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Red Alert: Anti-Vaccination in the Age of COVID-19

“Governments love pandemics for the same reason they love wars. It gives them the ability to control the population that the population would otherwise never accept.” —Robert F. Kennedy Jr., speaking to an audience of thousands in Berlin on August 28, 2020

Today’s leaders of the anti-vaccination movement, including Dr. Andrew Wakefield in England and Robert F. Kennedy Jr. in the United States, have been alleging over the past two decades that vaccination is injurious to human health. Now the movement has a new target: vaccines for COVID-19. The development of these vaccines, Kennedy claims, has been driven not by concern for health but by corporations seeking profit and “government totalitarian elites.” On Kennedy’s anti-vaccination website, “herd immunity” is dismissed as a “dishonest marketing gimmick.”1 This anti-vaccination messaging has not yet had much impact, since demand for COVID-19 vaccination so far this year has been outrunning supply. But that could change when the amount of available vaccine increases to the point that vaccination becomes available to everyone.

When that happens, the path to herd immunity may encounter a major obstacle: large numbers of people who decline to be inoculated. In early March of this year, an NPR/PBS/Marist poll2 found that 38% of unvaccinated adults in the U.S. answered “No” to the question: “If a vaccine for the coronavirus is made available to you, will you choose to be vaccinated or not?” And in late March a Kaiser Family Foundation poll reported that nearly 30% of Republicans and 30% of white evangelical Christians are saying they will “definitely not” get the vaccination.3 It’s true that public opinion may change as more people get vaccinated, and if over time vaccination becomes a less politically polarizing issue. On the other hand, at least in some states, vaccination rejection is likely to remain substantial.

Resistance to COVID-19 vaccination is also strong internationally: low rates of vaccine acceptance have been reported in the Middle East, Eastern Europe, Africa, and European countries that include France and Italy.4 Regions of sparse or absent vaccination may host new COVID-19 variants that disseminate globally, thereby slowing or halting progress toward herd immunity.

Vaccination is today standard medical practice, and globally 80% of infants are vaccinated during the first year of their lives against some disease. Yet vaccination has always faced resistance based on fear. Edward Jenner pioneered smallpox vaccine in England in 1796 and worked tirelessly to communicate its value to the public. But half a century later in that country, the Anti Vaccination League and the Anti-Compulsory Vaccination League were still trying to convince people that vaccination was dangerous. Despite its manifest benefit, smallpox vaccination had to overcome substantial popular opposition worldwide, and it took nearly two centuries to eliminate the disease.

The Anti-Vaccination Movement in California

Here in the United States repudiation of vaccination is well-funded, encouraged by print, television, and social media, and common in every state in the union. Anti-vaccination protesters in California shut down the COVID-19 inoculation center at Dodger Stadium in Los Angeles on the last Saturday in January 2021. Hundreds of people in their cars, lined up in a queue at one of the largest vaccination sites in the U.S., had to wait longer to get their shot. But such opposition to vaccination isn’t confined to Southern California. It remains vigorous as well in alternative medicine enclaves like Marin County and left enclaves like Berkeley, which for decades have been centers of vaccination skepticism.

That skepticism became politically influential during the debate in California about vaccinations that took place in 2015. An outbreak of measles in Southern California had attracted public attention to the fact that vaccination rates had dropped well below herd immunity level in some areas of the state. A group of parents joined with legislators to advocate for legislation strengthening California’s vaccination requirements. They drafted a bill, SB 277, mandating that school children be vaccinated against diseases that included measles, mumps, and pertussis. The bill disallowed exemption from vaccination on religious or philosophical grounds or because of belief that vaccination is unsafe, although it continued to permit exemption for a medical reason, such as a child’s immune-compromised condition or allergy to a vaccine.

