In a monumental victory for public health, California will no longer allow parents to forgo school vaccinations for their kids because of “personal belief.” California Gov. Jerry Brown stated that his choice to sign SB277 is rooted in the science, which supports the fact that vaccines protect children from a variety of diseases. However, many feel that vaccinations are unsafe and that California’s decision to remove the personal-belief exemption from mandatory vaccinations is an enormous public health risk as well as an infringement upon citizens’ rights.
Though vaccines emerged as early as the late 1700s, large-scale use of vaccines in the United States didn’t begin until the 1960s, when a growing number of state-mandated vaccinations spurred early anti-vaccine movements. Concerns about vaccines in the ’60s were rather like the fears today: Many questioned the necessity of vaccines, in particular the American-ness of compulsory vaccinations, which threatened personal liberty. (Vaccines = communism, of course!) Others fretted about the efficacy.
These concerns persist today. Anti-vaxxers, particularly small groups of outspoken parents, continue to propagate misinformation about the effects of vaccines. Sometimes they suggest that there is a cover-up to keep dangerous side effects from the public; others propose that the risks may not yet be fully understood. After all, the Food and Drug Administration does not always get the right answers. There are many historical examples of approved substances that caused severe negative consequences for those exposed to them. These include thalidomide, the anti-nausea drug given to pregnant women during the ’50s, and Agent Orange, an herbicide used by the U.S. military during the Vietnam War.
Both substances shed a great deal of light on the current vaccination debate and have been referenced by several anti-vaccine advocates. Michael Leunig, an Australian cartoonist and cultural commentator, was recently interviewed with ABC News Breakfast and compared vaccinations to thalidomide, alluding to the idea that vaccination is unsafe. Journalist David Kirby, author of Evidence of Harm, a book that told the story of vaccinations causing autism and other developmental disorders, spoke directly to the toxicity of thalidomide as the ghost of vaccines’ future in this Huffington Post piece. Wendy Callahan, director of the Vaccination Liberation Florida chapter, cites thalidomide as one of many examples where science got it wrong and approved an unsafe substance. Bill Maher, too, has invoked thalidomide as part of his anti-vaccination stance. And many articles the website Age of Autism draw parallels between children tainted by unsafe vaccines and those affected by Agent Orange. And in 2003, when several countries—including Australia and the United States—began to require anthrax vaccines for all military personnel, many refused due to fear of being military guinea pigs as they were during the Vietnam War and exposure to Agent Orange.
But those comparisons betray a poor understanding of history. In 1954 a German pharmaceutical company synthesized thalidomide and marketed it as a treatment for epilepsy. However, by the late ’50s, physicians in 46 countries, not including the U.S., had prescribed it to millions of pregnant women to treat morning sickness. By 1962, reports showed that exposure to thalidomide in the womb caused cleft lip, bone defects, cardiac and gastrointestinal problems, and shortening or fusing of bones in the arms. Those conditions affected and continue to affect millions.
One could justifiably view thalidomide as a symbol of an understudied drug made widely available before its safety was vetted. However, thalidomide never received approval for use in the United States. Though pharmaceutical companies repeatedly applied for FDA approval, FDA evaluator Frances Kelsey continued to ask for more information on early studies showing the drug’s toxicity. Though people use thalidomide as an example of scientific misinformation producing terrible tragedy (just read the comments section of any pro-vaccine article), it is actually the opposite: an example of the FDA doing its due diligence.
Agent Orange is a slightly different story. In the 1960s the U.S. military developed the herbicide for the Vietnam War. Between 1962 and 1971, the military sprayed 11 million gallons of Agent Orange on Vietnam’s vegetation. By 1978, evidence showed that exposure to Agent Orange caused severe conditions in individuals directly exposed, those exposed in utero, and children of exposed individuals. Though Agent Orange was not developed for medical purposes, the public often lists it as another example of deadly scientific misinformation, particularly by pointing out the similarities between the victims of the toxicity of Agent Orange and the perceived victims of unsafe vaccinations. However, prior to the use of Agent Orange, American scientists spoke out against Agent Orange due to already indicated health risks. Some argue the U.S. government knew about the toxic effects of Agent Orange as early as 1962. It appears that in the case of Agent Orange, decision-makers ignored science’s recommendations, not that science steered us wrong.
Anti-vaxxers like to say that when science gets it wrong, people get hurt. But thalidomide and Agent Orange instead illustrate the dangers of misinformation in another way: how our perceptions of past cases influence our modern actions.
Research from the Centers for Disease Control and Prevention, the FDA, universities, and research labs consistently supports vaccination as the most effective method to prevent most disease. In reflection of that, U.S. vaccination rates remain consistently high, approaching or exceeding 90 percent for most mandated vaccinations. Those include vaccinations for measles, mumps, and rubella, as well as diphtheria, pertussis, and tetanus. However, rising incidence of those infections indicates that vaccination levels are not high enough. In San Juan County, Washington, only 4 percent of sixth-graders were immunized against pertussis in 2011. We recently conducted a survey of 400 students at Arizona State University, where we are students, and found that 67 percent of respondents did not receive a seasonal flu vaccine for the 2013–2014 flu season, though most of them admitted to knowing the risks of influenza. (Future Tense is a partnership of Slate, New America, and Arizona State.)
In the United States, people often say that better communication among public health officials, physicians, the medical community in general, and patients could help keep vaccination rates in a safe range. The idea is that if individuals are given better information with which to make decisions, they will make better decisions.
Pediatricians taking more time to talk to parents about safety concerns may help convince them to vaccinate. But addressing safety concerns doesn’t alleviate fears that the system has made mistakes in the past. In a 2012 paper titled “Too Fast or Not Too Fast: The FDA’s Approval of Merck’s HPV Vaccine Gardasil,” researchers Lucija Tomljenovic and Christopher A. Shaw question whether the FDA fast-tracked approval of the HPV vaccine Gardasil out of fear of losing industry support, rather than evidence-based decision-making. It echoed concerns that have followed Gardasil since its approval. A study released in April supported Gardasil’s efficacy in preventing cervical dysplasia and potentially anogenital warts in girls ages 14 to 17. While Gardasil may prove to be a success of the FDA’s fast-track approval process, many drugs, including the arthritis medication Vioxx, were not. It’s another example of how one failure in the system can taint everything.
To address the deeper misconceptions about the substance approval process in the U.S., we need a more transparent approval process. Looking back historically, a transparent system could have helped to point public attention to the truth about Agent Orange and thalidomide. That might not have completely stopped today’s anti-vaccination movement. But it could have removed a significant talking point.
This article is part of Future Tense, a collaboration among Arizona State University, New America, and Slate. Future Tense explores the ways emerging technologies affect society, policy, and culture. To read more, visit the Future Tense blog and the Future Tense home page. You can also follow us on Twitter.