Denialism (10 page)

It was a decisive victory for science—but denialists have no interest in scientific decisions. “The vaccine court was wrong,” Jay Gordon wrote on the Huffington Post the next day about the nearly thousand pages’ worth of rulings in three cases. Gordon, or Dr. Jay as he calls himself, is read by many people and serves as, among other things, Jenny McCarthy’s pediatrician. He added, “Let me state very simply, vaccines can cause autism. . . . The proof is not there yet. It will be found.” His judgment on the court and the ruling was equally certain. “They were disdainful and unscientific in their approach and did not gather the needed evidence. . . . Vaccines as they are now manufactured and administered trigger autism in susceptible children.” (While rejecting scientific evidence themselves, denialists often explain their position by citing the “unscientific” approach of opponents.)

Nobody can blame any parent of an autistic child for skepticism, confusion, or anger. But when confronted with statements like Gordon’s, an honest researcher could only shake his head in wonder. “If it wasn’t for suspicion about science, I think the lack of that computing rationally would dawn on people,” Fauci said. “This is ridiculous! You have all these studies, you have this, you have that, it doesn’t matter. And it’s a combination of the underlying mistrust and the fact that people with autistic children see them suffering horribly and they need an explanation. What’s the explanation? Well, we don’t have one. Instead we have fear, and fear is what propels this movement.”

Because Hannah Poling’s encephalopathy included features of autism, it raised questions about how autism is defined and why case numbers have expanded so rapidly. Many reasons seem to have converged: new and broader diagnoses for Medicaid and insurance, increased awareness, and more access to services are all among them. The federal Individuals with Disabilities Education Act, passed in 1991, guarantees appropriate public education for children with autism. Soon after the law was enacted, schools began reporting an increase in the number of autistic students. That is one reason the act was written, but to receive special education a child must have a specific diagnosis. In the past, parents without a clear sense of what was wrong with their children were often vague. They had no choice, because states presented few options. Autism now appears on application forms for state aid, and it is one of the categories parents can consider when seeking special educational support.

Once again, the confusion surrounding the Poling decision was magnified by the Internet, causing a new wave of fear, anxiety, and, naturally, reluctance on the part of many parents to vaccinate their children. It also played into the anti-vaccine movement’s newest catch-phrase: “Too Many Too Soon.” The phrase implies that there are all sorts of toxins in our vaccines and that by receiving so many shots at such an early age, children’s immune systems are easily overcome. Now that thimerosal has proven ineffective as a propaganda weapon, the anti-vaccine forces have begun more frequently to invoke “Too Many Too Soon” and “Green Our Vaccines” as standard tropes.

As David Gorski, a surgeon who teaches at the Wayne State University School of Medicine, has pointed out in the blog Science-Based Medicine, they are brilliant slogans. Who doesn’t want a green vaccine? Jenny McCarthy likes to say she is not opposed to vaccines, just to the poisons they contain. “This is not an anti-vaccine rally or an anti-vaccine group,” she said at the Green Our Vaccines Rally in Washington in 2008. “We are an intelligent group of parents that acknowledges that vaccines have saved many lives, but what we’re saying is that the number of vaccines given [needs to be reduced] and the ingredients, like the freakin’ mercury, the ether, the aluminum, the antifreeze need to be removed immediately after we’ve seen the devastating effect on our children.

“I know they are blaming me for the measles outbreak and it cracks me up,” she continued. “What other consumer business blames the consumer for not buying their product? It’s a shit product. Fix your product. That’s what they are trying to do: scare people into vaccinating again and point the blame.” In April 2009, McCarthy and Carrey began a national tour to promote her third book on autism,
Healing and Preventing Autism: A Complete Guide
, written with McCarthy’s “biomedical” adviser, Dr. Jerry Kartzinel. Larry King has always been among McCarthy’s most enthusiastic enablers, and he was one of the couple’s first stops on the tour. King asked McCarthy why she thought pharmaceutical companies would expose children to so many shots and such danger. “Greed,” she said, making note of the increased number and type of vaccinations in the past twenty years. King asked: because they all want to make money? “Of course,” McCarthy replied.

