I want to talk about antivax and vaccine hesitancy.
I want to talk about how the way we are fighting
it isn’t working, about how we should maybe
change our perspective on the issue. And were
we to live in a lesser hellworld, I could
just pick any random video of an internet
skeptic that rants over someone who cries
about mercury in the shots and I could cut
him off at strategic moments in order to calmly
explain how persuasion works, how we should
focus not on individual choice, but on systemic
causes and maybe even look at the politics
underlining the phenomena. But I can’t do
that because the skeptics are having mental
breakdowns denying the science of human sexuality.
So I have to actually write an essay. With
a thesis, that I’ll have to defend. Using
facts. And logic.
The European Center for Disease Control reported
in 2018 over 1000 new cases of measles in
Romania, 2500 in Italy, 2500 in Greece and
almost 3000 in France. In Ukraine there were
12.000 cases reported. In Brazil over 2000
cases, in Venezuela over 5000. In Thailand
it’s hard to say, but the thousands of cases
resulted in over 20 deaths. In the Philippines
over 18000 cases. And I don’t think there’s
a lot of talk about it.
We care about measles not because it’s a
particularly deadly disease. It’s not, although
every death from a preventable condition is
a tragedy. We also are looking at measles
because it’s extremely contagious and it
spreads very fast. The gaps in measles immunization
coverage reveal gaps in coverage for other
vaccine preventable disease like polio or
diphtheria. This is why we can think of it
like a canary in the coalmine.
Yet it still doesn’t really interest people.
At most we get some article telling us that
the last month was even worse than the one
prior, without much contextualization and
maybe some hand wringing about anti-vaxxers.
The rational internet cartoon avatars [the
irony is not lost] that made their bread and
butter out of trying to inform the public
and mocking pseudo-science peddlers are now
screaming about SJWs or something. The liberal
TV edutainment and comedy people seem to think
that all evil in the world begins and ends
with Donald Trump. And the right-wing...well,
funny thing, the right-wing is profiting from
it. We’ll see how a bit later.
Now. The fact that the punditry is silent
even in the face of a politically maneuvered
anti-vax movement that coincides with a global
measles epidemic, also means, I think, that
the debate has been settled. The lines have
been drawn and the territory marked. There
is no controversy to fuel the engines of our
attention economy. The mainstream opinion
is that vaccines are good, while the vaccines
skeptics know what spaces to frequent to build
up networks and power, until they can topple
the mainstream in one fell swoop.
But if the pro-vaccines movement quote-unquote
won, it did so during those obnoxious debates.
Which I find troubling. Because just bombarding
people with facts, mocking them, presenting
them with study after study, won’t do us
any good. It didn’t up to this point, hence
the epidemic. It might even have backfired
as some studies about confirmation bias seem
to point out. This is why it’s more important
than ever to understand vaccine skepticism
and its relation to the measles outbreaks.
The narrative we’ve used up to this point
is simple: a parent reads on a blog or forum
or Facebook group that vaccines contain mercury,
cause autism, are made from human fetuses,
don’t actually work and that the diseases
aren’t actually that bad, in fact they’re
natural and healthy. So the parent doesn't
vaccinate the child. The child might or might
not get infected, but the parent certainly
is: with the antivax virus. And they themselves
start to frequent said blogs, forums or Facebook
groups, even starting ones of their own. This
is a simple story, with a simple solution:
debunk the bad science and convince the parents
to immunize their kids.
It’s of little wonder that this story was
favoured by science journalists and popularizers,
some more self-styled than others. Maybe they
liked the story, because they had the solution.
They could write their own blogs, set up their
own forums and Facebook groups, they could
author books, make videos, petition the politicians
to sign pacts for science and the governments
to fund programs or studies to exhaustively
debunk what was pretty obviously bunk science.
Because, you know, when you’re a hammer...
But more than anything, they liked the story
since it fit into an even broader narrative
they believed: that people are individual
agents who make rational decisions based on
the information they have access to. And if
they don’t take the “right” decisions,
it just means people don’t have the right
information.
But it’s clear for anyone even casually
pursuing those aforementioned spaces that
the bunk science is just a pretense and underneath
it steams a stew of distrust for authority,
grief, guilt, love for their children, the
need to be a good parent and the fear of failing
that, fear of doctors, of their aseptic, uncaring
ways and their relation to Big Pharma, suspicion
about the state and its power. Some of which
are incredibly valid feelings and justifiable
concerns, although not nearly as conspiratorially
linked. These concerns feel even more valid
when you’re already in a very private and
individualistic mindset. When you concern
just with yourself and maybe a few close friends.
When what you do with your kids is nobody
else’s business.
And what happens to anti-vaxxers’ kids?
In some rare and tragic cases they get very
sick, maybe even with lifelong repercussions.
