More transparency needed to combat public distrust on vaccines

Comments by prominent Republicans questioning government-mandated measles vaccinations for children signal the public's declining trust in government, the healthcare system and the scientific establishment.

But such rhetoric threatens to undermine the nation's ability to address public-health threats, even as the number of measles cases in the U.S. continues to rise, experts say.

Potential GOP presidential candidates Sen. Rand Paul (R-Ky.) and New Jersey Gov. Chris Christie recently spoke in favor of giving parents choice in having their children receive the measles, mumps and rubella vaccine. Medical experts overwhelmingly favor mandatory vaccination to protect public health.

States mandate children to be vaccinated before attending public school, with some medical, religious and personal belief exemptions.

Experts say such political talk fuels the public's already-skeptical view of science and healthcare, which has led to polarization on issues that include climate change, stem-cell research and the government's regulatory authority over food, drugs and medical devices. Some fear this could hurt the nation's ability to unite in times of crisis.

“It's important to have a system that's capable of coming together to say under certain conditions, we're willing to set problems aside because the consequences of not doing so are great,” said Michael Gusmano, a research scholar at the Hastings Center, a not-for-profit bioethics research institute based in Garrison, N.Y. Still, he added, “Fundamentally, you can't get around politics.”

Skepticism over the government's role was evident during last year's U.S. Ebola outbreak, when the Centers for Disease Control and Prevention faced criticism mostly from Republican politicians for its response. But politicizing public health goes beyond holding the government accountable for its performance in emergencies.

“There is a share of people who really don't trust government, don't trust scientists and think government recommendations have other agendas,” said Robert Blendon, a Harvard University expert on public healthcare attitudes. “It's hard to reach them because they just are suspicious that in the case of their own families, the advice that's being given is tainted by some connection that has some other interest beyond the interest of their child.”

That suspicion has led to an increase in the number of parents opting out of or delaying vaccinating their children under CDC guidelines. While the median state vaccination coverage rate for measles, mumps and rubella among U.S. kindergartners was about 95% for the 2013-14 school year, an October CDC report noted some communities have significantly lower levels.

In some affluent communities in California, for instance, kindergarten vaccination rates have been much lower than the overall state average of 92%. A number of counties reported high rates of parents who took personal-belief exemptions from vaccinations, including eight with rates above 10%.

The public's waning trust in government and the healthcare and scientific establishments has led to the rise of politicians who champion distrust in the government's role in public health, leaving less funding for such initiatives. “The anti-government sense that the role of government isn't completely legitimate ends up supporting people who want to reduce the size of government public-health activities,” Blendon said.

The science and health communities share some of the blame for the skepticism, he said. Missteps, scandals and a lack of transparency have played a role. One theory circulating among people opposed to vaccinations is that the federal government conspired with drugmakers to conceal data proving that vaccines were associated with the increase in child autism. The theory was fueled by a 2005 article by Robert F. Kennedy Jr. accusing the CDC and the Food and Drug Administration of hiding a study that supposedly found a mercury-based preservative in vaccines was responsible for the increase in autism and other neurological disorders. The study has since been discredited and retracted.

Blendon said the fact that the CDC's Advisory Committee on Immunization Practices includes the head of the Pharmaceutical Research and Manufacturers of America as a liaison member helps feed such theories. “Historically, there's a reason CDC has worked with pharmaceutical companies to try to get new vaccines and supplies,” he said. “But the need to be clear that the decisionmaking is separate from any private influence is much more important now than it was 20 years ago.”

Follow Steven Ross Johnson on Twitter: @MHsjohnson