Fever Pitch - Harper's BAZAAR (Copy) (Copy)

With measles cases at a five-year high and social media aflame with anti-vaxxer rhetoric, Alexandra English charts the border between wellness and avoidable illness

IN JUNE, Robert F. Kennedy Jr, a prominent American anti-vaccination activist, posted a photo to Instagram of himself with the actor Jessica Biel. They were seated together at the California State Assembly, lobbying against a state bill that would limit exemptions from vaccinations. Within minutes, social media erupted with fury and vitriol. Jessica Biel the “anti-vaxxer” was trending on Twitter. “There is something so poignantly privileged about rich people lobbying against vaccines when people in third world countries line up for miles just for the chance to get inoculated,” wrote one user. “I wish the 1 per cent would stop spreading disease to the 99 per cent,” wrote another.

Biel later clarified that she’s “not against vaccinations”, but, rather, is advocating for families to have “the right to make educated medical decisions for their children alongside their physicians”. But it’s scenarios like that involving Biel — where an affluent person with a public voice or a celebrity with no medical qualifications throws themselves behind a health cause — that Professor Julie Leask at The University of Sydney, a behavioural scientist who works in public health and specialises in vaccination, says skews public perception of the anti-vaccination movement. Suddenly, anti-vaxxers are everywhere, which, to the general public, seems to indicate that the movement is gaining traction and followers. Those who do vaccinate respond in kind with outrage, and news outlets keep circulating stories in a moral panic, which only serves to keep the anti-vaccination activists in the spotlight.

“This emotive, highly polarised public discussion makes it feel like there’s so much heat around the anti-vaccination movement right now,” Professor Leask says. “If you ask most people, they would say vaccination rates are declining, but that’s not the case. We’re simply being exposed to more anti-vaccine rhetoric online. Increase in discussion and worry about the anti-vaccination phenomenon comes when you have outbreaks like measles affecting the world, like we do right now.” Measles was eliminated in Australia in 2014, but at the time of writing, the disease is at a five-year high, with 135 cases reported since the start of 2019. The US, with more than 1100 cases, is having its largest outbreak since 1992.

Professor Leask has spent the past two decades researching the social and behavioural drivers of people who don’t vaccinate. Fears of the measles-mumps-rubella (MMR) vaccine causing autism persist despite the study that made that claim being debunked and the doctor who wrote it, Andrew Wakefield, found to be fraudulent in his research, but Professor Leask says there’s more to it than that. “We also look at the way people think and feel, and at practical barriers, which in some countries are the biggest reasons kids aren’t vaccinated fully.”

In Australia, Professor Leask explains, about 94 per cent of children under five are fully vaccinated, and those who are not vaccinated by choice make up a small part of the remaining six per cent. She describes the non-vaccinating parents’ feelings this way: “You’ve got your beautiful, pristine, healthy child and we as a society are saying, ‘You need to have these vaccines against these diseases you’ve never heard of ’, and you’re worried that the vaccines might have ingredients that could do harm, and you want to [ensure] everything going into their bodies is healthy and what they would call ‘nontoxic’, and so forth — then it’s understandable that some parents have this intuitive concern about vaccination. What I would say as a public health professional is that it’s very unfortunate that those parents take those concerns to the level that they don’t vaccinate, because in general, the benefits of vaccination still outweigh the risks.

“There’s always been an anti-vaccination movement, and there’s a small number of very loud anti-vaccination activists in Australia who are difficult to deter [from spreading misinformation],” she continues. One activist, who started out as a wellness blogger, has gained notoriety in some circles and admiration in others for her stance on vaccines. Per her website: “The benefits of vaccines are constantly over exaggerated and the risk of an adverse reaction severely down played by politicians, journalists and GP’s.” She runs nationwide workshops (at $200 a pop), that she says are designed to “foster transparency, arm us with groundbreaking information, liberate us from a fear-mongering culture and take back control of our family’s health”. The activist originally agreed to speak for this story on the proviso she be interviewed via email, but reneged after the questions were sent, instead sending through other questions she would have preferred to answer, along with a generic media statement saying she rejects the ‘anti-vaxxer’ label.

With an Instagram following of more than 20,000 and plenty of panicked and negative media coverage, the aforementioned wellness blogger turned activist is engaging, but her “potential to influence parents is slightly overrated,” Professor Leask says. “The most influential celebrities are the celebrity doctors. They use very familiar, colloquial language; they get alongside parents. They sound quite convincing, so we do worry about [them].” It’s to this end that social media platforms are cracking down on anti-vaccine messaging online. Instagram announced in May that it will use machine-learning technology to block anti-vaccination hashtag search results, Pinterest has blocked vaccine-related searches, and Facebook announced in March that it is “working to tackle vaccine misinformation on Facebook by reducing its distribution.”

Professor Leask cautions branding all vaccine-hesitant parents with the same iron as the anti-vaxxer activists. “[Non-vaccinating] parents have been painted as quite unidimensional — they’ve been oversimplified. Yes, we do get really angry when these parents seem to put others at risk by not vaccinating their child, but they’re a small group — roughly two per cent of parents actively reject some or all vaccines in Australia today — and they have lots of different reasons for rejecting vaccination. There are non-vaccinating parents all around Australia, many of them living quietly in the inner urban neighbourhoods, not talking about their decision because they’re afraid of the social consequences.”

