University of Idaho

Vaccine Myths and Declining Vaccination Rates in the United States:

Situational Analysis
By
Caleb Cotton
March 6, 2016

General Overview:
Despite the volumes upon volumes of scientific studies that show there is no
link between vaccines and autism, some segments of society refuse to
believe the scientific research and continue to blame many ailments on the
administration of vaccines. The anti-vaccine (anti-vax) proponents disregard
over 100 years of success in combating life-threatening diseases and focus
on the development of rare conditions, such as autism, that inflict a very
small percentage of the population.
With a well-established vaccination program, the United States has virtually
wiped out once common diseases such as polio (poliomyelitis), measles
(rubeola), rubella (German measles), and mumps while severely limiting the
contraction and spread of other diseases like tetanus and pertussis (cdc.gov,
Figure 1). Contracting any one of the aforementioned viruses could lead to
a variety of ailments from a simple fever to permanent disabilities including
loss of hearing, brain-swelling, and even death.

Figure 1. United States Mortality Rates from Various Diseases.

Polio is a highly infectious virus that spreads quickly and is most common in
young children (who.int). Once in the body, the polio virus can move into the
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nervous system where it can lead to permanent paralysis (who.int). There is

no cure for polio, only prevention. The polio vaccine has prevented over 13
million cases of paralysis since 1988 and over 650,000 deaths over the same
period (cdc.gov). If the polio vaccination program were to cease, an
estimated 200,000 children would become paralyzed every year due to the
contraction of polio (cdc.gov). In only 26 years of vaccinations, polio has
been almost completely eradicated (Figure 2).

Figure 2. Polio Elimination via Vaccinations (http://www.cdc.gov/polio/progress/)

Measles is a leading cause of death among children under the age of 5. In

2014, global measles deaths were near 114,900 people, almost 13 deaths
per hour (who.int). Between 2000 and 2014, measles deaths have decreased
79%, saving nearly 17.1 million lives. The measles virus is transmitted
through the air and infects the mucous membranes where it enters the body
and attacks the nervous and respiratory system (who.int). Measles cases in
the United States declined rapidly once the vaccine was distributed (Figure
3).

Figure 3. Measles in the US (https://www.sciencebasedmedicine.org/the-measles-vaccine-protectsagainst-more-than-just-the-measles/)

Mumps is a virus that is spread through saliva or mucus. If the virus moves
into the nervous system, encephalitis (swelling of the brain), meningitis
(swelling of spinal cord and brain tissue), and deafness can occur (cdc.gov).
When the mumps vaccination program began in 1967, approximately
186,000 cases were reported each year (cdc.gov). In 2012, only 229 cases
were reported in the US, but outbreaks in 2014 and 2015 have seen numbers
back to 1,000-1,200 in those years (cdc.gov). The mumps vaccine, as with
most other vaccines, becomes more effective when multiple doses are
administered (who.int).
The timing, amount per dose, and number of doses of a vaccine are
thoroughly studied by health professionals to maximize efficacy and prevent
disease. Anti-vax groups point to the increase in doses of vaccines and
attempt to correlate the increase in doses with the rise of autism
(historyofvaccines.org). However, scientific researchers have yet to find any
direct causal relationship between increasing doses of vaccine and autism
(cdc.gov).
Autism Spectrum Disorder, more commonly known as autism or ASD, is a
group of developmental disabilities that are not well understood (cdc.gov).
Approximately one in 68 children will be diagnosed with some form of ASD
(cdc.gov, Figure 4). Autism rates in United States have been steadily
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increasing (cdc.gov). The increase in ASD cases could be for a variety of

reasons. One such reason is that the definition of ASD has been broadened to
include many different developmental disabilities (cdc.gov). This broadening
of the definition of ASD makes the rate of diagnosis skyrocket, although the
total number of individuals impacted by developmental disabilities remains
largely unchanged. ASD is believed to be linked to genetics, not
environmental conditions (cdc.gov). The majority of people diagnosed with
ASD are males, leading researchers to believe ASD is an X-linked genetic
disorder (cdc.gov). Furthermore, while the number of people diagnosed with
autism has risen, so have many other factors, including the global
population. A rare condition may seem more frequent when the population
grows and more incidences of the condition appear.

Figure 4. Prevalence of Autism Spectrum Disorder

Fortunately, the anti-vax segment of society is small. According to a poll by

the Pew Research Center, nearly only 9% of people in the US believe
vaccines are unsafe. Unfortunately, anti-vax society uses technology to
spread false claims on a large platform. Websites are dedicated to theories
on why or how vaccines cause a multitude of illnesses, celebrities speak out

against vaccines, and doctors publish books and articles based on

circumstantial evidence that supports the anti-vax movement (Hughes,
2007).
The modern anti-vax movement was given momentum when a falsified study
was published by a doctor whose medical license was later revoked
(newsweek.com). The study showed a strong link between vaccines and
autism. Several theories on how vaccines caused autism spawned from the
debunked study, and still hold sway over many that claim to be anti-vax.
While the decision on whether or not to vaccinate ones children may be
based on personal or religious beliefs, the danger of not vaccinating is
greater than any potential moral dilemma. While many of the diseases that
children are vaccinated against are rare in more developed countries, less
developed nations are still battling with the same diseases that have been
kept under control in the US for decades (Table 1).

