TIME health

Privileged Parents Are Driving Vaccine Refusal

Baby vaccination
Science Photo Library—Getty Images

Why, in the face of science and the good of the commons, are people still refusing to vaccinate their children?


This story originally appeared on xoJane.com.

By now, you’re probably familiar with the fact that some people in the US refuse to vaccinate their children. You are probably also familiar with the raging debate over vaccine refusal and whether parents should suck it up and vaccinate their kids for the sake of herd immunity, the common good, and society.

But a recent piece in the Hollywood Reporter by Gary Baum really cuts to the heart of the vaccine refusal issue: It’s a class and privilege problem. The people refusing to vaccinate are primarily wealthy, coming from backgrounds of privilege, following in the footsteps of their wealthy and misguided peers — and they don’t care that their actions are harming society as a whole, which is another function of privilege. When the world revolves around you and your needs, your actions don’t have real-world consequences, and what happens to other people because of what you’ve done is irrelevant.

The numbers on vaccine refusal and its consequences are rather stark. In some states, including Michigan and Oregon, the number of parents seeking vaccine exemptions is in excess of 6%. In an evaluation of the relationship between the difficulty of getting an exemption and the exemption rate, researchers from Emory University noted that: “Our results show that nonmedical exemptions have continued to increase, and the rate of increase has accelerated.”

Six percent probably doesn’t sound like a big deal. However, to achieve true herd immunity in the case of, say, pertussis, a vaccine-preventable disease that’s on the rise, 93-95% of the population overall needs to be vaccinated. Given that some children really do have a genuine medical need to stagger vaccines or not receive them at all, the growing exemption list endangers those children, who are relying on herd immunity to limit their exposure to infectious disease. As the current population of unvaccinated children ages into unvaccinated adults (unless those individuals seek out vaccines later in life), the percentage of vaccination in the overall population will drop, which is bad news.

As a result of poor vaccination coverage, the number of vaccine-preventable outbreaks in the US has been increasing. It’s worth taking a close look at the map developed by the Council for Foreign Relations linked above, and following the patterns it reveals. Unsurprisingly, in Africa, where poor access to healthcare services, including vaccines, is an ongoing problem, vaccine-preventable outbreaks are a widespread issue. A similar phenomenon is present in India, where health care workers struggle to reach rural populations with vaccines.

But what gives with the ballooning outbreaks in Europe, the United States, Australia, and New Zealand? These are nations with ample access to vaccines, including the manufacturers to produce them, companies to handle packaging and shipping, and the facilities to store them, whether at doctors’ offices or elsewhere. Issues like poor refrigeration and lack of needles are not a problem in these regions, which means something is interrupting the chain between vaccine production and patient.

One issue is that pediatricians, the primary point of contact for vaccination, are having trouble with vaccine financing. Offering vaccines is a costly part of their practices, even with insurance coverage and government funding programs — but ultimately, most pediatricians still want to ensure that children get the vaccinations they need to be safe from infection. This is actually one thing Obamacare is supposed to fix: Under ACA, routine vaccinations will be covered.

If vaccines are available, why aren’t kids getting them? Because parents are refusing them — which brings us back around to the issue of which parents are refusing them. For relatively privileged parents, refusing vaccines is seen as an action with little consequences, and one that will benefit their children (while those parents are relying on terrible science and making terrible choices, it would be beyond unreasonable to suggest they aren’t trying to act in the best interests of their children). In the West, the incidence of vaccine-preventable diseases became so low at the end of the 20th century that many people hadn’t seen such illnesses first hand.

Meanwhile, in the Global South, parents of all social classes had ample incentive to vaccinate their children, because they knew what outbreaks looked like and they wanted to take steps to prevent them. Barriers to full vaccination primarily revolved around supply issues — making vaccines, making them affordable, transporting them, storing them, and getting health care providers where they need to go — not ideological ones. In the West, where vaccine refusal has become a growing issue, it’s primarily privileged classes of people who are sticking to the idea that refusing vaccines is scientifically and ideologically sound.

