TIME vaccines

7 Signs Your Child’s School Has Unvaccinated Students

The resurgence of the measles has drawn scrutiny to California’s fairly lenient vaccine policy, which allows parents to choose a personal-belief exemption to avoid vaccinating their kids. And while parents can send their non-inoculated children to school, the state also publishes detailed information on the vaccination rates at every public and private school in the state.

By comparing this information with characteristics of each school, we were able to draw a detailed picture of what sort of schools are attended by children of vaccine-skeptic parents. Here’s a breakdown by a few different school characteristics.

Vaccination rates go down with the percentage of students receiving free or reduced lunch—which is the best school-by-school economic indicator available. In other words: The better off the parents are, the more statistically likely they are to apply for personal-belief exemptions against the otherwise mandatory vaccinations.

Though it’s less commonly discussed, the religious affiliation of a school is also a useful predictor of vaccination rates. (As with all statistical correlations, this does not mean it is the religion that is dictating the choice not to vaccinate.) Baptist and Calvary Chapel schools are particularly likely to have unvaccinated students, though overall, private religious schools have higher vaccination rates than non-religious private schools.

And though they account for only 661 students, Waldorf schools (as identified by the name of the school) have extremely high rates of personal-belief exemptions, to the tune of 38 percent. Mother Jones caught up with a dean at one such Waldorf school who explained that, while there was no recommended policy on vaccines, she was accepting of whatever choice parents made.

Vaccine resistors are also more likely to be found in urban areas, as both the Washington Post and the New York Times have demonstrated.

Methodology

The raw data for this story is available for download on TIME’s GitHub account. The vaccination data was matched to public and private school registries as well as data on free and reduced lunch programs by school. The correlation between the percentage of students receiving free or reduced lunch and the rate of personal belief exemptions is -0.29, and the correlation with the number of enrolled students is -0.18.

TIME vaccines

Many Doctors Give In When Parents Want to Space Out Vaccines

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JGI/Jamie Grill—Getty Images/Blend Images

The vast majority of doctors don’t believe that spacing out childhood immunizations is a good idea, but they’re doing it anyway. Here’s why

It’s an eye-opening survey, to say the least, and its findings are clear: Nearly all — 93% — primary care doctors and pediatricians surveyed say that in a typical month, parents ask them to deviate from the recommended childhood immunization schedule and instead give the shots over a longer period of time, according to a report published Monday in the journal Pediatrics. And while nearly 90% thought that such spacing out of the immunizations would put the children, and the community at risk of spreading infectious diseases like measles, 37% said they agreed to do so often or always. That was a 131% increase since the last survey, conducted in 2009, when only 16% said they agreed to changing the recommended vaccine schedule.

“Doctors are feeling really conflicted because they overwhelmingly think this is the wrong thing to do, and is putting children at risk, but at the same time, they want to build trust with their patients and meet people halfway,” says Dr. Allison Kempe, professor of pediatrics at University of Colorado and Children’s Hospital Colorado, who is the lead author of the study.

MORE How Safe Are Vaccines?

Even more concerning, she says, is the fact that 40% of the physicians said that the vaccine issue was the source of their job dissatisfaction. The survey also asked them about different strategies the doctors employed with parents to discuss the importance of following the existing vaccination schedule, but the doctors revealed very little confidence in those methods. In fact, the strategy they believed worked most often only garnered a 20% effectiveness rating, and that was telling parents that the doctors immunized their own children according to the recommended schedule.

“It’s a terrible conflict when I have to make a decision when I’m doing my vaccine orders for a particular child and decide if it’s going to be the pertussis vaccine for that infant or the Hib or the pneumococcal,” says Dr. Julie Boom, director of the immunization project at Texas Children’s Hospital and associate professor of pediatrics at Baylor College of Medicine, of the decision she has to make when parents insist on giving their babies only one immunization during a visit. While Boom makes every effort to discuss with parents the importance of sticking with the recommended immunization schedule, she says “I will offer the vaccine at that visit and explain the risks and benefits of the decision that parent is making and try to get them to come back as quickly as possible to take the next vaccine so the baby will be fully vaccinated as on time as possible.”

