Talk about first-world pains—while countries like India struggle to ensure full vaccination coverage, the president of the United States has to go on national television to urge parents to get their children vaccinated against measles. Vaccination is a hot issue in the US in February as ‘anti-vaxxers’—parents suspicious about the benefits of vaccination—are blamed for an outbreak of measles. Originating from Disneyland in California, the infection wavefront reached New York on the East Coast last week. The numbers are piffling by Indian standards—just over 100 cases in the US, while there were 156 deaths per day in India in 2011—but for a nation which had been declared measles-free in the 21st century, it is a very big deal.
“I just want people to know the facts and science and the information,” president Barack Obama said in an NBC interview. Ironically, that is precisely what an Arizona doctor, who has become an anti-vaxxer mascot and media magnet, says in defence of his own position. He wants parents to look deeply into the vaccine vials that their children are injected with and evaluate their potential for being useless or harmful. The proposition is absurd, given that very, very few parents have the technical education to make an informed choice. Even a study linking the measles vaccine with autism which was dismissed long ago lingers in public awareness. Indeed, trying to persuade through the science of vaccination, whether for the motion or against it, is rather pointless. Lay people take decisions actuated by political and ethical concerns, and even suspicions, rather than technical issues.
In the US, vaccination is facing the very same brick wall that genetically-modified crops do in India —while the evidence in favour of the technology is sufficient to convince the scientific mind, it appears mysterious and potentially suspicious to the lay person. India is firmly on the GM map of the world, now that the International Service for the Acquisition of Agri-Biotech Applications has reported it to be the world’s fourth-most-deeply invested nation, with 11.6 million hectares under GM crops. That’s neck and neck with Canada, but only about one-seventh of the acreage in the US, which leads the field.
Besides, almost all of the acreage in India is under Bt cotton. Nations which have voted firmly for GM, like Brazil, tend to have a wide bouquet of crops. The fact that India is almost GM-monocultural and a slow adopter indicates distrust—like the measles vaccine, this is a political rather than scientific reaction, and is being addressed politically. For instance, Maharashtra has just cleared open-field trials of GM chickpea, rice, cotton, maize and brinjal—a strong signal.
Partly, the distrust is not about science and technology, but proceeds from unease at the staggering bigness of big biotech and big pharma.
Could information asymmetry be an issue here? While policymakers are easily assured that they have adequate access to information and data that they may want in order to make up their minds, the public is never certain of any such thing, and naturally fearful of being diddled.
In the West, part of the resistance to vaccines comes from the suspicion that big pharma invests in influencing medical professionals, policymakers and institutions to market superfluous and overpriced products, procedures and standards. Besides, while the WHO lays down guidelines for vaccine use, in practice, paediatricians do offer parents a small spectrum of choice depending on the geography of risk. In a location where a disease is unknown, the vaccine for it may be quietly passed over in the clinic. The very existence of choice opens a perceptual door, encouraging parents to wonder if even essential vaccines are unnecessary, and only exist to fatten big pharma.
The core of the problem is that those who are convinced need no proof, and no proof ever suffices for the rest. The remedy is political persuasion rather than scoffing at fears and pushing them aside with the bludgeon of science. Persuasion has kept the gigantic oral polio vaccine programme rolling in India in the face of critics who considered the target to be unachievable. WHO declared India polio-free last year and now, measles is the next target. In the early 1990s, India was perceived to be heading for an HIV/AIDS pandemic that would have dwarfed the crisis in Uganda. It was averted by a huge outreach programme against high-risk behaviour driven by government and NGOs— dismissed as lucrative scare-mongering at the time—which used multiple modes of communication, from the press to street theatre. Today, a pandemic is impossible.
So, though it looks slightly absurd, the president of the United States was quite right to go to the media when he needed to fight back against measles. In the battle against communicable diseases, the TV studio has more leverage than the doctor’s clinic.