1 Anti-Vax Culture of Conspiracy: Where Does It Begin and Where Does It End? Abigail Beach (Biochemistry), Destri Eichman (Bioch

Anti-Vax Culture of Conspiracy: Where Does it Begin and Where Does it End?

Abigail Beach (Biochemistry), Destri Eichman (Biochemistry and Spanish), Jacob Hansen (History),

Missy Rolseth (Political Science), and Stacia Schollmeyer Education

Alpha Chi, Missouri Delta

Westminster College

March 2, 2020

We began researching in December, assigning each group member a specific perspective with which to look at the anti-vax culture of conspiracy. We reconvened in January, forming an outline to better direct our research. We conducted a survey in early February and put a rough draft together in mid-February.

For the last two weeks, all team members have been extensively reading, editing, and commenting on other members’ sections. We are very proud of the interdisciplinary investigation we present.

Anti-Vax Culture of Conspiracy—Where Does it Begin and Where Does it End?

According to the CDC, up to 30% of children in the United States are not properly vaccinated every year. Although vaccines have been produced and distributed to improve public health and safety since the 1800’s, some parents make the decision to not vaccinate their children. Why do parents make this choice? Throughout history, conspiracies have been rampant in human civilization. From ill-placed blame during the Black Plague to claims of U.S. government involvement in the 9/11 terror attacks, conspiracy theories have made a significant impact on society. The anti-vax culture of conspiracy has been growing tremendously over the last two decades. What began as whispers alluding to bad medicine has exploded into a social movement that has been heard throughout the Western world. While other modern cultures of conspiracies lead to books, online threads, and heated discussions, the anti-vax culture puts the health and lives of children at risk. Anti-vax culture began with an irresponsible publication, was followed by misplaced celebrity advocation, blossomed into deadly epidemics, and is now at the one of the most significant political questions of the twenty-first century. As the echoes of affected children are heard throughout the United States, this culture of conspiracy is perhaps the most significant of the 21st century to date, requiring a resounding chorus of education and reason, leading to trust in science, responsibility of those with influence, and laws to prevent the unthinkable.

Before February of 1998, most people believed that vaccines were safe, effective, and had positive health outcomes (Assessing the State of Vaccine Confidence, 2015). After the eradication of polio and smallpox, individuals who lived in countries in which vaccines were readily available understood, or had even witnessed, their life-saving capabilities. But in February of 1998, Andrew Wakefield and ten co- authors published an article titled “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children” in The Lancet that has had reverberating consequences across the

Western world. However, papers published in scientific journals are, by construct, supposed to be peer- reviewed under strict guidelines (Björk & Hedlund, 2004). Thus, scientists were right to want to study

Wakefield’s topic further and see if his results could be replicated.

The premise of the research was to investigate symptoms and the possible causes of illness for children who had gastrointestinal conditions and had lost acquired skills. Through their investigation,

Wakefield et al. (1998) proposed possible correlations between the Measles, Mumps, and Rubella (MMR) vaccine and the observed symptoms through both parental accounts and previous research on the subject.

Given the article’s scientific nature and publication in a well-known research journal, readers who lacked an understanding of science quickly began to view the research as fact, allowing it to guide the medical decisions made for their children. However, upon further academic review, the article was found to have many fundamental flaws, as the paper presented data and correlated speculations that were problematic for the scientific community.

Scientific experimental design has long had an implied model to which scientists can look in order to construct analyses that are conclusive, unbiased, and clearly defined within the scope of their research field. An analysis into the article published by Wakefield et al. shows that while the authors adhered to the basic fundamentals of this type of research given the study’s structure and associated testing, they ultimately disregarded the principles that lay the groundwork of research (Seethaler, 2009).

