Welcome to Scientific American Science Talk posted on February 20th 2019. I'm Steve Mercy Headline. The Guardian Newspaper. February 12th Measles outbreak in Philippines kills 70 with vaccine. Fearmongering blamed headlines CBS News, February 10th. Number of people with measles tripled in Europe in 2018 World Health Organization says in the article. This sentence More than 82,000 people in Europe contracting the virus, which killed 72 people. And again from CBS News reporting from Washington State. This headline February 8th. Hundreds rallied to preserve right not to vaccinate Children amid measles Outbreak. The rally is a response to a bill that would take away the state's provisioned to allow parents to opt out of measles vaccines for kids, for quote philosophical reasons. End quote. The good news there is that in the region where the outbreak has occurred, vaccine rates rose some 500% Before these headlines ran.

There were other cases of outbreaks traced to unvaccinated kids, so I called Taras Smith. She's an epidemiologist at Kent State University's College of Public Health. In 2017 she published an article in the journal Open Forum Infectious Diseases titled Vaccine Rejection and hesitancy a review and call to action who spoke by phone. Why did you feel compelled to do this research and write this

paper? Eso is part of my eye. I was I was a distinguished lecture for the American Society for Microbiology. And so with that, I would go to different branch meetings so different meanings throughout the various states and give lectures. And one of the lectures that I gave commonly was a lecture on and if science, denial and especially vaccines and what microbiologists could do about it. So I had people, you know, asking me after every lecture. Have you ever written anything about this? Is there anything in the published literature that I could could turn to? And there really wasn't anything specifically for people who were not positions? Um, so I thought it would be a good time to do a review and talk about things that other people could do who did not maybe necessarily have patient contact every day.

What are the things that other people can do,

right? So there's a lot of different things, depending again kind of on people's interests hand, hand, expertise and time. I mean, some of the simple things I think are just really making vaccines normalized, you know? Still, most people, even though there's this, this conception, that vaccine hesitancy is growing, and in some ways it is. Still, most people get their Children vaccinated on time and with the recommended schedule. But we don't really talk about it a lot.

So I think one of the things to do is just to if you get yourself or your child immunized to post about it. You know, my my kid got their vaccines today. Next day, maybe they had a little bit of a fever. Or maybe they were a little bit grumpy. Or maybe they didn't have anything at all. They were just fine, so kind of normalizing vaccination instead of making it this this kind of underground thing that you only hear about when people have a bad reaction. And so these are the normal everyday vaccines that we don't hear about that there is very little reaction to. So that's one thing that anyone who gets a vaccination for themselves or their Children can D'oh! Um, you know, others were just talking to your legislators. So a lot of the the laws regarding vaccines are set at the local and the state level. So if you get to know some of your politicians and see where they are on some of these issues,

you know you can write to them about your concerns about vaccines, about maybe reducing vaccine exemptions in your state. Most states still have exemptions for philosophical or religious beliefs in addition to medical exemptions. Um, you know, you could write letters to the editor, those air still influential, even though we don't think maybe about, you know, paper newspapers as much every day and then kind of opening up in reading the beds. But those are those are online. Those are widely shared, especially if they're, you know, anti vaccine. So trying to do some to counter some of those anti vaccine attitudes just, you know, work to write a letter to the editor about your beliefs on vaccines and why you feel they're important. So those are things that just about anyone can do to try to to show support for vaccines and to really normalize

them. I just happen to be, ah, part of the other day, and I was talking to some parents from Ah, town in New Jersey and they were talking about their local school board had just very loose requirements for asking for Ah, exemption. Basically, you could just say, Well, it's against my religion. You didn't have to give any other information that would justify why you could get your kid out of the vaccine program. So is there. You know the legislation. You know, this This gets into this very sticky area of what the government can tell you is apparent, Ah,

to do with your kids. But there is this public health. Ahh, factor where somebody else's kids getting vaccinated is necessary for the entire communities. Health. So, you know, how do you deal with that issue?

Right. And it is a tricky one on, and sometimes it can depend depending, you know, state laws and differences between different states regarding who is exempted and public versus private schools. So, you know, I think the best thing to do, because again, I can't give a lot of universal advice because it does vary so much. Just get to know what your regulations are within the state. Um, what your school district suggests, especially if they're public versus private you know the rules there and see what you could do to strengthen them. See if it's something that you do have to start with your individual school, Um, or if it's something that you have to take to the state Legislature to get changed there.

