Читать книгу Global Issues 2021 Edition - Группа авторов - Страница 53

Rachel’s seven children range in age from 1 to 15. After her oldest received the vaccine for measles, mumps and rubella (MMR) when she was 18 months old, the child was hospitalized with a 106-degree fever. Despite her doctor’s assurance that the vaccination was blameless, Rachel was unsatisfied. Information from an anti-vaccine advocacy group convinced her that vaccines were harmful, so she did not vaccinate her youngest children.

Rachel, who asked that her real name not be used, is an Orthodox Jew living in Brooklyn’s Williamsburg neighborhood, where vaccination rates among the ultra-Orthodox community have dropped precipitously. Visitors from places where measles was spreading, such as Israel, enabled the disease to get a foothold in Brooklyn.¹ Similar conditions caused outbreaks in Rockland County, N.Y., and Ocean County, N.J. Washington state has had two outbreaks and 86 reported cases this year.² One was traced to an exposure at Sea-Tac Airport in Seattle and the other to Clark County in southern Washington, where only 78 percent of 6- to 18-year-olds are vaccinated.³

The World Health Organization (WHO) declared measles eliminated in the United States in 2000, but recently skepticism has arisen—fueled largely by misinformation on the internet and a campaign by high-profile critics—about the safety, efficacy and necessity of vaccines.

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U.S. Measles Cases Spike in 2019

The number of measles cases in the United States this year reached 1,241 by Sept. 5, more than three times the number in all of 2018, according to the Centers for Disease Control and Prevention. The last spike in measles cases in the past decade occurred in 2014, with much of the increase resulting from an outbreak among unvaccinated Amish communities.

Source: “Measles Cases and Outbreaks,” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Sept. 9, 2019, https://tinyurl.com/y39perlm

A sign in the Williamsburg section of Brooklyn in New York City tells people who have been exposed to the measles or who have symptoms of the disease not to enter the building. Earlier in 2019, Mayor Bill de Blasio declared a state of emergency during a measles outbreak in the city’s ultra-Orthodox Jewish community.

Spencer Platt/Getty Images

Immunization rates are down, particularly in certain communities, and the incidence of measles among the unvaccinated has been on the rise, reaching the highest level since 1992 during the first eight months of this year. Infectious disease experts say unless this trend reverses, the disease is poised to return full force this school year.⁴ Some states are eliminating exemptions from mandatory vaccination policies for schoolchildren, and health officials are using a variety of strategies to overcome skepticism about the necessity and safety of vaccines.

Measles is transmitted by direct contact with infectious droplets or spread through the air for up to two hours after an infected person breathes, coughs or sneezes. Babies, young children, pregnant women and people with compromised immune systems are at greatest risk. Measles is so contagious that a single child in a pediatric oncology clinic in Shanghai infected 23 other children; nearly 22 percent of them died and more than half suffered severe complications.⁵

Before the measles vaccine was introduced in 1963, about 4 million people in the United States contracted the disease annually, says Dr. Sandra Fryhofer, a member of the board of trustees of the American Medical Association. Of those who caught measles each year, 500 died, 48,000 had to be hospitalized and about 1,000 developed chronic disabilities from acute encephalitis, an inflammation and swelling of the brain that can cause hearing loss, pneumonia and brain damage, she says. “Worldwide, it killed between 2 and 3 million people annually,” she says.

Before the development of vaccines, thousands of people each year were sickened, impaired and even killed by common illnesses such as measles, mumps and chicken pox. Vaccines have led to the decline or eradication of many of those diseases, leading to public complacency about the dangers of diseases such as the measles, says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), a division of the National Institutes of Health that conducts and supports research on infectious diseases.

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Most Americans Support Mandatory Measles Vaccine

As the number of measles cases rises in the United States, Americans overwhelminglysupport requiring that all children be vaccinated against the disease, a stricter rule thanexists in most states today. A similar percentage say they have been vaccinated formeasles, and 87 percent believe the vaccine is safe.

Source: Gabriella Borter, “77% of Americans say kids should get measles shot even if parentsobject: Reuters Poll,” Reuters, May 7, 2019, https://tinyurl.com/y3qcxdkr

Although health officials in New York declared on Sept. 3, 2019, that the measles outbreak there had ended, by Sept. 5, 2019, 1,241 measles cases have been reported nationwide, with cases in 31 states, according to the latest report from the U.S. Centers for Disease Control and Prevention (CDC).⁶ Of those who caught measles this year, 130 people have been hospitalized and 65 have suffered complications such as pneumonia or encephalitis.⁷

Moreover, preliminary data from the WHO indicates measles is on the rise worldwide, with reported cases up 300 percent in the first three months of this year over the same period in 2018.⁸ A 43-year-old Israeli flight attendant and mother of three contracted the disease in March after flying from New York City to Israel. She suffered brain damage, fell into a coma and died on Aug. 13, the third measles death in Israel since 2018.⁹

Public health officials blame this year’s measles outbreaks on anti-vaccine groups and misinformation spread via the internet, social media and through documentaries such as Vaxxed: From Coverup to Catastrophe. This film was written, produced and directed by Andrew Wakefield, a British researcher who is best known for writing a 1998 article in the British medical journal The Lancet linking vaccines to autism, which has since been discredited.¹⁰ Amazon removed Vaxxed from its video streaming service after Rep. Adam Schiff, D-Calif., complained to Amazon CEO Jeff Bezos that it contained misleading information about vaccines.¹¹

Despite the overwhelming scientific consensus that the MMR vaccine is safe for healthy children, reluctance to have children vaccinated continues to pose a public health challenge—and is not limited to the United States. The WHO calls such “vaccine hesitancy” one of the top 10 threats to global health and a serious hurdle to the worldwide eradication of measles.¹²

In the United States, all states have requirements for schoolchildren to receive the MMR vaccine, but 45 states allow parents to opt out for medical, religious or philosophical reasons. Many parents who oppose vaccines have done so using the philosophical and religious exemption.

