Crunched: why are we still not vaccinating our children?
The FT's John Burn-Murdoch and Federica Cocco examine the data behind vaccination and why measles is back in the news. Cases have hit a 25-year high in America, with dozens of more serious outbreaks across the globe
Produced and directed by Juliet Riddell, edited and filmed by Richard Topping and Petros Gioumpasis
This week is International Immunisation Week. And vaccines have been all over the news.
I've seen so many stories about this massive measles outbreak. And I'm just wondering, why now? Haven't we been here before?
One thing that strikes me as interesting, having looked at some of the numbers here, is that I thought the narrative was actually good... a positive narrative of improvement. So I had a look at some stats from the World Health Organisation. So, if we look here we've got the measles vaccination rate. And up here we've got the rate of cases per million people. And all of these figures are global.
And in 1980, the numbers were up here. So we had a lot of cases and a relatively low vaccination rate. But since then the numbers have trended consistently towards this positive corner up to 2011 where cases are now way down. And the vaccination rate has improved. We've gone from about 800, a rate of 800 cases here, down to a rate of about 10 cases here. And vaccination rates have gone from about 15 per cent up to about 85 per cent. So haven't we got rid of the measles question?
Absolutely. And actually, let me pick up from 2011 because there's a really interesting database on the World Health Organisation. Now although it's a bit patchy it's very ambitious because it has number of measles cases for every country in the world, for every month, starting from January 2011. They did a 12-month rolling average to have a look at the trend. These are the global number of measles cases.
This is the trend, starting from 2011 to the last 12 months, ending in February 2019. And globally we have over 30,000 measles cases worldwide. So, my question is, what's happening now? Why is it that now people don't feel safe vaccinating their kids? Maybe we could employ good old-fashioned nuance and actually look at the individual cases in a number of countries and see what the underlying trend is in each case.
Great idea. Let's do it.
So I've got this really cool thing.
Let's map measles cases.
So we've got a pretty big outbreak in Ukraine.
Good lord, this cork is very hard... one over here in New York City.
There have been some cases in France, Madagascar.
This is Madagascar, right?
Yeah. And even some in Israel.
OK, let's spin the globe and start from the UK. The UK is arguably the birthplace of the anti-vax movement, thanks to a Lancet article published in 1998 by a man called Andrew Wakefield.
That's the study that's since been retracted, right?
It was since retracted. And this is what happened when this infamous article was published. We're going to look at measles cases, we're going to look at vaccination rates. This is in England. Number of measles cases, and then this is the trend the vaccination rates took. 1998 is when the Wakefield article was published. February 2010 is when The Lancet withdrew the article.
As you can see, babies are born here. It's time to vaccinate them. And measles cases rise as the coverage rate drops. And then they go down again once the coverage rate recovers. So there's clearly a correlation between the percentage... the proportion of kids that are vaccinated and the measles cases that go up.
So this is what's happened in the UK. It was the medical establishment that published this article - or I mean, The Lancet, not the whole establishment - published this article. And that led to the public... parents not wanting to vaccinate their kids.
Even now, 21 years after the article came out, there's still a long shadow in terms of the effect of that article.
Exactly, because so we've ended this in 2014. But the most recent figures show that measles cases have increased again. And Public Health England has said that this is because this is happening amongst teenagers and young adults.
And in fact... you must've heard... you go to festivals, don't you, as a young kid?
And the Rize Festival, which is the one that replaced the Beef Festival in Essex, was cancelled because of a measles outbreak. And this was happening, as I said, amongst 20-year-olds or around that age. And it's these kids that were born around this time that are getting measles now. So OK, let's move on maybe to Ukraine?
Yeah, so the really interesting thing in the Ukraine. So again we're talking about a very recent outbreak. This is an uptick in cases this year. But there are some different dynamics going on here. It's not necessarily about the anti-vaccination movement. Now you had a look at the vaccine coverage rate in the Ukraine. And what did you find there?
Well, in the Ukraine it increased from a staggeringly low 42 per cent in 2016 to 86 per cent in 2017. Yet, that hasn't prevented an outbreak, even though it's a massive improvement. Although, as we said before, the data is a bit patchy. Still, that shows an improvement.
And the reason that hasn't had that much of an impact is because the World Health Organisation says that there's basically a threshold. If under 93 per cent to 95 per cent of kids don't get vaccinated, it doesn't matter whether you've improved. The outbreak is going to happen.
Right. And that's because of what we talk about as herd immunity, so this idea that measles is such a contagious virus that it can spread really rapidly even if the vaccination rate drops just a tiny bit below 100 per cent.
So what happened exactly in Ukraine? Is it because... are they anti-vaxxers as well?
