Adverse reaction to anti-vaccination campaigners
It has been tough going for the anti-vaccine movement these past few weeks. They’ve been copping it in the United States, where unvaccinated measles carriers have helped spread an outbreak of the virus at Disneyland right across the country. They’ve been copping it in Australia, too, where a vigorous public campaign has successfully pressured American anti-immunisation advocate Dr Sherri Tenpenny into abandoning plans for a series of seminars here. And to top it all off, they’ve been copping it from the Victorian government, which in mid-January announced plans to introduce by 2016 “no jab, no play” laws, similar to the New South Wales regulations implemented last year.
In NSW the rules ban unvaccinated children from childcare centres – unless the child in question is immuno-compromised, or if one of their parents registers as a “conscientious objector”. To officially object, the parent must secure the signature of their local GP after undergoing a counselling session about vaccines. As it rolls out in Victoria, health officials from South Australia tell me they are watching with interest, while the West Australian government is seeking to pass the Public Health Bill 2014, which will toughen up childcare immunisation requirements, but not quite to the same extent.
Bronwyn Hancock is concerned about all this. For nearly two decades the Sydney-based anti-vaxxer has been running her own personal information service, alerting the public to what she believes are the dangers of vaccines. She questions why – at a time when overall vaccination rates are relatively steady – a crackdown on her community is necessary. Hancock claims that parents attending these meetings are being bullied and intimidated by doctors, and that the state is interfering in parental decision-making.
“This is how governments behave in fascist and communist countries, not free countries,” she tells me.
Anti-vaxxers are a diverse bunch. Some believe in avoiding vaccines altogether, while others think it best to delay or stagger injections, or that particular vaccines are not worth the perceived risk. What unites them is genuine concern for the safety of their children, and a distrust of the overwhelming majority of doctors. In the eyes of these parents, most medical professionals have at best been duped by the pharmaceutical industry, and at worst are knowingly accepting bribes from Big Pharma to systematically poison the population.
For these people, being forced to talk with doctors about vaccinations is just more evidence of the “vaccine mafia” interfering with their lives. Australian Vaccination-skeptics Network (AVN) president Tasha David says her group does what it can to help anti-vaxxers stick to their guns.
“We offer a buddy service, so if a person in the AVN is in the area, they can go along to provide moral support,” she says.
On February 1 the AVN Facebook page shared Vactruth.com writer Missy Fluegge’s guide to navigating discussions with doctors about vaccines. Fluegge claims that in conversation doctors recite scripts provided by pharmaceutical companies, and that patients ought to prepare their own scripted responses in advance.
She also urges people to trust their instincts, practise being assertive in other areas of life – such as asking a waiter for modifications to an entree – and to even reconsider taking their child for routine visits to the doctor in the first place.
Dr Brian Morton isn’t surprised. As chairman of the Australian Medical Association’s Council of General Practice, Morton helped oversee implementation of “no jab, no play” in NSW from the top, but also experienced how the system worked at ground level working as a GP at a clinic on Sydney’s north shore.
“They come primed with dialogue – they’ve learned,” he says of sessions with anti-vaxxer parents.
“Some of them tell you that you must do it [sign the conscientious objector form], but the doctor isn’t actually required to.”
While vaccine injections do present the kind of minuscule risks found in any minor medical procedure, Morton is emphatic that the major fears of anti-vaxxers have been widely discredited. He points to the most high-profile vaccine health scare, the link between the measles, mumps and rubella (MMR) vaccine and autism, made by British researcher Andrew Wakefield in 1998. The study was later withdrawn after being found to be fraudulent, and last year researchers at the University of Sydney carried out a systematic review and meta-analysis of 10 subsequent studies that included more than 1.25 million children. The conclusion? Absolutely no relationship between vaccinations and autism. None.
Nevertheless, Morton concedes that doctors can talk “until blue in the face” with anti-vaccine “ideologues” without making any progress, but he says enforcing such meetings proves worthwhile for patients who are on the fence, or who have just fallen behind without realising it. He believes these people make up the majority of Australians who haven’t kept up to date with their vaccinations, and that if they can be reached, herd immunity will be preserved for the wider population.
Associate professor Julie Leask of the University of Sydney School of Public Health says it is difficult to determine how many of Morton’s “ideologues” are actually out there. The Australian Childhood Immunisation Register’s 2012 coverage report is the most recent comprehensive national account of where vaccine coverage is at, and it found that 3.73 per cent of children born between January 1 and December 31, 2010, either registered a conscientious objection, or had not recorded any vaccinations at all.
“We think for every parent that lacks acceptance [that vaccines are safe], another simply lacks the opportunity, but that estimate is based on what the overall coverage figures are, minus registered conscious objectors, minus silent objectors, and then inferring the rest based on smaller scale studies,” she says.
Leask backs the process of pushing parents to consult a doctor before they can register a conscientious objection, but indicates it is important that government and the media do not bring in policies or use rhetoric that further isolates anti-vaxxers.
“It is important that we have firm but fair policies that encourage parents to get up to date, but if they are deadset against vaccination, we don’t punish the children for the decisions of their parents,” she says.
While there has been a significant rise in the number of official conscientious objectors over the past decade, Leask believes this is likely to be due to the greater financial imperatives to register, such as the Gillard government’s 2011 decision to withhold the Family Tax Benefit Part A end-of-year supplement from unregistered objectors.
The same Australian Childhood Immunisation Register report indicated that about 92 per cent of Australian children were fully up to date with their vaccinations, a number that has held relatively steady since 2007. Leask says while the steadiness of that overall figure is reassuring, it disguises crucial variations from one community to the next, and that “geographic clustering” of registered conscientious objectors can leave specific areas exposed to disease outbreaks. Several communities have registered conscientious objector rates above 10 per cent, including the Richmond Valley area of north-eastern NSW, and Noosa in Queensland.
“We need to think about working with those communities and supporting voices within them that support vaccinations – constructive trust-building discussions with key influencers,” she says.
“To typecast them as all radical hippies is unhelpful, because it reflects a lack of understanding of the complexity of this group.”
It is an ambitious goal, and with all the bad press anti-vaxxers have been hit with of late, they certainly aren’t feeling the love. In response to calls by RiAus director Dr Paul Willis to require that unvaccinated children attend separate schools and preschools, Tasha David penned an article on her AVN blog on the prospect of further state-driven segregation. In it she described the idea of separating vaccinated and unvaccinated children as something not seen since the segregation of children based on skin colour in the 1950s, and even threw in
a Malcolm X quote for good measure.
The comparison brings to mind something else that hasn’t been seen in Australia since the 1950s – mass outbreaks of polio. Morton muses that vaccines are a victim of their own success, with the memory of a time when mass immunisation programs really proved their worth gradually fading out of the national consciousness. Hopefully the anti-vaxxers never gain enough momentum to suffer the same twist of fate as the vaccines they so distrust – if anyone were to prove a victim of their own success, it’s them.
This article was first published in the print edition of The Saturday Paper on Feb 14, 2015 as "Adverse reaction". Subscribe here.