MORE Childhood Vaccines Are Safe, Says Pediatrics Group

But she does that knowing that the baby leaves her office at higher risk of potentially getting sick since he is not fully immunized. “The baby leaving my office is at risk of getting the illnesses for which he’s not vaccinated,” she says. “To know I’m going to pick one [vaccine] and leave the other behind, despite all the time I spend explaining the risks and benefits to the parents—it’s very difficult for me.”

And it’s increasingly a problem for her colleagues as well. While parents who refused to vaccinate their children gained the most media attention in recent years and likely contributed to pertussis and measles outbreaks, even more parents – about 13% — used an alternative vaccine schedule that included delaying some of the shots. These parents often express concern about “overloading” their babies’ immune systems with too many shots in one visit (the most that infants generally get are five, at the year-old visit). In the survey, 35% of doctors said they realized that allowing parents to delay shots sent mixed messages; parents could interpret the action as proof that the existing schedule wasn’t so important after all if doctors ended up changing it.

Part of the conflict may come from the advice from organizations to which these physicians turn for help. As some frustrated doctors began to “fire” their patients and refuse to see them if they declined to vaccinate their children or asked for alternative immunization schedules, in 2005, the American Academy of Pediatrics advised its members to not dismiss those parents and urged them to discuss and educate them instead about the importance of vaccinations and of getting them on time. That may explain why 82% of doctors in the current survey said they felt agreeing to delaying some vaccines would build trust with their patients; 80% said that if they refused to accommodate the parents wishes, these parents would leave to find some doctors who would.

MORE Nearly One in Ten Americans Think Vaccines Are Unsafe

“Nobody is in favor of dismissing patients, but I think we need to get a little bit straighter about communicating to these parents about how strongly we feel about vaccinations, and how detrimental spacing them out is for their child,” says Kempe.

Among the most commonly used strategies to convince parents, doctors cited their comfort with vaccinating their own children according to the schedule, stressing that spacing out vaccines puts their children at risk of getting sick, reminding them of recent outbreaks of vaccine-preventable diseases, and explaining that alternative schedule haven’t been studied for their safety. Doctors have even informed parents that bringing their child back for multiple visits to get jabbed with a shot can be more painful for the baby. None were rated by the physicians as being more than 20% effective, leaving doctors at a loss.

MORE Dr. Tom Frieden: Vaccines Can Prevent Measles From Being a Disease of the Future

That’s why professional organizations should take a stronger role in providing doctors with more guidance about what may work and what doesn’t. Conducting more studies on different methods of educating and addressing parents concerns could arm doctors with more data and scientific evidence to back up their belief in the established immunization schedule, for example. Kempe also notes that starting to educate parents earlier, such as during pregnancy, may help to reinforce their comfort with vaccines and what they can do to protect their baby once he is born. And reaching parents and parents-to-be on a more consistent basis may also be key to alleviating their concerns about vaccines. “We as doctors have not exploited mass media or the kinds of media that the anti-vaccine movement has,” says Kempe. “We are not doing a great job of countering the misinformation out there, and also not doing a good job of enlisting parents who are pro-vaccine in a proactive way to establish a social norm.”

Part of that has to do with the fact that the time that doctors typically have with parents during well-baby visits is short. Most doctors reported having to spend at least 10 minutes with parents to address their vaccine concerns; that’s about half of the time of an average visit, which also has to cover other important wellness issues such as nutrition, car safety, and more. So Kempe says other strategies, such as group visits or sessions to address vaccine questions specifically, or designated staff at family practices or pediatricians’ offices who are assigned the task of answering questions about vaccines and vaccine safety might be more effective. In Boom’s practice, she often schedules a separate visit for parents to discuss just their vaccine questions, so she doesn’t feel rushed to come to a decision about whether to help the parents space out vaccines or not.

For Boom, the key is understanding where the parents’ concerns come from. “For one parent it may be about long term effects of vaccinations, and for another it may be something else,” she says. “You have to understand where the misinformation is coming from, and then very specifically address each parent’s questions. It does take time.”

Using this strategy, Boom feels she is relatively successful in educating parents about the need to follow the recommended vaccination schedule. But she admits that working in an academic institution, she has the luxury or more time with her patients.

For those that don’t, it’s clear that frustration is reaching a boiling point in doctors’ offices. “I hope this study is a wake-up call, and I hope it’s time to say ‘okay, what we are doing isn’t working,’ and start asking ‘what should we be doing?’” says Kempe.