Table 1. Preventable Disease Deaths Worldwide

(http://www.who.int/immunization/monitoring_surveillance/burden/estimates/en/)

Background:
The anti-vax movement is not new. Many anti-vax organizations were active
during the late 1800s and early 1900s. One such organization, the Anti-

Vaccination Society of America, actively lobbied against compulsory vaccines

for smallpox in the US (historyofvaccines.org). The Anti-Vaccination Society of
America used print advertisements, books, and hymns to sway the opinion of
the people. The belief among the anti-vax groups in the 1890s was similar as
it is today; vaccines cause other ailments while preventing diseases that are
avoidable without vaccination (vaclib.org). There still is no cure or treatment
for smallpox, yet smallpox was eradicated worldwide by 1980 due in part to
an aggressive international vaccination program.
One of the more common theories in the modern anti-vax movement is that
vaccine ingredients cause autism. One ingredient, thimerosal, is a
preservative found in many vaccines. While still used in many vaccines
today, some companies have removed thimerosal from their vaccines
entirely (cdc.gov). Thimerosal is a mercury-containing compound that
prevents bacterial and fungal contamination (cdc.gov). Thimerosal contains
an ethylmercury compound-- not the same as the methylmercury found in
fish, which can cause nervous system damage in high enough doses (Dera
et al. 2013). Ethylmercury is shorter-lived in the body and is eliminated more
readily than methylmercury (Dera et al. 2013). Many studies from
organizations including the Centers for Disease Control and Prevention and
World Health Organization and highly renowned publications including
Journal of Pediatric Psychology, American Journal of Preventative Medicine
have published articles showing no link between thimerosal and autism. In
fact, although thimerosal levels have decreased in vaccines (due to public
outcry), autism rates have continued to climb (Verstraeten et al. 2003).
Other vaccine ingredients, such as aluminum, have also been blamed for the
purported link between autism and vaccinations. Consequently, no links have
been established between any vaccine ingredient and autism (cdc.gov).
Early exposure to antibodies, a process stimulated by vaccination, has also
been targeted as the autism link. A study published in 2013 showed that
antibody-stimulating proteins and polysaccharides in children after
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vaccination do not cause autism (DeStefano et al. 2013). DeStefano et al.

studied nearly 1,000 children from birth to 2 years old and concluded that
vaccines do not increase risk of autism.
Todays anti-vax movement uses much of the same propaganda that was
used nearly two centuries ago, only using different diseases, vaccinations,
and media to spread their message (Figure 5). Fortunately, those who
support vaccination have access to the same technology to spread their provaccination message and they also have access to a significant amount of
scientific research to support their claims. Growing up in a world free of
terrible diseases like polio, smallpox, and measles has sheltered many
people from the horrors caused by these diseases, which can give people a
false sense of security. An unvaccinated populace can succumb to an
outbreak, especially in the globally-connected world of today.

Figure 5. Anti-Vax Propaganda

The CDC is currently working on a strategy to increase immunization rates,

particularly among children from 19-35 months of age (cdc.gov). Advocating
for laws that require children to have been vaccined prior to entering school,
home visits to administer vaccines, and advertising have all had mixed
results. The most effective strategies (requiring vaccines before going to
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school and home visits) worked well, but only among certain populations
(cdc.gov). The AFIX (Assessment, Feedback, Incentives, eXchange) program
uses grants from states and other programs to improve vaccination rates by
working with doctors, government, and nongovernmental organizations that
work to vaccinate the public. The AFIX program also works to remind patients
of when the next vaccination in a series is due.

Scope and Urgency

A survey conducted by Kennedy et al. (2011) showed that 30-36% of
respondents had concerns about vaccines and autism. Of that cohort, 5595% indicated their children would either forgo some or all of the vaccines
recommended by the CDC. Some states allow families to opt out of
vaccinations, which can increase the number of unvaccinated residents
within that particular state (Figure 7). Since it is not necessary to provide
proof of vaccination to move between one state and another, the probability
of an outbreak of a preventable disease will likely rise as the number of
children without vaccinations climbs.
Vaccination rates have declined from 98% in 1983 to 91% in 2013, according
to the World Health Organization (who.int). According to the US Census
Bureau, the population of the US increased by 81.39 million people over that
time period (census.gov). With a population increasing and vaccine rates
decreasing, more and more people in the US are living unprotected from
potential outbreaks. An outbreak of measles in 2014 saw the largest number
of infected persons in the United States since 2000, with over 600 cases
(cdc.gov). Unfortunately, young children are the most susceptible to diseases
that are vaccinated against.
In Japan in 1974, approximately 80% of children were vaccinated against
pertussis. With only 393 cases of pertussis in Japan in 1974, people believed
the disease was defeated and stopped immunizing their children. By 1979,
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only 10% of children were vaccinated. The same year, a pertussis outbreak
infected more than 13,000 people and killed 41 (cdc.gov). Just because a
disease is well controlled, doesnt mean it wont reemerge.

