Last month, I received a nervous email from a highly educated friend: should she allow her daughter to receive the HPV vaccine at school to protect against cervical cancer? “You heard anything nasty about this one?”
Her anxiety is part of an endless cycle of angst over childhood immunisation. This week, Italy’s government voted through legislation overturning a 2017 law mandating childhood vaccines. It was part of broader populist attack on previous governments.
“I don’t think there is any other country where vaccines have become such a frontline battle in politics,” says Paolo Bonanni, a health professor at the University of Florence who has mobilised scientists against the growing “anti-vax” movement and related media bias.
The problem is not limited to Italy. More and more people are objecting to jabs, according to The Vaccine Confidence Project, based at the London School of Hygiene and Tropical Medicine.
Anti-vax arguments can be very seductive. Where science evolves through evidence-based debate, opponents sow doubt with slogans and cherry-picked facts.
This has caused great harm, notably in the US and eastern and southern Europe. Infectious diseases, once under control, are now causing unnecessary death and disability. It is not just unvaccinated children who suffer, but those with weakened immune systems who cannot now be vaccinated and are left even more vulnerable. Last year, at least 35 people in Europe died from measles and 97 US children died from flu.
Ironically, immunisation eradicated what were once widespread and threatening diseases, but this success reduced public awareness of these diseases and their causes. Many people no longer associate a jab with illnesses that they are unlikely ever to see. They would rather avoid brief pain from a needle and blame any resulting disease on some other unrelated condition.
Consider the recurrent but long debunked claim that the measles, mumps and rubella, or MMR, vaccine causes autism. Two decades after Andrew Wakefield made his infamous assertion in the Lancet journal (not in a peer reviewed scientific paper), parental doubts persist.
Then there are the conspiracy theories. Stories about venal Big Pharma in bed with “experts” and a “nanny state” have been exploited by populist movements and amplified by social media, uniting disgruntled, politically disparate groups.
It is, of course, true that vaccines can have side effects. And there are cases of poor-quality or fraudulent manufacturers, most recently in China. But regulators are constantly assessing safety, and trying to balance risks against the long-term benefits.
Moreover, most vaccines are commoditised, subject to competitive pressures through tenders and only modestly profitable. This is why the industry has consolidated in recent years. There is no conspiracy.
If anything, judging by the advertisements on some anti-vaccine websites, the purveyors of alternative health supplements have a stronger commercial interest in sowing doubts.
Indeed, the General Medical Council stripped Mr Wakefield of his right to practice medicine after considering his ethical conduct, including financial interests in alternative experimental vaccines to MMR. Rather than disappearing in shame, he has become a cult figure. He is reportedly dating the former supermodel Elle Macpherson, one of many health supplement-peddling “celebrities”.
Another star, Robert De Niro, was about to screen an anti-vaccine film at the Tribeca film festival, before backing down. Like other parents of autistic children, he may understandably have been trying to find an explanation. Peter Hotez, a US scientist and author of the forthcoming book Vaccines did not Cause Rachel’s Autism— a reference to his daughter — urges researchers, doctors and health agencies to do more to counter anti-vaccine claims.
As for my friend, she approved the vaccination — another small victory in the battle to reduce infection.