 people demonstrated against vaccines in Leicester, England.
“The National Anti-Vaccination League”, the first formal anti-vaccination organisation, has been active in London since 1896.
At the beginning of the 20th century, medicine was aware of vaccines against 12 diseases. Following World War Two, vaccines against the flu and polio are added to the list. The second wave of anti-vaxxers appeared in the 1970s. This is when some people began suspecting that the DTP vaccine (against diphtheria, pertussis and tetanus) caused brain damage in 36 British children. In further studies the connection between the disease and vaccines was disproven and the sample was too small, but many parents began to associate the children’s disease with vaccines. The machine began to roll, the percentage of vaccinated children dropped, pertussis returned. The fear of the disease return and parents trust in medicine followed.
It’s science, stupid. There’s an algorithm for that
What’s next? There are still active anti-vaccination groups active around the world, which derive their arguments from the falsified and unreliable research. The percentage of vaccinated children is falling as the number of illnesses grows. Scientists and doctors are fighting disinformation. Politicians have began to see the threat.
There’s an algorithm for that. Robert T. Chen and Beth Hibbs from the Centers for Disease Control and Prevention, the US agency that is part of the Health Department based in Atlanta, described the information cycle and its correlation with attitudes towards vaccination. First people are happy to get vaccinated because they still remember the danger and have contact with people who suffered the disease. There is fear of an epidemic among the population. When, as a result of vaccination, the number of cases of the disease falls, the trust in vaccines also falls, paradoxically. We forget the disease, the suffering, complications and costs. There is no direct threat on the horizon, so it seems that there’s no need to get vaccinated. The percentage of vaccinated people falls. The disease returns, fear grows and after some time the trust in vaccines returns, along with the belief that they are effective.