Senate panel warns of dangers of anti-vaccine movement
By LENA H. SUN | The Washington Post | Published: March 5, 2019
WASHINGTON — A Senate panel warned lawmakers Tuesday about the dangers of false information about vaccines and called for a national campaign, similar to the one against smoking, to counter the public health threat posed by anti-vaccine groups.
Virtually all the witnesses and members of the U.S. Senate's Committee on Health, Education, Labor and Pensions, which held the hearing, endorsed the safety and importance of vaccines. But one senator, Rand Paul, R-Ky., struck a defiant note.
Even though Paul said he and his children had been vaccinated because the benefits greatly outweigh the risks, he asked whether it was appropriate for the government to require people to be vaccinated against certain diseases.
"I do not favor giving up on liberty for a false sense of security," he said, prompting applause from the anti-vaccine activists in the hearing room.
Sen. Bill Cassidy, R-La., who, like Paul, is a physician, gave an impassioned rebuttal.
"Let me give some color to what Sen. Paul said," Cassidy said. "You may or may not know that I'm a physician. And I've seen people who have not been vaccinated, who require liver transplantation because they were not ... Or ended up with terrible diseases if for no other reason that they didn't understand vaccination was important."
Cassidy said hospitals commonly require their employees to be immunized against the flu because they understand the importance of community immunity. "If the nurse's aide is not immunized, she can be a Typhoid Mary, if you will, bringing disease to many who are immuno-compromised," he said.
As for parents who don't wish to follow state requirements to vaccinate their school-age children, Cassidy said there should be repercussions.
"There should be a consequence, and that is you cannot infect other people," Cassidy said.
The hearing witness who attracted the most attention was Ethan Lindenberger, an 18-year-old Ohio high school student who got himself vaccinated after questioning his mother's anti-vaccine stance. He said he tried many times to explain to his mother that vaccines are safe, citing information from the Centers for Disease Control and Prevention.
He fought a losing battle because his mother relied on false information from anti-vaccine groups rather than health officials. "These sources that spread misinformation should be the primary concern of the American public," he said.
In his written testimony, he described how he and his mother watched a video published by an anti-vaccine group that falsely said the measles outbreak was created by big pharmaceutical companies, and falsely said measles did not cause deaths. In fact, measles caused 110,000 deaths worldwide in 2017. Lindenberger said he never realized "how misinformed my mother was" until he started high school and "learned about the importance of finding credible information" by leading the school's debate club and from his teachers.
The Ohio teen said public health officials need to use the same strategy that makes inaccurate anti-vaccine messaging so powerful: anecdotes and personal stories.
"That speaks volumes to people," Lindenberger said. The public health community needs to share individual stories of people who suffer from preventable diseases that are ravaging other countries, and the side effects and complications of those diseases, he said.
"When you convince parents, not that information is incorrect, but that their children are at risk, that's a much more substantial way to get people to change their minds," the teen said.
Lindenberger described his choice to protect himself and other people, saying, "My school viewed me as a health threat."
Several anti-vaccine activists who were in the hearing room vehemently shook their heads in response while he spoke. They had filled the hallway of the Senate Dirksen Office building about an hour before the hearing started. One activist chased staffers down the hall yelling, "Do you care about the injured children of America?"
About 20 to 30 activists were among the roughly 100 people in the hearing room. They wore red clothing and donned pins and lanyards reading "Stop CDC fraud" and "Medical Freedom." As witnesses shared vaccine safety statistics, one woman wearing a "Stop CDC" pin mimed banging her head against a wall.
Several senators praised Lindenberger for his poise and testimony.
"You've done something that we don't often do in Washington," Sen. Bob Casey, D-Pa. "You've been been able to very clear about where you stand and bear witness to the truth, without being categorical and without being demonizing. I hope people are listening."
Sen. Tim Kaine, D-Va., praised his "critical thinking skills."
Other witnesses made similar arguments.
Washington state health secretary John Wiesman, who is overseeing the state's worst measles outbreak in more than two decades, urged the federal government to launch a national campaign, spearheaded by the CDC, to counter the anti-vaccine messages. In his written testimony, Wiesman said Washington state lawmakers who have proposed legislation to make it more difficult for parents to opt out their children from immunizations have received death threats and been stalked. A health-care professional who recently testified at a public hearing on one of the measures has been "vilified on their health practice website and in nasty social media posts," according to Wiesman's written testimony.
"We have lost much ground," he said. "Urgent action is necessary."
