The Toronto Star’s gift to the antivaccine movement

Last Thursday, the Toronto Star ran a front-page story on the Gardasil vaccine, describing the vaccine as having a “dark side”: debilitating illnesses. The headline and the story describe a supposed relationship between the vaccine and an array of serious adverse events:

What was the basis for the Star’s claim that the vaccine causes harm, and that risks are not being disclosed? The story primarily focused on interviews with women and their families who attribute different events to the vaccine. The Star went on to analyze Health Canada’s database and claims it found 50 “serious” incidents, including 15 hospitalizations. Studying the US adverse event database, the Star reported it found thousands of cases of harm, including more than 100 deaths. The implication the Star makes is clear: Harms and risks are not being disclosed to vaccine recipients. Yet while the cases the Star reviews are tragic and in some cases heartbreaking, the relationship to the vaccine is not established in any of the cases it profiles. A single sentence acknowledged the lack of actual evidence linking the vaccine to any of the adverse events it describes:

In the cases discussed in this article, it is the opinion of a patient or doctor that a particular drug has caused a side-effect. There is no conclusive evidence showing the vaccine caused a death or illness.

Relying heavily on anecdote instead of objective scientific evidence, The Star implies causation when all it could show is correlation. The result was a classic “false balance” picture painted about the HPV vaccine’s safety – a gift to the anti-vaccine movement, which also relies heavily on anecdotes and emotion, rather than scientific facts. False balance is always a fear with vaccine reporting, particularly because “false balance” propagates unfounded fears, implying a scientific “debate” when the consensus says otherwise. Given viewing anti-vaccine messaging for a even few minutes can decrease intentions to vaccinate, it is essential, from a public health perspective, to communicate vaccine safety information responsibly. But that didn’t happen with the Star’s vaccine story. From the headline through the reporting, the story failed to communicate risk and benefit effectively. This is unfortunate, because the the HPV vaccine has been studied – extensively. There is robust, high-quality data that establishes its safety. And the Star presented no evidence to demonstrate that the harms of the vaccine have been misstated.

Why the fight against antivaccinationists is important

The risks we face in our lives have been utterly transformed by vaccines. With the exception of clean water, no other health intervention has been as effective: More than 20 million lives in the past 25 years have been saved. Our parents and grandparents faced the risk of illness and death from diseases like smallpox, diptheria, and polio as a fact of life. Mass vaccination completely eradicated smallpox, which had been killing one in seven children. Polio is next.  Public health campaigns have also eliminated diptheria, and reduced the incidence of pertussis, tetanus, measles, rubella and mumps dramatically. More than 100 million infants are now immunized against the most common preventable childhood illnesses each year, saving more than 2.5 million young lives each year.

Yet as long as there have been vaccines, there has been those that oppose them.  I’ve spent quite a bit of time outlining the tactics and tropes of the antivaccine movement as well as considering ways in which health professionals and science advocates can improve the way they respond to antivaccinationism. And this battle continues, after over 100 years of immunization, and over two dozen diseases becoming vaccine-preventable.

Debating antivaccinationists can be dispiriting, especially if you’re a health professional. Getting personal insults in your email regularly isn’t encouraging. Your peers may not share your understanding of the issue, and your passion for it. Personally, I see  vaccine advocacy as part of public health advocacy, and part of my responsibility as a health professional, a science advocate and a parent. I’ve spent a lot of time along with my fellow bloggers at Skeptic North and Science-Based Medicine discussing the tactics of the antivaccine movement, and helping to educate and motivate. There is evidence that antivaccinationists can influence vaccination decisions.  There are four main tactics that they use:

• Skewering the science of vaccine safety and efficacy, while trying to create legitimacy for unfounded or discredited theories of harm.
• Shifting the hypotheses and the villain, from MMR, to thimerosal, to other “toxins”, and more recently, “too many, too soon”.
• Censoring criticism, whether it’s at Age of Autism, Mothering.com, or other antivaccine sites that delete comments or restrict access to their events.
• Attacking the opposition – whoever is an advocate.