You talk in the article about the fact that vaccine rates and you mentioned it earlier. They are still very high. But we do see these pockets, these regional, uh, kind of situations where you you have a lot of resistance. So as a general rule, how would you categorize this problem? I mean, we hear a lot about it, but is it really a huge problem?

I think it is, especially in some of those areas. So when we're talking about herd immunity, we're talking about the the amount of people in a population who need to be immune to block transmission of certain infections. And we usually use the term about 95% because that's the level of immunity that we need to block the most infectious pathogen, which is measles. And so when you start getting it down below 95% you have these these groups of individuals who are susceptible, especially to measles, and then if it gets lower, they're susceptible a swell to two months and and other organisms. So even though it's high overall, as you mentioned, we do have these pockets of areas that are well below 90%. In some cases, you have communities where their vaccination rate maybe a 60% or 50% so they become very vulnerable to those those infections when they're introduced from from somebody from the outside. So most of the outbreaks that we've seen over the past few years have been, you know,

people who have been traveling to places where measles is endemic, which is a lot of, you know, For example, European countries go there for vacation. They're not immunized. They come back to the United States and spread it to others in their communities. And it doesn't take very much a large population to be unvaccinated, to make the community susceptible to measles. So even though levels overall are pretty high, you know, we do have susceptibility to some of those introduced infections and so I think that's the thing that we need. Thio gonna be focusing on is to try to keep those levels high and and keep those really severe infections like measles has the potential to be out of our communities.

Since you've written the paper, we have seen some outbreaks. I mean, there's a one of the most noteworthy ones. Is in Minnesota among Somali population that's been very effectively targeted by anti vaccine activists.

Yes, yeah, I mean, that's one of the problems is that the trust is difficult. And so in that community, Andrew Wakefield, who, of course, was one of the, um, a former British position who is the 1st 1 to really put for this idea linking the MMR vaccine specifically to autism. And so he went to this community to actually really stoked fear, um, against vaccination, even while they were undergoing this epidemic. So it took a lot of of really pushed by the public health community there, including people who are within the Somali community,

and that they already trusted to get them to start vaccinating and to put an end to that epidemic. But it's hard without misinformation, is in a community. Um, it spreads, and it is really difficult to, um, kind of reverse that that fear and reverse that misinformation with accurate education. Once something gets in there, that is incorrect. It's really difficult to un ring that bell.

And we should point out that Wakefield has lost his license to practice in England

and multiple papers he's had retracted.

How bad is the situation today compared with what it's ever been you mentioned in the paper? That there seems to have been this increase of distrust and vaccination in the nineties? Is that really immeasurable thing,

right? It waxes and wanes, and it's It's really difficult to get an idea on kind of the country as a whole, because it may increase in one area and decrease in another. And what you see is often that when you get these outbreaks that people in that area often see what happens, and then you get at least a transient bump and immunization or you can get lost changed. I mean, for California, for example, of course, they had their measles outbreak associated with travel to Disneyland's, and that led to the introduction of SB 2 77 which took away philosophical and religious exemptions for California students, leaving only medical exemptions. So that has led to an increase in vaccination rates throughout the state. Um, so these are the kinds of things were seeing. It is you get these these kind of movements.

Um, but usually it takes an outbreak to get there. When we saw that in Ohio two we had about the same time as Disneyland. We had a large measles outbreak in our Amish population who are not necessarily anti vaccine, but usually don't get kind of routine vaccinations, you know, yearly. Like like we do with with our Children s o public health individuals there. Did you know thousands of vaccinations over the course of a couple weeks and got a lot of them caught up. But is that something that has stuck? You know, we don't really know if they're if they're now, you know, getting their Children vaccinated, purr like a CDC schedule, or if it's kind of back to that same old you know, kind of apathy about vaccination.

