What we talk about when we talk about vaccines

Recently, the CDC posted new, sobering numbers on the recent outbreaks of measles, a disease previously thought eradicated by mass inoculation efforts over the course of decades.  Like the spots found in the mouth of a patient, it’s not pretty:

Two hundred and eighty-eight cases of measles were reported to the Centers for Disease Control and Prevention (CDC) in the United States between Jan. 1 and May 23, 2014. This is the largest number of measles cases in the United States reported in the first five months of a year since 1994.

The cause is equally disgusting:

“The current increase in measles cases is being driven by unvaccinated people, primarily U.S. residents, who got measles in other countries, brought the virus back to the United States and spread to others in communities where many people are not vaccinated,” said Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunizations and Respiratory Diseases.

Keep these thoughts in mind. I’m going to tell you a little story.

As some of you are aware, polio, the debilitating disease that renders a person physically disabled for the rest of their life, still continues to persist in parts of the Middle East, especially the northern provinces of Pakistan. This is mainly due to efforts by the Taliban and related organizations, as well as tribal leaders, to prevent vaccine distribution. Now, from an untrained standpoint, some would suspect the motives of the Taliban’s anti-vaccine efforts have at least some backing in Islamic thought. But that is not really the case: Inoculation has long been used in the Middle East and the Indian subcontinent, predating Western introduction of the practice. While there were previous concerns surrounding the religious validity of modern vaccines, the use of Muslim medical workers alleviated this problem. There is not much religious justification going on against the vaccines themselves.

Rather, the problem is not so much the vaccines as it is the source:

Anxieties and distrust about the polio vaccine and its western providers were rampant in some communities, and suspicions about CIA links with the polio vaccination campaigns, and rumours they were a front for the sterilising of Muslims, had been around for a decade after 9/11.

Given all the attention Pakistan got after 9/11, that the CIA would be rumored to have some sinister involvement in polio eradication did not seem far-fetched for the average Pakistani. Then came the revelation that a Pakistani doctor led a fake vaccination drive as a CIA cover operation to confirm Osama Bin Laden’s hideout in Abottabad in 2011, which caused the whole thing to fall apart. Two years after the fact, the region remains the largest endemic source of polio and continues to grow.

In essence, the issue is no longer scientific, or even religious, but cultural. The problem is not that there is anything wrong with the polio vaccine, but that the United States, the source of the polio vaccine, continues to wantonly attack tribal areas through the use of drone warfare that causes extensive collateral damage. When the same people who have been sending weaponized robots to kill your family on the grounds that one of them is possibly a terrorist try to give you medicine from their labs, would it be wrong to be suspicious, if not outright hostile to taking it? No. You would feel morally justified in rejecting it.

What is happening in Pakistan is happening here and in the United Kingdom, only the disease is different, as is the cultural problem. You see, the anti-vaccine problem in the western world is not the MMR vaccine. The problem isn’t even the use of mercury-based preservatives such as thimerosal in vaccines.

Autism is the problem.

Google “autism.” What would be the words you would describe it, based on that first page?  Would “disease,” “disorder,” and/or “disability” sound about right? Words like that give the impression that autism is some lifelong debilitating condition that makes people less than human, despite some people who’ve done well for themselves. Add to that a still incomplete understanding of it in the field of medicine, the idea that it is “without a cure,” and that it is occurring in greater numbers among children (even though that number is under 1.5 percent of the overall population), and you have the workings of a moral panic.

When doctors and related professionals throw around negative connotations like “epidemic” and “plague,” and beliefs that autistic people are immoral monsters if left unchecked, that gets people scared, gets them into a hating mood. Consequently, it gets parents worried that their child might end up becoming a useless burden to them, and/or to society. So, is it all that surprising that parents would thus seek to eliminate whatever might lead to autism, even if such causes are built on outright lies and criminal behavior? Even if that elimination revives a nasty disease that is traumatizing in its own way?

The unwieldy emotional aspect of parental thinking is not to be understated: Skipping on a lifesaving vaccine is nothing when compared to the imagined possibility that one’s child will be shunned by society, that he or she may or may not be able to function at an acceptable level to them. They may be able to function to a human level with enough effort, but there will always be something that will make them not “pass” within society, even among those who are classified as “mild” or with Asperger’s syndrome. That keeps parents up at night.

When so-called “pro-cure” autism advocacy organizations such as the celeb money vacuum Autism Speaks — which support treatments which could count as abuse in other circumstances — have been actively promoting the anti-vaccine ideology, it is easy to see that the vaccine problem is actually about autism. While the medical profession did a great amount of effort in eliminating Andrew Wakefield’s shameless act of blasphemy from the records, the damage was already done: Vaccines have now become a cultural problem that they cannot easily fix.

Much like drones killing wedding parties stop Pakistanis from accepting polio vaccines, the idea of the autistic person, even at his or her most positive, stops Americans and Brits from accepting MMR and other infant/toddler vaccines.

Such a problem requires a radical solution that addresses the cultural fear. “Curing” autism is one, yet the idea of curing something with as much variability as the wind on the ocean seems impractical, implausible, and foolish.  Even if a cure were attainable, the spectrum makes it impossible to cover every case. If it can be done, so be it, but it exacts a great cost to one’s individuality, given the autistic’s strong connection to that individuality.

A more radical solution is to stop looking at autism as a problem, to stop looking at it as a disease. Perhaps accept it as part of the human condition. Doing so would require eliminating it from the DSM and related psychiatric manuals, and focusing on ways of integrating autistics into society as they are rather than “fixing” them through such means as applied behavioral analysis. This would not necessarily mean that autistics themselves would be entirely free from certain responsibilities, but it would give them the freedom to be themselves and at least be human.

As stated before, when the Red Crescent and other health organizations started having Muslim doctors and aid workers distribute the vaccines, the religious stigma surrounding vaccines slowly faded.  When you eliminate the “problem” of autism, the foundation of the anti-vaccine movement similarly disintegrates, leaving only conspiratorial fragments. By eliminating the cultural issue, vaccines become acceptable again.

Drastic social changes are necessary for this, even with a cure, since we simply cannot switch people around like the aid organizations did. But it’s not without precedent. After all, the medical profession did have homosexuality in the books as a mental illness four decades ago.

(Image source: World Bank, CC-BY-ND-NC)

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