Why America Is Playing Vaccine Roulette
What the great vaccination debate reveals about our social immune system

By Douglas Rushkoff. Published in Medium on 31 July 2019

I got shingles last week. I went to sleep scratching what I thought was a particularly nasty bug bite, and woke up with what felt like a thousand of them — only they burned right down to the bone. Too much stress, I told myself. Too many appointments and emails and commitments, competing for my nervous system’s attention.

But deep down I know the real reason I got sick: I’d played a bit of vaccine roulette, and lost. Although I get the flu shot every year, I’d selectively ignored the CDC’s recommendation for healthy adults over 50 to get the vaccine for shingles. And as I sit here, contending with the bizarrely alternating burning and itching, fever and chills, I find myself replaying the twisted vaccine logic that went through my head, as well as the way it reflects the greater vaccination panic facing America today. The issue, itself a sort of cultural virus, epitomizes what’s wrong with our public conversation, our relationship to facts, and our sense of civic duty.

Despite my age (over 50), my doctor hadn’t even told me about the vaccine. I’d heard about it from a woman in my yoga class, but she’d added a few notes of caution, recommending that I pick a day where I could afford to be a little sick and pointing out that I’d have to get a follow-up shot within six months for the treatment to be effective and adding that the second vaccine was often out of stock. Meanwhile, the website for the vaccine noted a strong possibility of “short-term side effects more intense than you are used to from other vaccines,” and another study cautioned that it may only last for four years before you need to get it again. I weighed my options, and placed a bet on my immune system — a losing bet, it turns out.

At least I only hurt myself. Shingles is not typically a contagious disease; it’s more like a relapse of childhood chickenpox that’s lay dormant for years in a person’s nervous system.

Many others are currently enacting a similar calculus, with similarly myopic judgment and worse information, but they’re doing so with contagious diseases like the flu or measles that can end up affecting everyone else.

One of the billionaires I wrote about last year, the guys who wanted advice on their doomsday bunkers, gamified the vaccination conundrum for me: “As long as everyone else gets vaccinated,” the California tech investor explained to me, “my kid doesn’t have to.” To his way of thinking, vaccines are really just a way to create a buffer between the disease-ridden masses and the wealthiest among us, and as long as the masses stay up to date on their shots, the elites can stick to organic food and chemical-free living.

After all, it’s the rich, white, and educated who are so adept at getting their kids exemptions from vaccines. The underlying assumption, of course, is that vaccines are actually somehow bad. It’s a little like the way Silicon Valley developers who make iPad games for kids forbid their own children from playing them, because they know the dangers. The difference being that at least the tech developers’ hypocrisy is based on legitimate knowledge about the harm their products do. This isn’t the case when it comes to vaccines.

ecently, I decided to dig as deep as I could into the vaccination debate, and it turned out to be among the most difficult stories I’ve ever investigated — in part, because almost no one would go on the record. I spoke with two general practitioners and two pediatricians who recommend vaccines for all patients who aren’t actively sick. But they were all reluctant to share their names, lest they be flooded with negative internet reviews by a well-organized and passionate opposition.

I also spoke to two MDs who believe in limiting certain patients’ exposure to particular vaccines. They also asked not to be named, lest they have their licenses revoked.

This doesn’t mean that a “balanced” piece of journalism needs to give both sides of the vaccination debate equal weight. People should get immunized. Period. (At least, most of us should, most of the time.).

At times, the anti-vaccination movement has taken on the contours of the bogus anti-fluoridation movement of the 1950s. But while fears that adding fluoride to the water supply largely dissipated as mainstream doctors arrived at a consensus that it was safe, this was decades before the internet came along to turbo-charge all fears of the unknown into fully fledged conspiracy theories.

A more recent corollary might be climate denialism, but the vaccine research isn’t quite as cut-and-dried as the science behind the climate crisis. Humans are changing the climate — in ways that are already having profound negative consequences for life on earth — beyond any shadow of a doubt. To deny this is to deny reality. The vaccine debate is a tad more subtle. Vaccines work, and for the most part, the risks are infinitesimal. But a few people may in fact be experiencing bad reactions to vaccines. The correlation between vaccines and autoimmune diseases is extremely low, but it’s not zero. There’s even a National Vaccine Injury Compensation Program (known as the NVIC) funded by the government to reimburse people if some entirely unlikely, one-out-of-a-million negative scenario were to take place.