Mmm. You mentioned, um, writing to your newspaper or talking to your legislator to try to get your beliefs across. I think the word belief is really interesting here because, I mean, you and I, I think, share a belief that vaccines are completely positive. Um, but our belief is is rooted in in measurable information that we know to be true. And the belief of an anti vaccine per person is is not rooted in that thing. That same structure,

right? And that's spent. There's been a lot of research on that, looking at why people accept or refuse vaccines, and some of that does have to do with values. I mean, if you don't value, um, Western Medicine. If you don't value scientific research, then you won't necessarily value vaccines as well. You may see them as you know, a tool of the government. You know, something that that medicine is doing to harm you instead of help you. There's a lot of messiness that comes who with accepting or denying vaccines. And even with that,

um, you know, as I do mention in the paper as well, you know, it's not black and white right there is. There's a whole spectrum of individuals who choose to vaccinate or not. Some may vaccinate selectively. They may vaccinate for things like like the measles, um, and maybe some other routine childhood vaccinations. But don't vaccinate, maybe for chicken pox or for influenza or HPV. Um, so you know, it's not something that is all or nothing. And some of those beliefs and values come into play is as well when it when it comes to those aspects.

Yeah, I you know, I'm a little older than ah ah. Lot of the audience, probably. And I remember, you know, people say, Well, we didn't have to We don't have the seat belt laws and we're all here. Yeah, those are the people who survived. You know, the little kid who I was friends with when when I was a little kid across the street was not wearing a seat belt, and he did not survive. Ah, kid who was a block away from me when we were in grade school,

got meningitis, and he did not survive. So, you know, I I don't mean to sound like a grizzled war veteran, but, you know, I remember friends of mine as a kid dying from these preventable things. So, you know, and you do mentioned in the paper were victim of our own success in many ways,

right? And that's how public health is in general and again, lots of times, it becomes invisible until there is some kind of an outbreak. Orsino in public health more generally some kind of crisis, the water crisis, like in Flint's that calls people's attention to drinking water. Or, you know, outbreak of infectious disease. I mean, look, right now in Asheville, North Carolina, where you have a chicken pox outbreak. I mean, I also I was the generation before the chicken pox vaccine,

so I had that. It's a child. Um, but I don't remember. It is just a mild childhood disease. I was miserable. I was on the couch for over a week. I have scars on my face, from it to my parents. Put, you know, two layers of socks on me and duck Take them to my arms so I would stop scratching on my my scabs off. You know, I did survive it, but, you know,

I knew I didn't not want my Children to have to go through that. Um, even if you know, there was a good chance they would survive, you know, they could end up hospitalized. They could end up with secondary infections. Before the vaccine, 100 Children a year in the United States died of chicken pox So it's something that is rare today, but it's rare because of the vaccine. And we're seeing that North Carolina, that when you have a population with low vaccine coverage, it can pretty easily come back.

Yeah, So, um, you know these these air such serious things and And when um when it's preventable it just feels even more tragic. And you know, the parents who have lost kids over preventable conditions because they they didn't get a vaccination? Um, it's just gotta be the most heart wrenching thing toe have to live

with, right? Right. And that's why so many of them have started becoming advocates for vaccines once they see you know how sick they're chilled theirjob child got from a vaccine preventable disease or they lost them to that disease. You know, they don't want others to go through that same thing,

and I don't know if we can say this enough times, But there is no evidence connecting vaccines with autism. There is no evidence that vaccines are dangerous in any way other than you know. The usual. Any intervention is goingto have some small risk factor, but it's much I mean, you have to look at this? Ah, a population level. And so you are going to Ah, on a population level, you are going to save just so many lives using these interventions. And, you know, you have to look at it statistically,

And that's a hard thing for people. Is that you know that risk calculus just doesn't come normal. Two people write the stories feel more riel. So that's why you know, it's of course, it's flu season right now. And every year in the United States, somewhere between about you know, 40 to 50% of people will get a flu shot. So that's a really big population. And, you know, serious reactions occur, and maybe one in a 1,000,000 or so people. So again they do exist. But they're really rare. Um,

but there's a story right now of a man in Nevada who has John Barr A syndrome, and it came on a few days after his flu shot. And so this story has gotten so much press. You know, there's this this one man who developed, um, a condition that may or may not have been caused by the flu

shots, right? The proximity in time.