Sometimes even ending with their death or
life-long damage. But for the most part, if
they somehow catch it, they’ll probably
stay at home with a rough fever and itching,
playing videogames and drinking lots of liquids
because they have parents that do and can
care for their children, despite their bizzare
ideas about immunology. As we can see in this
accurate documentary film [clip din Home Alone
3]. Sometimes parents will organize measles
parties so they can control when the child
gets the virus. These aren’t the populations
that epidemics are made out of. And aren’t
really the populations that can be persuaded
by facts and logic.
Studies, testimonials, intuition and especially
the present moment show that just offering
information doesn’t really change minds.
What does tend to work is leveraging interpersonal
relationships, building a relation of trust
with the pediatrician, seeing first-hand the
effects the disease can have when it reacts
especially strongly or when there is no care
provided to the patient. And by building a
sense of responsibility and solidarity with
the whole community.
But that’s haaaaaard! It’s worse than
hard! There’s nothing to be gained from
it. Other than the wellbeing of our society.
In which we live [Joker trashboi]. There’s
no online brand-building, there’s no book
deal, there’s not even an idea for a snarky
sketch.
So, is trying to change anti-vaxers minds
worth it? Yes! Absolutely! The more unimmunised
nodes in the population graph there are, the
wider it can spread, the harder it is to be
contained, the more it puts at risk the general
population. Especially young children who
didn’t get to take their shots or people
who cannot be immunized because of other health
issues. These two vulnerable groups are also
those most likely to die from the disease.
A non-trivial number of those infected in
this current wave of outbreaks are those who
skipped immunisation during the 1998 Wakefield
study scare, when the MMR vaccine was wrongly
linked with autism. So vaccine hesitancy is
linked to the current epidemic, but more obliquely
than we would like to think.
If we go beyond the numbers and broad, country-wide
statistics and look at those who actually
get sick and how, we’ll arrive at a different
story.
In 2017 Octavian Coman investigated the measles
epidemic for the Romanian magazine DoR. He
finds that it started in the Reteag village
mostly affecting the local roma community.
The people there are living during most of
the year in Italy, near Naples, migrating
back home during the winter. We’ll come
back to Naples in just a bit. They travel
with their children who miss getting their
shots in Romania and cannot get them in Italy
because they’re not cared for by the Italian
public health system. While abroad the children
are catching the virus and on their returning
are spreading it throughout the community
and beyond, especially through hospitals where
they can come in contact with other unvaccinated
patients, whose immune system is already strained.
This dynamic is hardly unique. It repeats,
for example, in the Belgian city of Charleroi.
This explains how the virus travels between
countries and why it’s so much more spread
out in Europe than in the US. It still doesn’t
explain why the number of registered cases
in any one European country is one order of
magnitude greater than in the whole of US.
For that we should look at why the infected
people people weren’t immunised in the first
place.
Contrary to some perceptions, there is poverty
and disenfranchisement in Europe. Especially
in the South and in the East, in rural regions
and in minority ethnic communities. These
poor and marginalized people sometimes aren’t
even registered to any GP, or figure into
public statistics. But that’s the least
of their concern because they live in improvised
housing, without plumbing or electricity and
are suffering from hunger. This is how you
get to situations like that from Zizin village,
Romania, where half the children aren’t
vaccinated. Some among them think the sickness
comes from the grime and the dirt. You might
think that’s an ignorant anti-vax position,
but that would miss the point. Their skepticism
doesn’t come from reading a mommy-blog.
They think like that because they have been
pushed to the margins of society, they’ve
been ignored and mistreated by the authorities,
even by the doctors, and are living in abject
poverty in makeshift houses. Even so, when
they struggle to get the shots, as was the
case for some of the people interviewed by
Coman, they find that there’s a shortage
and there aren’t any more doses. All the
education and mobilisation campaigns in the
world would do squat if there is no vaccine
to administer.
The stock is so limited that in some cases
doctors received 20 times less doses than
they required. Octavian Coman concludes that’s
because the Ministry doesn’t care for the
people in general, not just about poor people
or roma people in particular, and because
of historical political instability. This
doesn’t explain why in the past coverage
could have been maintained at over 95%. And
why the situation repeats itself in other
European countries.
Since 2010 the immunization rate started to
fall in Bulgaria, Croatia, The Czech Republic,
Estonia, Finland, Greece, Lituania, Holland,
Poland, Romania, Slovakia and Slovenia. Yeah,
those are two different countries. Some experts
opine that the vaccines are the victims of
their own success, and people don’t seek
out immunisation now that the disease is a
distant memory. They also think that the anti-vaccination
movement is at fault. This sounds more like
speculation. Speculation coming from a place
of expertise and speculation that might very
well point to a real phenomena. But speculation
that doesn't explain why it happens in all
these countries, in the same historical moment.
After all, the Wakefield study was published
in 1998. But there is something that might
explain this convergence. The Great Recession
and the austerity measures that followed.