Why, in the face of science and the good of the commons, are people still refusing to vaccinate their children? Many people, of course, don’t want to admit that they’re wrong — and the vaccine refusal juggernaut has become so large that it’s difficult to go against it. Others have absorbed bad science as gospel, relying on information fed to them by the media they self-select to reinforce their beliefs on vaccination. And all of them rely on the idea that their personal choices have no effect on the world around them, which is setting the West up for a dangerous snowball effect.

This attitude isn’t necessarily innate to human nature, though some might think that it is. It’s a specific belief that’s born of privilege — when people spend their lives being taught that they don’t need to consider the needs, interests, and concerns of others, they internalize that belief. That’s manifesting in the current spate of vaccine denial, where people refuse to consider anything beyond their own children.

Consequently, 2012 marked the most pertussis deaths since 1955. But hey, it’s just someone else’s kids, right?

S.E. Smith is a writer, agitator and commentator based in Northern California.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

U.N. Chief: ‘Ebola Has Gone Beyond Health Issues’

The virus threatens political stability in West Africa, Ban Ki-moon warns

The Secretary-General of the U.N., Ban Ki-moon, said Tuesday that the Ebola epidemic in West Africa has “gone beyond health issues” and could even affect the political stability of the region.

“It has gone to the areas of affecting social and economic situations, it may even affect political stability if this is not properly contained and properly treated,” he said during a press briefing.

The Ebola virus has killed more than 2,400 people and there have been nearly 5,000 reported cases of the disease.

Ban said the U.N. is “taking the lead” in global efforts to fight Ebola, the Associated Press reports.

He will attend an emergency meeting Thursday between the U.S. and the World Health Organization to discuss a global “action plan” to contain the outbreak.

On Wednesday, President Barack Obama confirmed increased U.S. efforts to contain the spread of Ebola.

TIME ebola

The WHO Says It Needs $1 Billion to Fight Ebola

World Health Organization's Assistant Director General Bruce Aylward holds a report on Ebola virus during a press conference on global aid pledged to fight the Ebola outbreak in west Africa FABRICE COFFRINI—AFP/Getty Images

That's up from $100 million about a month ago

The World Health Organization needs at least $1 billion to keep the number of cases in West Africa’s deadly Ebola outbreak within the “tens of thousands,” United Nations officials said at a Tuesday news conference in Geneva.

Thus far, there have been 4,985 cases of Ebola, while 2,461 have died of the disease.

“The numbers can be kept in the tens of thousands,” WHO Assistant Director Bruce Aylward said during the conference. “But that is going to require a much faster escalation of the response if we are to beat the escalation of the virus.”

And the figure could increase given the escalating nature of the outbreak.

“The amount for which we requested was about $100 million a month ago and now it is $1 billion, so our ask has gone up 10 times in a month,” said Dr. David Nabarro, senior U.N. coordinator for Ebola. “Because of the way the outbreak is advancing, the level of surge we need to do is unprecedented, it is massive.”

The United States announced its own plans Tuesday to send 3,000 troops to West Africa to help build treatment clinics and train health workers to fight the disease.

TIME White House

U.S. to Commit $500 Million, Deploy 3,000 Troops in Ebola Fight

On Tuesday, President Obama will announce more efforts by the U.S. to lead a global battle against the spread of the deadly virus

Updated at 4:34 p.m. ET

The United States is dramatically escalating its efforts to combat the spread of Ebola in West Africa, President Barack Obama announced Tuesday, during a visit to the Centers for Disease Control and Prevention in Atlanta.

The unprecedented response will include the deployment of 3,000 U.S. military forces and more than $500 million in defense spending drawn from funding normally used for efforts like the war in Afghanistan, senior administration officials outlined Monday. Obama has called America’s response to the disease a “national-security priority,” with top foreign policy and defense officials leading the government’s efforts.