Ignore. Yeah, ignoring all the people that got a flu shots and, you know, did not have anything happen. Many millions, many millions and are protected by flu

and other people who might have gotten Gin Beret without getting

the flu shot. Right? Exactly, exactly

right. It's just a proximity thing. There's no, uh, there's no evidence that that's the causal event. But, you know, that's the way our minds work. We're going to assign that to be the causal event. We should just tell people working. Emburey is

rice was a neurological condition that can cause paralysis, sometimes temporary. Sometimes it can be permanent on it. It can be caused by infection that can be caused by influenza infection. The most common cause of it is actually campylobacter infection, which is a food borne bacterium, but a lot of times the causes and easily determined. So it can be kind of mysterious, and it can be scary, which is understandable. But these stories, you know, those are the ones that linger in people's minds. Not all those people who got a flu shot and had no reaction, but this one man who got a flu shots and maybe had a condition afterwards that maybe was related to to the flu shot.

Right? Um, just in case anybody's interested the ah, the great writer Joseph Heller, who wrote Catch 22. I had a case of GAM Beret and wrote a book about it along with Hey had a friend. I think the friend's name was Speed Vogel, and the two of them wrote this book. Speed took care of Joseph Heller while he was recovering during his almost year with the G and Beret in the recovery and the book about because Joseph Heller was a funny guy and Speed Vogel is also funny guy and the book, while giving you really useful info about this condition and describing life with it, is hilarious. So I really recommend I wish I could remember the name of the book, but it's Joseph Heller and Speed Vogel, and there are plenty of books out there about flu epidemics. The 1918 gigantic pandemic of the flu that just ah killed so many people, maybe 20 million people, is that right?

Estimates put it up to 100,000,050 to 100 million.

Wow. So you know, if the thing I always tell people who are thinking about it is, ah, whether or not they should get vaccinated or vaccinate their kids. If you were in Africa right now in an area with Ebola and there was a vaccine that they were offering, I think you'd probably rush out to get it. Ah, but we live in a such a relatively safe society that these things again, we're victims of our own success, is we. We tend to just take these things for granted, and we figure, well, it's, you know, it's there's there's no huge epidemic out there,

so probably I don't have to do anything to avoid getting it. But you know what? I'm a broken record, but cheese were all in this together. I've got my flu shot to get one every year,

right? Right, And that's the thing. I mean it. We know what the flu shot. It's not perfect, but we know that it that getting the flu shot, it helps reduce your risk of getting the infection. If you do get sick, it reduces your risk of being hospitalized or dying from that and that There, you know you don't come back from dying, right? So there's a pretty serious things. So So I get it every year knowing that it's not perfect knowing that I still might get flu. But, you know, knowing that if I do, it probably will be more mild than if I had not gotten that vaccine.

That's good. You don't come back from dying. I'm gonna put that up there with my other favorite thing lately, which you see it on T shirts and bumper stickers. Vaccines cause adults,

right? Yes.

So, um, what are you working on since this article came

out, we're still working on, um, trying to do some studies to implement some of the things that we talked about in the article. So they're happened. Some a few articles out, looking at some of the interventions by parents and by other scientists to to discuss with vaccine hesitant parents or parents to be, um, some of the facts about vaccines and see if that helps sway them a little bit toward vaccination of their Children. So we're trying to put together some studies with some fish physician collaborators to start testing some of these in the local

area. That's great stuff. Ah, really glad I happened on your paper and had a chance to talk. And I, um I just think that the kind of work you do is you know, emergency room physicians are heroes and they save somebody's life. And they may save, you know, a few people's lives every week. And then epidemiologists sit at a desk and, uh, they may save millions of lives. And I think that what epidemiologists like you do is just so important. And, um, I only wish there could be a TV show about your exploits, but unfortunately, it would just be you on the computer and the phone a lot.

Maybe not so exciting for TV.

Write what you know may, maybe going out to a, uh, to a site to interview people also, But it's Yeah, it's not the same a ZR, but, uh, but But it's just it's such vital work. And I want to thank you for, uh, for doing it and for taking the time to

talk today. No, thank you. I appreciate you having me on.

That's it for this episode. Get your science news at our website, www dot scientificamerican dot com, where you can read Scott Barry Kaufman's article, titled liberals and conservatives are both susceptible to fake news, but for different reasons and follow us on Twitter. We'll get a tweet whenever a new item hits the website. Our Twitter name is at Siam for Scientific American Science stock. I'm Steve Mercy. Thanks for clicking on us.