World Immunisation Week: The rise of the anti-vaccine movement and what it means for public health

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Vaccines are widely seen as one of the greatest inventions in medical history. By introducing an agent into the body that resembles a microorganism - from polio to measles or smallpox - vaccines have saved millions of lives. Annually, an estimated two to three million deaths are prevented by jabs and liquid drops - a figure that could rise by 1.5million if more children and adults were treated, according to the UN’s World Health Organisation (WHO).

Each year, the WHO reminds the public of the importance of vaccinations, and the tragic and preventable deaths caused by infectious disease during World Immunisation Week. For instance, since 1988, polio cases have decreased by over 99 per cent worldwide, and only Afghanistan, Nigeria and Pakistan continue to fight against the infectious disease which can cause muscle atrophy and deformities. Smallpox, meanwhile, was declared wiped out in 1980 following the WHO’s global immunisation campaign. Prior to that, smallpox has killed between 300 to 500 million people during the 20th century.

Still, vaccination - and immunisation enforced on children in particular - are highly contentious issues. Just like climate change, an individual's rationale for rejecting vaccines that are backed by scientific evidence is varied and complex. However, vaccines work because of herd immunisation: where the spread of infections disease is prevented by vaccinating, ideally, the entire population. The balance between maintaining trust in medics and worsening fears by forcing vaccines is tricky, but one on which effective immunisation relies.

“There are multiple types of ‘movements’ who are critical or questioning of vaccines,” explains Heidi J Larson, PhD London School of Hygiene and Tropical Medicine. These people are unlikely to consider themselves to be members of the ‘anti-vaccine movement’ per se, she adds, but see questioning vaccines as part of their wider sceptical world view. “The first anti-vaccine movement formed in 1866 was the UK’s ‘anti-compulsory vaccination league’ against smallpox vaccination mandates,” says Dr Larson.

“Now, some are totally dedicated to questioning or refusing vaccination as their primary mission. Others are movements who started around other issues such as: freedom from government control; anti-big-business; naturopathy and homeopathy – adding vaccines to the list of non-natural substances to avoid, such as vaccines perceived by some as having excessive chemical and toxins - and anti-GMO groups who also sometimes converge with anti-vaccine groups and sentiments."

“Sometimes these movements spring up around an adverse event, perceived to be caused by a vaccination, although rarely confirmed to be causal,” she adds.

Vaccines are seen as another for way for "big pharma" to make money. Some believe that a healthy lifestyle is enough to keep the immune system in order and fight disease. Parents against vaccinating their children fear that the jabs will cause side-effects, and are frightened by the now discredited findings of Andrew Wakefield who published a study concluding that the MMR vaccine is linked to autism. More recently, Donald Trump stoked the flames of sceptics by expressing concern about a “tremendous increase” in autism rates, even though numerous studies have disproved this apparent link. Experts say that allaying these fears is vital for public safety.

“Rates of vaccine-preventable infectious diseases are currently low in the UK, thanks to generally high rates of vaccination coverage,” says Sarah Loving, Vaccine Knowledge Project Manager, Oxford Vaccine Group.

“However, if vaccination rates fall it is relatively easy for infectious diseases to re-establish themselves, especially the highly contagious ones like measles and diphtheria,” she warns. “The UK experienced a significant measles outbreak in 2012 and 2013 - particularly in South Wales - caused by a dip in MMR vaccination rates in the early 2000s. In 2012 there were 2,016 cases of measles in the UK. In the first six months of 2013 there were a further 1,287 cases of measles; 257 of these people were admitted to hospital, including 39 with serious complications such as pneumonia, meningitis and gastroenteritis, and one young man died of measles complications.

But the harder that medics push for vaccines, the worse distrust in much-maligned experts becomes. To make matters worse, those who are against vaccines feel ignored and victimised by mainstream science and media. Like any responsible parent, they are trying to protect their children from what they see as a grave danger to their health.

“I will not risk my baby’s health if she is healthy and well already we are born perfect have been since the beginning of humanity,” wrote one mother under an anti-vaccination article online.

Anna Watson, the head of anti-vaccine organisation Arnica, says she was bullied by medical professionals when she refused jabs for her child.

