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The Hollywood Reporter recently published what is mostly an exposé on privileged Hollywood parents who have elected to delay, limit, or avoid altogether immunizing their children. The most common headline coming out of this article is that some LA communities have vaccination rates at third-world levels, such as South Sudan. The issues raises many questions pertinent to the promotion of science-based medicine – what leads an otherwise well-educated individual with financial security to make decisions that actually put their own children (and others) at risk?

Some background

We have often observed at SBM that the anti-vaccine movement is likely to experience a serious backlash once epidemics of vaccine-preventable diseases start to emerge. I think we are seeing the beginning of this prediction coming true. Vaccines are partly the victim of their own success. The diseases they prevent, such as polio, measles, whooping cough, and others, are now uncommon. Modern parents have the privilege of not fearing these diseases because the vaccination program has reduced them to sporadic cases. Therefore, when pseudoscientists or ideologues stoke fears against vaccines, the fear of the diseases they prevent is not there as a balancing force.

That may be changing, however. The CDC reports:

During 2012, 48,277 cases of pertussis were reported to CDC, including 20 pertussis-related deaths. This was the most reported cases since 1955. The majority of deaths occurred among infants younger than 3 months of age. From January 1-August 16, 2014, 17,325 cases of pertussis have been reported to CDC by 50 states and Washington, D.C.; this represents a 30% increase compared with the same time period in 2013.

Vaccine refusal is clearly an important factor in the recent pertussis outbreaks. That doesn’t stop antivaxxers from distorting the science. They claim, for example, that most pertussis cases occur in those who are vaccinated. This is a common misdirection. It is true that most cases occur within those who are vaccinated, but that is not the relevant statistic. It’s misleading because most people are vaccinated. The relevant statistic is the risk of being infected with pertussis in vaccinated vs unvaccinated individuals, and the risk is clearly much higher for vaccine refusers. Further, pertussis outbreaks tend to cluster in communities with higher rates of vaccine refusal.

They also point to recent concerns that pertussis strains may be evolving resistance to the current acellular pertussis vaccine. While this is a legitimate concern, it is an emerging issue, and not the cause of the recent epidemics. Ironically, the acellular vaccine, which has narrower coverage, replaced the whole cell pertussis vaccine largely over unfounded fears of side effects.

Vaccine refusers

The Hollywood article includes this illuminating passage:

For instance, actress Ione Skye, herself a former Gordon patient (“I never had antibiotics growing up; he really went the natural route”) who now brings in her own two daughters to see the physician, believes that the alternative path she and her husband, musician Ben Lee, have chosen makes “instinctive” sense. “With my kids, I spaced them out and waited and missed some,” she says. “As a mother, it just felt better to me —and my kids never had any reaction.”

This sentiment captures what is perhaps the core problem with antiscience in general. People like to trust their instincts or “gut feelings.” We largely behave based upon what feels right. The problem is, there are numerous flaws and biases in the subconscious processes that result in our gut feelings. (A full discussion of which is beyond the scope of this article, but is explored at length in numerous blog posts here and at my other blog, NeuroLogica.)

Antivaccine propaganda talking points tend to resonate with our intuition, but not with scientific data. Such data can be abstract, counter-intuitive, and highly complex. People generally have a poor intuitive grasp of statistics (so-called innumeracy). A relevant example of the role of innumeracy was given just above – how easy it is to mislead with statistics, such as considering the number of people who become infected (vaccinated vs unvaccinated) vs the risk of getting infected.

Antivaccine rhetoric, for example, includes that notion that the current vaccine schedule is “too many too soon,” and that the tiny bodies of infants are being overwhelmed with too many antigens. However, the antigens in the vaccine schedule has actually decreased over the years (as the vaccines have become more targeted), and the number of antigens children face on a daily basis from the environment vastly outnumber the few additional antigens in vaccines.

The Hollywood Reporter article focuses its attention on West Hollywood communities that are wealthy and favored by celebrities, which have demonstrated the highest levels of vaccine refusals. In some schools vaccination rates are less than 20%. While overall vaccination rates remain high (>90%), these pockets of lower vaccination rates represent a local loss of herd immunity, and are therefore breeding grounds for communicable diseases. In fact, that is what the data shows.

In addition to overreliance on instinct and general scientific illiteracy and innumeracy, what other psychological factors among the privileged might be contributing to such high rates of vaccine refusal? This is a question that could use further exploration. What we can point to are the cultural environments that tend to be most conducive to distrusting science. The alternative medicine community in general has fostered an environment of distrust for authority, distrust of government and the medical establishment, and distrust of the institutions of science.

One might also argue that the powerful and privileged in particular would feel that “going along with the herd” cannot provide the best option for their children. Surely their privilege must afford them something better.

Filling that demand for an approach that rises above the herd are the “doctors to the stars.” Dr. Robert Sears and Dr. Jay Gordon have most famously filled that demand, with alternate vaccine schedules. They even admit that their schedules are not based on hard science, but their own intuition – what “feels right.” This sells well to the privileged.

Conclusion

The evidence is overwhelmingly clear, not only with vaccines but with medicine in general. Following scientific guidelines that are based on robust evidence leads to the best outcomes.

Further, one of the strengths of science is that it is both egalitarian and a meritocracy (at least when functioning optimally). Data is king, and privilege and intuition should have nothing to do with it. There is a democracy to science, which is universal.

In medicine this means that treatments based on rigorous science are the best option for everyone, and the standard of care applies equally to everyone. (Of course, a significant challenge is for the delivery of medicine to also be fairly distributed, but that is a separate issue.)

No amount of money or privilege can buy you better science. It is perhaps for this reason that some people choose “alternative” science. They think they are getting something better than the herd. Ultimately, however, this is just a cleverly marketed deception. In the case of alternative vaccine schedules, all they are buying is higher risk for their children for infectious and potentially serious diseases. Further, they are exporting this risk to others, perhaps with less privilege.

Perhaps we are seeing the beginning of a backlash from the real “99%.”