Good question. And the interesting thing that's happening there is that, although a small part of it probably is to do with anti-vaccination movements, the big factor there is just a fundamental shortage of the vaccine. When rates drop as low as 42 per cent as they were in 2016, that's not just because of a mass movement against vaccination. They simply didn't have enough of the vaccine to go around. So that's another factor which certainly in other countries, like less developed parts of the world, is often the reason that it takes a long time to get that initial vaccine coverage rate up.
So another one that I think serves as an interesting illustration is this outbreak just a couple of months ago, a couple of weeks ago, in fact, in New York. Another factor that can come up is religious exceptions to having the vaccine. So in certain parts of New York, particularly among Orthodox Jewish communities, there has been a sort of community-wide rejection of the vaccine, a refusal to have children vaccinated. And so in certain religious schools, the vaccination rate is as low as 60 per cent. So even though across New York State as a whole, the vaccination rate, the average is 92 and 1/2 per cent, in some schools it's as low as 60 per cent.
And, of course, in a community like that, people are moving around, interacting with one another in close quarters. So when you get one outbreak, it spreads rapidly. And that's why we are now seeing hundreds of cases simply because of a religious reason to exempt children from the vaccine.
More broadly, in the US the anti-vax movement has also been endorsed by a number of high-profile celebrities. Jenny McCarthy comes to mind. She gave a really famous interview with Larry King. Even Donald Trump has tweeted a couple of times about the link between vaccine and autism. And this endorsement by celebrities and high-profile people is something that's happened in Italy as well.
And that brings me to, oh, world's gone mad, because with the rise of populism we've seen a couple of politicians, and some members of the Five Star Movement come to mind, which have talked about this link, this conspiracy theory about vaccinations and autism. Whilst researching this article, we had a chat with a couple colleagues. And they all came up with their own interpretation of what's going on.
Some people have talked about the rise of social media and fake news websites. Or there was an interesting theory about the rise of wellness and a backlash against medicalisation or excessive medicalisation rather? So, to me, this is really more an epidemic of irrationality. But I don't want to believe that the world has gone mad. So, I was thinking that maybe we could have a chat to somebody that has really looked into this. And maybe he can convince us that people are still in their right minds.
Great idea. Who are we going to call?
So the person that I have in mind is Bobby Duffy. He is the head of policy at King's College. And previously he worked at Ipsos MORI. And he led this annual survey that Ipsos MORI did called the Perceptions Index. And they focused on the gap between facts and how people perceive things and how sometimes flooding people with facts and with information isn't actually effective at all.
So we did a huge study when I was at Ipsos MORI across over 30 countries, asking people whether they thought there was a link between vaccines and autism in healthy children. And very depressingly, about 20 per cent of people thought that there was a link despite that being disproved. On top of that 20 per cent, there's 40 per cent of people who are not sure one way or the other.
And it's a very longstanding and consistent view. And there's a number of reasons for that. First of all, this is a very emotional issue, particularly when you're talking about the health of your kids. When we're in that emotional state, we're less good at thinking about rational facts. It worries us, so we think it's a bigger issue than it really is. And this is about probabilities.
There are absolutely minuscule probabilities that if you have an underlying existing condition, that these vaccines can exacerbate it and that can present as autism. But it's not really a factor that should be taken into account. But as soon as you raise that as an issue people are drawn to those vivid anecdotes and don't think about the probabilities, really.
It's not just about how we think, though. It's both how we think and then what we're told reflects a little bit this trend that we have towards balanced reporting, where you would give two sides of an argument even though one side is discredited. So a typical example is 99 per cent of scientists believe this. But there is 1 per cent of scientists who believe something else. And the problem with that is we still hear and focus on the 1 per cent more than we should.
And then finally, you've also got people who are actively trying to mislead people, things like the National Vaccine Information Centre, which is actually just a front for campaigning groups. When these things interact, they become very sticky. This is not an issue that's going to go away very quickly.
Is one solution for us in the media that we really think about the use of emotions and emotional narratives when we're trying to inform people about things like vaccinations?
Give people a story that they can hold on to, a narrative that they can follow, are much more effective than just throwing facts at people.
There's a clear disconnect between fact and perceptions. And a lot of that comes down to ineffective communication. We both work with statistics. We throw facts and stats around all day. But emotions, our narratives, are crucial to effectively communicating about vaccines.
So it's not enough just to say, vaccine rates are x and measles rates are y. You've got to talk to people about the pain of what it's like to actually have your child contract measles and how this can be a pretty traumatic experience that you should want to avoid at all costs. And people are much more moved by that than just by reading a factsheet.
And hopefully, if we manage to achieve that, then we'll be able, to some extent, prevent tragedies like this one.