That week, in an interview with
Time
magazine, McCarthy actually said she thought that old diseases would have to return—as in fact they have. “I do believe sadly it’s going to take some diseases coming back to realize that we need to change and develop vaccines that are safe. If the vaccine companies are not listening to us, it’s their fucking fault that the diseases are coming back. They’re making a product that’s shit. If you give us a safe vaccine, we’ll use it. It shouldn’t be polio versus autism.” As she has repeatedly, McCarthy cited the number of vaccines children receive as a large part of the problem.

Nobody can dispute that the number of vaccines has multiplied enormously. One hundred years ago children received a single vaccine: smallpox. By 1962 that number had grown to five (diphtheria, pertussis, tetanus, polio, and the MMR). Today children are vaccinated for eleven diseases, and by their second birthday that can entail as many as twenty separate shots. Yet because molecular biology has made it possible to create vaccines with fewer antigens, children are exposed to far less of a burden than children in past generations had been. The smallpox vaccine, for example, contained two hundred proteins—all separate molecules. Together, the eleven vaccines that children routinely receive today contain fewer than 130. The bacteria that live on the nose of a newborn child or the surface of their throat number in the trillions. “Those bacteria have between 2,000 and 6,000 immunological components and consequently our body makes
grams
of antibody to combat these bacteria. . . . The number of immunological challenges contained in vaccines is not figuratively, it is
literally
, a drop in the ocean of what you encounter every day,” Paul Offit has written.

The Poling decision opened the door to a new round of debates, and one of the first to rush through it was Bernadine Healy, a former director of the National Institutes of Health. She stunned parents and scientists alike in 2008 by saying that while “vaccines are safe, there may be this susceptible group. I think that public health officials have been too quick to dismiss the hypothesis as irrational.” That year, the anti-vaccine blog the Age of Autism, which describes itself as the “daily web newspaper of the autism epidemic,” made Healy its person of the year. She often tries to present herself as a calm voice of reason caught between two equally emotional camps. Following Jenny McCarthy’s appearance on
Larry King Live
in 2009, however, Healy ventured even deeper into denialism. “The work is long overdue; shockingly, so is a study comparing groups of vaccinated and unvaccinated children,” she wrote on the blog she maintains for
U.S. News and World Report
. Actually, those studies, involving more than a million children, have been carried out in several countries and for many years.

“How many studies are enough?” Fauci asked. “The Institute of Medicine did all it could do. But the real problem here is that no politician can afford to appear as if he or she is brushing off the agonizing concerns of a parent with an autistic child. So none would say what needed to be said. I would have liked to have seen some political leaders say, Folks, come on,” Fauci said. “We’re going to put fifty million more dollars into autism research and look at what the real causes might be. But it’s dangerous politically to do that, because of the intensity of the people who believe that vaccines are the problem. When you have a suffering family, and an innocent kid who’s got a life that is going to be difficult, it’s very, very tough to go and make a pronouncement that this is not the case. Particularly because you will then have that rare event when a vaccine might precipitate an underlying genetic defect that might just as well have been set off by something else, like the flu. It’s just dangerous politically for anybody to speak out. It’s not very courageous not to do it, but when political people look at all the things they’re going to step up to the plate on, that’s not one of them.”

IT’S HARD TO GET to Marie McCormick these days. You have to make it past two guards at the entrance of her building at the Harvard School of Public Health. There is another guard not far from her office. Most of the time, she lets assistants answer the phone, and she sends a lot of e-mail to the spam box, too. McCormick has been subpoenaed to appear in a vaccine compensation case—not an occurrence she envisioned when she took the position as head of the Institute of Medicine’s Immunization Safety Review Committee. She remains cheerful and committed to her work, yet she and other public health officials have watched as a steady stream of troubling facts emerged over the past decade: more parents are choosing to homeschool their children, and while that is usually for economic or religious reasons, surveys suggest that an increasing number of parents do it because vaccinations are not mandated for most children schooled at home.

