Deadly Choices: How the Anti-Vaccine Movement Threatens Us

"Paul Offit is considered by many to be the leading authority on infectious disease in children in the United States, and he wrote this important and illuminating book in response to the growing problem of vaccine hesitancy in the late twentieth and early twenty-first century. Two major events were responsible for fuelling what would turn out to be groundless fears about the safety of vaccines. But once the damage had been done, it proved very difficult to restore confidence with large-scale consensus science. In 1974 a research paper in the respected British Medical Journal described 36 children with epilepsy and linked their condition with vaccination against whooping cough (pertussis). This sowed the seeds of uncertainty. In Britain, vaccine uptake fell to 31 per cent, while in Japan, little more than 10 per cent of children were vaccinated. Another notorious publication, in 1998, did even greater harm, when British scientists suggested the MMR (measles, mumps, rubella) vaccine might be associated with autism. The paper was later discredited. Offit meticulously traces the events surrounding these setbacks, how they breathed new life into the anti-vaccination movement, and how this resulted in hundreds of preventable cases of infectious disease in the twenty-first century. He also highlights the lamentable failure to reap the benefits of new vaccines such as the HPV vaccine introduced in 2006. Almost 50 per cent of children go unprotected. Full uptake of this vaccine would probably prevent around twenty-six thousand cases of cancer each year in the United States. “In Britain, vaccine uptake fell to 31 per cent, while in Japan, little more than 10 per cent of children were vaccinated” But Offit doesn’t stop there. As well as documenting the large scale studies, conducted over decades, which firmly demonstrate the absence of a link between vaccines and developmental disorders, he details, in the case of convulsive seizures and arrested development, the true cause of the problem—a rare genetic disorder discovered in 2006. Offit is much admired for his wisdom and his willingness to engage with and reassure those with doubts. While some authorities on vaccine hesitancy analyse the sociological reasons behind vaccine refusal, Offit is the principal champion of objectivity, clinical investigation and the paramount importance of scientific understanding. Since Offit’s authoritative publication in 2010, updated in 2015, the character of the anti-vaccination movement has shifted and changed. During the 2020 pandemic, conspiracy theories relating to coronavirus, the contents of COVID-19 vaccines, and the motivation behind vaccination policy gained ground, and these tapped into beliefs held by both right-wing libertarian extremists and left-wing proponents of wellness philosophy. During the turbulent events surrounding the U.S. presidential campaign, radical anti-vaccinationists sometimes found common-cause with militant protest groups. Nevertheless, the unparalleled success of the international collaborative endeavour to deliver safe and effective vaccines against COVID-19 has strengthened the majority view that vaccination is a powerful global weapon and a force for good. One of the unsolved problems in immunology is highlighted by the pandemic. The coronavirus is not a serious infection for most people. In the majority, the immune system readily prevails. But a large and ever increasing group is highly vulnerable—the elderly. Before the twentieth century, life expectancy was limited but today most of us survive much longer. Understanding immunosenescence – how and why the immune system declines with age – is a major challenge for modern immunology. Another major frontier relates to the young. The increased incidence and severity of allergic diseases such as asthma has yet to be explained and new therapies have been slow to emerge. Overly aggressive immune responses may be related to modern hygiene and the control of infections. Understanding this area will be important for progress in the future. The opposite problem—immunodeficiency disorders in the young—also remains a challenge. As we saw in The Beautiful Cure , immune therapies for cancer have proved elusive until recently. Understanding how the immune system normally exercises restraint through regulatory cells has opened the way for new therapies. Blocking the checkpoints that restrain the immune responses has enormous potential in persuading immune cells to attack tumours. A complementary approach employs tailor-made treatments for cancer. By identifying immune targets on tumours, it’s possible to design individual anti-cancer vaccines. This is precisely what BioNTech scientists were doing before COVID-19 came along – producing customised mRNA vaccines for individuals with melanoma and prostate cancer. They were also combining these vaccines with checkpoint inhibitor therapies. These strategies have great potential for the future. Get the weekly Five Books newsletter Despite the stunning success of COVID-19 vaccines, we still lack highly effective vaccines against many developing-world diseases. These include TB, malaria, HIV and diarrheal diseases—the biggest killer of small children around the globe. Combination diarrheal vaccines, designed to complement hygiene measures, are in the early stages of development. Understanding the causes of autoimmune diseases and the rational development of more effective treatments is another important frontier. Monoclonal antibodies for clinical use, designed to target immune regulatory molecules, have revolutionised the treatment of diseases such as rheumatoid arthritis, but there is still a long way to go. Such purpose-built antibodies have recently been joined by monoclonal T-cell receptors—engineered receptors removed from cells and used as therapeutic drugs. Immunology has traditionally depended on fundamental, curiosity-driven research to reveal secrets and enable the delivery of new therapies. But, as you can see from these answers, twenty-first century research is very much focussed on the manifold problems of disease."