Read next: I Was on the Front Line of L.A.’s Last Measles Outbreak

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TIME health

The Vaccine Everyone Wanted

Salk Cover
TIME Jonas Salk on the Mar. 29, 1954, cover of TIME

Feb. 23, 1954: The first mass inoculation of children against polio with the Salk vaccine takes place, in Pittsburgh

In the midst of the contentious debate between anti-vaxxers and those who side with mainstream science, it can be hard to imagine a time when Americans almost universally embraced vaccination.

That time was the 1950s, when the very real, utterly devastating effects of polio overshadowed any hypothetical questions of vaccine safety. In 1952, the worst polio outbreak in American history infected 58,000 people, killing more than 3,000 and paralyzing 21,000 — the majority of them children. As TIME reported, “Parents were haunted by the stories of children stricken suddenly by the telltale cramps and fever. Public swimming pools were deserted for fear of contagion. And year after year polio delivered thousands of people into hospitals and wheelchairs, or into the nightmarish canisters called iron lungs.”

When Dr. Jonas Salk’s vaccine debuted its first mass inoculation against polio on this day, Feb. 23, in 1954, the only fear most parents felt was that it wouldn’t become widely available fast enough to save their kids.

Children from the Arsenal Elementary School in Pittsburgh, where Salk ran his research lab, took part in the first “field test” of the new vaccine, although Salk had already tried it on volunteers — starting with himself, his wife, and their children — who’d successfully produced polio antibodies without getting sick. By June, nearly two million schoolchildren in 44 states had been inoculated, and a year later the vaccine was officially licensed.

During its initial testing, the most salient safety question about Salk’s vaccine centered on the potential danger of injecting humans with monkey tissue. To make his vaccine, Salk’s team harvested kidneys from live monkeys and injected them with live polio virus, which quickly multiplied in the kidney cells. Then the team used formaldehyde to kill the virus before injecting it into humans.

But the traces of monkey kidney present in each dose of the vaccine were so minute that they posed no health risks, as Salk told the New York Times.

Instead, the greatest safety threat came not from monkeys but from human error: One of the labs licensed to produce the vaccine accidentally contaminated a batch with live polio virus in 1955. That batch killed five people and paralyzed 51.

With stricter oversight, however, the vaccine continued to be the lifesaver it was initially hailed as. Within the first few years, it cut polio cases in the U.S. by half. By 1962, the number of new cases had dropped to fewer than 1,000. And by the time of Salk’s death at age 80, 20 years ago, polio was already virtually extinct in the U.S. and dwindling worldwide.

Read the 1954 cover story about the polio vaccine, here in the TIME archives: Closing in on Polio

TIME health

Facebook Must Shut Down the Anti-Vaxxers

Prove it: Silencing the anti-vaccine crowd can save a lot of lives
Justin Sullivan; Getty Images Prove it: Silencing the anti-vaccine crowd can save a lot of lives

Jeffrey Kluger is Editor at Large for TIME.

Mark Zuckerberg should unfriend the crazies before more people get hurt

Mark Zuckerberg has never been famous for his reading choices. No one knows or cares if the founder of Facebook got around to Moby Dick when he was at Harvard. But in January, Zuckerberg launched an online book club, offering reading recommendations to members every two weeks. Earlier suggestions included such important works as Steven Pinker’s The Better Angels of Our Nature and Sudhir Venkatesh’s Gang Leader for a Day.

But Zuckerberg dropped something of a small bombshell with his most recent—and most excellent—choice, On Immunity by Eula Biss. It’s a thoughtful exploration of what’s behind the irrational fear and suspicion in the anti-vaccine community, as well as a full-throated call for parents to heed medical wisdom and get their kids vaccinated. “The science is completely clear,” Zuckerberg writes, “vaccinations work and are important for the health of everyone in our community.”

So kudos to Zuckerberg for getting the truth out and challenging the lies.

And shame on Zuckerberg for enabling those lies, too.

Social media sites can do an exceedingly good job of keeping people connected and, more important, spreading the word about important social issues. (Think the ALS Ice Bucket Challenge would have raised the $100 million it did for research into Lou Gehrig’s disease if people couldn’t post the videos of themselves being heroically doused?) But it’s long been clear the sites can be used perniciously too.