First, this research has an integral fault in the sample size. In this study, only twelve children within one specific pediatric hospital unit were observed and examined. In order to feel confident making generalizations about populations and ensuring that those generalizations are not due to random chance, scientists are less likely to trust data collected from few participants. Given this, these researchers should not have drawn sweeping conclusions from such a small sample size. Further, among the twelve participants, only one was female. To ensure the most definitive data, almost all scientific studies include participants only of one sex or a comparable number of participants from each sex. Those studies that do not choose participant sexes in this way typically do so for a specific reason related to their research questions. Additionally, there were significant issues with data collection and presentation. Wakefield et al. (1998) attempted to claim that the MMR vaccine was the cause of a variety of symptoms that the authors claimed were associated with its exposure: fever, delirium, self-injury, rash, repetitive behavior,

loss of self-help, convulsion, gaze avoidance, diarrhea, disinterest, lack of play, vomiting, and recurrent viral pneumonia. The authors went further to discuss behavioral diagnoses—some definite, others not— of the 12 participants: autism, autistic spectrum disorder, “post-viral encephalitis?,” “post-vaccinial encephalitis?,” “disintegrative disorder?,” and “autism?” (1998). A tenant of scientific research and statistics is that correlation does not equal causation. Thus, even if Wakefield et al. could statistically show a correlation between the MMR vaccine and the smorgasbord of symptoms and inconclusive behavioral diagnoses, it still would not show that MMR causes these things, particularly with the small number of participants. In other words, there is no evidence that shows that vaccines cause autism or any of the other ailments that Wakefield et al. claim.

In fact, there are studies that directly refute the results of Wakefield and his co-authors. Taylor et al. (1999) published a paper one year after the publication of the Wakefield et al. article titled “Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association.” In this paper, Taylor et al. examined children born since 1979 who had been diagnosed with autism and charted that trend against the introduction of the MMR vaccine. Taylor et al. had 498 participants from eight different health districts in the United Kingdom. They found no discernable change in the rate of children diagnosed with autism, even across the time period during which the MMR vaccine was introduced, thus disproving any correlation between the two.

While there were many issues with the way that Wakefield et al. conducted their research, what many considered to be the biggest issue was the blatant conflict of interest involved in the study and its findings. In 2004, the editor of The Lancet (the journal in which the Wakefield paper was originally published), Richard Horton, published a statement saying that an investigation into the ethics, data collection, and results of the Wakefield et al. article revealed that the Wakefield study was funded by the

Legal Aid Board, who were in the midst of a legal battle with a pharmaceutical company that produced vaccines. Despite all the evidence against it, the Wakefield et al. study was not retracted by The Lancet

until 2010. Furthermore, even though the article was retracted, it is still the influence for a chorus of anti- vaxxers heard throughout the nation.

The vibrations of the Wakefield et al. article, despite the research’s innate issues, penetrated developed societies throughout the world. This prompted an array of reactions that have agitated not only health outcomes in relation to vaccine preventable diseases, but also the healthcare systems as a unit itself. Conspiracies give way for believers to stake tangible blame on someone for their perceived predicament. Most of the time, especially in this instance, believers place this blame on the

‘establishment’ which tend to be figures of the government or scientific communities. Science has long been linked to conspiracy theories, as many associate its inner-workings with militaries, government, and large corporations like pharmaceutical companies (Goertzel, 2010). Although this can very rarely be the case for some medical researchers, a majority of those within the healthcare system who are proponents of vaccination are family physicians and pediatricians whose entire careers are dependent on the health and safety of their patients. In fact, a majority of healthcare distrust stems from the overplayed media attention of outlying doctors who have been caught gaming the system (Girgis, 2017). This is not the first time that scientific inquiry has been disregarded in favor of conspiracies.

The anti-vaccination movement presents a danger to modern American society. It has the capacity to echo other cultures of conspiracy that have existed throughout history, many of which have threatened and harmed individuals and entire communities within the societies that propagated them. During the

Black Plague pandemic, the Jewish population in Europe began to be heavily persecuted for the plague outbreak. This occurred after Christian Europeans spread a rumor that Jews were poisoning communal water sources secretly, claiming that this poisoning was the source of the disease (Porter, 2014). These accusations, as emphasized by Porter, were completely unfounded; modern medical knowledge reveals that the cause of this plague was the spread of the disease through sources such as contact from those who were already sick (Porter, 2014). Nonetheless, these accusations resulted in the torture and even execution of Jews for their alleged crime (Porter, 2014). One conspiracy theory, completely unfounded by

science and based entirely on prejudice, led to immeasurable pain for an entire ethnoreligious group. This historical example shows just how damaging uneducated conspiracy theories can be.

