Keep vaccines out of politics

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Robert F Kennedy Jr is a man best known for his years of tireless work undermining public confidence in vaccines, and repeating long-debunked claims about their health risks. The likelihood that he will take charge of all US healthcare policy is a bracing prospect. Until an arsonist is put in charge of a fire department, it will be hard to find a more fitting symbol of our age.

Vaccines are entangled in politics in a way that most medicine is not. You can see that most obviously in the widespread reluctance among Republicans to vaccinate themselves against Covid-19, while Democrats enthusiastically embraced the vaccine. Flu vaccinations are now much more popular with Americans than Covid vaccine boosters, because a Covid booster has become a political signifier in a way that the flu vaccine has not.

This isn’t the first time such a thing has happened. The HPV vaccine — which protects against the sexually transmitted human papilloma virus, and thus against cervical cancer — became politically controversial when introduced to the US in 2006. This was partly because HPV is a very common infection and, therefore, the vaccine would ideally be given to people too young to have contracted HPV by having sex. The prospect of 11-year-old girls being vaccinated in anticipation of becoming sexually active made some parents uneasy. Political entrepreneurs were quick to express a view, and HPV vaccination became a cultural issue rather than a medical one.

Vaccine scepticism is, in fact, older than vaccination itself. It began with opposition to variolation, the deliberate infection of people with a controlled dose of smallpox in order to confer immunity. Variolation worked but it was dangerous. In the minds of colonial Americans, the idea was hardly burnished by the fact that it came to them from enslaved Africans. The preacher Cotton Mather learnt about variolation from his own slave, Onesimus, and advocated the practice in colonial Boston in 1721. Someone tossed a bomb through the window of Mather’s home with the note, “Mather, you dog. Damn you, I’ll inoculate you with this.” The bomb failed to explode.

Later, vaccination with cowpox prevented smallpox, but that required rubbing pus from cows into cuts in humans. That was less dangerous but neither risk-free nor particularly tempting.

Modern vaccines are vastly safer. But then, they ought to be. Unlike most medicines, vaccines are given to people who aren’t ill and require no treatment. The bar for safety and effectiveness is rightly set high.

Nevertheless, many people remain reluctant. So what to do? The first principle must be to avoid deepening the polarisation around vaccines. Easy as it is to mock or belittle people who seem to reject “the science”, it’s counterproductive. The very fact that so many people will go to their doctor for a flu jab while turning down a Covid booster suggests that the “anti-vaxxer” label is not helpful. Many people are suspicious of particular vaccines, but few shun vaccines in general.

Second, the mainstream media need to do better, perhaps by taking their own health and science reporters more seriously. Time and again, media outlets who should know better have amplified scare stories about vaccines. In 2005, Rolling Stone and Salon jointly published a long essay about mercury in vaccines, written by none other than Robert F Kennedy Jr himself.

After repeatedly publishing corrections, Salon decided “the best reader service is to delete the piece entirely”, but not until 2011. For all the concern about misinformation circulating on Facebook or WhatsApp, many of the most damaging myths about vaccine harms have been repeated by establishment media sources.

Third, we need to get the basics right. That means minimising any financial and logistical obstacles that might trip people up on the journey to vaccination. Behavioural scientists have long known that trivial-seeming barriers can loom large, especially when faced with the prospect of hassle right now and benefits much later. It should be easy and cheap — arguably free — to get the standard vaccines.

And getting the basics right also means reaching out to people who are sitting on the fence. There are always people who will not budge on the topic of vaccination, but there is also a larger group who may delay on the basis of vaguely recalled rumours. Given time and training, healthcare professionals can listen to people’s concerns and a respectful and well-informed conversation is often enough to persuade people to opt for vaccines.

The stakes here are high. Vaccines save lives, and vaccine hesitancy can kill. Japan and the UK both suffered bouts of concern about the safety of the pertussis vaccine in the late 1970s, but when immunisation rates collapsed, 41 people died from the disease in Japan and 70 in the UK.

There is plenty of reason for hope. The latest vaccines are better than they have ever been, and the performance of Operation Warp Speed, the signature achievement of the first Trump presidency, reminds us that we can develop, test and roll out new, life-saving vaccines with astonishing speed.

This is a time, then, for treating people as individuals rather than as members of a tribe, for more robust, accurate journalism from the mass media and for respectful conversations with people who disagree. True for vaccine communication, and true for life. A fitting symbol of our age, indeed.

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