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No More ‘Truth Decay’

In a world where so many things need to be set right, perhaps the most frustrating is the loss of consensus over public policy that we once thought was written indelibly in the social contract.

The alarming global rise in what public health authorities delicately refer to as “vaccine hesitancy” is a stark example. Worldwide childhood vaccination rates have plummeted for years.

As a result, the essential threshold of what scientists call community or “herd” immunity is at risk. If this numerical dam (a 90%-95% vaccination rate for highly communicable diseases like measles, 80%-85% for less communicable ones like polio) is breached, society could once again confront tragic and costly new epidemics of “conquered” diseases, such as polio, rubella, mumps, measles, and pertussis.

The consequences of “vaccine hesitancy” could unravel decades of healthcare progress, and render meaningless some of the greatest triumphs of medical research in the last century.

Despite, or perhaps because of, the clear and undisputed success of childhood vaccinations — it has been estimated that for each birth cohort in the United States receiving recommended childhood immunizations, around 20 million illnesses and more than 40,000 deaths are prevented, resulting in $70 billion in savings — the public health establishment has failed to respond assertively to opponents of mandatory immunization.

Not on the Fringes Anymore

We have too often dismissed this opposition as a rag-tag army of quack researchers, religious kooks, misguided yuppies, libertarian zealots, and opportunistic politicians. The truth is that these so-called “anti-vaxxers” have now coalesced as a powerful international sociopolitical force that has successfully leveraged social media platforms to create a degree of momentum that will demand concerted pushback if mandatory vaccination is to remain viable public policy.

The issue has become so grave that the World Health Organization lists “vaccine hesitancy” as one of the top 10 global health threats in 2019. “Anti-vaxxers” are now in company with antibiotic-resistant infections, the Ebola virus, air pollution, and climate change as public health threats. We believe that the public health community has good science, good data and good health information on its side. However, based on our combined seven decades of experience in public and private sector health affairs, we believe that the public health community by itself may lack the media resources, strategic communication orientation, and popular acceptance to address what we now recognize as a palpable threat to the health of the world’s children.

Anti-Vax in the U.S.

In America, for example, measles stands as a stunning example of how the “anti-vaxxers” have united to helped bring back a disease we thought we had consigned to the dustbin of history. Three generations ago, uncontrolled annual epidemics of measles infected three million to four million Americans annually. Victims typically suffered a painful itching, sometimes scarring rash, accompanied by fever and diarrhea. Severe cases led to pneumonia or encephalitis. In bad years, as many as 48,000 American children were hospitalized, 4,000 contracted encephalitis, and 450 died.

Beginning in the mid-1960s, an effective measles vaccination was mandated for American schoolchildren, and the disease was brought to heel. By 2000 the U.S. Public Health Service proudly declared that measles had been eliminated in the United States.

But this year, a scant two decades after we declared final victory, sustained “anti-vax” pressure on young parents has brought measles back with a vengeance, with 372 cases confirmed in 2018. So far through Feb. 10, 2019, already over 250 cases have been reported, almost all in children who have not been vaccinated. The problem is not confined to the U.S., as measles cases have also seen a 30% annual increase globally.

This alarming rise in measles cases, driven by variation in vaccine coverage and consequent losses of herd immunity in regions of the U.S. and other countries, stems entirely from “anti-vaxxer” messages that link the measles vaccine to autism. Scientists have long since disproven this connection, but the “anti-vaxxers” continue to push it aggressively. Increasing number of parents now choose to give their children no vaccinations at all.

Fake News on Vaccines

Despite clear evidence of success and peer-reviewed studies of the value of childhood vaccines, anti-vax” publicity continues to debunk science. These avatars of “fake news” have unleashed what the RAND Corporation calls “truth decay” Ironically, the first victims of the societal scourge of anti-vaxxers will be children who are too young to read the news, and were exposed to a vaccine-preventable disease that their parents “refused.”

We advocate urgent investment in a new multi-sector initiative to inoculate society and create a “vaccine literacy” to counter the anti-vaxxers. Good science and accurate information must remain at the forefront of pro-vaccine messages. But it is now time to fight fire with fire. We must reinvigorate the pro-vaccine cause through visible local advocacy for immunization, aggressive social and mass media campaigns to promote immunization, and a far less permissive “opt-out” strategy for parents who do not wish to comply with regulations requiring immunization of school-age children (as California has done).

What Can We Do?

Ultimately, it comes down to renegotiating the social contract that underlies all successful public immunization programs. We need to rebuild trust in mandatory childhood immunization policy through a communication strategy to reach today’s generation of physicians, parents and policymakers with understandable information about vaccine benefits and risks in language that is tailored to their concerns, delivered by sources they trust via the media they use. The stakes are high. The threat of resurgent diseases that should have no presence in the 21st century is a challenge to us all.

Scott Ratzan, MD, is senior fellow at the Mossavar-Rahmani Center for Business & Government, Harvard Kennedy School. He is editor-in-chief of the Journal of Health Communication and a past member of the CDC board of scientific counselors on infectious disease. Kenneth Rabin, PhD, is a partner in Baird’s Communications Management Counselors and a member of the editorial board of the Journal of Health Communication.