The officials said Obama believes that in order to best contain the disease, the U.S. must “lead” the global response effort. In the CDC’s largest deployment in response to an epidemic, more than 100 officials from the agency are currently on the ground and $175 million has been allocated to West Africa to help combat the spread of Ebola. Those efforts will be expanded with the assistance of U.S. Africa Command, which will deploy logistics, command and control, medical, and engineering resources to affected countries.

Officials said that the Department of Defense is seeking to “reprogram” $500 million in funding from the department’s “overseas contingency operations” fund to assist in the response. Obama has also requested another $88 million from Congress for the U.S. response, including $58 million to expedite the development of experimental treatments for Ebola.

The Pentagon will deliver 130,000 sets of personal protective equipment, thousands of kits used to test for the disease, two additional mobile lab units (one is already on the ground), and a 25-bed mobile hospital to the region. In addition, Africa Command engineers will construct additional treatment units, while the others set up a training center for to educate up to 500 health workers per week. The United States Agency for International Development will also airlift tens of thousands of home health kits and protection kits, including disinfectants and protective equipment, to be delivered to communities affected by the outbreak.

The U.S. effort, named Operation United Assistance, will be based out of Monrovia, Liberia, the country hardest hit by the Ebola epidemic and where the disease is currently spreading fastest, and will be commanded by an Army general. Obama’s announcement follows weeks of calls from global health organizations that global assistance, in particular American help, is needed to address the disease.

The World Health Organization announced last week that as of Sept. 7, there have been 4,366 confirmed, suspected, or probable cases of the disease, with 2,218 deaths. More troubling is the pace of infections, which has steadily risen despite local, regional, and international containment efforts. The WHO has predicted “thousands” of new infections in the coming weeks, calling on the global community to make an “exponential increase” in its response efforts.

U.S. officials have maintained that there is a minimal threat to the United States from the disease, but Obama warned in an interview earlier this month with NBC’s Meet The Press that failing to act could elevate the risk to the nation. “If we don’t make that effort now, and this spreads not just through Africa but other parts of the world, there’s the prospect then that the virus mutates,” Obama said. “It becomes more easily transmittable. And then it could be a serious danger to the United States.”

While the affected countries have imposed screenings at their airports to stop infected individuals from boarding aircraft, U.S. officials outlined efforts to build up detection and prevention capabilities at home, including new training efforts for airline employees and flight attendants to spot ill passengers. Customs and Border Protection officers manning ports of entry to the U.S. have also received additional training to spot potentially infected travelers. Currently the disease can only be spread by direct contact with the bodily fluids of infected patients.

U.S. officials said that in addition to the potential for the disease to spread to the U.S., they are concerned by economic, security, and political instability in countries heavily affected by the outbreak.

Earlier this month, Obama released a video to the people of West Africa, raising awareness about the disease.

TIME Infectious Disease

Gates Foundation Pledges $50 Million for Ebola Battle

Health workers before entering a high-risk area on Sept. 7, 2014, at Elwa Hospital in Monrovia, Liberia, which is run by Doctors Without Borders Dominique Faget—AFP/Getty Images

The foundation said it would give funds to U.N. agencies combatting the disease

The fight against Ebola received a desperately needed monetary boost Wednesday, with the Bill & Melinda Gates Foundation announcing a $50 million donation.

In a statement, the foundation said it would release flexible funds to U.N. agencies combatting the disease, which has already killed over 2,000 people in its worst ever outbreak.

“We are working urgently with our partners to identify the most effective ways to help them save lives now and stop transmission of this deadly disease,” said Gates Foundation CEO Sue Desmond-Hellmann.

The foundation said it has already committed $10 million out of the total $50 million to fighting Ebola — $5 million to the World Health Organization (WHO) for emergency operations and research, and another $5 million to the U.S. Fund for UNICEF to support efforts in the worst-hit countries of Liberia, Sierra Leone and Guinea. In addition, it will also pledge $2 million to the U.S. Centers for Disease Control and Prevention.

