Vaccine conspiracy theories

President-elect Donald Trump met recently with Robert Kennedy Jr., an environmental activist who opposes mandatory vaccination laws because he believes in discredited conspiracy theories that immunizations are dangerous. Kennedy told reporters that Trump had asked him to lead a commission on vaccines.

Though Trump transition aides later said that the decision wasn't final, the meeting was alarming to doctors, epidemiologists and public health experts. Kennedy is neither a physician nor a scientist; he has been at the forefront of pushing bogus assertions that vaccines cause autism (they do not) and has compared side effects of immunizations to the Holocaust.

Which makes their encounter the latest indication that the next president might be willing to discard science and medical research on vaccination in favor of debunked myths.

It took decades of hard work by doctors, the Centers for Disease Control and Prevention and state and local health departments to get vaccination rates to where they are today--over 90 percent for vaccines against polio, hepatitis B, chickenpox, measles, mumps and rubella.

The modern era of immunization programs began in the early 1960s when President John F. Kennedy, Robert Kennedy Jr.'s uncle, signed into law the Vaccination Assistance Act. This law allowed the CDC to support health departments in immunization-related activities.

In the late 1960s after several measles outbreaks, there was a push for state laws requiring children to be vaccinated before starting school. By the early 1980s, all states had mandatory immunization laws in place.

These efforts led to a gradual increase in vaccination rates among American children. But outbreaks of measles between 1989 and 1991 demonstrated that vaccination rates varied by population, and the vaccine delivery system required an overhaul. In 1991, President George H.W. Bush announced support for achieving immunization levels of 90 percent or more for children under 2 years old. That effort received a major boost from the Clinton administration's Childhood Immunization Initiative and the Vaccines for Children Program. By 2001, the 90 percent vaccination rate target was achieved for most of the recommended vaccines.

Since the late 1990s, though, there has been a trend of increasing vaccine refusal. If vaccination becomes an idea associated with political identity, the high vaccination rates required to maintain what experts call herd immunity--indirect protection from infections when a large percentage of a population is vaccinated, decreasing the likelihood that an unvaccinated person will encounter someone who is infected--might be at risk.

Experience in other countries suggests that vaccine confidence can decrease precipitously once challenged. In the most notorious example, vaccination rates in Britain declined after a 1998 article in the journal Lancet pushed the purported link between the measles vaccine and autism. The measles vaccination rate, approximately 92 percent in the year before the 1998 paper, declined to a low of 80 percent by 2003 in England and Scotland. It took until 2011 for immunization rates to return to their earlier levels. The article was eventually retracted and found to be fraudulent, and its lead author lost his medical license.

Here in the United States, vaccine refusal is associated with outbreaks of preventable disease such as measles and whooping cough. The Disneyland measles outbreak in 2015 was substantially attributed to vaccine refusal.

The American Academy of Pediatrics, American Medical Association and Infectious Diseases Society of America not only support immunization but also endorse adhering to the vaccine schedule recommended by the Centers for Disease Control and Prevention.

Trump, however, has challenged that schedule, saying in a 2015 debate that he wanted "smaller doses over a longer period of time." A few years before that, he repeated the false claim that vaccination was causing autism.

Vaccines are one of the most successful advances in public health of all time. Among American children born between 1994 and 2013, 322 million cases of illnesses and 732,000 deaths will be prevented by vaccines. Threats to vaccine confidence can result in a large number of avoidable illnesses and even loss of life.

Elections have consequences. It would be awful if one consequence turns out to be potentially thousands of preventable childhood deaths.

Saad Omer is the William H. Foege chair in global health and a professor of global health, epidemiology and pediatrics at Emory University.

Editorial on 01/15/2017

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