The Washington PostDemocracy Dies in Darkness

Some will refuse a coronavirus vaccine. Can anything change their minds?

People gather outside the Massachusetts State House in Boston last month to protest a state mandate that all students enrolled in child care, preschool, grade school and post-secondary institutions must receive the flu vaccine this year. (Photo by Scott Eisen/Getty Images)

Once again, people around the world are waiting eagerly for a vaccine. As with polio, rabies and other infections in the past, teams of scientists are racing to develop one. If they succeed, Americans will line up to be immunized, part of a global campaign to protect the world’s population from the novel coronavirus. But if history is any guide, some will hesitate, frightened by claims that the new, potentially lifesaving vaccines are part of a government effort to control our bodies, that they are harmful or that some untested, alternative treatment is preferable.

Vaccines are one of humanity’s greatest achievements, a testament to our species’ intelligence, science and altruism. Smallpox, once a constant threat in most regions of the globe, killed about 30 percent of its victims each year in England and France before a vaccine was introduced there during the first half of the 19th century. By 1850, smallpox deaths in France, estimated at 50,000 to 80,000 annually before the advent of the vaccine, had declined to a tenth of their previous level.

In 1980, after a decades-long international effort, smallpox was declared eradicated worldwide, the only such victory to date against an infectious disease. During the 20th century, an estimated 300 million people died of it. Now, no one does.

Yet, as author Jonathan M. Berman recounts in his new book, “Anti-Vaxxers,” foes of vaccination began to emerge soon after the first vaccines were deployed. When the British government passed the Vaccination Act of 1853, making smallpox immunization mandatory, John Gibbs, a practitioner of hydropathy, or water therapy, argued that it infringed on people’s control over their bodies, benefited doctors, had failed in some cases and might “lower the vital resistance” to illness. (In fact, vaccines train the immune system to recognize and fight off specific infections.) In 1866, Gibbs’s cousin, Richard Gibbs, founded the Anti-Compulsory Vaccination League in England — the first organized opposition — and in 1879, a similar group, the Anti-Vaccination Society of America, was established in the United States. When smallpox spread to Montreal in 1885, a riot erupted in the city’s streets to fight compulsory immunization. The resulting smallpox outbreak was the last to occur in a major city in the developed world.

Opposition to vaccines persists today, periodically gaining traction in the United States and other countries. Berman, an assistant professor of basic science at an osteopathic medical school, explores the history of anti-vaccine movements and how best to counter them. Such movements, he finds, share beliefs and features: wariness of government control, distrust of the medical establishment and its products, false claims about vaccines (often made by people with economic interests), and unfounded fears of harm, spread by misinformation and social media. Those most vulnerable to such claims are often parents trying to decide what is best for their children’s health. Rather than learning from reliable sources why childhood vaccines are necessary to protect both individuals and the population as a whole from infections, they may receive unreliable information from others in their community who oppose vaccination.

Historically, accidents or errors in vaccine production have been rare but, on occasion, calamitous. In 1955, more than 100,000 doses of polio vaccine manufactured by Cutter and Wyeth Laboratories were improperly inactivated, and caused 250 cases of paralytic polio and 11 deaths. The disaster shook the faith of parents, doctors and health authorities, and slowed the progress of the campaign to vaccinate the world’s children against polio. It led, however, to stricter oversight and testing of vaccine manufacturing.

In the United States, vaccine coverage overall remains high, with rates above 90 percent for most recommended childhood immunizations in 2016. The best predictor of whether American children receive vaccines is access to medical care, which is influenced by insurance coverage, race and socioeconomic status. According to a 2004 study, under-vaccinated children (those who had missed some recommended shots) were more likely to be Black, poor and live in a central city. Unvaccinated children (those who had received no vaccinations) were more likely to be White, to have parents who were vaccine doubters, to live in a higher-income household and to attend private school.

