They have always hated school vaccine mandates. The spillover of opposition to vaccine mandates for health care workers or by any private company, whether mandated by government or decided upon by a private entity, occurred during the Pandemic. The opposition to vaccine mandates is nothing new for a lot of people who only started paying attention to the antivaccine movement. It has been a part of the antivaccine movement for a long time. I have warned for a long time that the end of the antivaccine movement is the elimination of all vaccine mandates. They don't have to go to the trouble of obtaining a personal belief exemption to get rid of all such mandates.
I was reminded of this history over the weekend when I was using social media to keep an eye on what the opposition was doing. CHD is a mandatory stop on any tour of antivax websites given RFK Jr.s prominence in the antivaccine movement. The news part of CHD is referred to as The Defender and it published an article under the byline of The Defender. More parents are questioning childhood vaccines than ever.
Children and teen vaccination rates began plummeting with the onset of the pandemic, and as concerns surfaced around the safety of COVID-19 vaccines, some parents also began questioning the need for the long list of other vaccines recommended by public health officials.
RFK Jr. and his band of antivaxxers think it's a good thing that the suspicion of COVID-19 vaccines is metastasizing to long-used childhood vaccines. Let's look at the facts first, then I'll discuss this more.
Since the first hit of the Pandemic, there has been a decline in childhood vaccinations. The decline was caused by the closing of family practice clinics for routine medical care. Last month, it was noted in Science.
In what UNICEF Executive Director Catherine Russell called a “red alert,” childhood vaccination rates in many countries worldwide have dropped to the lowest level since 2008, in part because of the COVID-19 pandemic. UNICEF and the World Health Organization together track inoculations against diphtheria, pertussis, and tetanus—which are administered as one vaccine—as a marker for vaccination coverage overall. In 2021, only 81% of children worldwide received the recommended three doses of the combined vaccine, down from 86% in 2019. As a result, some 25 million children remain insufficiently protected against the three dangerous diseases.
The Association of American Medical Colleges warned in an article earlier this month that the US's childhood vaccination rate had fallen as well as the number of children who missed vaccines.
The latest data from the Centers for Disease Control and Prevention (CDC) show that most of those children have since gotten their shots. However, the national childhood vaccination rate among kindergarteners declined by 1%, from 95% in 2019 to 94% in 2021.
“One percent may sound like nothing, but it’s not nothing … when you put it in terms of number of doses or kids,” says Kelly Whitener, JD, an associate professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.
According to CDC data, approximately 211,000 kindergarteners did not have all required vaccines in 2021, compared with about 201,000 in 2019, even with 2021 enrollment down by 10%.
Antivaxxers used to point to numbers like a 94% childhood vaccination rate and ask why doctors were worried about a minor decline. Community/herd immunity requires a high vaccine rate for diseases that are transmissible. If you average out the vaccination rate for the whole country or individual states, you can see a big decline in vaccine hesitancy in certain areas. The areas with the lowest vaccine rates can serve as foci of vaccine-preventable diseases.
The year before the Pandemic, we saw this dynamic play out in the US when there were many cases of the disease. The most famous of these was in the Orthodox Jewish communities in New York. The Brooklyn Orthodox Jewish community was the site of a large outbreak of vaccine hesitancy in 2013). The Orthodox communities in Rockland County and Brooklyn experienced an increase in the number of measles cases as a result of antivaccine misinformation being spread by outsiders. A group called Parents Educating and Advocating for Children's Health published a 40-page handbook called "The Vaccine Safety Handbook" in order to spread misinformation. The misinformation is being spread on Telegram.
Just to give you an idea, here is a sample from that past.
It’s worth noting that most of the speakers are secular antivax activists. Del Bigtree and Andrew Wakefield himself are also on the docket.
— Jaclyn Jeffrey-Wilensky (@jeffwilen) May 14, 2019
This was advertised through robo calls and what’s app groups starting Sunday night. Big names on anti-vaccination circuit Including Andrew Wakefield – the author of 1998 debunked study on supposed link between vaccines Ana autism.
— Gwynne Hogan (@GwynneFitz) May 14, 2019
The same communities were being targeted with misinformation about the COVID-19 and COVID-19 vaccines. In my state, Orthodox religious authorities have a history of working with public health officials to encourage vaccinations in their communities.
My point is not so much to focus on this group, other than as a convenient example to demonstrate that history matters, and when childhood vaccination rates fall slightly in the Us overall there is a risk that they will. Last month, there was a case of the disease in the US. Guess where it took place. An unvaccinated 20-year old man was hospitalized in Rockland County in June for a disease.
