Things are getting down and dirty now. And millions of lives are at stake. I cannot possibly state strongly enough how dangerous it is that President-elect Donald Trump has embraced the notion that vaccination is the cause of autism.
Robert F. Kennedy Jr., a celebrated vaccine skeptic, met with Trump on January 10. Speaking to reporters outside Trump Tower in Manhattan after the meeting, Kennedy said he will chair a commission “on vaccine safety and scientific integrity” at Trump’s request, because, “we ought to be debating the science.”
(One news organization, the Guardian, later reported that the Trump team denies Kennedy will lead such a commission, but offered no other explanation for why the environmentalist was summoned to meet with the president-elect.)
Kennedy has long held the position that vaccines are dangerous, and that the measles-mumps-rubella (MMR) vaccine administered to all American children is a likely cause of autism. Like any good conspiracy theorist, Trump has long questioned the wisdom of vaccines. On October 22, 2012, Trump tweeted that vaccines constitute “doctor-inflicted autism.”
In August 2016, Trump met with the disgraced ex-physician, Andrew Wakefield, who originated the claim. Formerly a gastroenterologist, Wakefield conducted experiments on children that, he claimed, proved they acquired autism from MMR immunization. The research was published in the British medical journal Lancet in 1998 but was retracted in 2010 by the journal, which stated: “ 1/8I 3/8t has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were ’consecutively referred’ and that investigations were ’approved’ by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.”
Wakefield’s license to practice medicine in the United Kingdom was stripped by the country’s General Medical Council after three years of investigations, having found him guilty of “serious misconduct.” The British Medical Journal went even further, denouncing Wakefield’s work as “fraudulent.” Before the investigation was completed, Wakefield relocated to Austin, Texas, where he continues to lead vaccine opposition today.
Wakefield produced a documentary, Vaxxed, in which he defends his work and claims to be the victim of a vast conspiracy. His defenders adhere to the conspiracy idea, insisting that the Centers for Disease Control and Prevention, the entire global vaccine industry, the World Health Organization (WHO), the National Institutes of Health, the pharmaceutical industry, and all the major science and medical journals in the world are joined in the mission of inflicting autism through vaccines.
For years, pediatrician Paul Offit, chief of infectious diseases at the University of Pennsylvania, has served as a punching bag for Wakefield’s supporters, as he has tirelessly addressed Wakefield’s claims using every medium to reach parents and dissuade them from vaccine hesitancy. At the London School of Hygiene & Tropical Medicine, Heidi Larson runs a project to track the Wakefield effect and understand why parents in rich countries are declining immunizations. Since 2007, of vaccine-preventable diseases worldwide, noting a striking shift over time in measles, pertussis, rubella, and mumps - all surfacing more often in wealthy North America and Europe and less frequently in poorer parts of the world in the absence of extraordinary disruptions, such as wars, refugee crises, and natural disasters.
So let’s get a few things straight, Mr. Trump.
Yes, there has been an increase in autism diagnoses in parts of Europe, the United States, and Canada - but this is largely because psychiatric associations have widened the definition of the disorder, now describing autism as a spectrum that ranges from the extreme of complete nonfunctionality all the way to socially challenged genius, or Asperger’s syndrome. Some additional rise in rates may not be fully explained by the expanded diagnostic definition: It is likely that parent and physician awareness, coupled with lowered stigma, has brought more cases to light. Boys are at least five times more likely to be diagnosed with autism spectrum disorder than girls, yet the genders are equally likely to be vaccinated.
No, I do not think Trump’s primary motivation for raising autism concerns is his son Barron. There has been considerable controversy regarding 10-year-old Barron’s public behavior and allegations that he is autistic: Such discourse has no place in public health. It is stigmatizing, both by pointing a finger at a child and by de facto insinuating that people who are on the autism spectrum deserve to be singled out.
And, yes, Mr. Trump, back in the day when you and I were children and were vaccinated - thankfully - to prevent us from getting measles, rubella, polio, diphtheria, tetanus, and other awful diseases, a mercury-based preservative was used to keep vaccines from going bad on doctors’ shelves. Kennedy claims the mercury is still used as a preservative and causes brain damage. But the American Academy of Pediatrics and the Food and Drug Administration removed Thimerosal, the preservative in question, from vaccines and it has not been used in MMR since 1999. The terrific science writer Seth Mnookin documented all of this in his book The Panic Virus.
Given Trump’s interest in Russia, he might be interested to know that the first claims of an association among vaccines, mercury, and child neurological health problems were raised in the early 1980s by Soviet virologist Galena Petrovna Chervonskaya and trumpeted in the Communist Party’s Komsomolskaya Pravda. Vaccination rates fell so low following the report that Soviet soldiers returning from war in Afghanistan, where diphtheria was still common, unwittingly spawned an epidemic that swept the Soviet Union, causing the worst outbreak since World War II. Some 200,000 unvaccinated children contracted diphtheria, which killed roughly 2 to 3 percent of those infected, varying by region.
Vaccines save lives. Back in 1970, when measles was the No. 1 cause of death for African children under 5, most of the continent’s nations had child mortality rates around 400 per 1,000 live births, meaning nearly half the toddlers wouldn’t survive to celebrate their fifth birthday. I bitterly recall walking through pediatric wards in northern Tanzania in 1983, filled to capacity with tiny children, covered in measles rash, fighting for their lives.