Katharina, a nutrition coach and mother of two who lives on a farm deep in the Byron hinterland in New South Wales, says vaccinations “always felt unnatural” to her and her husband. She lists her concerns as the frequency and early target age of the first vaccines, as well as their “toxicity”. “Before we had kids, we got interested in the topic, watched documentaries and listened to a lot of talks,” she explains. “We have a very holistic approach, so we just knew that we would rather make sure that our kids’ immune systems are strong. We do vitamin C and probiotics, and we have a lot of bone broth. It really boosts and strengthens your immune system.

“I think where we live is the number one place where people don’t vaccinate their kids,” she continues. (She’s right. According to the Northern NSW Local Health District, 74.9 per cent of five-year-olds in the Byron area were fully vaccinated for 2018, the lowest rate in the state; nationally, it was 94.78 per cent.) “This area attracts people who think alternatively,” she offers. “[They’re] open-minded and everybody likes to have a healthy lifestyle and everybody does their own research. People are really into health around here.”

This ‘healthy lifestyle’ mindset is something Dr Ayesha Kapoor at Sydney’s Royal North Shore Hospital encounters in her area (immunisation rates here are 93.3 per cent, the third-lowest in the state, followed by Sydney and South Eastern Sydney health districts, which are each at 92.7 per cent). “The general demographic of the north shore is a well-educated community on the higher end of the economic spectrum, so I don’t believe access to health- care or lack of education can be claimed as contributing factors [to lower rates],” she says. “I feel there is a wellness movement with a focus on all things natural, which can be positive, but on the most dangerous end of this spectrum is where modern medical treat- ment is rejected in favour of naturopathic remedies.”

Catherine Hughes’ son, Riley, was just 32 days old when he died from whooping cough and pneumonia complications in 2015 (he was too young to be vaccinated and the 28-week pregnancy booster shot was not yet available in Western Australia, where Hughes lived). Since then, she has been travelling the country to share her family’s story and engage with parents at all points on the vaccine spectrum. She says she comes across a few parents with this kind of ‘alternative health’ mentality. “It seems that being natural is something worth striving for [to the point where there’s] almost this fear of anything manmade: fear of chemicals, fear of medicine, and this is where we see the vaccine rejection start,” she explains. “I understand that we want to protect our children. We all want to do our best. Sometimes it’s hard to decide what is the right thing to do with our children. Overwhelmingly, most people support immunisation, but some parents have been fooled by the well-funded movement of the professional anti-vax activists who profit from publicly denigrating vaccines, sell tickets to workshops or sell alternative remedies or health treatments.”

“It’s difficult not to be frustrated with the people who do not vaccinate, particularly in the context of a well-educated, affluent individual with ample access to medical care,” Dr Kapoor says. “I feel this is the highest form of privilege. However, for these so-called activists to go out of their way to misinform people in the public realm, particularly on an issue that greatly impacts the health of not only the individual but also the wider community, is reprehensible.”

The Northern Rivers region has a reputation for attracting alternative health enthusiasts, but it’s these clusters of unvaccinated communities that concern medical professionals. In areas with low vaccine coverage, immuno-compromised adults [such as cancer patients] and babies like Riley who are too young to be vaccinated are more vulnerable during outbreaks. Dr Catherine Bateman- Steel is the deputy director of South Eastern Sydney’s Local Health District public health unit. Hers is the department where all notifiable diseases are reported. She explains that the “problem with measles is that it’s so infectious that if you were not vaccinated and you walked past somebody in the same airspace with measles, you would likely get measles. We have to have very high rates of vaccination to stop it circulating in the community.”

“There’s a great sense of anxiety for people who can’t be vaccinated, who do rely on the community immunity around them,” Professor Leask says. Hughes echoes this. “Herd immunity is really, really important for protecting little babies like Riley, but I don’t think it’s a motivating factor for people who believe that vaccines cause damage to their children — they’re not going to think about other people’s children when they’re worried about their own.”

Katharina disregards this sentiment, but, unlike the anti-vaxxer activists, she doesn’t sound vindictive. “To be honest, I don’t really think [herd immunity] is an argument [to vaccinate],” she says. “I’m not going to give something that is potentially toxic to my kid to potentially avoid someone else getting sick. It wouldn’t concern me if someone else was a carrier ... If one of my kids were sick, I would probably just stay at home. Everybody should be able to choose what they think is best for their kids,” she continues. “If someone believes that vaccinations are the best thing, I’m not going to go in their way and say ‘Don’t do it.’ I’m trying to do the best that I can to keep my children healthy and strong.”

Professor Leask says that if we really want to protect the vulnerable, instead of expending our energy raging against the anti-vaccination movement on social media, we need to first take a look at ourselves. “I think we [as a society] are quite obsessed with active refusers,” she says. “We’re so focused on blaming [them] that we overlook the fact that we should all be asking ourselves if we’re up to date with our vaccinations. You could transmit measles if you haven’t had two shots in the past. We all have a responsibility.”

This story originally appeared in the September 2019 issue of Harper’s BAZAAR magazine. Image: Dan Martensen/Trunk Archive/Snapper Images.