The legislative debate about SB 277 lasted for four months, during which the bill was subjected to libertarian, religious, and legal assaults. Anti-vaccination activists organized statewide to spread the word that vaccination is dangerous, and they traveled to the state capitol in Sacramento to hold rallies and press their representatives to defeat the bill. But pro-vaccination families were also well organized, and passionately made a science-based case for tightening up the state’s vaccination requirements. (We published an article on this debate in Skeptic, entitled “Winning the Vaccination War in California.”6) SB 277 was signed into law in June 2015 and its passage has improved statewide herd immunity for measles and other diseases.

Yet there remain pockets of low vaccination rates throughout the state. At the Berkeley Rose School, for instance, only 29% of the 2017–18 kindergarten class enrolled were vaccinated, and at the Marin Waldorf school the figure was 22%, according to state immunization data.7 In violation of California law, parents find physicians who are willing to exempt their children on the grounds of contrived medical conditions.8

Parents who withhold their children from vaccination replace reliance on public health authority with reliance on vaccination skeptics whom they find more persuasive. The dynamic here is based on an essential method humans use to learn about the world — reliance upon the judgment of people whom we trust. That begins with children’s dependence on adults for information and guidance, and extends through years of schooling when teachers assume this instructive role. The consequence is that we enter adulthood prepared to believe what those whom we accept as “authorities” tell us is true. Of course, adults have some choice in determining which sources of information they deem credible. But in an age of widespread mistrust of public institutions, corrupt leaders, and a medical system that is dysfunctional in many ways, a charismatic individual can readily capture the attention of many and win a credibility contest against scientists, public health officials, and fact-oriented political leaders.

Charismatic Leaders

Candidates for political office aren’t the only ones exploiting this human weakness. In the world of vaccination resistance, Robert F. Kennedy, Jr. is famous not only because of his family name but also for finding fault with vaccination. And his voice is amplified by other vaccination challengers, past and present, with whom many parents have a trusting relation. In the case of California Waldorf school communities mentioned above, respected opinion leaders warn parents that vaccination poses a danger to their children. To begin with, there is Rudolf Steiner himself, the founder of the Waldorf school tradition, who is still looked upon today as an esteemed mentor.9 Steiner’s worldview, “anthroposophy,” postulates a spirit world accessible through clairvoyant insight. And that “insight” leads Steiner to pronounce:

Smallpox vaccination has very much to do with the psyche…. If we were to replace this belief with something else, if we were to educate people in a way that is in accord with nature, so that they would be impressed by something other than that we are vaccinating them, let us say by taking them closer to the spirit again, then it would certainly be possible for us to be as effective …”10

Thus vaccination, for Steiner, represents secular civilization’s impoverished substitute for spiritual enlightenment. This message is conveyed in Waldorf schools by teachers and other school community members whom parents trust. Among them in Northern California where we live is Jennifer Schmid, a nurse who sells food-supplements online and whose three children attended Waldorf school in Silicon Valley. Her podcasts and blog reach a nationwide audience that is much larger, however, than just Waldorf school parents. One of her anti-vaccination postings, she writes, “has gotten over 21,000 hits and 5000 Facebook likes in 3 days…. The feedback for the blog has been overwhelmingly positive.” Vaccination science is not credible, Schmid states, because “all the studies are industry-funded.” She writes that the pharmaceutical industry “is going to make billions of dollars on a coronavirus vaccine that will sacrifice safety and effectiveness.”11

Sources of Doubt

Vaccination hesitancy has various rationales and reflects diverse cultural perspectives and values. Someone who is persuaded by the baseless claim of Dr. Andrew Wakefield that “messenger RNA vaccine is actually genetic engineering” repudiates COVID-19 inoculation for a different reason than does a member of the Church of Christian Science or a Muslim who perceives in vaccination a challenge to the will of Allah.

This variety of reasons notwithstanding, we believe that rejection of COVID-19 vaccination has three main sources — two of them pseudo-scientific — while the third makes a legitimate critique of health care priorities in the United States and worldwide. (We will not consider here unhinged conspiracy theories about COVID-19 vaccination, e.g. that it is a manipulative plot devised by the CDC, Big Pharma, or Bill Gates, although such ideas circulate on social media and may dissuade some people from vaccination.)