Want to spend some time in the birther swamp, trading conspiracy theories with people who absolutely, positively can tell you the Kenyan hospital in which President Obama was born? You can find them online. Ditto the climate-denying cranks and the 9/11 truthers.

But the anti-vaxxers have a particular power. People who buy the nonsense on a birther or truther page can’t do much more than join that loony community and howl nonsense into the online wind. Climate change denial is a little more dangerous because every person who comes to believe that global warming is a massive hoax makes it a tiny, incremental bit harder to enact sensible climate policy.

Anti-vaxxers, however, do their work at the grass-roots, retail, one-on-one level. Convince Mother A of the fake dangers of vaccines and you increase the odds that she won’t vaccinate Child B—and perhaps Children C, D or E either. And every unvaccinated child in her brood increases the risk to the neighborhood, the school, the community—the entire herd, as the epidemiologists put it. The multi-state measles outbreak that began in Disneyland, along with the epidemics of mumps and whooping cough in Columbus, Ohio and throughout California, have all been fueled by falling vaccine rates.

One thing that would help—something Zuckerberg could do with little more than a flick of the switch, as could Twitter CEO Dick Costolo and the other bosses of other sites—is simply shut the anti-vaxxers down. Really. Pull their pages, block their posts, twist the spigot of misinformation before more people get hurt.

The very idea of muzzling any information—even misinformation—will surely send libertarians to their fainting couches. Similarly, people who believe they understand the Constitution but actually don’t will immediately invoke the First Amendment. But of course they’re misguided. Is Facebook a government agency? No, it’s not. Is Zuckerberg a government official? No, he’s not. Then this is not a First Amendment issue. Read your Constitution.

It’s not as if the folks at Facebook aren’t clear about the kinds of things they will and won’t allow on the site, providing a brief listing and a detailed description of what are considered no-go areas. “You may not credibly threaten others, or organize acts of real-world violence,” is one rule, so nobody would get away with posting instructions for, say, how to build a pressure cooker bomb. There is nothing in the regulations that specifically prohibits trafficking in bogus medical information, but the first section of the policy statement begins, “Safety is Facebook’s top priority,” and then goes on to say “We remove content and may escalate to law enforcement when we perceive a genuine risk of physical harm, or a direct threat to public safety.” (Emphasis added.)

It’s worth wondering if Facebook would consider a page arguing that HIV does not cause AIDS and that therefore condoms are not necessary a threat to public safety. What about one that told teens that bogus research shows it’s OK to drive drunk if you’ve had no more than, say, three beers? If the site managers didn’t block these pages and a multi-car crack-up or a cluster of HIV infections occurred as a result, would they wish they they’d made a different decision? It’s hard to know. (As of publication time, Facebook had not responded to TIME’s request for a comment on, or further statement about, its policies.)

Facebook is equal parts town square, medium of communication and commercial bazaar—complete with ads. And it does all of those jobs well. What the site shouldn’t be is a vector for lies—especially lies that can harm children. Free speech is not in play here. This should be an easy call.

Read next: Doctors Who Minimize Measles Should Lose Their Licenses

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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 health

Why Measles Continues to Plague Us

Measles Outbreaks Spread In U.S.
Handout / Getty Images In this handout from the Centers for Disease Control and Prevention (CDC), a histopathology of measles pneumonia is seen in this microscope image from 1972

There is no virtue in ignorance, especially in deliberate ignorance that can compromise the well-being of children

This post is in partnership with the History News Network, the website that puts the news into historical perspective. The article below was originally published at HNN.

Not so long ago (2011) the world was declared officially free of the cattle disease, rinderpest. As with the 1980 eradication of human smallpox, the basic weapon was vaccination. The rinderpest virus and measles virus are very similar, perhaps diverging from a common ancestor about 1,000 years back. We’ve had effective measles vaccines for around 50 years and the world could, and should, be rid of measles. But, apart from the problem of getting vaccine into war zones and other problems in very poor nations, we are nowhere near doing that. Why is that so?

The latest outbreak associated with visitors to Disneyland is just one of continuing, sporadic events all over the advanced world. Measles is very infectious. Classically, a young, unvaccinated person is taken on family vacation to a country where the virus is actively circulating, contracts the disease and brings it back to spread rapidly in (often) an “alternative” school where there are many other unprotected children. Such schools are often the choice for intelligent, well-educated parents.