All over Europe the public health systems
were hit with budget cuts, especially in the
preventative care departments. This means
a dwindling stock of vaccine doses, limited
and strained personnel that cannot offer sufficient
access to their patients, much less extend
that access to people from poor and marginalized
communities, compounding the lack of interest
or even antagonism the authorities already
showed to these population. As a way to manage
this, the states started to put more pressure
on individuals to provide care for themselves,
turning healthcare from a community concern
to a personal matter. For example, when I
was a little trashboi I got my shots at the
daycare and at school. There were enough doses
for all the children, it was fast, efficient
and the schools could keep accurate records
of who got what shots. Now the vaccination
is done at the GP, so the parents have to
make time, set up an appointment, take the
child to the doctor to have their shots, if
there are any. I have the feeling that this
change does little except to obfuscate the
lack of resources and personnel available.
The state being both unable and unwilling
to offer care to its citizens finds in the
anti-vaxxers the perfect scapegoats. Who,
in turn, find in the state’s disinterest
and incapacity a perfect justification for
their belief. Every time some government official
reports the wrong number of people who got
infected, the anti-vaxxers can gleefully shout
that the state is lying about or fabricating
the whole epidemic. Not that the anti-vaxxers
are completely blameless, especially as they
get closer to the reins of power.
In Italy, during their last election both
the far-right nationalist Northern League
party and the populist Five Star Movement
courted anti-vaxxers. One of the first acts
of their coalition government was allowing
parents to self-certify to the schools that
their children had the required vaccines.
That, of course, ends up allowing unvaccinated
kids into the classrooms. It’s worth mentioning
that, for all that’s worth, after years
of fanning the flames of anti-vaccination,
Beppe Grillo, one of their most prominent
figures, signed a so called ”pact for science”.
This was aimed at curbing the distortion of
medical and scientific facts for political
gain. After the party got into power.
Earlier I said to keep in mind the city of
Naples, as the place where seasonal migrant
Romanians contracted measles and brought it
back in their own country. It also was one
of the earliest cities that embraced the Five
Star Movement. Not surprising since it is
the hometown of its leader Luigi Di Maio.
Hmmmm.
Even if the party wasn’t close to people
with a strained relation to the scientific
fact its agenda which focused on a broad anti-corruption
message and promising techno-utopian solutions
such as an Universal Basic Income does little
to address the problem of an underfunded medical
system and of marginalized populations with
little to no access to it.
And let’s not forget their dangerous coalition
partners, Liga Nord, a right-wing populist
party that favours a flat income tax and were
the ones responsible for allowing parents
to send unvaccinated children into schools.
Liga Nord is as well an anti-immigration party,
so you might imagine what their solution to
an epidemic might be. They’d certainly not
extend the public healthcare system to include
every resident, not just Italian citizens.
Instead they’d offer but paranoid control
of the borders
In France which has a rate of measles immunisation
below the 95% threshold needed for herd immunity,
Marine Le Pen stokes anti-vaccine sentiment
when the country already has a shockingly
high rate of skepticism towards vaccines.
A 2016 survey revealed that out of 67 countries,
France ranked the highest in anti vaccine
sentiment.
Surse:
Most recently Republicans in six American
states blocked laws that would tighten regulation,
making it harder for parents to avoid immunising
their children, while in a few others they
made efforts to loosen existing regulation.
You could say there’s an epidemic of right-wing
hostility to vaccination. This has been labeled
as an anti-science stance. But that stance
isn’t a means onto itself. They’re not
anti-science because they’re uneducated.
They simply cannot educate themselves, because
the facts would run against the very core
of their ideology. Which demands starving
the state, at least pertaining to public services,
and posits an antagonistic relation between
the state and the citizens and an atomization
of community into individuals who make rational
decisions for their own self-interest.
This is why all over the world right-wing
politicians are leaning into skepticism towards
vaccination if not downright stoking the fires.
It’s not that they don’t believe the science
or that they have a deep, genuine, albeit
misguided, concern about vaccines. They may
or may not. But for them it’s just another
way of cutting costs, of ruining the public
sector and of pushing their nationalistic
agendas. And they don’t use arguments, logic,
stats. They appeal to the people’s distrust
of the government. They make accessing public
services much harder, but they make the people
feel empowered.
This doesn’t really look like the anti-vax
movement of old. It’s not the collection
of white suburban ladies that Samantha Bee
made fun of on Comedy Central, celebrities
that peddled their own naturist cures and
american-style libertarians. They are all
still there and are probably still doing the
brunt of the work in building hesitancy towards
immunisation. But now they are instrumented
by populist politicians who present themselves
as having the same worries as the common folk
regarding the intrusive, opaque and forceful
imposition of the state into the lives and
bodies of the people.
Which is why the measles epidemic won’t
be fought by applying a really sick burn to
Jenny McCarthy on Twitter or by making yet
another video about why the Wakefield study
is bunk. It will be fought by building a shared
sense of community. It will be fought by creating
a state that’s safe, democratic and trust-worthy.
It will be fought by having a comprehensive,
well-funded public health system that leaves
no one behind no matter their background,
class, race or ethnicity.