1. Safety and Effectiveness. Charismatic leaders of the anti-vaccination movement such as Robert Kennedy Jr. allege that vaccination is dangerous and ineffective. Just about every claim that they make in this regard is false.12 Kennedy has said that the Moderna vaccine against Covid-19 is “extremely reactogenic.” But the statistics show that it is not; yes, people “react” to the vaccine, but almost always in harmless ways that just show that it is working as it should. Kennedy argues that vaccine safety has not been confirmed by placebo studies, but this standard scientific protocol was followed in testing the Moderna and Pfizer vaccines, both of which showed a high degree of efficacy against placebos. “There’s no evidence that it [the Moderna vaccine] prevents death,” Kennedy has claimed. On the contrary, testing of the vaccine has shown that it greatly reduces death rates as well as severe COVID-19 symptoms, hospitalization, and the need for ICU care.

Despite the absence of evidence for his claims, Kennedy remains a guiding light of the anti-vaccination movement, with more than half a million followers on social media. Their respect for the man, whose tireless advocacy for environmental causes is indeed admirable, contributes to their willingness to accept what he says about vaccination at face value.

2. Does COVID-19 Vaccination Weaken “Natural” Resistance to Disease? Some vaccination critics allege that vaccination interferes with the “natural immunity” of the human body to strengthen and heal itself. The idea here is that a vaccine is like a crutch or pill that substitutes for the body’s inherent reparative capacity. The trouble with this analogy is that vaccination does not substitute for the ability of the human body to heal itself. On the contrary, vaccination grows that ability, by educating and strengthening the immune system, helping it to recognize disease antigens and mobilize its own resources — T cells, B cells, antibodies — to meet future challenges. Vaccination does not work like a crutch or a pill, but more like an exercise machine: use of a treadmill or elliptical trainer does not dispense with or replace one’s physical capacities, but instead builds them.

3. Underlying Causes of Illness. Vaccination, however effective, is no substitute for attention to the underlying social conditions that contribute to human illness, including lack of access to high-quality health care. Many people suffer and die from infectious diseases because of their life circumstances. Risk factors include economic poverty and stress, structural racism, and air pollution, all of which increase vulnerability to COVID-19.

Because of point 3 above, responsible public health advocacy must address social and environmental contributions to ill health, including the current pandemic. At the same time, though, vaccination remains essential, given that our most effective remedy to COVID-19 will be advance toward herd immunity, which only vaccination can achieve without massive and unacceptable loss of life.13

Countering Vaccine Misinformation

What can be done to counter vaccine misinformation? Currently the manifest effectiveness of COVID-19 vaccination is the most persuasive argument for its value. And sometimes it is possible to strengthen that argument by directly challenging those who make false or misleading claims. In December 2020, Robert F. Kennedy’s grand-daughter, Dr. Kerry Kennedy Meltzer, an internal medicine physician, wrote in a New York Times op-ed, “His [RFK’s] concern—that the Covid vaccine is potentially unsafe, and hasn’t been properly tested—is widespread, and dangerously wrong.”14 Others in the Kennedy family have been similarly critical of his anti-vaccination views. There is a risk, though, that even negative attention given to vaccination skeptics may help them gain an audience.15 Here in California, pro-vaccination advocates have focused attention not on countering the false messaging of these critics but on communicating accurate vaccination information to the public. For example, when legislation mandating vaccination of school children was under consideration in California, parents allied with respected authorities to make their case.