What’s happening with measles is a good example of the maxim that: “partial knowledge is dangerous.” In the main, people have a very limited understanding of infectious diseases. Viruses grow in cells and kill them. One virus particle is enough to initiate a full cycle of replication in what becomes a “factory” producing millions of progeny that are, in turn, released to go on and infect other cells. With influenza, the disease that I study, the successive cycles of infection, cell loss and inflammation are limited to the respiratory tract. That kills if the lung damage is sufficiently severe. With measles, though, the virus travels the body and can end up in any tissue.

Most 1st world citizens and doctors who are under 60 have never seen a case of measles. Those who do know anything about this disease understand that the kids get prominent skin spots. Each one of those red “lesions” reflects a focus of virus growth. The measles virus invades via the oropharynx, multiplies there and is then disseminated via the blood. The effects in the skin are obvious, but we don’t see what’s happening in the lung, the brain, the middle ear and elsewhere. The measles sequelae can include long-term hearing problems, persistent lung damage and (fortunately rare) the terrible disease subacute sclerosing panencephalitis (SSPE). In SSPE, a defective measles virus “hides out” in the brain, then suddenly re-emerges in adolescence. A fit teenager can suddenly go into a coma and die. SSPE disappeared with the widespread use of the measles vaccine. Nobody wants to see it return.

The measles vaccine is an “attenuated” virus strain that undergoes limited replication, infects few cells and does not disseminate widely via the blood. Given that the recommended immunization schedule has been followed, it provides long-lasting immunity.

So why does this vaccine get such a bad rap with some parents? Apart from a tendency of “empowered” adults to disregard medical advice and say “I will decide what is given to my child,” there are claims that injecting the measles, mumps rubella (MMR vaccine) is associated with the development of autism. This appeared in a 1998 paper by Andrew Wakefield and 12 others published in the prestigious British journal, The Lancet. The data set was just 11 cases, and the correlation was with MMR, not with the measles vaccine as such. There has been no confirmation, despite massive, international efforts to replicate the Wakefield et al findings. Major issues have been identified with the original Lancet paper, which has been retracted by the authors, excepting Dr. Wakefield. Apart from the tragedy that children are now needlessly contracting measles, the claim distracted those who are seeking a cause for autism, particularly some in the patient advocacy groups.

Why was this underpowered Lancet study so readily accepted? The thought that you might cause your child to develop autism is obviously horrific, and the problem with autism is that it often emerges around the age that children are receiving the standard vaccines. Listening to people arguing this case, it’s obvious that people will connect anything bad that happens to their kids back to vaccines given weeks, or even months previously. And the fact of the matter is that vaccination, like any medical procedure, has to be looked at through the lens of relative risk. There was a recent situation in Australia where an influenza vaccine was too “reactogenic,” causing fever and convulsions in a few very young children. The vaccine was quickly withdrawn and replaced by a safer product, with the event being thoroughly investigated by the US FDA and by the relevant Australian authorities. There were similar issues way back with whooping cough vaccines, which have been replaced by much “cleaner” products, though they are less effective in the immunity sense.

If, in reading this, you want to find out more, go online and watch the excellent NOVA documentary: Vaccines: Calling the Shots. Made by the Australian film-maker Sonya Pemberton, it first aired “down under” as Jabbed and was modified for a US audience. Then, I did my utmost to write an easily understood chapter on infection and immunity and how vaccines work in my recent (2013) Q&A book, Pandemics: What Everyone Needs to Know.

We all realize that parents want to do their best by their kids. That involves, though, not believing what some dubious and ignorant “celebrity” says on TV, but doing your utmost to understand the evidence and find out what is real. There is no virtue in ignorance, especially in deliberate ignorance that can compromise the wellbeing of children. Measles is highly infectious, and vaccination is a collective responsibility. According to the World Health Organization, some 145,700 children died of measles in 2013, with most fatal cases being in babies who are too young to be vaccinated and/or those with poor nutritional status. Who would want to be responsible for killing a vulnerable child?

