COMMENTARY

What to Tell People Who Are Against Measles Vaccination

Arthur L. Caplan, PhD

Disclosures

May 14, 2019

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU School of Medicine. Well, we've talked about this in the past, but the measles outbreak that has beset the United States just keeps going. Many states are reporting cases.

There is a huge number of cases in New York, both in New York City and in Rockland County. The Orthodox Jewish community is a particular subgroup that has been affected by the measles outbreak. Diseases have spread quickly within this community, due to large families with many children.

People have gotten sick from travelers who aren't vaccinated and had measles but didn't know they had it. I'm told that there's at least one flight attendant who was on a flight to Israel and has fallen into a coma, with encephalitis due to measles. I know that there are a number of children who are in ICUs because of measles. This is not a trivial disease.

Measles once did not exist in the United States. The CDC announced its eradication more than 12 years ago; yet, we're struggling with it again. This is primarily due to fears and worries circulated by people opposed to vaccination.

What should you be ready to say if you get into a discussion with someone about vaccines? How are concerns about vaccination today different from what they were 10-30 years ago?

The objections of antivaccinators have evolved. It used to be that the primary concerns antivaccinators had were safety related, particularly the connection to autism, and distrust of the pharmaceutical industry—that the pharmaceutical industry was pushing vaccines to make a lot of money. Those are the old objections. They probably fueled some of the resurgence of things like measles and mumps, and not getting the flu shot, that we see today.

Some new arguments have been added. One new argument is that natural is good. We're starting to see this—not in communities that are poorly educated or don't understand much about vaccines, but in educated, upper-class, wealthy communities.

Think of it as the people who are paying close attention to Gwyneth Paltrow and trying to use natural foods, supplements, and other natural substances to treat or prevent illness. These are also the people who believe that nature is good and that whatever is going on wouldn't be happening if we weren't designed to adapt to it, accept it, and live with it. That's a very dangerous attitude, but it's one you need to probe for and see if it exists.

There are people out there who are saying that it's better to develop measles naturally than to receive a vaccination. That's clearly false. Given the number of people who are hospitalized, the danger of brain damage, and the danger of death—in some parts of the world, tens of thousands of people are dying from measles—there's nothing good about developing a natural case of measles.

It's true that many people who have measles don't suffer bad side effects other than some inconvenience, itching, fevers, and rashes. But overall, this notion that nature is always good and that measles wouldn't exist if we weren't ready to cope with it is just false. In fact, it strikes at the heart of why we have medicine.

Medicine is there to help and to render assistance when nature does us wrong. Sometimes nature is out to kill us. People and patients need to understand that nature or what's natural isn't always the best thing. You need to be prepared to address that particular concern.

The other argument that's new is, "I have a right to do what I want to do." We see a lot of individualism in our society now, with people saying, "You can't make me get a vaccine," or "I'm not going to do it because I want to do what's best for me and my kids."

I think that's unfortunate because it doesn't get to the point that there are many people out there who can't vaccinate—newborns, immunocompromised people, elderly people whose immune systems are getting weaker—and we have to protect them. It isn't right to say, "I don't care about my neighbor." It should be stressed that the point of vaccination isn't just, "Well, do you want to protect yourself or not?"; it's to do something in the community.

Related to that, when children are involved and need their vaccinations, the state does have the right to say, "You must do this or you'll be fined." It's the basis for what we do with car seats and bicycle helmets.

We sometimes say that parents' choices about their kids are not absolutely untouchable. The government can step in and protect kids. Kids have a right to health, and vaccination is a part of that. This argument that "It's up to parents, and that's the end of the story" needs to be addressed. Not when it comes to children's health, and not when it comes to the health of the community.

I think we've beaten back the safety concerns successfully. Study after study has debunked the idea that autism is linked to vaccinations. The Big Pharma complaints also have been beaten back because Pharma is making a lot more money treating diseases than preventing diseases.

The alternative medicine movement makes a fortune, too. I believe there is almost a 3 to 1 ratio of profits between people selling natural foods, and natural solutions to problems like the measles, than what the vaccine industry is making off of the sale of vaccines.

It's these newer arguments that I think are now accounting for the reoccurrence of measles—vaccine concerns and vaccine objections. We have to take seriously the idea that some people think that what's natural is okay and we don't have to do anything about that, or the idea that "I have rights and no one can tread on them—they're immutable, untouchable, and no one can challenge them."

Both of those points are wrong. When you talk to patients or people in the community, you should be ready to point that out.

I'm Art Caplan. I'm at the Division of Medical Ethics at NYU. Thanks for watching.

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