Often, these cultures of conspiracy hurt the societies who propagate them. The religious, non- scientific reasons given for the cause of HIV’s spread within African communities exemplify why uneducated conspiracy theories are dangerous for entire communities. According to Bryan Forsyth et al., within African communities, those who test positive for HIV are often seen by other members of the community as deserving of the disease; many assume affected individuals to be cursed, involved in witchcraft, or sinners (2008). Therefore, in many African communities, HIV is not understood through scientific explanation, but instead is viewed as divine punishment. According to Forsyth et al., these myths are reinforced by illiteracy and misinformation (2008). The conspiracy is firmly rooted in a lack of education and extremely religious cultures. The religious causes, driven by a lack of education and literacy, to which HIV is attributed within Africa has caused counterproductive beliefs about HIV to spread throughout Africa, marking yet another example of the harm that uneducated conspiracy theories can cause within societies.

Not all individuals influence the anti-vaccination movement equally--some voices are louder than others. Those who have a large presence in public life and culture have abused how far their voices carry to spread the anti-vaccination message. In fact, the manager of the clinical and immunization programs for Rite Aid, Chris Altman, believes that celebrities strongly influence society, especially as in the age of social media, which has amplified their voices. These celebrities can push people over the edge and into the “anti-vaccination camp” (Antrim 2018). Anti-vaccination celebrities have strong influence when it comes to arguing against vaccinations. Jim Carrey has claimed that it is a huge logical leap to claim that no causation exists between vaccines and autism; he believes one does exist (Loomes, 2018). He accused the 2015 California Governor of being a corporate fascist who was poisoning children because he enacted tough laws that required all schoolchildren in California to be vaccinated (Loomes, 2018). The public

presence of celebrities and their vast number of followers on social media give their voices disproportionate clout compared to the average doctor or individual.

It is not simply through public influence that celebrities can give voice to this culture of conspiracy. Fame amplifies the voices of celebrities such that they possess the power necessary to influence politics in a way that the average person cannot. According to Helen Branswell, Robert

Kennedy Jr. had argued for years that vaccines cause developmental conditions and announced publicly that he was to chair a commission on the safety of vaccines in 2017 (Branswell, 2017). While this commission was never subsequently appointed, Robert Kennedy Jr. still successfully managed, for a time, to get approval to use government resources to investigate the safety of vaccines. This action supported the anti-vax culture of conspiracy. Despite the wealth of evidence supporting the benefits of vaccines and the lack of evidence suggesting harmful effects, a lone influence in the anti-vaccination camp managed to convince the government to invest in blatantly unnecessary research. Robert Kennedy Jr.’s influence on the American government shows just how much celebrities can aid the anti-vaccination movement through both their large amount of public outreach and their political impact.

In order to understand the importance of vaccines, one must first understand how the body fights illness. When a harmful particle invades the body, the immune system recognizes pieces of its exterior and builds machinery to combat that particle. If that particle, or one with a similar exterior, invades the body again, the body is already prepared to combat it before it can progress into a debilitating disease.

This is how vaccines work. Labs take deadly particles like smallpox or measles and weaken them. They then take the recognizable parts of the exterior, which are no longer able to cause the illness, and introduce them to the body, typically via an injection. When the immune system encounters these recognizable parts, it builds the machinery to fight the disease. If a vaccinated person encounters a deadly particle that has not been weakened in a lab, the body is already familiar with the particle, has the proper machinery to combat it, and is able to prevent infection. When enough people in a population have the familiarity with and proper machinery to combat diseases, through vaccination or prior infection, that

population has achieved “herd immunity,” a status of a population in which so many individuals are immune to a disease that it cannot spread. Herd immunity protects vulnerable subsets of the population such as infants, elderly, and immunosuppressed who are unable to be vaccinated. This protection is impossible when people choose to not vaccinate, leaving a subset of the population susceptible to a disease. A disease (like polio or smallpox) is considered eradicated when the herd immunity is so strong, that vaccinations are no longer required (Fine, 1993).