Peter Doherty shared the 1996 Nobel Prize for Physiology or Medicine for illuminating the nature of the cellular immunse defense. He is a member of the Department of Microbiology and Immunology, University of Melbourne, Australia. You can find him on Twitter @ProfPCDoherty

TIME Opinion

Why the Founding Fathers Wouldn’t Have Been Anti-Vaxxers

Signing of the Declaration of Independence
Hulton Archive / Getty Images Postcard of 'The Signing of the Declaration of Independence', painted by John Trumbull

Look to the 18th-century philosophers who created the modern world

Are you a vaccination skeptic? Or are you skeptical of the vaccination skeptics? Your answer will most likely depend less on science and more on political ideology. The science jury is in when it comes to vaccinations, as it is for climate change and evolution. Vaccinations work, climate change is real and evolution happened. But, though skepticism in all three cases tends to be the product of politics, to doubt science is to run up against the very heart of America’s political framework.

The founding principles of America were the product of 18th century Enlightenment thinkers who were inspired by 17th century scientists such as Galileo and Newton. (This is an argument I make in my new book, The Moral Arc: How Science and Reason Lead Humanity Toward Truth, Justice, and Freedom.) The experimental methods and analytical reasoning of science that these Enlightenment thinkers consciously applied to solve social, political and economic problems created the modern world of liberal democracies, civil rights and civil liberties, equal justice under the law, free minds and free markets, and prosperity the likes of which no human society in history has ever enjoyed.

The founding fathers of the United States often referred to the “American experiment” and to democracy as an “experiment” because democratic elections are analogous to scientific experiments: every couple of years you carefully alter the variables with an election and observe the results. If you want different results, change the variables. Part of the reason that democracies systematically replaced autocracies was because of the scientific appeal of empowering individuals with a methodology to solve problems instead of an ideology to obey.

Many of the Founding Fathers were, in fact, scientists who deliberately adapted the method of data gathering, hypothesis testing and theory formation to the construction of a nation. They understood that no one knows how to govern a nation in all it’s complexities, and so they constructed a system that would allow constant tinkering to adjust for unforeseen circumstances. Instead of thinking about government as a place where power is up for the taking, they saw it as a social technology for solving problems. Their conception of democracy was not dissimilar to their vision of science, as Thomas Jefferson articulated it in 1804: “No experiment can be more interesting than that we are now trying, and which we trust will end in establishing the fact, that man may be governed by reason and truth.”

Consider the principles underlying the Declaration of Independence. We usually think of this great document as a statement of political philosophy, but it was, in fact, a type of scientific argument. Consider this sentence, one of the most famous in all political philosophy: “We hold these truths to be self-evident, that all men are created equal….” In Thomas Jefferson’s first draft he penned “We hold these truths to be sacred and undeniable.” Why did he change it? He didn’t. Benjamin Franklin did. Here is what happened, as described by Walter Isaacson in his biography Benjamin Franklin: An American Life, in a passage that reveals the scientific foundation of one of the greatest political tracts ever published:

The idea of “self-evident” truths was one that drew less on John Locke, who was Jefferson’s favored philosopher, than on the scientific determinism espoused by Isaac Newton and on the analytic empiricism of Franklin’s close friend David Hume. In what became known as “Hume’s fork,” the great Scottish philosopher, along with Leibniz and others, had developed a theory that distinguished between synthetic truths that describe matters of fact (such as “London is bigger than Philadelphia”) and analytic truths that are self-evident by virtue of reason and definition (“The angles of a triangle equal 180 degrees”; “All bachelors are unmarried.”) By using the word “sacred,” Jefferson had asserted, intentionally or not, that the principle in question—the equality of men and their endowment by their creator with inalienable rights—was an assertion of religion. Franklin’s edit turned it instead into an assertion of rationality.

Sticking with science paid off. Where people embraced the Enlightenment worldview that morals and values must be grounded in reason and science, it was no longer acceptable to merely assert that your beliefs, morals and ways of life are better than others. After the Enlightenment it was necessary to provide reasons for your beliefs and values, and those reasons had better be grounded in rational arguments and empirical evidence or else they could be ignored or rejected.