Rare cases like this one, in which the court concluded that there was a cause and effect relationship between vaccine and immunological injury, are enough to give parents pause. They also provide ammunition and justification for alternative healthcare practitioners — many of them MDs, themselves — who advise certain patients to avoid certain vaccines. One homeopathic MD I spoke with, again not for attribution, told me they recommend most vaccines for most of their patients, but that for certain of their more immunologically sensitive patients, or those with certain sensory or spectrum disorders, they sometimes recommends going without, except when mandated by law.

By acting as if atypical responses don’t exist at all — or suggesting that every worried parent is a nutcase — those encouraging vaccine compliance don’t do us any favors. Facebook’s suppression of anti-vaccination pages may expose fewer people to the mental contagion of conspiracy theories surrounding vaccination. But it can also have the reverse effect, creating more evidence for true believers that the medical establishment — in cahoots with Big Media — is involved in a cover-up. Having Facebook’s censors on your side is not necessarily a positive affiliation.

In an effort to deny anti-vaxxers any wiggle room for non-compliance, authorities end up reinforcing the widespread perception that the pharmaceutical industry is willing to risk human health for profit. Government mandates also tend to fuel the righteous indignation of parents who believe their children’s autism was a direct result of required vaccinations — even though the original study suggesting a link was since debunked and retracted. On the other hand, links between vaccines and autoimmune diseases, which are extremely rare, are still being studied. Even within my small town, I know of two parents eager to describe the disorders that have befallen their children — and their beliefs about what caused them — with anyone who will listen. And many do.

From what I can tell, particularly among the coddling, affluent parents with whom I often come in contact, such arguments and folktales can easily become an excuse for avoiding something that’s not really dangerous, so much as it is inconvenient. No parent particularly enjoys watching their six-month-old get four shots at once or suffer with an overnight fever. And anxious, internet-informed new parents don’t like the idea of even a highly remote chance of an allergic reaction to an MMR vaccine, even though the probability of dying from an otherwise preventable childhood disease is way higher if a child is denied a vaccination. Their fear may not be logical, but it is an emotional reality. One pediatrician I spoke with said, “Parents often conflate something with a very low risk but high ‘PR’ prominence with something else that is much higher risk. Parents take a much higher risk driving their child to the pediatrician without thinking twice, but then some protest a vaccine whose risk is a very small fraction of that of driving.”

Another tells me that he achieves higher rates of compliance by making a gentler pitch for vaccines. Instead of lecturing fearful parents and scoffing at conspiracy theories, he explains to them that “nothing is perfect, including vaccines and peanut butter sandwiches. But if you or a loved one becomes ill or succumbs to a vaccine-preventable disease? That’s a tragedy. The benefit far outweighs the risk.”

Meanwhile, in many cases, declining a vaccine puts the entire community at risk. (While people can still spread diseases for which they are vaccinated, they are much less likely to do so as their infections are usually less severe.) In a perfect world, no one would have to get innoculations, pay taxes, or wait at red lights. But living in a society means not only taking responsibility for one’s own health but making emotionally difficult choices for the collective welfare. It’s also why we have to contribute more, not less, to the government agencies that do the research and recommendations on public health policy, so they can make better, clearer cases for the benefits of vaccination for all.

Sometimes it seems like our society has been paralyzed by a faulty immune response to the vaccination issue itself. Like a runaway internet meme, vaccines trigger our nation’s currently troubled relationships with science and authority, facts and social media, and individual liberty and collective welfare.

Just as our bodies learn to recognize a virus once and then remain immune for a lifetime, we must learn to recognize the cultural code embedded in the vaccination wars, and engage honestly and openly with one another about the fears — real and fake. The notion of herd immunity (that a certain percentage of the population needs to be vaccinated to protect the group) applies equally well to ideas. Inoculating ourselves with some hard science would allow us to expose ourselves to thoughtful questions without doing real damage.