“I was told my child would die,” she tells The Independent. “Many people have told me in private that their children have been affected by vaccines but they rarely speak out, especially if they work in the medical profession, for fear of losing their jobs.” She claims that three children in her town were put on life support after receiving vaccines. “I don't disagree with vaccines or medicines because in some cases for some people vaccines and medicines may be a risk worth taking and it’s important to have free choice. However, the idea that a parent or adult would ever be forced to take a vaccine - and in the UK there are nearly 50 vaccines during childhood - which comes with the risk of death is beyond my comprehension,” she adds.

Thousands and thousands of people agree with Watson, including some 40,000 people who have signed a Change.org petition against mandatory vaccines.

Experts agree that vaccines aren’t perfect, but that the alternative is much scarier by exposing those with immune deficiencies to infectious disease, but also risking the unravelling of decades of immunisation work.

“Nothing is 100 per cent safe,” says Vaccines Today editor Gary Finnegan. “But vaccines have far fewer side effects than most medical interventions.”

“I took my own kids to have a meningitis vaccine recently and one of them had a temperature afterwards. This usually doesn't happen but I can see that when it does it's unpleasant. However, now he's very unlikely to get this very serious disease and I take a lot of comfort from that.”

While the medical community agrees that vaccines are necessary, the issue of an individual’s freedom - which for a child is in the hands of their parents - remains divisive.

"I really think we need to put down our guns on this issue. It is only making the situation worse," says Dr Larson. "The current polarisation of anti- and pro- sentiments is creating a war-like environment, fighting for ‘who is winning’. I think that is one of the most dangerous and counterproductive trends. The other ‘worst’ outcome is children dying because they are not getting life-saving vaccines that could have protected them from serious illness or even death from diseases such as measles and diphtheria which have had proven and safe vaccines for decades."

"One very dangerous misconception is that reported 'adverse events following immunisations (AEFI)' are necessarily caused by vaccination. They are not. AEFIs are reported because they are perceived to be caused by vaccination and need investigation. What we do not have is a place where people can see what is reported with a column next to it that says whether or not it is confirmed in an easily accessible manner. We need to do better in the public health and science community in being much more accessible and clearer in communication as well as listening better.

“For those who are sceptical of experts, we need to think about how their peers can appeal to their sense of community or the desire to protect your own children," says Finegan. "For example, in Australia, a very innovative approach was taken by the I Immunise project where local people told their personal stories to encourage others to vaccinate. For me, it should be a combination of storytelling and science."

While he doesn’t agree with anti-vaxxers, he can understand why the sentiment is spreading. "Most of us haven't seen the disease for more than a decade. If a parent hear a scare story - even if they are pretty sure it's nonsense - they may still be tempted to skip vaccination just in case. But this is what has allowed these serious infectious diseases to creep back."

For Dr Dyan Hes, Medical Director of Gramercy Pediatrics, giving parents a choice is too risky. She doesn’t allow patients in her practice who are unvaccinated, or under-vaccinated.

“What kind of a doctor would I be if they contracted a vaccine preventable illness in my waiting room?”

“Childhood vaccines should be mandatory, not optional. This is called public health. You take care of all the children to protect the public at large. Families who receive government subsidies or health insurance should not be allowed to opt out of vaccines. There should be no religious exemptions for vaccines. Un-vaccinated or under vaccinated children should not be allowed in schools or day cares, period. This should be regardless if the school is public or private.

“The anti vaccine movement is very dangerous."They are also completely misinformed and believe that doctors make money by giving vaccines. The truth is that the cost to physicians and health organisations is enormous. In the US, doctors and hospitals have to purchase vaccinations up front. They then have to store them and administer them. If the vaccines go unused, they lose money. Vaccine costs go up exponentially and this is actually a reason many private practice physicians have closed their practices. The cost for them to keep their patients healthy is unrealistic."

"They are insidious as they plant false ideas into the minds of worried parents. The irony is that they all survived because they were vaccinated and did not succumb to common childhood illnesses that cause death or permanent disability. They shouldn't be given a platform in the interest of balance. It's a bit like climate change. We have to move away from framing every scientific discussion as though it were a political issue with two equal sides."

Asked what the public needs to take away from immunisation week, Larson adds: “Vaccines are one of the best health inventions in history, and have saved millions of lives. They are not perfect, and they will never be perfect.

“But, as with all science and health interventions, you need to keep aspiring to improve what you have to make it better. And in the meantime use the best tools we have to prevent disease and save lives."