California Senator Richard Pan (photo)

California Senator Richard Pan, accompanied by family advocates for vaccination, supports pro-vaccination legislation at a press conference. Credit: Senate Office of Richard Pan

Such grassroots support for vaccination is especially important today. In the past, vaccination acceptance has relied on the trust that people have in physicians, nurses, and pharmacists. But recently that re-assuring face-to-face contact between health care providers and the public has been attenuated, partly because so much medicine is practiced virtually, as a safeguard against exposure to the virus. That places more responsibility on everyone else. We can counter misinformation not only by electing political representatives who favor pro-vaccination health policies but also by communicating with people in our local communities, where much of the discussion about health matters takes place. Available sources of evidence-based information about COVID-19 vaccination include the CDC16 and the Vaccine Education Center at the Children’s Hospital of Philadelphia.17

In the race between the mutating virus and the vaccines, Dr. Ashish Jha, Dean of the Brown University School of Public Health, says that “It’s going to be a close call. We are vaccinating really well, that’s the good news. These variants are spreading pretty quickly across the country, that’s the bad news.”18 Our collective advocacy may determine the outcome of this competition. END

About the Authors

Raymond Barglow majored in physics at Caltech and received a doctorate in philosophy at UC Berkeley. He has taught at UC Berkeley and Trinity College and writes on science, ethics, and public policy issues.

Margret Schaefer received a doctorate in English at UC Berkeley, and has taught at UC Berkeley, San Francisco State, and the University of Illinois at Chicago. She is a cultural and literary critic, journalist, and translator.

References
  1. https://bit.ly/3ddu72s
  2. https://bit.ly/3cOXWrv
  3. https://bit.ly/2PMJ83w. Republican leaders are mounting opposition to a Biden administration initiative to provide guidelines for coronavirus vaccination certificates (“passports”). https://wapo.st/3sPuk2M
  4. Malik, Sallam. 2021. “COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates.” Vaccines 9(2) February 16. https://bit.ly/3fpuzxz
  5. Dr. Anthony Fauci, Director of the U.S. National Institute of Allergy and Infectious Diseases (NIAID) and medical advisor to the president, points out that “You blunt that negative effect [of the mutations] …by vaccinating as many people as you can as quickly as you can…. Viruses that love to mutate don’t mutate unless they replicate. If you can prevent them from replicating either by vaccination or public health measures, then you will diminish the potential of their mutating.” https://bit.ly/3cGkJ8w
  6. https://bit.ly/31xBigz
  7. Pogash, Carol. 2019. “As Anti-vaxx Dispute Rages, Attention Turns to California’s Waldorf Schools.” The Guardian. May 28, 2019. https://bit.ly/2QOu6up Figures from 2017 are the most recent to be released by the California Public Health Department.
  8. https://bit.ly/3fpAu5G
  9. There are nearly two thousand Waldorf schools in more than 70 countries, and the education they offer is for the most part an effective alternative to more orthodox pedagogy.
  10. Adams, David. 2018. “Rudolf Steiner on Traditional Childhood Illnesses and Vaccines.” Our Spirit. March 1. https://bit.ly/3sE0dv0
  11. Pogash, op. cit. and Schmid, Jennifer. 2020. Oasis Wellness Blog, March 21. https://bit.ly/3rL2h3b
  12. Brill, Steven, et al. 2012. “Robert F. Kennedy Jr. on Vaccines, COVID and Dr. Fauci: ‘I Read the Science’.” Newsweek, March 1. https://bit.ly/3fqgqQv
  13. Sweden’s experiment with approaching herd immunity by de-emphasizing quarantine and mask wearing, allowing people to catch the disease and recover, had disastrous results: the death rate in Sweden as of October 13, 2020 was five times higher than the rate in neighboring Norway and ten times higher than in Denmark or in Germany.
  14. https://nyti.ms/3fukf7d
  15. When we respond to critics of vaccination by saying, for example, that the evidence shows conclusively that “vaccination does not cause autism,” that response may actually strengthen the psychological association made in vaccination-skeptical minds: “vaccination-autism,” although our statement explicitly denies such a connection.
  16. https://bit.ly/3sCEQKD
  17. https://bit.ly/39sxy4t and https://bit.ly/3cCLCdO
  18. Maxouris, Christina. 2021. “The race between variants and vaccines in US will be a close call, expert warns, and eased restrictions aren’t helping.” CNN Health, March 18. https://cnn.it/2Po1hVp
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