There have been promising developments in the search for a cure, with a new vaccine reportedly producing positive results. However, the rapidly accelerating spread of Ebola has caused the WHO to project that over 20,000 people will be infected by October.

TIME health

Why What We Know About Ebola Hasn’t Changed Much

Ebola 1983
From the July 4, 1983, issue of TIME TIME

The Ebola virus first showed up in TIME Magazine in 1980, described as a "mystery malady"—a classification that's still be accurate today

Pity the poorly-named okapi.

In 1957, TIME magazine announced the birth of “Ebola,” a baby okapi born in the Vincennes Zoo in Paris. The okapi is the first mention of “Ebola” in TIME magazine, and though it was remarkable baby Ebola lived so long — most okapi infants died when bred in captivity — the animal’s name would soon be synonymous with a nasty and fatal infectious disease that emerged in 1976 and is currently ravaging West Africa in it’s largest spread in history.

The virus now known as Ebola was given its name after the Ebola River in the Democratic Republic of the Congo, near which the disease first emerged. The first TIME mention of Ebola, the disease, was in 1980 as part of a list of new “mystery maladies” keeping scientists on their toes. Ebola was under the category of hemorrhagic fevers found mostly in Africa, which can kill up to 90% of victims. The author writes that animals apparently harbor the disease without symptoms, then pass it along to humans, and that the animal source is unknown. “What makes these diseases particularly grim is that they can be spread person to person, often to nurses and doctors, through infected blood,” the story reads. Ebola was mentioned in an aside in a 1983 article about the Centers for Disease Control, and then references tapered off, even as Richard Preston’s book The Hot Zone and the movie Outbreak helped the disease gain popular awareness.

Then, in the mid-’90s, it returned. An Ebola outbreak in Zaire and then in Gabon brought the disease back into the news. By then, it was becoming increasingly clear that human infections can come from eating bushmeat — a common practice in rural areas. A 1996 article says scientists believe the disease may infect humans via chimpanzees, considered prize protein in the area, but that they are still unlikely to be the original host. So far insect testing had come up negative.

“We’re still in the dark,” Dr. David Heymann, head of the emerging-diseases division at WHO at the time was quoted in the story.

On Tuesday, the World Health Organization released new numbers about the current outbreak, the largest Ebola epidemic to date, which has infected over 4,269 and taken more than 2,288 lives. And even now, decades after the virus was first reported on, not much has changed in our knowledge of the disease. The facts mentioned in the ’80s and ’90s — the risk to doctors, the problem with bushmeat — are still likely to be mentioned today. The only real breakthrough is that scientists believe the virus’ host is likely the fruit bat—but even that has not been completely confirmed. There’s still no vaccine or cure for the disease, and health care workers remain at a particularly high risk of contracting the disease.

Outbreaks of Ebola are not as common as say, the seasonal flu or even malaria. The lack of innovation when it comes treatments for Ebola has said to be largely due to a low financial incentive for pharmaceutical companies. Until now, the disease has not exactly been a top priority.

Thankfully, Ebola outbreaks of the past have informed the current public health groups attempting to contain the outbreak in West Africa. And though there’s no specific cure, it’s now well known that isolating patients with the disease and providing supportive care can help stop the spread and increase survival rates.

You can follow TIME’s most recent coverage of Ebola here.

TIME Disease

Hundreds of Children Stricken by Rare Respiratory Illness in Colorado

The illness appears to almost uniquely target children

Just as schools usher in a new group of students, plus all of their germs, hundreds of children in Denver have come down with an unusual and severe respiratory illness that has ailed communities across the U.S. in recent weeks.

Officials at Children’s Hospital Colorado told the Denver Post that the hospital has treated more than 900 children for the illness since Aug. 18. Similar outbreaks have been reported in geographic clusters around the Midwest this summer, including in St. Louis.

Health officials believe that the sickness is related to a rare virus called human enterovirus 68 (HEV68), the Post says. HEV68, first seen in California in 1962, and an unwelcome but highly infrequent visitor to communities worldwide since then, is a relative of the virus linked to the common cold (human rhinoviruses, or HRV), according to the Centers for Disease Control and Prevention.

