Last week Vancouver Coastal Health reported two new measles cases, bringing the B.C. total to 15. Twelve of them stem from a family that travelled to Vietnam and came home infected. They had already been infected with fear of vaccine-related autism, according to a CBC News report, which was why the father hadn’t had his kids vaccinated when they were little. Perhaps he hadn’t learned in the past ten years that the original 1998 “research” article that linked the measles vaccine and autism had been not just refuted but shown to be fraudulent. There are enough other parents like him that B.C.’s NDP government will by September require children in school to prove they are vaccinated against measles and other diseases. Measles was once just another childhood disease, like mumps and chicken pox, something that kids like me in 1940s had to put up with. A measles vaccine was developed in the 1960s, and combined with vaccines with mumps and rubella (“German measles”), the MMR shot gradually became part of every baby’s life. The mid-20th century worried about nuclear war, but it didn’t lose a moment’s sleep about vaccines. We took our shots and clamoured for more. That was because we knew that diseases like measles could be fatal. According to a 2004 study, Canadian measles fatalities peaked in 1926 at 892. After the vaccine was adopted, recurring outbreaks showed that two doses worked better. A two-dose program was adopted in 1996-97, and succeeded remarkably well. The study concluded, “Despite imported cases and outbreaks in certain religious communities … the absence of spillover into the general population supports our belief that immunization coverage in the general population is high and that population immunity is more than adequate to prevent reestablishment of endemic transmission.” Mass immunity, mass amnesia Unfortunately, mass immunity comes at the price of mass amnesia about the original threat. Vancouver’s recent outbreak suggests population immunity is growing patchy. Twelve of 15 measles cases were in schools after one student returned from overseas travel. That indicates “herd immunity” — normally strong with a 95 per cent vaccination rate — is well below that rate. Public health experts feel understandably frustrated. A disease halted over 50 years ago ought to be a mere footnote in medical textbooks. Instead it’s turning up in Canadian families who ought to know better. To some extent, the experts themselves are to blame. When the science is as settled as it is on vaccination, questioning it sounds stupid, and experts in any field tend to be impatient with what they see as stupidity. The health experts forget that their patients didn’t have years of training in this field — but their patients do have access to every quack and snake-oil peddler on the internet. Patience with patients Online information thrives when it offers jolts — surprising, exciting news, whether good or bad. The quacks offer jolts galore, and they have learned how to monetize their audience’s ignorance. Old folks fear dementia, and dementia “preventives” sell very well. Young families fear for their children, so the quacks invoke threats like autism, and parents shrink from vaccinations. Overworked family physicians sometimes fire vaccine-wary patients, but some are ready to take such patients from where they are to where they ought to be. Dr. Iris Gorfinkel, a Toronto doctor, recently described on CBC Radio’s Day 6 how she uses this approach. Dr. Gorfinkel listens to anxious young mothers, shares her own experience as a mother, and asks what specifically worries them. Then she deals with those worries as one mum to another. In that role, she can invoke numbers that otherwise wouldn’t be so reassuring: “We see serious adverse events in three out of one million vaccinations… In a career of 27 years of general practice, I have never seen a serious adverse event with a vaccination.” Obviously more doctors should deal with their patients as Dr. Gorfinkel does. We would see more relieved parents and fewer kids with measles, and public health could turn its attention to new challenges. Sometimes health professionals’ own misplaced confidence costs them their patients’ trust. Doctors once prescribed thalidomide for pregnant women’s morning sickness, and their children were born with shrunken arms and legs. As Dr. Heather MacDougall of the University told Michael Enright on CBC Radio’s Sunday Edition recently, francophone male doctors’ hostility to midwifery turned a lot of Quebec feminists against them. Aggravating the problem, Dr. MacDougall said, was political apathy. Politicians weren’t feeling enough pressure from voters to implement a national measles program in the 1970s, so provincial health ministries put federal money into other needs. The roots of skepticism Measles hesitancy is one problem. Measles skepticism is another; skeptics are unlikely to darken a doctor’s door in the first place, whether for a measles shot or any other preventive measure. The skeptics think they know better than the professionals they regard as mere tools of Big Pharma and Big Government. The skeptics don’t realize that they are being cheerfully duped. The cause of the skepticism isn’t the stupidity of the skeptics; it’s their alienation, their sense of not belonging to the world and especially not to the people who seem to run it. Politicians and health authorities are always telling us how to live well when we may feel little in common with them. But celebrities, brilliant self-marketers, know how to make us identify with them. They’re famous for being famous, not for knowing what they’re talking about. This alienation has become a serious public health issue in the self-described “advanced” countries. In the U.S., it’s being cultivated by the American right wing, doubtless with some spillover to Canada. An Arizona state representative recently denounced the idea of mandatory measles vaccination as “Communist.” Another Arizonan, Dr. Jane Orient, executive director of the right-wing Association of American Physicians and Surgeons, recently wrote to Congress, asking: “Are potential measles complications including death in persons who cannot be vaccinated due to immune deficiency a justification for revoking the rights of all Americans and establishing a precedent for still greater restrictions on our right to give — or withhold — consent to medical interventions? Clearly not.” It’s in the interest of the far right to encourage mistrust of public institutions, and to promote the idea of every person fighting for individual survival in a hostile world. So the far right tells the alienated they need to protect their “freedom” above their health. And the alienated are listening, clinging to the right to say “no,” if only to assert a little personal power in the face of the evidence. Mistrust of public health, like mistrust of democratic institutions, is dangerous to all. In this toxic political environment, medical experts need to listen, and to show they understand their patients before they can give them proper care.