The Message of Measles | The New Yorker
One day in the early sixties, Saul Zucker, a pediatrician and anesthesiologist in the Bronx, was treating the child of a New York assemblyman named Alexander Chananau. Amid the stethoscoping and reflex-hammering of a routine checkup, the two men got to talking about polio, which was still a threat to the nation’s youth, in spite of the discovery, the previous decade, of a vaccine. At the time, some states had laws requiring the vaccination of schoolchildren, but New York was not one of them. In his office, on the Grand Concourse, Zucker urged Chananau to push such a law, and shortly afterward the assemblyman introduced a bill in the legislature. The proposal encountered resistance, especially from Christian Scientists, whose faith teaches that disease is a state of mind. (The city’s health commissioner opposed the bill as well, writing to Chananau, “We do not like to legislate the things which can be obtained without legislation.”) To mollify the dissenters, Chananau and others added a religious exemption; you could forgo vaccination if it violated the principles of your faith. In 1966, the bill passed, 150–2, making New York the first state to have a vaccination law with a religious exemption. By the beginning of this year, forty-six other states had a version of such a provision; it has proved to be an exploitable lever for people who, for reasons that typically have nothing to do with religion, are opposed to vaccination. They are widely, and disdainfully, known as anti-vaxxers.
Because of the success of the anti-vaccination movement, measles cases have since turned up in twenty-nine other states, but New York has had by far the most cases: 1,046 as of last week, out of a national total of 1,203. This has threatened to wind back decades of success in the containment of the disease since the first measles vaccines were introduced, in 1963—an era when the United States saw between three million and four million cases a year. In 2000, the U.S. declared that measles had been eliminated in the country; if this outbreak isn’t contained by October, it could jeopardize the nation’s so-called measles-elimination status. This would be a dire step back for our public-health system, and a national embarrassment. (Britain, well acquainted with national embarrassment, lost its elimination status this year.)
Measles, often called the most contagious disease on earth, is an airborne virus. If a person with measles walks into a room, the pathogens can linger there for two hours after the person has gone.
The virus is infectious even before the appearance of the rash, during which the symptoms can be fever and the “three Cs”: cough, coryza (runny nose), and conjunctivitis. The vast majority of measles cases turn out O.K.—a fortnight of misery—but bad things can and do happen. It isn’t Ebola, but it isn’t chicken pox, either. (That said, it has killed more people in the Democratic Republic of the Congo this year than Ebola has.) The rate of hospitalization is about one in five, mostly owing to pneumonia, and the mortality rate is about one in a thousand. (In developing countries, it is more like one in a hundred.) Measles may also have a suppressive effect on the immune system for two years—“the shadow of measles,” as I heard one doctor describe it. The disease can cause hearing loss and, in rare cases, five to ten years later, a usually fatal form of encephalitis. Its prevalence, before the development of the vaccine, made it a scourge. Pretty much everyone got it. Its virtual disappearance since has made it seem like an abstraction, one of those common experiences of yesteryear that old-timers think kids today are too coddled to abide, like schoolyard fistfights, helmetless cycling, and child labor.
“Some people seem to think measles is some happy Norman Rockwell rite of passage for American youth,” Howard Zucker told me. A popular long-standing anti-vax meme depicts a clip of Marcia Brady, in a 1969 episode of “The Brady Bunch,” declaring, “If you have to get sick, sure can’t beat the measles!” Parents who might agree sometimes throw so-called measles parties, to get it over with for as many kids as possible, as soon as possible. What was once a folksy response to inevitable exposure now carries a hint of Munchausen by proxy.
One need not relitigate the case for vaccines here. There have been more than a dozen large-scale, peer-reviewed studies—the most recent one in Denmark, involving more than six hundred and fifty thousand children—that have found no connection between the M.M.R. vaccine and autism. Are there side effects to vaccines? Sometimes. Are there bad doses or batches? If there weren’t, there would be no such thing as the National Vaccine Injury Compensation Program. Does Big Pharma benefit from the vaccine protocol? You bet. At the end of July, Merck, the only U.S. manufacturer of the M.M.R. vaccine, announced that it had earned six hundred and seventy-five million dollars in the previous quarter from the M.M.R. vaccine and the chicken-pox vaccine, a fifty-eight-per-cent increase from the same period last year.
But vaccines work, both for individuals and for the general public. They are one of the great advances of modern times. And they do not cause autism. The science on this point is settled, to the extent that any science ever is, in the pursuit of proving a negative.
The measles outbreak has helped clarify for many public-health professionals that the virus they’re fighting isn’t so much measles as it is vaccine hesitancy and refusal. With the spread of mass shootings and conspiracy theories like QAnon, we are becoming more comfortable with the concept that ideas behave like viruses. This pandemic’s Patient Zero is harder to pinpoint. Suspicion of authority, rejection of expertise, a fracturing of factual consensus, the old question of individual liberty versus the common good, the checkered history of medical experimentation (see: Tuskegee, Henrietta Lacks, Mengele), the cynicism of the pharmaceutical industry, the periodic laxity of its regulators, the overriding power of parental love, the worry and suggestibility it engenders, and the media, both old and new, that feed on it—there are a host of factors and trends that have encouraged the spread of anti-vaccination sentiment.
But, if we have to pick a Patient Zero, Andrew Wakefield will do. Wakefield is the British gastroenterologist who produced the notorious article, published in The Lancet in 1998, linking the M.M.R. vaccine to autism. The study, which featured just twelve subjects, was debunked, the article was pulled, and Wakefield lost his license to practice medicine—as well as his reputation, in scientific circles anyway. But, owing to his persistence in the years since, his discredited allegations have spread like mold. In the anti-vaxxer pantheon, he is martyr and saint.
“It’s shocking how strong the anti-vax movement is,” Zucker said. “What surprises me is the really educated people who are passionately against vaccinations. I see this as part of a larger war against science-based reality. We need to study vaccine hesitancy as a disease.” He gave a TEDx talk recently about the crippling disconnect between the speed at which information, good or bad, spreads now and the slow, grinding pace of public-health work. He managed, by way of the general theory of relativity, to establish the equivalence of H1N1, Chewbacca Mask Lady, and Pizzagate: “How do we immunize and protect ourselves from the damaging effects of virality?”
People often talk about the anti-vaccination movement as a social-media phenomenon, but in the ultra-Orthodox community, where women are discouraged from using computers and smartphones, it has apparently spread mostly among mothers by word of mouth, through phone trees, leaflets, and gatherings: still viral, but analog. “It’s more about social networks than social media,” Gellin, of the Sabin Vaccine Institute, said.
In May, there was an ultra-Orthodox anti-vaccination “symposium” in a ballroom in Monsey—men and women separated by a makeshift wall, Wakefield present via Skype. A Satmar rabbi, Hillel Handler, stood and suggested that the measles outbreak was an anti-Hasidic conspiracy concocted by Mayor Bill de Blasio, as a cover for diseases imported by Central American immigrants. Others equated what they called “forced vaccination” with the Holocaust.