In the United States, population pockets with low vaccination rates (such as in Boulder, Colorado, and Ashland, Oregon) have existed for some time, and the great fear among many governmental medical authorities is that high-profile claims about vaccine dangers will widen the phenomenon, with potentially disastrous consequences. Already, medical and religious vaccination exemptions are climbing: In New York State they totaled 4,037 in 2006, nearly twice as many as in 1999. In New Jersey they came to 1,923 in 2006 versus only 727 in 1990. It is not just exemptors: The far larger concern, according to McCormick and others, is those parents referred to as “vaccine hesitaters.” They have heard all the noise about vaccines and will probably get their children shots because they feel they have to, but their skepticism is growing.
Children who would have been classified as mentally retarded or learning disabled were now being classified on the autism spectrum.
Offit points to still another threat: litigation. The wave of autism-related claims filed with the U.S. government’s Vaccine Injury Compensation Program is unprecedented. Since 2001 autism claims have outnumbered nonautism cases almost four to one. Following the science, the court has now dismissed many of them, but there is the possibility that civil litigation will follow. “I still think it’s going to be another 10 years before this really washes out in litigation,” Offit says. If the legal atmosphere becomes too difficult for vaccine manufacturers, they could stop producing them or be forced out of business.
Ultimately, that is why the vaccine-autism saga is so troubling—and why it is so important to explore how science and so many citizens fell out of touch.
“It wouldn’t have been possible without the Internet,” says journalist Arthur Allen, who has covered the vaccine-autism story since 2002, when he wrote a high-profile New York Times Magazine article that took the thimerosal risk seriously. Over time Allen changed his mind, coming to reject the idea that vaccines are to blame. Still, he recognizes why it persists. “If people believe something happened to them, there are so many people on the Web you can find who believe the same thing.” The Internet has become a haven for a number of autism support groups that continually reinforce the vaccine-autism argument. This has led to the radicalization of some elements who have denounced scientists as “vaccine barbarians,” “pharmaceutical and medical killers,” and so on. And after all we have heard about environmental and chemical risks—some accurate, some not—people are now easily persuaded about all manner of toxin dangers.
But if the Internet has made it easier for pockets of antiscience feeling to grow and flourish, scientific authorities also deserve some of the blame. “I don’t think they woke up that this was a serious problem until maybe 2008,” David Gorski says about the growing antivaccine sentiment. George Washington University’s Hotez notes that “the office of the surgeon general, the secretary of Health and Human Services, and the head of the CDC have not been very vocal on this issue.” True, the CDC, the Food and Drug Administration, and other governmental organizations feature accurate and up-to-date information about vaccine risks on their Web sites. But that is very different from launching a concerted communications campaign to ensure that the public retains faith in vaccination.
Some outspoken scientists may have actually increased the polarization on this issue. For example, calling those against vaccines “scientifically illiterate”—or, as CDC vaccine expert Stephen Cochi reportedly put it to one journalist, “junk scientists and charlatans”—may just lead to a further circling of the wagons.
The most promising approach to the vaccine-autism issue comes from the government itself. Consider the work of Roger Bernier, a CDC scientist who turned to emphasizing the public-engagement aspects of the vaccine problem after hearing one parent declare any new government research on the topic “dead on arrival.” The central problem Bernier has confronted: how to deal with a situation in which so many parents are unswervingly convinced that their children have been harmed, in which they could be harming their children even more by using untested therapies, and in which dangerous misinformation abounds.
“There’s no end to the kind of noise people can make about vaccines,” he observes. “And so if you’re in the vaccine community, what’s the best approach to this? I don’t think it is ignoring people.” Instead, Bernier has headed up a series of award-winning projects that bring together average citizens with scientists and policymakers to reach joint recommendations on vaccines, holding public dialogues across the country to break down boundaries between the experts and everybody else, literally putting multiple perspectives around a table. His example suggests that while science’s first and greatest triumph in this area was to develop vaccinations to control or eradicate many diseases, the challenge now—not yet achieved, and in some ways even more difficult—is to preserve public support for vaccine programs long after these scourges have largely vanished from our everyday lives.
“The problem is not only research,” Bernier says. “The problem is trust.”
Chris Mooney will continue to report on the vaccine-autism controversy on his blog, The Intersection.