By contrast, countries that quash free inquiry, distrust reason and practice pseudoscience, such as Revolutionary France, Nazi Germany, Stalinist Russia, Maoist China and, more recently, fundamentalist Islamist states, have historically tended to stagnate, regress and often collapse. Theists and post-modernist critics of science and reason often label the disastrous Soviet and Nazi utopias as “scientific,” but their science was a thin patina covering a deep layer of counter-Enlightenment, pastoral, paradisiacal fantasies of racial ideology grounded in ethnicity and geography.

This idea of equal rights for individuals is the product of the Enlightenment, as is the principle of free speech and the use of reason in an open dialogue that forces us to consider the merit of what the other person is saying. And if the other person makes sense, their superior ideas gradually chip away at our prejudices. Reason alone may not get us there. We need legislation and laws to enforce civil rights. But these institutions are premised on law being grounded in reason, and the legislation being backed by rational arguments. Without that, there is no long-term sustainability to moral progress, as it is just a matter of might makes right. To make morals stick you have to change people’s thinking. And more than any other it is the Classical Liberal worldview grounded in reason and science that is bringing about moral progress—even when politics get in the way.

Michael Shermer is the Publisher of Skeptic magazine, a monthly columnist for Scientific American, the host of the Skeptics Distinguished Science Lecture Series at Caltech, and a Presidential Fellow at Chapman University. His latest book is The Moral Arc: How Science and Reason Lead Humanity Toward Truth, Justice, and Freedom (Henry Holt, 2015).

TIME Infectious Disease

9 Ways Advertisers Think We Could Convince Parents to Vaccinate

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Getty Images

We asked marketing execs how they would sell vaccines—and they dreamed up apps and celebrity cagefights

For decades, science has proven that vaccines work, but they still have a messaging problem among some parents. There are now 102 cases of measles confirmed in 14 states, many of them among people who are unvaccinated.

We asked advertising and marketing executives to share how they would choose to market vaccines, if the struggling medicines were their client.

1. Market them to kids. There’s a reason Saturday morning ads are all about food, toys and games. Getting kids to ask their parents for a product—a strategy called “pester power”—works. And it could work for vaccines too, says Bill Wright, global executive creative director for McCann Worldgroup (the firm behind ads for Verizon FiOS, General Mills and Mucinex).

Wright suggests an ad that says to kids: “Get vaccinated and you won’t get measles. Measles are horrible and hurt. And by the way, when you get a shot it’s customary to eat ice cream and get a small toy.”

2. Make it funny. Imagine an ad with a celebrity cage fight: on one side, anti-vaxxer Jenny McCarthy, and on the other, pro-vaccine Amanda Peet. That’s the advertising fantasy of Robin Fitzgerald, VP/creative director at CP+B LA, the firm behind ads for Netflix and Burger King. “We have it at Caesar’s Palace and Hillary Clinton and Bill O’Reilly are in front row seats cheering on Peet,” she says. “Just so people really feel the hyperbolic ridiculousness and the level the debate has gone to.”

Alternatively, Fitzgerald sees a sequel to the film Clueless starring Alicia Silverstone, who’s expressed vaccine skepticism. This time, it’s called Still Clueless and Paul Rudd keeps canceling playdates with Silverstone’s kids over vaccines.

Humor is the way to go, agreed folks at The Martin Agency, the company behind the GEICO ads. “A campaign using humor makes the situation much more approachable,” says CCO Joe Alexander. Funny ads appeal to millennials, Alexander says, which is an age demographic more likely to think parents should have a choice when it comes to vaccinating their kids.

One of the most successful campaigns to try this approach was “Dumb Ways to Die,” by Metro Trains in Melbourne, Australia. In the video (below), animated characters die in “dumb” ways like lighting themselves on fire and poking a grizzly bear with a stick. The goal was to promote train safety, and the campaign went viral. Alexander says the same approach could be used for measles.

3. Try sarcasm. Imagine a somber ad thanking anti-vaxxers for the measles outbreak. Wright says a message like this could work: “We would like to thank you for bringing back archaic diseases like measles, mumps and whooping cough. Yay, it’s like 1800 all over again, way to go!”

4. Get personal. We need stories that combat the narrative from loud voices like Jenny McCarthy, says Elizabeth Cleveland, vice president/planning director of The Martin Agency. But instead of hearing from doctors, she says, moms with kids who contracted measles should have the voice. Cleveland asked her own pediatrician for some stories, who supplied the perfect one-liner from a mom: “If my son can’t bring a peanut butter sandwich to school, then you can’t bring your unvaccinated child.”