Today that horror has plummeted, thanks to UNICEF, GAVI, the Bill & Melinda Gates Foundation, WHO, and hundreds of nongovernmental organizations around the world that have brought the power of immunization to the poorest and most remote parts of the planet. It’s been an enormous fight, getting more manufacturers on board, bringing vaccine prices down, figuring out how to keep them cold and safe during weeks of transport across challenging terrain, getting ample supplies of sterile syringes, and training tens of thousands of volunteer health care workers in injection techniques. Many times over the years, it has seemed as if some force would overwhelm the effort, as money-raising stumbled or vaccine-makers, tired of all the lawsuits and hassles, threatened to cease manufacture. But since 2000, measles vaccination has spared 17.1 million children’s lives. If worldwide contributions to vaccine efforts stay on course, the combined impact of all immunizations from 2011 to 2020 will be 23.3 million lives saved, most of them babies.
Trump should know that the most virulent anti-vaccine force on Earth is the Taliban, which has executed, bombed, kidnapped, and maimed about 10 times more polio vaccinators in Pakistan and Afghanistan since 2005 than there are children who have contracted polio. In Nigeria, Boko Haram has blocked immunizers and spawned outbreaks of polio and measles. Thanks to the Syrian war and massive disruptions of family lives across the Middle East, polio has returned, measles has erupted, and millions of dollars’ worth of special vaccination campaigns are underway in refugee camps and war-torn parts of Syria and Yemen.
Perhaps these lives in far-off places aren’t Trump’s concern: As he’s said, American lives come first. But consider that, as of Jan. 10, the Arkansas Department of Health is tracking 2,421 cases of children with mumps, arising from parental refusal to vaccinate, and is telling parents that the “MMR vaccine is safe and effective.” And Arkansas is not alone: Mumps outbreaks are cropping up all over the USA, according to the Centers for Disease Control and Prevention. Measles caseloads are also increasing, and more than half are linked to parents’ refusal to vaccinate. Whooping cough, or pertussis, is soaring across America - another disease prevented with proper vaccination.
Trump soon will have to deal with another disease called Zika: We don’t yet have a vaccine for that one. Zika causes a horrible range of birth defects, from hearing loss to skull and brain malformation, all the way to stillbirth and post-birth death. It is often likened to another virus, rubella or German measles, which reached epidemic proportions in the United States in 1964. Like Zika, rubella was most dangerous for fetuses, and most babies born deaf or blind in 1963-1965 were victims of the German measles epidemic: 20,000 babies were born in this country with rubella congenital syndrome. In April 2015, WHO declared rubella eradicated from the Americas, thanks to MMR vaccination. I’m sure Trump doesn’t want to be responsible for its return.
Some wealthy Americans have reasoned that measles, mumps, diphtheria, rubella, rotavirus - these and other vaccine-preventable diseases are really only threats to poor kids, living in slums or developing countries. Vaccine-refusal rates are highest in American communities of wealth, such as Marin County, California. Those school districts are most likely to have elected boards of education that offer families opportunities to opt out of immunization, while still enrolling their youngsters to sit with other children in the classroom. For their children, the logic holds, raised in clean environs on healthy diets and fresh air, those bacteria and viruses pose no risk. They have the luxury of focusing on unproven challenges posed by vaccination, either due to the products’ alleged contamination or to their babies’ inability to tolerate so many immunizing doses in such a narrow time window. Trump appears to share these views.
They are, of course, wrong. Unimmunized children are already growing up, going to college, and falling victim to whooping cough, measles, mumps, and other microbes lurking in their dormitories, gyms, and elsewhere. When they take their well-financed school-year abroad, lack of full immunization will put them at risk for infections. And as for the pacing of the immunization schedule, I can only ask whether they have spent any time watching their infants’ behaviors. In a single day’s play crawling on the floor, chewing on Fido’s tail, stuffing toys shared with other toddlers into their mouths, fighting over food with siblings, or licking the cat’s milk dish, they are bringing their environs into their bodies, exposing their immune systems to doses of antigens millions of times larger than are contained in all of the American Academy of Pediatrics’ recommended vaccine doses, combined.
Babies have two jobs: 1) Absorb noise, sights, and smells to program their brains and learn language. 2) Slobber over everything in sight to train their immune systems to recognize the difference between what’s OK and what constitutes danger. Failure to properly build up immune defenses can lead either to an inability to fight off even mild infections or the reverse - allergies and asthmatic responses to routine elements of life. All vaccines do is help nudge that immune system programming along.
Trump was vaccinated. I was vaccinated. No doubt you were vaccinated. And we are all better for it. I can’t imagine traveling without proper yellow fever immunizations, and as soon as it was available I lined up for the hepatitis B vaccine. I wish the chickenpox vaccine had existed when I was a baby, so I wouldn’t have nearly died of the disease as an infant and suffered a horribly painful bout of shingles when I was 30, thanks to the latent virus awakening and noshing on my spinal cord.
Taking any steps that lend credence to the anti-vaxers’ conspiratorial fears will only prompt more parents to resist giving their children the same lifesaving treatments as were given to them, decades ago. Shame on anybody who would dream of putting children’s lives at risk, all over the world, for the sake of political expediency or the fears of rich white people.
Garrett is senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer.