Vaccines, once the savior of an entire generation, have become a hotly contested issue in American culture, and fears that they might cause autism have dominated parents’ discussions about vaccines for more than a decade.
Parents of as many as one in 10 children refuse to vaccinate their children with a state-mandated vaccine, and more than a third of American parents may delay or outright refuse a doctor-recommended vaccine for their children. To make matters worse, officials have found that vaccine exemptions cluster in particular areas within a state and around the country, so some communities have very high rates of under-vaccinated children.
Claims about a potential link between vaccines and autism emerged in the late 1990s from two independent sources. In Britain, a group of researchers published a paper suggesting a potential link between the combined measles, mumps, and rubella vaccine [MMR] and symptoms associated with autism.
Subsequent researchers roundly rejected their hypothesis, and the journal eventually retracted the paper. At the same time in the U.S., parents learned that many childhood vaccines contained a mercury-based preservative, thimerosal, and they grew concerned about its effects on their children.
Studies have failed to demonstrate any deleterious effects from thimerosal, but it has nonetheless been removed from most childhood vaccines. By the turn of the century, these two separate claims merged and the so-called vaccine/autism debate flowered.
Health officials aggressively defend the safety, effectiveness, and necessity of childhood vaccines, and they are dismayed by the resiliency of parents’ fears that vaccines might cause autism. Hundreds of published studies and countless authoritative statements from health authorities seem to have little influence on the debate.
Physicians and public health officials allege that ignorance and anti-science attitudes are to blame, and they worry that science alone is not enough to compel parents to vaccinate their children. Nonetheless, medical professionals continue to attack the claim that vaccines cause autism as they call for increasingly strict laws to compel vaccine compliance.
The fear that vaccines might cause autism is in fact proxy for a complex set of concerns that many parents have about the modern vaccine schedule. Health officials have failed to address parents’ underlying fears, and most parents lack the technical knowledge to effectively parse the many intertwined concerns that they have about vaccines.
What are parents really worried about? They are worried about the high number of shots kids get in the first several months of their lives. Today, a fully vaccinated six-year-old will receive nearly three-dozen inoculations, most of them in the first 18 months of life.
The routine vaccination schedule now calls for shots at almost every well-child checkup, including four inoculations at the two-month appointment and five inoculations at both the four- and six-month appointments. As parents scramble to explain their fears, the only explanation available to them is the claim that vaccines might cause autism. But when their anxieties are carefully and respectfully examined, we see that they emerge from a wide variety of often well-informed philosophical and moral concerns parents have about their children’s health.
The solution for the problem of vaccine non-compliance is not increased pressure on parents or more passionate rhetoric from health officials. State legislatures that have made it easier than ever for parents to opt out of mandatory vaccines and the increasing number of “vaccine friendly” doctors who authorize medical exemptions mean that most American children can be legally exempted from some or all of their vaccines.
The only way to effectively address parents’ vaccine anxieties is to admit them and respect the fact that their concerns ought to be considered alongside scientific evidence as we add new vaccines to the modern vaccination schedule. If our ultimate goal is to ensure that as many children as possible are vaccinated against as many dangerous diseases as possible, it is critical that we preserve parents’ trust in vaccines and in their medical care providers.
This requires respectful engagement with vaccine-anxious parents and careful consideration of their particular concerns and contexts. Pediatricians who kick non-compliant parents out of their practices and health officials who continue to insist that vaccine anxieties are merely the result of ignorance and anti-scientism heighten the growing tension between vaccine-anxious parents and mainstream medicine. Their actions drive parents into the arms of the anti-vaccinators and undermine their own efforts to increase vaccine compliance rates.
Do you believe in keeping to the recommended vaccine schedule, or do think it's safer to delay or refuse vaccinations? Let us know in the comments.
Mark A. Largent is an historian of science and medicine and an associate professor in James Madison College at Michigan State University. His most recent book is Vaccine: The Debate in Modern America.