5. Talk about measles, not vaccines. Go after the disease itself, rather than the vaccine debate, says Pete Harvey, creative director/partner at advertising agency barrettSF. (Harvey worked previously on highly successful “Truth” campaign against tobacco.) His idea? An ad with one simple message: “The measles are back.”

“That way, there is a common enemy that isn’t the person you are trying to convince,” says Harvey. “Everyone will say we have to fight this—no parent would say no to that.”

6. Launch a social media campaign. Find a way for everyone who gets vaccines to raise their hand and say so. Wright suggests creating a shareable graphic on Twitter and Facebook that says: “I got my kids vaccinated, did you?”

The idea is similar to the Human Rights Campaign’s viral campaign that got millions to change their profile pictures to a red equal sign for same sex marriage (see below). “It needs to be a coordinated effort, not a series of biting tweets,” says Patrick Godfrey, managing partner and president of the firm Godfrey Q. “Move [the anti-vaxxers] into a corner.”

Human Rights Campaign

7. Add a little fear. Create a film chronicling the measles outbreak, suggests Fitzgerald, who notes that she’d recruit Danny Boyle, the director behind the post-apocalyptic film 28 Days Later. “We open in Disneyland, we see someone cough, and it takes off from there,” she says. “We market the movie by having big groups of red dotted men, women and children appear flash-mob style in public places dancing to Desmond Dekker’s You Can Get it If You Really Want.”

8. Make it a game. Create an app calculating your risk of getting measles, similar to the app “Am I Going Down?” which determines the chance that your plane is going to crash, suggests Tiffany Coletti Titolo, president of cummins & partners, the firm behind Jeep ads. Parents would input demographic data and get stats about the likelihood of getting measles, plus the unlikelihood that someone has an adverse event from the vaccine. For example, you’re 100 times more likely to be struck by lightning than to have a serious allergic reaction to the vaccine.

9. Whatever you do, don’t preach. The Internet has chastised anti-vaxxers, but simply yelling at them isn’t going to change a parent’s mind. In highly emotional debates, some people get very stuck in their ways—but it’s not impossible to change their minds, says Wright, who also worked on the “Truth” campaign against tobacco. “Before, anti-tobacco was very preachy—we just wanted to present the facts,” he says. “We found that the fact that resonated the most [with teens] was that Big Tobacco was just another preachy adult telling them what to do.”

“It’s all about parents wanting to feel like they have a say in the matter,” Harvey agrees. “If you say they shouldn’t, they dig their heels further.”

TIME Infectious Disease

California Lawmakers Move to End Exemptions for Measles Vaccine

Carmen Lopez, Charles Goodman
Damian Dovarganes—AP Pediatrician Dr. Charles Goodman talks with Carmen Lopez, who is holding her 18-month-old son Daniel after being vaccinated with the measles-mumps-rubella (MMR) vaccine, at his practice in Northridge, Calif., on Jan. 29, 2015

More than a hundred people have been infected in a recent measles outbreak.

Lawmakers in California have moved to end parents’ right to exempt their children from school vaccinations based on personal beliefs.

The state senators said Thursday that they planned to introduce the legislation to make California the 33rd state to bar the exemption, Reuters reports.

More than 100 people have been infected with the measles in a recent outbreak partially linked to Disney California Adventure Park in Anaheim, Calif. Most of those infected were unvaccinated.

“The high number of unvaccinated students is jeopardizing public health not only in schools but in the broader community,” state Senator Ben Allen said in a written statement. He is co-sponsoring the legislation along with fellow Democrat Richard Pan. “We need to take steps to keep our schools safe and our students healthy.”

[Reuters]

TIME vaccines

Watch the Science Cop Take on Chris Christie’s Vaccine Talk

Christie isn't a doctor, so why is he dishing out advice on vaccines?

Chris Christie called for “balance” this week between public health and parents’ right to choose when it comes to vaccinating their children, going against the prevailing science.

Christie’s office was quick to walk back his comments and say “with a disease like measles there is no question kids should be vaccinated.” But TIME’s Science Cop Jeffrey Kluger explains why statements like this, and the ongoing decision by many to forego vaccinations, are harming America’s children.

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