In Ohio, for example, the number of religious and philosophical exemptions for vaccines nearly quadrupled between 1998 and 2008, from 335 to 1,186. (In most states, though, it is actually easier to get exemptions from vaccine requirements than to have your child vaccinated.) Maine led the nation in immunizing children in 1996 with a compliance rate of 89 percent. By 2007, that figure had fallen to just 72.9 percent. The numbers vary widely even within states. On Vashon Island, an upscale suburb of Seattle, nearly 20 percent of parents have opted out of vaccination, and as the number of exemptions grows, infectious disease proliferates. In early 2009, after a lengthy investigation, the
Los Angeles Times
found that while the California state exemption rate was only 2 percent, the bulk of those exemptions were clustered in just a few school districts.

The trend lines are clear. In 1997, 4,318 California kinder gartners entered school with vaccine exemptions. By 2008 the number—with fewer students enrolled—had more than doubled. At Ocean Charter School near Marina del Rey, 40 percent of kin dergartners entering school in 2008 and 58 percent entering the previous year were exempted from vaccines, among the highest rates in the nation. These numbers are particularly discouraging because they threaten herd immunity. The term refers to the fact that if you are unvaccinated and everyone around you—the herd—is, there would be nobody who could conceivably spread the illness. The herd would protect you. When vaccination rates drop significantly below 90 percent, however, herd immunity begins to disappear and infectious diseases can spread. Without herd immunity, math takes over, and the results are easy to predict. The winter after Wakefield’s
Lancet
article appeared, for example, more than one hundred children were hospitalized in Dublin, three of whom died. Until that year, Irish public health officials regarded measles as a disease that had essentially been eradicated.

Viruses are tenacious and they multiply rapidly; without vigilance, past successes are quickly erased. By June 2008, as a result of the declines in vaccine coverage, measles became endemic in the United Kingdom fourteen years after it had practically vanished. That means that for the foreseeable future the disease will recur with predictable regularity. Since April 2008, two measles-related deaths have been reported in Europe, both in children who, due to congenital illnesses that affected their immune systems, were unable to receive the MMR vaccine. Children like that depend on herd immunity for protection from an infectious disease like measles, as do children under the age of one, who normally are too young to have received the vaccine. Unless the vast majority of children are vaccinated, herd immunity disappears.

It is a remarkable fact that measles is on the rise in countries like Britain and the United States even as death rates have plummeted over the past five years in the developing world. The United States had more measles infections in the first half of 2008 than in any comparable period for nearly a decade. There are regions where half the children remain unvaccinated. Measles is particularly virulent and moves rapidly. “Somebody who has taken an exemption from school laws, like a philosophical or religious exemption, is thirty-five times more likely to get measles . . . and twenty-two times more likely to get whooping cough,” said Dr. Lance Rodewald, director of the Centers for Disease Control’s Immunization Services Division. Usually in the past, deaths began to occur when the caseload reached into the hundreds. Many public health officials feel that is now inevitable.

The threats are not theoretical—nor are they confined to measles. Early in 2009, five children fell ill after an outbreak of Hib influenza (
Haemophilus influenzae
type B) in Minnesota. One of the children died—the first Hib fatality in the state since 1991, the year after a vaccine became available. Until then, severe Hib infections would typically sicken twenty thousand children under the age of five every year in the United States, resulting in about a thousand deaths. Of the five Minnesota cases, three—including the child who died—were infants whose parents had refused to vaccinate them.

There has been a concerted international effort, led by the Bill and Melinda Gates Foundation and the World Health Organization, to eradicate polio. But success has been elusive, largely because of opposition to vaccines in northern Nigeria. In the summer of 2003, Muslim clerics banned polio vaccinations, claiming that the drugs were a Western plot to spread HIV and sterilize Muslim girls. People stopped taking the vaccine, and the results were disastrous: HIV rates didn’t change but polio infections rose rapidly; some of those people traveled to the hajj in Mecca, infecting others. Soon there were cases in a dozen other countries. A world on the verge of eradicating polio would have to wait for another day. “Never forget that the longest flight any person can take anywhere in the world is shorter than the shortest incubation period of an infectious disease,” McCormick said. “So you really have to understand that it is not only possible, but inevitable, that if people aren’t vaccinated they will get sick.”