The measles outbreak in the Pacific Northwest has sickened at least 75 people, most of them unvaccinated children under 10. That accounts for more than one-third of the 206 measles cases reported in the United States in just the first two months of 2019.
The Pacific Northwest is home to some of the nation's most vocal and organized anti-vaccination activists. That movement has helped drive down child immunizations in Washington, as well as in neighboring Oregon and Idaho, to some of the lowest rates in the country.
Also appearing before the panel were Saad Omer, a professor at Emory University in Georgia, whose research has focused on ways to increase vaccine acceptance; Jonathan McCullers, pediatrician in chief at Le Bonheur Children's Hospital in Memphis; and and John Boyle, who heads the Immune Deficiency Foundation, a nonprofit patient organization representing people with primary immunodeficiency diseases, who are unable to be vaccinated themselves and rely on herd immunity.
The Senate hearing comes as the resurgence of measles across the United States is spurring a backlash against vaccine critics. Several states, including Iowa, Minnesota, Maine, New Jersey and Vermont, are considering measures that would make it harder for parents to opt out of immunizing their children. Washington and Oregon are among 17 states that allow parents to opt out of vaccinating their children for personal or philosophical reasons.
But the legislatures in Washington and Oregon are considering laws that would remove nonmedical exemptions for the routinely administered measles vaccine.
The United States eliminated measles in 2000, which was considered a significant public health success. But since then, the resurgence of cases is mostly the result of U.S. travelers returning home with the infection or spreading it to communities with high concentrations of individuals who aren't vaccinated. The virus can be contracted by someone up to two hours after an infected person has left a room. It spreads through the air and infects the respiratory tract. It can be deadly, especially for children
Global concern about vaccine hesitancy is also rising as measles cases have jumped because of gaps in vaccination coverage. For the first time, the World Health Organization listed vaccine hesitancy as one of the top 10 global threats of 2019.
UNICEF warned recently that global cases of measles are surging to alarmingly high levels, led by 10 countries that account for more than 74 percent of the total increase, and several others that had previously been declared measles free. Ukraine, with more than 35,000 cases in 2018, tops the list of countries with the largest increase in cases from 2017 to 2018. The Washington state outbreak is believed to have started with a U.S. traveler to Ukraine who brought the disease back to Clark County, Washington.
In recent years, there have been several large sustained measles outbreaks in Britain, Germany, France and Italy, all popular tourist destinations for U.S. travelers.
In the United States, part of the problem for clinicians and nurses in talking to parents about vaccine-preventable diseases, such as measles and whooping cough, is that few people have firsthand experience with these illnesses.
As public memory of the terror of measles epidemics has faded, however, doubts about vaccines have grown - often stoked by discredited and fraudulent research claiming a link between the shots and autism. The latest evidence unequivocally denying any link between autism and the vaccine for measles, mumps and rubella came Monday in a paper published in the Annals of Internal Medicine.
Measles is highly contagious, remaining for as long as two hours in the air of a room where an infected person has been. While the illness often begins with cold-like symptoms and a rash, infected people may fall victim to additional complications, including pneumonia and, in more severe cases, inflammation of the brain known as encephalitis and even seizures.
Anti-vaccine narratives do particularly well on social media because personal anecdotes and sensational content play better than the dry recitation of scientific facts, according to a study last year. Anti-vaccine proponents are a small minority, but on social media they may appear to be the majority.
Medical professionals and lawmakers have been pressuring companies like Facebook and Google to take action against anti-vaccination content in the name of public safety. Pinterest has been suppressing search results on vaccinations since December. Google's YouTube has said it would begin removing videos with "borderline content" that "misinform users in harmful ways." Amazon also appears to have removed anti-vaccination documentaries from search results on Amazon Prime Video, as well as from the catalog of videos included with its Prime service. (Amazon founder and chief executive Jeff Bezos owns The Washington Post.)
Several witnesses said it is imperative for public health and health-care providers to share the science about the safety and importance of vaccines in a way that reaches vaccine-hesitant parents. Clinicians, especially physicians, are the most trusted source of vaccine information, even among those who refuse vaccines, said Emory University expert Omer. Research has found that a strong physician recommendation for vaccines is one of the most important factors in immunization acceptance. But pediatricians often have only limited time to have detailed conversations with vaccine-hesitant parents during a short wellness visit with a child. Under insurance guidelines, pediatricians don't get reimbursed for the time they spend counseling patients on vaccine safety.
Omer said the federal government should consider making vaccine counseling reiumbursable. "We need to use that tool more effectively," Omer said, referring to clinicians.
The Washington Post's Ilana Marcus contributed to this report.