The debate over the anti-vaxx movement, and the seemingly growing number of parents who are delaying or declining to get their children vaccinated, has been one of the most high-profile, and controversial, topics in the news and on social media over the last few years. The spotlight on the issue has only intensified recently, thanks to a breakout of measles in Rockland County, NY, that caught public attention in October 2018 and has led to government intervention. So just how concerned should adults be as this anti-vaccination phenomena moves forward?

Measles was declared eliminated from the U.S. in 2000, according to the Center for Disease Control and Prevention (CDC), since the country had not seen a transmission of the disease for more than 12 months. The CDC recommends children get vaccinated with measles, mumps, and rubella (MMR) at 12 to 15 months of age and again before entering school at the ages of 4 to 6. Still, there has been a worrying reemergence of the disease in the years since, and now, New York is dealing with its worst measles outbreak in decades, with 133 cases recorded in Brooklyn alone. Last Tuesday, Rockland County, New York, which includes towns and villages like Ramapo and Nyack, also declared a state of emergency, blocking children and teenagers who weren’t vaccinated against measles from public areas. An additional 100 cases have been confirmed in 20 other states, including North Carolina, Oregon, Washington, Tennessee, New Jersey, and more. 

Zooming out on the issue, global measles cases increased by nearly 50 percent between 2017 and 2018, according to data calculated by UNICEF on 194 countries from the World Health Organization (WHO). So, what gives?

“In the U.S., we don’t have measles naturally occurring here,” says Ross D. Silverman, professor of public health and law at the IU Robert H. McKinney School of Law. “It’s basically imported from people who travel abroad and are exposed to it, and then travel back to communities where there are vulnerable populations,” he says. Measles is one of the most easily transmittable, highly communicable diseases, says Silverman. “It’s very infectious,” he says, “because someone can have it even before showing any symptoms. It is also a very resistant illness so, basically, people who are infected can walk through a room and the virus can stay in the air on surfaces for two hours, and you can pick it up that way,” he adds.

Community or Universal Concern?

In a close-knit community with common beliefs concerning vaccination, such as the Orthodox Jewish areas of Rockland and Brooklyn where the outbreaks have been most prevalent, it can cause a cycle of anti-vaxx. Orthodox Jewish communities believe that inoculations are ineffective or even harmful, and a large number of U.S. states allow families to opt out of vaccinations if it conflicts with religious beliefs.  But can the disease spread beyond these communities? “It does, and it doesn’t,” says Silverman. “Rockland County is a suburb of New York City. The community that is exposed there is an ultra-Orthodox community that tends to travel in more narrower groups. New York City and New York State, generally, have very high vaccination rates, so that better protects the public and makes it harder to transmit the disease.”

Dr. Arthur Caplan, professor of bioethics at New York University’s Langone Medical Center, believes the measles outbreak is “the chickens coming home to roost,” and is a direct result of the misinformation that’s being spread about vaccinations in the country. The issue in the U.S. is part of a wider anti-vaccination movement that exists globally, buoyed by concerns that the measles vaccination, which also protects against mumps and rubella, causes autism or other diseases. No matter how much scientists have debunked the idea, it has perpetuated, according to Caplan, thanks, in large part, to social media. 

The number of measles cases, alone, reached 220 in the U.S. last year, according to the CDC—an increase from 120 in 2017 and the 86 from 2016. A study out the UK may shed some light on social media’s impact on the lack of early vaccinations. The Royal Society for Public Health found that more 91 percent of parents in the United Kingdom considered vaccines important to their child’s health but also acknowledged more negative reporting about vaccines on social media than positive. The agency links the growing misinformation and negativity toward vaccinations to a severe decline in the number of children receiving the MMR vaccine in the UK since 2015. The number of measles cases in Britain increased from 250 in 2017 to more than 900 in 2018, according to the National Health Service.

“Vaccine hesitancy is now a top 10 health issue for the WHO and for good reason,” says Dr. Dominic Gaziano, director of Body & Mind Medical Center in Chicago. “Our government should heed what’s going on in the rest of the world and not wait for thousands of cases to erupt in the U.S. We are already dangerously close,” he believes.

The Anti-Vaxx Movement
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Precautionary Measures 

How concerning is it for the average person who comes into contact with an area that’s been a site of infection? “It’s more of a concern if you have a compromised immune system,” says Silverman. “It is an opportunistic disease, so if someone had cancer, for example, they’re going to be at a higher risk if they’re exposed. And for those who work in places where they come into close contact with others, such as medical facilities, schools and health care places.”

For the general population of adults, Silverman advises anyone who is worried to check with their physician about the vaccines they should have had in their childhood, adding that most people would have been required to have had two vaccines against the measles. “If you’re not sure, check with your doctor or get an additional MMR shot to get up to date.” If you’re an international traveler, you should make sure you’re up to date on the necessary shots too, he advises.

Caplan suggests an additional step as a precaution: “Don’t believe what you see on the internet,” he says, adding that he’s happy to see companies take some responsibility for the false information that has been spreading online. Earlier this month, Facebook announced it would be removing anti-vaxx groups from ads and recommendations, and Google will stop recommending scientifically inaccurate information. YouTube, Instagram, and Amazon are also cracking down on any inaccurate, anti-vaxx information on their sites. “I think we’re finally seeing some pushback and that’s good,” says Caplan.

Time for Intervention

In the meantime, some are calling for more government intervention, including Body & Mind’s Gaziano. “There is a precedent for government being involved in mandating laws to save lives and improve health of others,” says Graziano. “That’s simply public health. It is the law that when in the car you must wear a safety belt. We don’t argue that seat belts are not in the government’s realm to prevent people from getting injured from a future event.” He adds, “It’s not a stretch then to do the same to mandate vaccines for all, in public places such as schools, to prevent a future outbreak or halt a current outbreak in a community as we’re seeing in Rockland County.”

As for whether the anti-vaccination movement will continue to gain momentum, Silverman says it’s hard to say. “It’s a small population but the numbers are rising,” he says. “At the same time though, we have the highest percentage of children who are up to date with their vaccination program.” He adds, “What we see in a lot of communities, for example in Washington State (where a measles outbreak in January led the Governor to declare a state of emergency), there was a massive rise in the request for vaccinations. I do think people recognize when the disease is present, the value of public health protection.”

Caplan echoes this sentiment, saying the epidemic provides an opportunity to reflect. “It alerts people to the importance of vaccines,” he says. “It wakes people up.”

The issue may not go away any time soon, says Silverman. “There have been opponents to vaccination since there have been vaccines.” he says. But Silverman also believes interest in the topic is important. “The more people who are talking about this, and the need to have vaccinations, whether they have children or not, the better,” says Silverman. “It is really the normal thing to do, we just haven’t really talked about it much, so I think the voices that have had concerns have gotten louder. It’s good conversation to be having.”