Given the herd immunity amongst a majority of the United States population, many argue that choosing not to vaccinate poses no real threat to their loved ones or the greater community. However, numerous studies have shown direct correlations between decreased vaccination rates and increased communicable disease outbreaks, alluding to a breakdown in the herd immunity that is so important. At the conspiracy’s epicenter in the United Kingdom, researchers were especially interested in how the reverberations of danger had impacted vaccine rates in the subsequent years. Their study, which observed vaccine rates in comparison to the distribution of known measles outbreaks, found that as vaccine rates declined, measles outbreaks both increased in incidence and size (Jansen et al., 2003). A longitudinal study spanning from the development of the MMR vaccine (1988) to the year of the release of the

Wakefield article (1998) conducted in Colorado found that vaccine exemptors were 22.2 times more likely to contract measles and 5.9 times more likely to contract pertussis (Feikin et al., 2000). Further, speaking to the effect of the anti-vaccination movement, of those who exempted in the same study, only

13% did so on religious grounds. This implies that those exempting are choosing to do so because of personal beliefs, most likely founded on the anti-vax movement. More recently, researchers were able to correlate a 2015 measles outbreak in Disneyland to substandard vaccine rates. Their research, which used a mathematical formula to determine the reproductive characteristics of the disease, estimated that vaccination rates among the Disneyland population was between 50-86%, a far cry from the 96-99% needed to protect herd immunity (Majumder et al., 2015). The evidence that exists about the relationship between vaccines and negative health effects show that not getting vaccinated has a direct correlation to

contracting the dangerous disease from which a vaccine can protect. And despite this clear conclusion, large portions of the population are still under the spell of the anti-vax culture of conspiracy.

The pervasiveness of the anti-vax culture of conspiracy has created political questions as a result of its growth in supporters. Does the government have a right to require vaccinations or is choice a matter of individual liberty? As of 2019, five states have eliminated nonmedical vaccine exemptions (Hoffman,

2019). The other forty-five states allow exemptions for personal—typically religious—reasons.

Politically, there is no definitive consensus on which ideological or demographic group subscribes to the anti-vaccine conspiracy theory (Conrow, 2018; Gander, 2019; Sun, 2019). Across the spectrum, notably at either extreme, people proclaim that vaccines are detrimental to health and therefore unnecessary or even harmful, which, as shown above, is an incorrect and dangerous view. However, each extreme defends their reasoning for anti-vaccination differently. On the right, people tend to cite religious liberty, a common exemption for schools, and a distrust for big government. On the left, people tout individual freedoms and the right of personal choice in health matters.

Research has found that parents who choose not to vaccinate their children tend to be more affluent and educated (McNutt et al., 2015; Warner et al., 2017; Yang et al., 2016). This correlation is shocking; why do educated parents choose to ignore the realm of science? While there is evidence supporting this correlation from numerous studies, it may not be advanced education that is causing the flourishing anti-vax movement. Vaccines, because of their success, have essentially eliminated the fear of some harmful diseases because society no longer sees the devastating effects (Hoffman, 2019). One example here is polio. Since its eradication in the United States, there is little remembrance of the excruciating effects polio could have. Thus, because the fear is no longer prevalent, the understanding of the necessity of vaccines is limited. Further, affluent parents may be under the belief that should their child become ill, they have the financial resources to effectively combat this, whereas non-affluent parents would prefer an affordable vaccine that limits the possibility for their child to contract the illness altogether. Despite different anti-vax arguments on either side of the political spectrum, there appears to

be some consensus that a distrust in the pharmaceutical industry plays a significant role in this conspiracy

(Hoffman, 2019). This also is relevant to the finding that more educated parents distrust vaccines. In recent years, the pharmaceutical industry has been attacked for its lack of transparency, high costs, and limited liability as a result of government protections (O’Donnell, 2019). The opioid crisis is one example of how big pharma has been perpetuating harmful health effects (O’Donnell, 2019). Parents who are aware of the political entanglement with the opioid crisis and the complicated relationship between the government and pharmaceutical companies are likely to be wearier of vaccinations.