The story is complicated by the fact that the vaccine-derived strain used in the oral vaccine has not been used in the US in over 20 years because in rare cases it can be weakened to make it less effective. In impoverished areas, the OPV has many advantages, including being cheaper and easier to administer. Again, without getting lost in the weeds, the point is that if vaccine uptake declines as a result of increased distrust of childhood vaccines due to fear of COVID-19 vaccines, we're likely to see the first outbreak in communities that have historically had a low level of confidence in childhood vaccines
It's not a bug, but a feature of antivaccine messaging, as I pointed out a couple of months ago.
RFK Jr. and his antivax group see a silver lining. The article starts out with a description of how childhood vaccine use fell in 2020 all over the world and how, contrary to what was expected, it hasn't yet rebounded to prep andemic levels. Since I am a native Michigander and have lived in Michigan since 2008, this passage caught my attention more than any other in RFK Jr.
When Michigan compared its 2020 vaccination data against the 2016-2019 period, it found vaccination coverage had declined in “all milestone age cohorts, except for birth-dose hepatitis B coverage.”
At this juncture, state officials are openly speculating that COVID-19 shots — thus far rejected by the parents of 97% of under-5-year-olds — are the reason parents are increasingly ambivalent about childhood vaccination more generally.
Referring to this “spillover doubt,” a Michigander public health spokesperson said parents who once accepted childhood vaccination without question are now saying, “Wait a minute. Do I really need these vaccines?” and asking, “How are these vaccines made?”
According to another Michigan official, “vaccination” — the “V-word” — has become a “trigger word” for irate parents who believe government not only overstepped its authority during COVID-19 but is fraudulently pushing unsafe vaccines on their little ones.
The issue of antivaccine misinformation celebrated by RFK Jr in Michigan has been cited in a Bridge Michigan article.
At the LMAS health department in the Upper Peninsula, a social media post about an “immunization” clinic prompted one resident to accuse the health department of sneaking COVID vaccines in among other routine childhood shots, said Kerry Ott, department spokesperson.
Vaccination opponents have “gained new members because of COVID,” she said.
Ott said “vaccination” is now considered a “trigger word” among those who feel the government overstepped its authority during COVID or who have doubts about vaccines developed to combat the virus.
“I wasn’t expecting to be accused of trying to vaccinate people with the COVID vaccine and telling them that it’s polio,” Ott said. “There is a solid wall of people that are not going to budge from believing these conspiracy theories, and I have not found a way to even open a conversation with folks on that side (and) behind that line.”
Conspiracy theories are the root of antivaccine misinformation.
Michigan is not the only one. POLITICO reported in April that public health officials in ten states are concerned about an increasing number of families because of vaccine distrust. The way in which antivaxxers have made their messages to the general public is consistent with what I have been writing.
Parents who were hesitant to vaccinate their children before the pandemic have now been joined by people who think the government mishandled the crisis, see Covid-19 vaccine mandates as federal overreach, or are exposed to misinformation about childhood vaccinations, said Rupali Limaye, professor of International Health at the Johns Hopkins Bloomberg School of Public Health.
“You get a decline in trust towards your government, and people looking for other sources to inform their decision-making process,” she said. “So they go to social media, [where] misinformation is outpacing evidence-based information.”
Immunization advocates say it was easier to bat down spurious claims that drove pre-pandemic hesitancy, such as that vaccines cause autism. But it’s harder to push back against an argument about personal freedom from government mandates.
“I would have told you in April 2020 that that was going to actually be our moment to turn the anti-vaccine tide,” said Melissa Wervey Arnold, CEO of the Ohio Chapter of the American Academy of Pediatrics. “Unfortunately, instead, the freedom movement took over.”
Early in the Pandemic, I noted how quickly antivaxxers joined the general reaction against public health interventions designed to slow the spread of COVID-19. I predicted a decade ago that antivax beliefs would become more and more tied to far right wing politics, as popular culture still mistakenly viewed antivax beliefs as more associated with the hippy-dippy lifestyle. Right-wing antigovernment, anti-regulation ideologies have become more associated with the ideology that used to be associated with the left. I think this is a very dangerous development and antivaxxers are rejoicing.
RFK Jr. and his associates recount a number of antivax conspiracy theories in order to make parents suspicious of vaccines. The misuse of the Vaccine Adverse Events Reporting System ( VAERS ), a frequent topic on this blog recently and dating to back before the Pandemic, is one of the reasons I won't mention them all.
