This month has been filled with news stories about the growing problem of measles outbreaks in the U.S. and around the world. In the U.S. this has been a growing concern over measles in airports, potentially impacting travelers. However this is just a smaller part of a worldwide trend. The WHO estimates that over 140,000 people have died from measles related issues since 2018, with reported cases increasing by 300% in the first three months of 2019, compared to the same period in 2018. Furthermore, in 2018 four European countries, Albania, Czechia, Greece and the United Kingdom, lost their measles elimination status from increased outbreaks. Measles cases have seen a resurgence across the globe, and currently the worst of that outbreak is happening in Samoa, which had over 5,600 cases by the end of this month. The cause of this outbreak has been credited to an increased fear of the measles vaccination after the deaths of two infants from an improperly mixed vaccine, and subsequent misinformation about the cause of these deaths, causing the overall measles vaccination rate to drop to 31% of the population (from a previous vaccination rate of 60% in 2016). This diminished the herd immunity of the population, and has led to 81 measles deaths in Samoa. The state of emergency in Samoa was just lifted, but this shows some potential consequences of anti-vaccination movements within a population, as well as the potential resurgence of infectious diseases previously thought to be eliminated or controlled.
In the U.S., measles outbreak concerns are often tied to concerns about the anti-vaccination movement, and the potential exposure of unvaccinated children. The anti-vaccination movement in the U.S. is generally tied to a retracted 1998 paper, which misused experimental data to claim a connection between the MMR (measles-mumps-rubella) vaccine and autism. In recent years, the vaccination rate has been falling in certain U.S. states, which allow parents to opt of vaccinating their children for religious or philosophical reasons. The increase of measles cases in the U.S. this past year threatened the measles elimination status, which has been in place since 2000. Although last year’s outbreak in New York has ended, keeping the measles elimination status intact, there is increased concern about anti-vaccination clusters, or communities where many people are choosing to not vaccinate their children. However, as Conis notes in her book Vaccination Nation, children who are not vaccinated in the U.S. make up less than .5% of the population, and the number of vaccinations that most Americans receive has continued to increase.
The recent concern about measles outbreaks in airports, is reminiscent of the 2014-2016 West Africa Ebola outbreak, the Zika outbreak, or this year’s earlier Ebola outbreak in the Democratic Republic of the Congo, which led to FDA approval of the first Ebola vaccine, which was still experimental during the 2014 outbreak. These concerns about the global movement of people, and with them their illnesses, are seen as a major problem in global health, and often command global attention, through media coverage drawing on fears and fascinations following the “outbreak narrative.” Historically, “outbreak narratives” have had a variety of consequences, including stigmatizing individuals and groups blamed for infecting others – inspiring a wide variety of anthropological research (see below). In current outbreaks, the anti-vaccination movement is often considered a primary factor and population to blame, spawning articles and books on how this movement is a threat and the need for compulsory vaccination. Additionally, while much attention is given to vaccine refusal for outbreaks like measles, the ambivalence around getting the flu vaccination does not receive the same level of stigma or blame, despite (or perhaps because of) the prevalence of yearly flu cases.
However, these movements against vaccination as well as for forcible vaccination also have long and fraught histories. Travis Chi Wing Lau’s Somatosphere post discusses the historical and political issues concerning vaccinations since their invention in the 18th century, to argue that anti-vaccination movements are not a new phenomenon. Furthermore, eradication campaigns for infectious diseases have also been fraught with controversy. Anthropologists have studied the ways that eradication vaccination efforts such as the smallpox and polio campaigns relied on techniques of coercion and intimidation of local populations, in order to meet goals of peoples vaccinated. While eradication campaigns represent progress in global health, making diseases a thing of the past, the resurgence of these same diseases like measles represent failures for global health programs and challenge this narrative of progress by eliminating epidemic-causing diseases which has driven many global health programs.
These histories (such as the anti-vaccination movement in Victorian England) are important in understanding current anti-vaccination movements as well as outbreaks. As Priscilla Wald notes in her book Contagious, the narratives we tell about vaccines, outbreaks, and diseases have consequences, and the values that people give to vaccines impact the ways that they are used, as well as who is blamed when outbreaks happen. While the anti-vaccination movement and the spread of misinformation about vaccines are often blamed for the resurgence of infectious diseases like measles, the social and political implications of epidemic narratives are also important to understanding the politics of vaccine refusal as well as those of global health eradication campaigns. Indeed politics around vaccine refusal and suspicion in situations like the polio vaccination campaign in Pakistan show the ways that epidemic narratives ignore the social and political consequences of global health campaigns. As the resurgence of infectious diseases like polio or measles continues, the ethics of vaccination and eradication campaigns, as well as anti-vaccination movements, will continue to be contested; new laws will attempt to address these issues as well, and new technological solutions will be attempted for the next decade.
Baciu, Alina. The Smallpox Vaccination Program: Public Health In an Age of Terrorism. Washington, DC: National Academies Press, 2005.
Briggs, Charles L., and Clara Mantini-Briggs. Stories In the Time of Cholera: Racial Profiling During a Medical Nightmare. Berkeley, Calif.: University of California Press, 2003.
Conis, Elana. Vaccine Nation: America’s Changing Relationship with Immunization. Chicago: Chicago UP, 2015.
Greenough, Paul. 2005. Intimidation, Coercion, and Resistance in the Final Stages of the South Asian Smallpox Eradication Campaign, 1973-1975. Social Science and Medicine 41(5): 633-645.
Hirsch, J. S., Wardlow, H., Smith, D. J., Phinney, H. M., Parikh, S., & Nathanson, C. A. The Secret. Nashville, Tennessee: Vanderbilt University Press, 2009.
Marshall, P.A., O’Keefe, J.P. and Fisher, S.G. (1990), Touch and Contamination: Patients’ Fear of AIDS. Medical Anthropology Quarterly, 4: 129-144. doi:10.1525/maq.1990.4.1.02a00080
Martin, Emily. Flexible Bodies: Tracking Immunity In American Culture From the Days of Polio to the Age of AIDS. Boston: Beacon Press, 1994.
Navin, Mark. Values and Vaccine Refusal: Hard Questions In Ethics, Epistemology, and Health Care.
Ruha, Benjamin. “Informed refusal: Toward a justice-based bioethics.” Science, Technology, & Human Values 41, no. 6 (2016): 967-990
Wald, Priscilla. Contagious: Cultures, Carriers, and the Outbreak Narrative. Durham: Duke University Press, 2008.
Whitney Arey is a PhD candidate in Cultural Anthropology, with interests in abortion access, reproductive and global health. Whitney received her MA in Anthropology from Brown University.