To test the affluence and education trend, we decided to examine a sample of our student body to identify the ratio of vaccine supporters and opponents and to determine any consistent characteristics among these two groups. We conducted a survey and asked a series of questions about their views on vaccines (Appendix I).

The majority of respondents indicated that they do not believe vaccines to be harmful and that they would choose to vaccinate themselves and any future children. For the first question, there were two respondents who indicated they did believe this; one was a senior and one was a freshman. Both of these respondents also labelled themselves on the conservative side of the political spectrum and on the higher end of income: upper middle class to upper class. The freshman respondent also indicated that they would not vaccinate themselves or any future children. However, the senior responded that they would vaccinate themselves or any future children. Regarding the question about negative health effects (Question 1), there were three freshmen who selected the option “unsure; would like to do more research.” Two of these were conservative and the other was a moderate. There was no consensus on income for these three.

Our results indicate that students who identify on the right-wing of the political spectrum— varying from right of center to far right—are more likely to be cautious about vaccines or opponents of vaccination all together. Additionally, family income may be indicative of anti-vaccination, but the limited respondents make this difficult to correlate. Finally, all but one of the respondents that expressed a desire to do more research or caution about the effects of vaccines were freshmen. Though admittedly this

is a small sample, these results suggest that as students at Westminster College continue their education, critical thinking skills develop that allow them to recognize the positive nature of vaccines.

We recognize that this survey is limited in finding any conclusive evidence. This was done to examine Westminster College’s students and identify any trends that appear that follow broader, more conclusive scientific studies. Additionally, only thirty-five students completed this survey, about 5% of the student population. Results were split with eighteen seniors and seventeen freshmen responding.

Although many people and interest groups on either side of the issue are quick to call for legislation on the subject of vaccinations, the personal liberty allocated by the United States Constitution makes this difficult. Personal health decisions have been protected by the Supreme Court under the right to privacy and the Bill of Rights provides protection for religious liberty. Thus, lawmakers are likely hesitant to draft any legislation on the subject as it is highly likely that it would be challenged and possibly found to be incompatible with Supreme Court precedent and unconstitutional.

Due to celebrity influence and user-generated Internet content, it is easy for an Internet user to believe there are more anti-vaxxers than actually exist. Anti-vaxxers engaged on interactive Internet platforms, such as blogs and social media, present their misguided opinions as factual evidence. The same incorrect information continues to circulate among those established in the online anti-vaxxing community and concerned parents looking for resources (Kata, 2012). An estimated 75-80% of Internet users search for health information online. Further, of these users, 70% say that their Internet research influences their medical decisions (Kata, 2009). Unsupported Internet claims continue to convince parents that they are making the best decisions for their children, when, in reality, they are putting them in danger.

In fact, a study found that parents exempting their children from vaccinations were more likely to have received their decision-making information from the Internet than those who did vaccinate their children

(Mitra, Counts, & Pennebaker, 2016). A majority of this Internet information comes from personal, unprofessional resources. A 2017 study analyzed popular parenting blogs published within the decade prior (Meleo-Erwin et al.) Not only were the content of the blogs themselves considered, but the

conversations that had taken place in the comment sections were also reviewed. Of the forty-six blogs investigated, twenty-four discouraged the use of vaccines, six were ambivalent, and eighteen encouraged the use of vaccines (Meleo-Erwin et al., 2017). A common theme among these bloggers was that these biomedical interventions would do nothing but harm their children.

Although there is correlation between socioeconomic status and anti-vaccination opinions, it is unlikely that this factor influences and can predict anti-vaccination sentiment. Predictors can include conspiratorial thinking, religion, or a perceived infringement on personal freedoms (Swingle, 2018).

