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Jill Wechsler is Pharm Exec's Washington Corespondent
April 04, 2016.
Even though the organizers of New York’s Tribeca Film Festival decided last week not to air the anti-vaccine film written and directed by discredited British researcher Andrew Wakefield, the so-called documentary is getting a healthy run and further perpetuating the myth of a link between childhood vaccination and autism. Wakefield’s “Vaxxed: From Cover-Up to Catastrophe” has all the emotional elements to convince millions that vaccines are unsafe and dangerous. It promotes the conspiracy theory of a “cover-up” by the Centers for Disease Control and Prevention (CDC), hits pharmaceutical companies for pushing preventives for profit, and even attacks the press for buying into the pro-vaccine story. All this, despite repeated and continued research by eminent scientists as to the safety and enormous benefits of broader immunization for children and adults.
The rush to develop vaccines to combat the Ebola virus outbreak and now the spread of Zika reflects growing evidence of the effectiveness of vaccines to control lethal infectious diseases. To quell a serious meningitis outbreak in 2013 at Princeton University and other college campuses, authorities rushed to import a vaccine from Europe, as no preventive was then approved in the U.S. Most of today’s parents have never experienced the high fevers, rashes and scars left by chicken pox or measles. Or have had to hospitalize a child with whooping cough, or reassure pregnant friends that no one has rubella, which has been linked to birth defects.
Yet, the refusal of parents to vaccinate children for measles led to a major outbreak of the disease in California two years ago, an event that triggered investigations and widespread commentary on inadequate vaccination rates in the U.S. Similar anti-vaccination campaigns raised alarms about vaccines for human papillomavirus (HPV), delaying uptake by physicians and insurers of this important preventive. Public health officials blame the anti-vaccine movement for thousands of unnecessary deaths and many more illnesses.
There’s a very selfish aspect to vaccine resistance. A healthy child who fails to get vaccinated for measles or other common infectious diseases faces relatively low risk of actually getting sick due the “herd immunity” provided by broad community immunization that curbs the spread of infection. Yet children with cancer and other conditions that reduce immunity and rule out vaccination, and elderly patients who may have limited protection from decades-old vaccines, can suffer severe consequences from exposure to infection.
The 1998 study by Wakefield purporting to document the vaccine-autism link was later retracted by the British medical journal The Lancet, and Wakefield lost his UK medical license. But the damage was done, and the anti-vaccine movement remains strong. Even though all 50 states in the U.S. require children to receive all CDC-recommended vaccines before entering kindergarten, most states permit exemptions for religious reasons, and about half allow personal or philosophical exemptions. Up until recently, only Mississippi and West Virginia permitted only medical exemptions. But in the wake of the 2014 Disneyland measles outbreak, California enacted a law last year limiting exemptions to only medical reasons, and Vermont ruled out philosophical exemptions.
Opponents of mandatory vaccination range from anti-government libertarians to ardent liberals and include religious and environmental groups. Activist Robert F. Kennedy Jr. campaigned vigorously against the California bill and continues to press for the removal of the preservative thimerosal from vaccines; his aim is to prevent the exposure of infants to mercury that he claims can cause neurological harm, a discredited argument reiterated by Kennedy in a 2014 book on the issue.
Public health leaders hope that the California action will lead to a shift away from increasingly flexible state exemption policies. Vaccine manufacturers can help by producing effective, high quality products and supporting broad coverage of vaccines by health plans and insurers. Obamacare has expanded reimbursement for routine vaccines, but Medicare drug plans have been criticized for maintaining high co-pays for many adult treatments. Vaccine prices remain a target, and pharma companies often run into charges that they support universal immunization just to boost profits. Industry needs to explain more effectively the complexity and costs involved in vaccine R&D, including the benefits of newer combination products.
Rising support for global vaccine initiatives since 2000, led by the Bill & Melinda Gates Foundation, has expanded the market for many vaccines and encouraged further R&D. Biopharma companies continue to research new preventives for cancer, AIDS and other serious diseases, despite disappointments. There’s also interest in developing more user-friendly delivery systems that avoid jabs painful to children. But the continued success of the vaccine deniers and skeptics stands to derail such important innovation in the disease prevention field.