There was a case of measles at my sons’ school this spring. An adult, not a child. It was one of a cluster of four cases in the city. The other three came from people on airplanes that flew in from other countries, the measles an uninvited guest hitching a ride.
The best they can figure, the staff member at my sons’ school was at an airport at the same time as someone with one of these other cases of measles.
At first, I had assumed that she caught it from an unvaccinated child at the school, and I was ready with my self-righteous anger at the anti-vaxxers to decry the dangers of their selfishness. There is nothing so deliberate or purposeful about our brush with it, though. There is no easy target for me to rail against. Of all things, the poor woman had the bad luck to breathe the same air or touch a door handle or a table top that an infected person had also touched, the virus living long enough between human hosts to catch a new ride out of the airport.
News of the case made the newspapers and television news. People kept using the word “outbreak,” but it isn’t one. Public health set up a clinic at the school to check vaccination records and provide booster shots to those kids who have not yet had their second MMR vaccinaton. Over 120 children were excluded from school, because almost none of the kids in the Kindergarten classes had had their second shots yet. There were none for parents, though, so I had to phone my own doctor to figure out what to do. Had I been born a year earlier, I’d be in the clear. Those born before 1970, they say, have been in the world long enough to have encountered and fought off the disease and, therefore, they do not need a booster. This has more to do with statistics than immunology, as far as I can gather, and I can’t quite get my mind around such an apparently arbitrary cut-off date. I’m right on the cusp, so I called my doctor’s office to ask what I should do.
They were a bit flummoxed.
“You’ve been in contact with the measles?!”
“No, not personally, but there is one confirmed case at my kids’ school. We are being asked to check our immunization records. I don’t know if I’ve been immunized, and if I have, I don’t know if I need a booster.”
After a spell on hold, the receptionist asks me to stay by the phone and to expect a call with further instructions. It’s all very Mission Impossible. A while later, I get a call from the nurse. She says that I should come in to see the doctor and that I should identify myself immediately as a patient in need of isolation.
When I went to get my booster shot, I was told that they were expecting me. The receptionist used hand sanitizer after she passed back my health card.
She took me to a wing of the clinic I’d never been to before; it was deserted. I was asked to wear a mask. As I was about to put it on, the doctor who would be treating me came down the hall, and I asked if I should still bother to put on the mask, having assumed that it was a temporary measure. He remained at a distance, down the hall, and said that, yes, I did still need to put on a mask and to wait in the room. He stayed outside of the examining room and did not cross the threshold until he was gowned, gloved and masked. The gown was tucked into the sleeves of the glove. This was a serious suiting up, and I felt decidedly radioactive.
I mention all of these details only to demonstrate how seriously those in the medical profession take this issue. As slim as the chances may have been that I had the measles, they weren’t taking any. I was given the choice of a shot or a blood test to see if I needed a shot, in which case, I would have to come back.
I got the shot, which hurt, but not much, and off I went, feeling like a good citizen, but also feeling quite annoyed at having had to do this at all. Needles don’t faze me, but more than 100 kids being excluded from school, the fear that we may be losing our herd immunity, the success of anti-vaccination activists. Those things faze me.
These diseases should be extinct by now. We should not have to be on the lookout for a monster that could easily have been slain. The science is conclusive: the benefits of immunization far outweigh the risks. But conspiracy theories, benign neglect, and poor comprehension now plague us, and anti-vaccination activists have created public health problems that ought not to even exist.
The most frustrating thing for me is that I get it. I used to be one of them. I postponed my first-born’s shots. When Eldest was born in 2001, all of the anti-vaccination fears were new, and it seemed wise to wait. What I said to myself was, “If enormous mistakes like Thalydamide can happen, shouldn’t we be cautious?” We read about Dr. Andrew Wakefield’s research into links between autism and vaccinations published in the august The Lancet. We were alarmed and frightened and wanted to get to know our baby, to be able to rule out autism, before giving him a series of shots that might cause it. We were also, god help me, a wee bit smug about being so in the know, about questioning authority, about not taking anything for granted. Our doctor agreed to let us postpone the normal vaccination schedule. I am grateful that he does not hold it against us.
Andrew Wakefield has since been exposed as a fraud. The studies were immediately called into question and exposed first as faulty and then as outright fraudulent, The Lancet apologised and refuted his findings, he was stripped of his medical licence, many studies have followed and not one has found a link between autism and vaccination. Unfortunately, none of this matters to those who want to believe that it’s true, and vaccination rates have declined as a direct result of his fraud. He refuses to admit any fault and is still speaking publicly about the links between autism and vaccination. It turns out that what we should have been afraid of was not a repeat of a public health disaster like Thalydamide, but the public health disaster of fake science. And fake science has turned out to be a very menacing foe because even though his work has been thoroughly discredited, the seed was planted and cannot now be rooted out.
We followed the story of Wakefield’s fraud, we revised our own behavior and we vaccinated the next two kids on schedule.
I understand the fear. What I don’t understand is the stubborn persistence of fear once the reasons for it have gone. I want all of the anti-vaxxers to take the same path that I have taken. I want to corral all of the errant fear and paranoia. “Come back!” I want to shout, brandishing the yellow immunization record card. “It was all a mistake!”
The desire to believe in this fraud is so powerful that it has caused a major outbreak of measles in Minnesota. Wakefield himself can be directly linked to the outbreak because he came to Minnesota to speak to parents in the community to dissuade them from vaccinating their kids. Most, but not all, of those affected are from the Somali community. I honestly don’t even know where to begin parsing the racial aspect of this. How did they become so susceptible to the anti-vaccination activists? What made this community particularly vulnerable? Their vaccination rates dropped from 92% to 42% from 2004 to 2014. So now, more than 40 children have been infected in this 2017 outbreak. That is something to rail against. There is something deliberate and purposeful and tragic here to decry.
The temptation is enormous to say that people who do not vaccinate their children get what they deserve, but there are two problems with that. First, it’s exactly the same kind of failure of empathy and community-mindedness for which I find anti-vaxxers guilty. The ugliness of “they get what they deserve” is no different than the ugliness of the myth that choosing not to vaccinate only affects your child. Herd immunity requires about a 90% vaccination rate, depending on the disease; choosing not to vaccinate affects the rate that keeps the general population healthy. That leads to the second problem: poetic justice is more logical than disease. Infectious diseases don’t have an agenda, they don’t follow the linear trajectory that assumes moral or intellectual failure will result in their getting their just deserts. Infectious diseases won’t just find a host in those who refuse to accept scientific fact. Infectious diseases are happy to hitch a ride to any host.
Which brings us back home to the Toronto airport and the vastly random chance that measles hitched a ride to my child’s school.
I want to pin this on someone, but there is no moral failure in the story of my brush with measles. It was just bodies passing each other in an airport, and that is precisely the problem. Bodies will keep passing each other in airports and schools and bars and theatres and community centres, and without herd immunity, without the gifts that science and reason have given us to stop it, measles will make us sick. The measles virus does not care about your stance on vaccination.