Target Population Data

Young parents, or soon-to-be parents, are the group that are least likely to
vaccinate, and will therefore be the primary focus of the communication
effort. Surveys show that 20% of young people (ages 18-29) believe a link
exists between autism and vaccinations. Only 3% of people aged 65+
believe such a link exists (Figure 6). Celebrities such as Jenny McCarthy and
Jim Carey have spoken out against vaccines on social media. Young parents
or soon-to-be parents with access to social media and who are likely to adopt
the opinions of celebrities should be targeted with correct information.

Figure 6. Vaccinations and Autism Questionnaire

A 2013 Pew Research Center survey shows that 89% of internet users from
18-29 use some form of social media (pewinternet.org). Of that social media
use, 71% use Facebook (Figure 7). The current generation of 18-29 year
olds have never had to deal with massive disease outbreaks. Polio, measles,
mumps, and rubella have virtually been eradicated in the United States for
decades. Not having been impacted by the effects of contracting a common
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disease probably leads the 18-29 year olds to believe that vaccinating is not
important.

Figure 7. Social Media Use by Age Group (http://www.pewinternet.org/fact-sheets/social-networkingfact-sheet/)

Available Resources
While some celebrities have spoken out against vaccines, other celebrities
are very active in speaking out in support of vaccines. Microsoft founder Bill
Gates and his wife Melinda are very active in the vaccine debate. Likewise,
Mark Zuckerberg, CEO and founder of Facebook, has demonstrated his
support of vaccines by posting pictures of his baby getting vaccinated and
recommending books that promote childhood vaccination (facebook.com).
In some areas where vaccine rates are dropping, recent legislation has
removed personal choice options to decline vaccines (time.com). Using
legislation to improve vaccination rates and remove opt out options could
lead to a higher vaccination rate in the US (Figure 8).
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Figure 8. Percentage of Kindergartners Exempt from Vaccination by State

Expanding the AFIX program and including a social media campaign element
could allow the CDC to reach an even larger audience with a pro-vaccination
message. Modeling the social media campaign to be similar to other types of
national health campaigns (such as the smoking cessation campaigns) could
be a valuable way to get pro-vaccination images and messages to large
audiences.
The World Health Organization (WHO) has launched a World Immunization
Week. Every year in April, the WHO supports immunization efforts around the
world through education and vaccine administration. Using WHO material as
well as CDC information to educate the target audience through social media
can help to drown out anti-vax voices and help people make more
informed decisions.

Funding Sources

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Money from government grants would be the main source of funding for the
communication. The CDC National Center for Immunization and Respiratory
Diseases (NCIRD) provides grants and works with entities, both public and
private, that seek to increase immunization rates. The CDC also uses
government funds to buy vaccines and distribute them where they are
needed.
Nongovernmental organizations (NGO) that provide funding for vaccine work
are typically funded by government grants. The NGOs typically take the
money and use it on their own projects, but they may also make some funds
available to other groups and individuals to further vaccination awareness
and increase vaccination rates.
Gavi, the Vaccine Alliance, also provides funds for new vaccination
dissemination. New vaccine programs can be expensive to get started and
Gavi funds activities associated with nascent programs. Gavi also provides
support for pre-vaccine launch programs.
The Bill and Melinda Gates Foundation provides funds for public health
programs in underdeveloped countries. While most of their work is outside of
the US, focusing vaccination efforts on countries with high numbers of
emigrants to the United States could reduce the overall number of nonvaccinated people in America.
The 317 Coalition supports children vaccinations and uses funds from the
CDC for vaccine studies, disease surveillance, outbreak detection, and
education programs.
The International Society for Infectious Diseases provides money for adult
vaccinations. While the majority of focus is on childrens vaccinations, adults
that were not vaccinated as children can still benefit from vaccination even
after they are grown.

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Summary
Vaccination rates in the United States are decreasing. Celebrities and
uninformed internet mouthpieces are spreading false information about
vaccines and the so-called dangers of vaccinating children. While there are a
number of programs that support vaccination efforts, the anti-vax population
tends to be highly vocal although the best they can do is to provide weak or
falsified data to support their claims. Spreading a pro-vaccination message
among younger people that have less experience with terrifying diseases is
necessary to reverse the declining vaccination trend.
The benefits of universal vaccination include a lower childhood mortality
rate, reduced frequency of outbreaks, and possibly even annihilation of
certain communicable diseases altogether. When people dont get
vaccinated, if they contract the disease, its too late. Getting vaccinated
prevents infection and propagation of disease.
Working with programs that are already in place, creating and distributing
messages will resonate with a generation of young adults that will help
young people understand why vaccinating is necessary and what can happen
if children arent vaccinated. Educating people about the dangers of not
vaccinating on a mainstream platform could help eradicate these serious
diseases once and for all.

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