The point is to point out that, as predicted, the antivaccine misinformation, misinformation, and conspiracy theories have been discussed at one time or another on this very website. RFK Jr. quoted an antivaccine doctor who apparently worked to get the attention of CHD's staff.
Want to know what I'm experiencing on the frontlines of medicine? Parents are DONE with giving their kids any and all
. Not only that but they're disgusted with what they had already allowed to be injected into their kids. They wish they could turn back
.
— Heather Gessling, MD (@HGessling) August 6, 2022
RFK Jr.'s crew pivots to "natural health" in order to find a silver lining.
Sadly, whatever temporary or longer-lasting silver lining may have emerged from the COVID-19-induced lull in childhood vaccination, children and their parents still face many challenges.
According to a Centers for Disease Control and Prevention study, the weight status of children and adolescents who were already overweight or obese worsened significantly during 2020, and children’s food insecurity is rising both domestically and internationally.
In addition, the massive social and behavioral changes commanded through government restrictions have prompted dire headlines about young people’s mental health — although experts caution these could counterproductively lead to overdiagnosis and overmedication with black-box-warning drugs known to cause violence and suicide.
Rather than more vaccines or drugs that have never delivered on their hype or promises, what children and youth need to thrive are the slower-but-surer public health fundamentals — such as solid nutrition, safe housing and economic security — and the loving attention of their parents.
Does anyone want to know what that last part is about when they click on the link? If you have already clicked on the link, you don't need to cheat. Sanitation and nutrition do more to prevent vaccine-preventable diseases than vaccines do, according to an article on CHD. I wrote about how easy it is for the ecological fallacy to be used in epidemiology. According to the study, a one percentage point increase in households with toilets equates to less measle cases for children under five. It doesn't make sense that more toilets and better Sanitation would have an effect on the spread of Measles since it is a Highly Transmissible Respiratory Disease. CHD didn't mention that there was no association between tetanus and diphtheria, since both diseases are transmitted through respiration.
CHD is correct about the fact that distrust of COVID-19 vaccines is spilling over to affect public attitudes about routine childhood vaccinations. According to the AAMC, the first effects will be seen in areas with traditionally low vaccine use, but, thanks to the fusion of right wing messaging equating vaccine mandates with assaults on freedom, I fear that it will be there for a long time.
AAMC says so.
In addition to pockets of vaccine hesitancy among likeminded communities, the U.S. has also seen an uptick in vaccine distrust in certain regions of the country. In Texas, for example, conscientious exemptions have increased from 0.45% of K-12 students in the 2010-2011 school year to 2.7% in the 2021-2022 school year, according to data from the Texas Department of State Health Services. For private schools, the vaccine exemption rate for the last school year was 4.23%, but some schools report even higher rates. One private school in Travis County, Texas, had 43% of its student population exempt from at least one vaccine, while nearly 50 schools recorded more than 10% of their student populations with exemptions.
Texas has a history of resistance to vaccine mandates due to conflating freedom with resistance to mandated childhood vaccines. When the next big outbreak of vaccine-preventable diseases happen, they will most likely happen in Texas. The affinity between the far right and antivaccine beliefs is contrary to what so many of the intelligentsia think. Events have made me believe that I was correct, although I would add Florida, Idaho, and a number of other states with high levels of COVID-19 conspiracism to that list.
I fear that these predictions are incorrect.
In many ways, he worries that there is little that scientists can do to reverse the trend of vaccine distrust.
“Academic institutions can answer scientific questions … [but] the majority aren’t [refusing vaccines] because there’s a specific scientific concern,” Offit says. “The data are there; the issue is this cultural issue” of distrusting the government and federal mandates.
Rupali Lamaye, PhD, MPH, deputy director of the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health, also believes that there will be repercussions down the road to continued resistance to vaccines.
“I think this is going to be our future for a bit. We’re going to continue to see outbreaks,” she says. “We’ve lost too much trust over the pandemic.”
When I naively believed that a vaccine-preventable disease outbreak would bring the vaccine-hesitant and antivaxxers back to the table, I was wrong. I knew how naive I had been, as I witnessed outbreak after outbreak of antivaxers doubling down. I have been paying attention to the antivaccine movement for nearly 25 years and have never seen anything like COVID-19.
The information deficit model of distrust of science has been shown to reverse science denial if good information is provided. It is incredibly difficult to fight a belief embedded in an ideology that is core to a person's self-identity. It is similar to changing a person's politics or religion when you come to it.
There is a reason why antivaxers are happy.
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