When these factors are combined with mass media coverage and emotional anecdotes, they have the potential to be more influential than scientific facts and reasoning. Even when an outbreak does occur, such as the measles outbreak at Disneyland in 2015, it affects so few people (relatively) that most anti- vaxxer parents remain unworried about their children (Capurro et al., 2018). Largely, their lack of concern is due to their inexperience with the effects of the disease, leading to an underestimation of the complications it can cause (Hobson-West, 2003).

If public opinion among populations in the western world reflected a trust in information from credible experts, this crisis would not exist. Ignorance to the capabilities and positive effects of vaccinations is not the underlying problem; the source of the information is often more influential than the facts presented (Hobson-West, 2003). To a parent, an experienced mother writing a blog is more relatable and trustworthy than a scientist touting a jargon-laden argument. Many argue that scientists have been wrong before, meaning they cannot possibly know what is best for someone else’s children.

Due to lack of trust in science and healthcare workers, education alone is not likely to be enough to change the minds of anti-vaxxers. This is not to say that current efforts to educate either through emotional appeals or factual articles should not be seen as useless; rather, it is imperative to continue to circulate the correct information that needs to be seen. Anna Kata suggests ways in which social media can be used: “[creating] web-based decision aids about vaccination, using real-time Internet tracking to determine public attitudes, or launching social media campaigns” (2012). Education and interactive

websites may not be enough, but they are a step toward changing the minds of parents putting their children at risk of preventable diseases.

Due to the lack of trust in science and healthcare workers, education alone is not likely to be enough to change the minds of anti-vaxxers. While current efforts to educate the public on using reliable information from credible sources to make medical decisions is important, we could be doing more. The

Internet, which has previously been the greatest obstacle in the fight against the anti-vax culture of conspiracy, could prove to be the greatest asset. Anna Kata argues that social media can be used to track online discussion of vaccines, enabling vaccine proponents to better target demographic groups that need the most attention (2012). Further, given the apparent waning in healthcare trust among the general population, it is necessary for the medical community to make proactive solutions. A suggested approach is the implementation of vaccination liaisons within individual health centers. If such a position is unavailable for a given center, increased physician training over vaccine conversations between hesitant individuals would also prove to be beneficial (Domachowske & Suryadevara, 2013).

The anti-vax movement is the epitome of a culture of conspiracy. This wide swept phenomenon has broken down the herd immunity of the American people in just over two decades. What started as a poorly performed study has exploded into uncertainty, distrust, and misplaced belief in unchecked conclusions. There has long been evidence of conspiracies threatening the health and well-being of populations. This conspiracy began in 1998 when the scientific community failed to protect the community from a bad study touting false information. It continued to grow, as others in our history have, as more influential individuals began to support it. It has led to a significant decrease in vaccination rates in one of our most vulnerable populations. It has been on the minds of political scientists as they try to discover what demographic groups are most at risk. Finally, it has continued to permeate our society as false information wins out over findings supported by data. While this culture of conspiracy has resulted in consequences reverberating through our society, there is still hope that, with education and reason, the truth can ring out loudly, carrying across the western world.

Appendix I

Below is a voluntary survey that was administered to freshmen and seniors to search for a correlation between education level and vaccination distrust. Participants were advised that this was completely anonymous.

1. Do you believe that vaccines can have negative long-term health effects?

2. Would you vaccinate yourself?

3. Would you choose to vaccinate any future children?

4. How do you politically identify?

5. What is your estimated family income?

The first three questions had the following as answers: Yes, No, Unsure; would like to do more research.

The political identity question asked respondents to place themselves on the political spectrum from the following choices: liberal, moderate liberal, center, moderate conservative, conservative.

The estimated family income was divided up into the following brackets, chosen from the US census: less than $49,999 (lower class/poverty); $50,000-139,999 (middle class); $140,000-$149,999 (upper middle class); and $150,000 or more (upper class).

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