HEV68, which almost uniquely affects children, tends to first cause cold-like symptoms, including body aches, sneezing and coughing. These mild complaints then worsen into life-threatening breathing problems that are all the more dangerous to children with asthma. Since viruses do not respond to antibiotics, hospitals have treated the illness with asthma therapies.

Although extremely unpleasant, no deaths have so far been reported from this summer’s outbreak.

There is no vaccine for HEV68, and health officials are encouraging the same practices that guard against the common cold: keep your hands to yourself, and wash them often.

TIME Infectious Disease

Officials Urge Use of Ebola Survivors’ Blood to Treat Patients

Amid outbreak that has killed more than 2,000

Health officials on Friday recommended the use of Ebola survivors’ blood to treat those suffering from an outbreak of the deadly disease in West Africa.

“We have to change the sense that there is no hope,” Marie-Paule Kieny, an assistant director-general of the World Health Organization, said during a conference of health experts, the Associated Press reports.

The use of blood was one method on a long list of experimental treatments suggested at the conference. RNA-based treatments and pre-existing drugs designed for other diseases were among the other potential options. The experts stressed the need for rigorous data-keeping and evaluation to determine the efficacy of each potential solution.

Kent Brantly, an American doctor who survived an Ebola infection, was given blood from another Ebola survivor during his infection. He also received ZMapp, a vaccine that has been developed to address the disease.

Experts said it will take time to produce more ZMapp and another promising vaccine that could stem the spread of Ebola, which has already killed more than 2,000 people in West Africa. The Obama Administration has asked Congress to provide funds to accelerate the development of ZMapp.


TIME Infectious Disease

Ebola Spreads to Southern Nigeria With 3 Cases Confirmed and 60 at ‘High Risk’

An aerial view of the oil hub city Port Harcourt in Nigeria's Delta region
An aerial view of the oil hub city Port Harcourt in Nigeria's Delta region May 16, 2012. Akintunde Akinleye / Reuters—REUTERS

WHO officials warn that the epidemic is accelerating rapidly

Correction appended, Sept. 4.

Three cases of Ebola have been identified in the southern Nigerian city of Port Harcourt, the World Health Organization (WHO) says, confirming that the disease has spread outside Lagos, where five people have died.

Officials in Port Harcourt — a teeming city of 1.4 million in the Niger delta — are now monitoring over 200 people, 60 of whom are considered at high risk of having contracted the disease. It is a worrying expansion of an epidemic that has now killed 1,900 in West Africa and defied the attempts of under-staffed and under-funded aid teams to halt it.

WHO officials warn that the virus is not just expanding geographically but also accelerating. Ebola has now sickened upwards of 3,500 people and in the past week alone almost 400 people have died of the virus, said Dr. Margaret Chan, director-general of the WHO at a press conference in Washington D.C. on Wednesday.

“This Ebola epidemic is the longest, the most severe and the most complex we’ve ever seen,” said Chan. Experts, she added, “have never seen anything like it.”

Some $600 million in supplies will now be needed to duel with the epidemic, the worst on record, WHO officials said—up $110 million from the estimate given last week, according to Reuters. The increased sum will further test the willingness of the global community to tackle the disease at source. Health organizations such as Doctors Without Borders have already been highly critical of what they say is a lackluster international response.

As the epidemic expands, resources on the ground have not, WHO officials said. There is no room in what few hospitals there are in the worst-hit areas; terrified medical staff have stopped showing up to work; and in Liberia the bodies of Ebola victims are being left unattended in the streets. Some who contract the disease are also choosing to hide their illness—in the meantime, unwittingly infecting those around them—rather than be turned upon by neighbors.

Meanwhile, some 150 scientists and experts convened Thursday at the WHO’s headquarters in Geneva, Switzerland, for a two-day meeting to review available experimental Ebola drugs and vaccines and draft testing plans for the most promising. None of the drugs have been tested in humans, but one of them, ZMapp, was given to two Ebola patients who survived their illness.

