By ROBBIE MAHOOD
Routine childhood vaccination is one of the cornerstones of modern public health. Evidence points to its major role in improving health by a dramatic reduction in the incidence of infectious diseases that formerly caused significant illness and death.
Yet, as any nurse or physician delivering primary care can tell you, there is a small but significant number of parents who refuse vaccines for their children. Vaccines are suspect because they are not “natural.” Scientific and medical authority have been eroded. There is widespread criticism of the pharmaceutical industry that produces the vaccines. The claim of a link between the Measles, Mumps, Rubella (MMR) vaccine and autism has frightened many people even if the claim has been de-bunked.
Opposition to vaccines springs from religious, anti-scientific or anti-elitist sentiment. Such opposition goes back to the time when vaccines were first introduced experimentally in 18th century Britain. Today’s anti-vaccine movement has a long pedigree.
Modern vaccines have mild side effects and, rarely, an allergic or other significant reaction. It is not possible to exclude adverse consequences that have not yet come to light. However, based on current evidence, involving rigorous testing, large-scale studies, and years of experience across an entire population, vaccines are overwhelmingly beneficial and without significant risk.
British gastroenterologist Andrew Wakefield claimed to show a link between the MMR vaccine and autism in a study published in The Lancet in 1998. The study was widely publicised and led to a decline in vaccine uptake followed by outbreaks of measles. Further studies failed to duplicate Wakefield’s findings. After it was found that he had falsified data, his article was retracted by the prestigious medical journal, and in 2010, he was struck off the UK medical register.
Wakefield has continued his campaign to indict MMR as a cause of autism, declaring himself a victim of a conspiracy by the medical establishment. Recently, he directed a film entitled “Vaxxed” (2016), in which he is interviewed at length along with parents whose children developed autism apparently after receiving the vaccine. The film appeals to the emotions, presents no convincing evidence, and implies a secret conspiracy involving medical bodies, the pharmaceutical industry, and epidemiologists to hide the truth.
Autism appears to be on the rise. Whether this is because of increased reporting and an expanded criterion for diagnosis or a genuine increase in incidence is unclear. The cause of autism is unknown but suspected to be multi-factorial with a strong familial predisposition based on a combination of genetic and environmental factors.
In the case of the proponents of an autism-MMR connection, we have crossed the line from doubts or apprehension to fixed beliefs that are actually anti-scientific and trade in emotional manipulation, fraudulent claims and conspiracy theories.
How should socialists approach anti-vaccine beliefs and anti-Vaxx campaigners who hope to recruit to their cause? For example, is there a case to be made for obligatory vaccination in childhood?
We can start by posing the issue of children’s rights. Parents who refuse vaccination are denying their children an important health benefit that may have consequences later in life. Babies and toddlers cannot give informed consent.
Secondly, parents who do not vaccinate are getting a “free ride” from families that do vaccinate their children. A high vaccine uptake creates so-called “herd immunity” protecting the small minority who are not vaccinated. A fall-off in vaccination rates below a critical threshold will result in a return of infectious disease in the community that puts vulnerable persons at risk.
Thirdly, there are situations involving epidemics or other health emergencies in which public health considerations override civil liberties. Measures such as compulsory treatment, quarantine, and restrictions on the right to travel might be justified. The Ebola outbreak in West Africa is such an instance.
Finally, vaccination is a social, not an individual, question. In other words, we have to resolve questions collectively rather than defer to individual choice. Resort to mandatory vaccination therefore cannot be ruled out in principle.
However, coercion would be counterproductive in the current situation, with a risk of driving people into the anti-vaccine camp. Refusal to vaccinate does not at present constitute a public health emergency. What is required is reasoned explanation of the case for vaccination in the expectation that the proportion who are immunised can be maintained above the critical threshold.
Let’s remember, as well, that coercive and punitive measures can be part of a reactionary agenda. For example, the withholding of social assistance to families who refuse or neglect to vaccinate their children or barring entry to day care for unvaccinated children have been proposed by right-wing governments in Australia.
We should not encourage blind obedience to medical authority, and there needs to be acknowledgement of the pharmaceutical industry’s influence on medical practice. However, under-vaccination and infectious disease outbreaks continue to be a public health problem in the global South. In richer capitalist countries, like Canada, there is underfunding of vaccines by governments looking to cut costs.
Socialists should defend free mass vaccination and argue further for public ownership of the drug industry under democratic control. That is the way to resolve questions of safety, efficacy, and access in a way that is transparent to all.
The fraudulent claims and irrational arguments of the anti-vaccine zealots need to be challenged. However, it would be wrong to suppress the anti-vaccine movement by denying them a platform. We cannot leave it to the medical experts to decide what arguments can and cannot be heard. And we should have confidence that ordinary working people can sort out the questions being debated.
New Zealand socialist James Robb expresses this class perspective on contentious health-care issues rather well: “It is not trust in the medical profession that the working class needs. It is trust in scientific evidence … trust in their own judgement and above all trust in their own power to effect changes in society. When the working class gains such self-confidence and begins to act independently of the bourgeoisie and its professional appendages, it will find many medical workers and professionals are fighting by its side.”*
*”Why ‘Vaxxed’ gets a hearing and why defence of vaccination can’t be left to doctors,” A Communist at Large, June 5, 2017.
Robbie Mahood is a member of Ligue pour l’action socialiste in Montreal and a semi-retired family physician.