Medical Examiner

Could a Zika Vaccine Break the Vaccine Stalemate?

The new drug could restart the polarized conversation about the benefit of vaccines.

Man received the vaccination.
Could a Zika vaccine cut through the anti-vax sentiment?


Great news: The first clinical trials for a Zika vaccine are slated to start as early as next spring. As the disease has spread, research has shown that Zika can cause devastating birth defects, including microcephaly and associated brain abnormalities. Preventing congenital Zika infections is the primary goal of a Zika immunization initiative, and for good reason: There have already been 16 infants born with Zika-related birth defects and 5 known Zika-related fetal losses in the U.S. Even if the virus does not become epidemic here, international travel and sexual transmission ensures that it will continue to pose a real risk.

But the development of a Zika vaccine could be a game-changer for an entirely different reason: Its development and adoption could help us make tangible progress forward in the current stalemate of a debate we’re having over vaccination.

Not since the rubella epidemic of 1964–65 has the American public had the chance to watch this type of public health crisis unfold in real time on American soil. The striking parallels between Zika and rubella have been noted; both of these single-stranded RNA viruses tend to cause very mild symptoms in otherwise healthy children and adults, but when mothers are infected early in pregnancy, they can cross the placenta and disrupt fetal development, resulting in severe congenital defects. This makes Zika seem more frightening than other recent outbreaks, like the 2009 H1N1 pandemic (which still posed higher risks to vulnerable populations like pregnant women and babies). But Americans are ambivalent at best about the flu vaccine.

When the first rubella vaccine was introduced in 1969, it was announced triumphantly on the front page of the New York Times. “The Government licensed today a vaccine against rubella, thus winning a race against the next nationwide epidemic of this virus infection, which is an important cause of human birth defects,” the paper proclaimed. The 1964–65 epidemic alone was responsible for tens of thousands of miscarriages, abortions, stillbirths, and babies born with congenital rubella syndrome; the public appetite for vaccination was huge, and the vaccine was a big success: “23 Million Children in U.S. Vaccinated Against Rubella” read another headline in 1971. This was the first guaranteed way to prevent congenital rubella syndrome, and it worked. In the ensuing years, the number of yearly cases of congenital rubella syndrome dropped to the single digits.

It’s worth noting that this once-celebrated rubella vaccine is none other than the infamous MMR, which inoculates recipients against mumps, measles, and rubella (the three individual vaccines were combined in 1971). This was the vaccine targeted by the fraudulent, and ultimately retracted, 1998 Lancet paper that ignited the anti-vaccination movement and cast a dark shadow over the modern vaccine program that the medicine and public health community remains unable to shake off to this day. Though the author of the Lancet paper was disbarred from medicine, and the safety and efficacy of vaccines has been demonstrated definitively and repeatedly, there is a vast and disturbing chasm between the reception the rubella vaccine initially received and the public attitude towards vaccines today.

It’s been widely remarked that vaccines have been a victim of their own success. There is limited appreciation of what the world looked like before the modern vaccine era. The burden of death and disability, particularly among babies and children, was staggering. There were more than 15,000 deaths from diphtheria in 1921 prior to the introduction of the diphtheria vaccine in 1923, and nearly 10,000 deaths from pertussis in 1923. An estimated 50–70 percent of those pertussis victims were younger than 1 year old. One can only imagine the disproportionate impact this had on women and mothers, to say nothing of the overall impact on society and the economy.

But then vaccines came in, and they worked. Because of this, these once-feared diseases faded from public consciousness. The risk of harm from vaccine-preventable illness is now widely perceived as remote and purely theoretical. Enter the seductive lure of anti-vaccination as status symbol, and potent marker of cultural and class identity, fashioned from a particularly American array of pro-individual libertarian rhetoric, anti-science sentiment, conspiracy theory, and false worship of what’s “natural.” There’s been spotty progress here and there with strong vaccine policy and advocacy, but by and large as a society we have been complacent. There has been tacit acceptance of anti-vaccination as a legitimate choice falling under the false pretense of personal belief, and there are deep-seated threads of racial, class, and gender discrimination that inform not only the response to anti-vaxxers, but also the resistance of pediatricians acknowledging that the current approach isn’t working.

But Zika presents a different possibility. This is a stealthy disease that can and does cause grave harm to developing babies, including right here in the United States. It feels scarier than the flu, and it’s more tangible than any of these long-eradicated diseases. In many ways, unborn babies are exquisitely vulnerable and bring out some of our more noble tendencies. In fact, Zika is already making people reassess their own risk-related values, as evidenced by the significant jump in acceptance of genetically modified Zika-fighting mosquitos among Americans. This is likely thanks to the fact that we see Zika as a real threat that could actually affect us.

We don’t yet know whether a Zika vaccine will be broadly recommended for Americans outside the context of travel, and if so, whether the target demographic will be children, adults, or both. But when it does come to market, it represents an opportunity to reframe the conversation around vaccines and reassert them as the medically critical form of preventative care that they are.

With pictures of microcephalic newborns imprinted into people’s minds, and the ongoing discoveries of other congenital anomalies caused by the virus such as hearing loss, Zika has the chance to change the arc of the vaccine narrative for the better. Like the rubella vaccine, which prevented the suffering and deaths of thousands and thousands of babies, with Zika we could again have a vaccine that is celebrated as the triumph that it is: a victory of science and public health over the scourge of senseless suffering and disease. As we bear witness in real time to the impact an infectious disease can have on a generation of children, we have the chance to move beyond our myopic and self-centered inclinations, and restore vaccines to their rightful place as a fundamental pillar of a just and moral society.

Zika could succeed where the HPV vaccine, introduced in the past decade, has failed. Rather than evoke appreciation that a vaccine could dramatically lower one’s chance of some very dangerous cancers, the HPV vaccine instead provoked ridiculous debates over whether we are sexualizing our children by protecting them from deadly diseases (that, yes, happen to be sexually transmitted). It was not widely embraced. While Zika is also transmitted sexually, the fact that the primary means of infection is via mosquitos could help negate this kind of detrimental characterization.

A Zika vaccine could solve a public health problem that currently has no other solutions. It could also help expose the hypocrisy of the anti-vax movement. While we don’t know who will be recommended to get the vaccine in the U.S., it’s easy to imagine a scenario in which there is broad public support—and expectation—for mass immunization in Central and South America. If anti-vaxxers support this movement, it would show that their hesitancy about the use of vaccines in their own lives (and the lives of their children) is not in fact driven by earnest concerns. If they actually believed that the vaccine was inadequately tested for safety, may cause devastating side effects, and contains “unnatural” and toxic substances, then they ought to object to vaccination in these developing countries as unethical. To my knowledge, for all the sensationalism and fear-mongering of the anti-vax movement, there has been no initiative to date to protect the children of sub-Saharan Africa or Bangladesh from the horrors of vaccines. (These areas still see lack of routine vaccination and subsequent outbreak of diseases, but that is the result of funding challenges, not anti-vax sentiment.)

The lack of outrage around vaccination is probably because many anti-vaxxers don’t actually believe the accusations leveraged against vaccines. They simply cling to them because it is an easier narrative than unpacking the complex identity politics that actually underlie the anti-vax movement: a general but unwarranted distrust of the medical establishment. The true test may be whether, once the vaccine has stemmed the tide of the virus, these same vaccine-hesitant Americans will resume their beach vacations in the tropical, tourism-dependent climes that have hosted the virus. Will they be content to have offloaded the burden of vaccination to locals while still reaping the benefits? If that is the case, Zika will have at least provided compelling new evidence to highlight the privilege and spurious claims that prop up the movement against vaccination.