How do antivaccinationists attack? Viciously. Imagine you’re the parents of a child that died of a vaccine-preventable disease. And you’ve used this tragedy to publicly advocate for improved vaccination programs, which could have prevented the death of your child. What do you think the response would be? If you’re Toni and David McCaffery, parents of of Dana McCaffrey, this isn’t a thought exercise – it’s exactly what happened. Dana died at four weeks old of pertussis (whooping cough). The reaction from antivaccinationists? Heinous:

Antivax 101: Tactics and Tropes of the Antivaccine Movement

This is the first of a series of posts adapting a presentation made at The Ontario Public Health Convention in April, 2011. The presentation, “Fighting in the Trenches: Countering Anti-Vaccine Sentiment with Social Media” was a panel discussion from Scott Gavura and Kimberly Hébert:

One of the best parts of the infectious disease outbreak movie Contagion was the decision to include an antivaccinationist, conspiracy-minded, alternative health advocate, played by Jude Law. Law gave a character-perfect performance of someone intent on deliberately and selfishly thwarting public health advice, putting lives at risk as a consequence. Sadly, the writers didn’t have to look far for real world examples: It’s hard to forget “Health Ranger” Mike Adams’s paranoid music video produced in 2009, at the height of H1N1, when he decided to put every antivaccine argument into one performance.

But the Health Ranger is just the current manifestation of antivaccine sentiment which has been around since vaccines were invented:

When a theory has been confirmed so completely by facts as has the proposition that vaccination effectually performed will prevent an individual from contracting small-pox, or at least so fundamentally modify the disease that it is no longer a serious malady, there is in many minds a natural distaste to fight the battle again or to be constantly defending the position against the attacks of ill-informed or prejudiced persons.

– British Medical Journal, July 24, 1897

But this battle is still being fought, after over 100 years of immunization, and over two dozen diseases becoming vaccine-preventable. The anti-vaccine movement is a real movement, and it’s doing what it can to create fear, uncertainty and doubt regarding public health messaging. There is evidence that antivaccinationists can influence vaccination decisions. The arrival of social media over the past decade means there’s the need for public health advocates to adapt their messaging to this new medium. What seems clear is that “traditional” public health tactics, with warnings and arguments from authority, are dwindling in their effectiveness. All aspects of medicine are moving towards models of shared decision-making. This is an overdue change, and it’s been facilitated by the widespread availability of health information. Information is no longer hidden from public access. Want the approved product monograph for a vaccine? It’s available online. Even the primary literature is becoming more freely accessible.

Unfortunately, the power of the Web 2.0 and social media has made it easier for antivaccinationists to foster antivaccine fears and sentiment. In order to combat this misinformation, the movement’s tactics and tropes must be understood, so they can be called out.

Anti-anti-vax: Getting to the gist

I’m currently putting the finishing touches on a presentation for the The Ontario Public Health Convention next week, where I’ll be speaking, with occupational therapist Kim Hébert, about the anti-vaccine movement and social media (SM): how antivaccine advocates use it, and the challenges and opportunities for public health advocates. I’m pleased to see Seth Mnookin, author of The Panic Virus, is one of the keynote speakers – his perspective will be valuable for the public health crowd which has traditionally relied on fairly static “key messages” for disseminating information on vaccine safety and effectiveness. The panel discussion of which I am a part will be an examination of challenges and opportunities presented to public health advocacy, and particularly vaccine advocacy, in a Web 2.o environment. What seems clear is that the old public health channels don’t cut it anymore: these methods are distant and insufficient to address the wide and rapid spread of misinformation in an era of social media. We all remember the anxiety over H1N1 just a few years ago – and judging by the poor uptake of the vaccine, it seemed the anti-vaccine movement had some success in propagating fear, uncertainty, and doubt. I’d almost forgotten about this chestnut from the Health Ranger himself: