Markos Kounalakis

Fear of doctors, vaccines in California and around the world

Protesters against legislation requiring California schoolchildren to get vaccinated rally at the Capitol this month. Senate Bill 277, if approved, would require most California parents to vaccinate their children as a condition of enrolling them in private or public schools.
Protesters against legislation requiring California schoolchildren to get vaccinated rally at the Capitol this month. Senate Bill 277, if approved, would require most California parents to vaccinate their children as a condition of enrolling them in private or public schools. The Associated Press

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Doctors take a pledge to “First, do no harm.” This credo is derived from the Hippocratic oath – a sworn solemn duty doctors make when they embark on their career. The Hippocratic oath is nothing to sneeze at; few other professions require a swearing of allegiance to a millennia-old professional ethical and moral code.

Modern society deeply depends on doctors. Which is why recent international reactions against doctors – from mistrust to outright attack – represent a disturbing trend that can not only lead to an immediate threat to global health workers but also precipitate that all-feared outbreak of an uncontrollable epidemic.

Fear of doctors and vaccine programs is a worldwide phenomenon, from developing nations to the United States. American trepidation toward state-mandated vaccines in school drew demonstrators last week against California legislation. Protesters came to the capital to fight a change in immunization exemptions. Celebrities added fuel to the fire.

Robert F. Kennedy Jr. stirred up a Sacramento crowd by challenging the legitimacy of the federal Centers for Disease Control and Prevention. Kennedy spoke at the film screening of “Trace Amounts,” linking vaccines to autism, a theory debunked by significant scientific evidence. He roused public emotion by saying vaccines are leading to a “holocaust.” He later apologized for using the charged word.

Measles have made a comeback, and Disneyland recently became a disease hotspot. In 2000, the CDC declared measles eliminated in the United States, but the theme park’s December outbreak has catalyzed growing concern for unvaccinated children.

Mice and rabbits are disproportionately infected in clinical testing labs. They also weigh heavily in the vaccine debate. The Disneyland outbreak made Mickey Mouse a symbol for the pro-vaccine argument, while former Playboy bunny and vocal skeptic Jenny McCarthy is the poster-girl of the anti-vaccine crowd.

Anti-vaxxers may need little medical proof to stop immunizations around the U.S., but in Pakistan, the backlash against vaccines has even less to do with medical science: It is fueled by a vaccination program that led to the killing of Osama bin Laden.

The CIA discovered bin Laden after a fake hepatitis B vaccination program got his DNA. Good news, except it led to fear of – and in some cases, a ban on – foreign aid workers. Hoping to calm the situation, the CIA has since promised not to use medical programs as cover.

Government regimes now use past CIA covert actions as an excuse to attack medical personnel. But violence against aid workers predated the bin Laden ploy; the Taliban banned polio vaccines long before he was killed. Attacks on aid workers, however, have steadily increased since the SEAL Team 6 raid in 2011. Just last month, Afghan gunmen killed three polio workers.

Militants continue to delegitimize anti-polio aid workers, creating new pressures on Pakistan’s largest international aid agency, Save the Children – the NGO linked to the now-imprisoned doctor who identified bin Laden. The organization denies the claim, but remains the target of suspicion and government restrictions. In light of this backlash, Pakistan has become a polio hotspot. In 2014, the World Health Organization reported that 306 of the 359 worldwide cases of polio were in Pakistan. By contrast, the Bill and Melinda Gates Foundation previously helped eradicate polio in nearby – and democratic – India.

Authoritarians and conspiracy theorists continue to fuel attacks against medical aid workers who are also in grave danger because they often operate in areas of armed conflict. The Medecins Sans Frontiers film, “Access to the Danger Zone,” explores what it’s like to navigate the war zones of Somalia, Afghanistan and the Democratic Republic of the Congo. In Yemen, recent airstrikes have put medical facilities, even makeshift ones, in danger of becoming collateral damage.

If hostile patients and danger zones are not enough, international medical workers are also threatened with infection. Ebola became notorious for jumping from patient to health worker, as with nurse Nina Pham, who is now suing Texas Health Resources for lack of proper training and equipment.

Ebola protective gear and blood tests fed fear in the local populations, too. In Sierra Leone, Guinea and Liberia, patients ran and hid from doctors because of conspiracy rumors that health workers were intentionally spreading the disease. Ensuing panic, according to United Nations-cited reports, led to “attacks on Ebola treatment centers, hospitals and even health personnel.”

Even the surest plans for disease control can have unexpected consequences. In Uganda, international aid often comes in the form of effective anti-malaria mosquito nets. But many Ugandans instead use the nets for fishing. This not only fails to prevent malaria, it contaminates local water sources with insecticide.

Doctors were once looked upon as gods. After all, they deliver life and save lives. Certainly medical workers do God’s work. From Anaheim to Abbottabad, the shot heard round the world should remain a doctor’s inoculating hypodermic needle – it usually does no harm.

Markos Kounalakis is a research fellow at Central European University and a visiting fellow at the Hoover Institution. Contact him at markos@stanford.edu and follow him on Twitter

@KounalakisM.

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