On Tuesday, the U.S. Department of Health and Human Services awarded a contract worth up to $42.3 million to ZMapp’s manufacturer, jump-starting clinical trials and fresh production of the drug, supplies of which are currently tapped out.

The W.H.O estimates that Ebola will take 20,000 more lives before its transmission is stopped.

Correction: The original version of this story incorrectly identified the capital of Nigeria. It is Abuja.

Footage of life in Dolo Town, some 40 miles (60 k.m.) east of Monrovia, Liberia, which has been quarantined to contain the spread of Ebola.

TIME Infectious Disease

Desperate WHO Calls Ebola Drug Summit As Crisis Worsens

Health care workers, wearing protective suits, leave a high-risk area at the French NGO Medecins Sans Frontieres (Doctors without borders) Elwa hospital in Monrovia, Liberia on Aug. 30, 2014. Dominique Faget—AFP/Getty Images

The world urgently needs to find a drug that can fight Ebola

More than 100 scientists and industry executives will convene this week at the WHO’s headquarters Geneva, Switzerland, in response to a spiraling Ebola crisis. Their urgent mission will be to comb through the world’s stock of experimental Ebola drugs and vaccines and agree on a plan for clinical trials.

The Sept. 4 to Sept. 5 meeting comes about a month after the WHO said that while it had a “moral duty” to conduct clinical trials, treating Ebola patients with drugs never previously tested on humans would be ethical given the severity of the crisis.

Experimental Ebola drugs – though still wildcards – have been touted as possible miracle workers in the international fight to quell the outbreak, the worst on record. The epidemic has subsumed Sierra Leone, Guinea, and Liberia, and it has appeared in Nigeria, Senegal, and the Democratic Republic of Congo.

ZMapp, one of the drugs before the WHO, cured all 18 monkeys that had been infected with Ebola as part of a recent study. Even so, anecdotal evidence of its effectiveness in humans is inconclusive: it has never been tested on humans but was given to seven Ebola patients, two of which have lived, and two of which have died.

On Tuesday, U.S. health officials announced a $25 million contract with ZMapp’s supplier, Mapp Biopharmaceutical Inc., to begin testing the drug, as well as to jumpstart its production, as supplies are currently exhausted. The U.S. National Institutes of Health (NIH) will also begin clinical trials of an Ebola vaccine next week, and trials of additional vaccines are set for the fall.

Meanwhile, the WHO announced last week that it has drafted a broad roadmap to “dramatically scale up the international response” to the crisis and halt Ebola’s spread within six to nine months.

Health workers have been highly critical of what they say is a lackluster international response to the emergency: after a U.N. meeting on Tuesday, Doctors without Boarders president Joanne Liu excoriated the leaders of unaffected nations for scrambling to secure their own borders against the virus, but failing to sending sufficient aid and experts into the crisis zones.

“Six months into the worst Ebola epidemic in history, the world is losing the battle to contain it,” Liu said, calling on able countries to send bio-defense teams to West Africa. “We cannot cut off the affected countries and hope this epidemic will simply burn out. To put out this fire, we must run into the burning building.”

Liu told the U.N. much of what has been done so far to stop the virus is not working. “Riots are breaking out,” she said. “Isolation centers are overwhelmed. Health workers on the front lines are becoming infected and are dying in shocking numbers. Others have fled in fear, leaving people without care for even the most common illnesses. Entire health systems have crumbled.”

The U.N. meanwhile warned on Tuesday that the quarantines are expected to cause a food crisis in West Africa, as restrictions on movement in and out of afflicted communities are affecting food supplies, and as panic buying is jacking up the prices of ever-scare staples.

More than 1,500 people have died in West Africa – almost half of the some 3,500 cases confirmed since the disease was identified in March. The WHO predicts that around 20,000 more people will fall ill with the virus before its spread can be stopped.

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