Opposition to vaccination in certain communities or states has caused declines in local vaccine coverage, contributing to outbreaks of measles, such as the Disneyland outbreak in California in 2014-2015, and a bigger one in 2019, with more than 1,000 cases, that began when an unvaccinated child returning from Israel brought measles to an Orthodox community in New York state. Measles, caused by a highly contagious virus, can lead to fatal pneumonia or brain inflammation. A very large U.S. outbreak of pertussis, or whooping cough, which is sometimes fatal to babies, occurred in 2012.

Berman recounts in detail the story of a notorious scientific paper published in 1998 in the Lancet by Andrew Wakefield, which he calls “the trigger for the modern anti-vaccine movement.” It claimed to find a link between a childhood vaccine (MMR, which protects against the measles, mumps and rubella viruses) and cases of autism, a serious developmental disorder. Affected children have difficulty with communication, language and social situations. Extensively covered by the media, the claim prompted congressional hearings, caused vaccination rates to drop and energized vaccine opponents. The fact that the article was rebutted and, eventually, retracted by the Lancet received far less attention.

Reporting by Brian Deer, an investigative journalist, revealed in 2004 that Wakefield had been paid to produce research purporting to link the MMR vaccine with autism in a specific group of children, for the purpose of lawsuits. He had not revealed this conflict of interest or the fact that, of 12 children included in the study, at least four, according to Berman, were covered by Wakefield’s contract. Deer also examined the National Health Service medical records of the 12 and concluded: “No case was free of misreporting or alteration. Taken together, NHS records cannot be reconciled with what was published.” Wakefield’s British medical license was revoked, he was found to have committed research misconduct, and he moved to the United States, where he continues to raise money and promote his opinions on autism and vaccines.

Meanwhile, dozens of additional studies were conducted to search for a link, if any, between the MMR vaccine and autism. None has been found. “The quantity and quality of this scientific body of work is impossible to ignore,” Berman writes. Yet, bogus claims linking vaccines and autism continue to resurface in celebrity interviews, television news features and, in 2016, a documentary film, “Vaxxed,” directed by Wakefield himself. It was withdrawn from the Tribeca Film Festival after actor Robert De Niro and a group of scientists viewed the film and concluded that it would not contribute to the public health discussion of vaccines.

“Anti-Vaxxers” devotes attention to other prominent anti-vaccine activists and their claims — as well as their proposed modifications to the schedule of childhood shots and their promotion of an array of unproven alternative remedies for boosting the immune system. These chapters are packed with more scientific detail than some readers may want, although they make the book a useful reference. More enlightening and practical, at least for everyday life, is Berman’s advice on how to talk with people who are uncertain about vaccinating their children.

Studies suggest that committed anti-vaccine activists are likely to respond to scientific arguments by becoming even more entrenched in their opposition. But many parents who are initially wary of vaccination simply tend to distrust health professionals or worry that too many vaccinations might “weaken” their child’s immune system. They may be seeking information but relying on social media or biased websites. Berman recounts the stories of parents who were persuaded by friends “who nonjudgmentally shared positive information” about having their own children vaccinated. Others decided to vaccinate after reading helpful books such as Seth Mnookin’s “The Panic Virus” or works by pediatrician Paul Offit. Some sought exemptions from vaccination but changed their position after a family member contracted a vaccine-preventable illness like chickenpox or rotavirus.

“People change their own minds; we can’t do it for them,” Berman concludes. However, as friends, relatives or acquaintances of vaccine doubters, we can offer our experience and point others to good sources of information. As citizens, we can support better access to medical care, including vaccinations, for children who are poor and uninsured.

Vaccination is a duty and a common good: By ensuring that most of the population is immunized against dangerous infections, it prevents outbreaks in our communities, and protects those with weakened immune systems or medical conditions that make vaccination unsafe for them. In a time of pandemic, that duty is more important than ever.


How to Challenge a Misinformed Movement

By Jonathan M. Berman

277 pp. $19.95 paperback