Linda Fentiman, a professor at Pace University School of Law and author of Blaming Mothers: American Law and the Risks to Children’s Health, says anti-vaxxers are “disproportionately people with more education, more wealth or more time. They typically cluster in groups, and the word spreads about how to claim exemptions.”

But Richard Moskowitz, a family physician specializing in homeopathic medicine, has a different view. In his book, Vaccines, A Reappraisal, he wrote that making vaccines mandatory poses significant risks of disease, injury and death, deprives citizens of genuinely informed consent and prevents parents from making health care decisions for their own children.

“If you cannot voluntarily decide when and for what reason you are willing to risk your life or the life of your child, your unalienable right to life and liberty has been taken from you,” said Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center, a group based in Sterling, Va., that lobbies for vaccine safety reforms and for informed consent protections for parents.¹³

Fisher was referring to vaccines in general, and neither Fisher not Moskowitz gave examples of children dying from getting the MMR vaccine. In fact, the MMR appears to be one of the safest vaccines available, according to data from the National Vaccine Injury Compensation Program, a federal program that compensates people who have been injured by vaccines. Between 2006 and 2017, some 101 million doses of the MMR vaccine were distributed in the United States, but only 123 people were compensated for an injury from the vaccine during that period, according to the program’s database.¹⁴

An anti-vaccine parent holds up a prescription document as she waits to enter a hearing about vaccines before the Senate Committee on Health, Education, Labor & Pensions in March, 2019. While some celebrities and internet activists help spread the idea that vaccines are unsafe, most Americans support mandatory vaccinations for schoolchildren.

JIM WATSON/AFP via Getty Images

John Leddy swings his 2-year-old daughter, Vanessa, with wife Christy Lambertson, at a park in Culver City, Calif. When the couple found out that the day care center they were considering for their daughter had a low measles vaccination rate, they decided not to enroll her there.

Robert Gauthier/Los Angeles Times via Getty Images

While many vaccine opponents believe vaccines are unsafe, others make a different argument: Parents are best positioned to determine whether their child needs a particular vaccine and are better qualified than health experts or public health agencies to decide what is in their family’s best interests.¹⁵

But Fentiman says it is not that simple. “No matter how much a parent tries to educate themselves, most are not physicians and aren’t able to assess the risk because there is so much misinformation,” she says. In addition, “When a parent decides not to vaccinate their child, other children are … being put at risk.”

Several well-known people, ranging from President Trump—before he took office—to Hollywood celebrities, have at times used their highly visible platforms to spread doubts about vaccine safety and oppose mandatory vaccinations. In June 2019, actress Jessica Biel lobbied California state legislators against a proposed bill that would make it more difficult to claim a medical exemption, arguing that vaccine decisions should be left to parents, not mandated by the state. Other performers who have opposed mandatory vaccinations include Robert DeNiro, Jenna Elfman, Jim Carrey and Juliette Lewis.

“Celebrities have always had an exaggerated and often unwarranted influence on society,” said Andrew Selepak, a media professor at the University of Florida. “That we place such high value on the uninformed opinions of celebrities is one problem, but the bigger problem is when we act on these uninformed opinions and it puts ourselves or others in danger.”¹⁶

In 2014, before entering electoral politics, Trump, a Republican, lent credence to the discredited claim that vaccines can cause autism, tweeting: “Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes—AUTISM. Many such cases!”¹⁷ Shortly before he was sworn in as president, Trump met with vaccine skeptic Robert F. Kennedy Jr., who later said Trump asked him to lead a commission on vaccine safety. However, the commission was never formed.¹⁸

But after this year’s measles outbreaks, the president urged parents to vaccinate their children. “They have to get the shots. The vaccinations are so important,” Trump told reporters in April. “This is really going around now. They have to get their shots.”¹⁹

Dr. Dean Blumberg, chief of pediatric infectious diseases at UC Davis Children’s Hospital, says Trump’s mixed message is harmful. “You need clear, consistent messaging. One slip-up and we’re back to the conspiracy theories,” says Blumberg. “Every time a respected public figure waffles on the issue, that is a definite setback that will take years to overcome.”

In addition, if the Trump administration succeeds in its effort to overturn the Affordable Care Act, insurance companies will no longer be required to pay for federally recommended vaccinations with no out-of-pocket costs, making them unaffordable for many families, wrote University of Connecticut law professor John Aloysius Cogan Jr. in a piece for the medical news website Stat.²⁰

U.S. health officials are using a variety of strategies to improve measles vaccination rates and halt the disease’s spread, starting with repeatedly debunking widespread misinformation. Fauci, of the NIAID, says it is important to involve community and religious leaders and health care workers so skeptics can get reliable information from their peers rather than from government officials.

“Public health officials can’t pejoratively confront them because that will turn them off,” says Fauci. “We have to present the communities with the facts in a measured way and get them to understand that they need to make health decisions based on facts, not on distorted and false information.”