September 5, 2017
On May 8, The Boston Herald published an editorial calling for my execution. They didn’t know much about me, but had heard about an event in Minneapolis at which I spoke. I learned subsequently the piece was written by Rachelle Cohen, editor of the newspaper’s editorial page. Her brief essay didn’t refer to me by name, but cited a Washington Post article from May 5th that did, describing me as “a Boston businessman” and “anti-vaccine activist.”
Cohen wrote that during "this latest outbreak [of measles in Minnesota], anti-vaccine groups have fanned the flames, making it hard for public health officials and doctors to be heard above the noise. These are the facts: Vaccines don’t cause autism. Measles can kill. And lying to vulnerable people about the health and safety of their children ought to be a hanging offense." [emphasis added]
Four months later, the much-hyped Minnesota measles outbreak has passed with little notice, but there are important lessons to be learned from the events surrounding it. What really happened? Why all the fuss? What are the salient facts about measles, vaccines and autism? What was my role in the process? Most importantly, what does this episode teach us about the state of public health policy and the ongoing concern for vaccine safety and parental rights. To explore those questions, let’s first take a look at the outbreak itself.
The Minnesota measles outbreak of 2017
On April 13, the first news report of three measles cases among “toddlers” in Minneapolis was published (see HERE). The next day, confirming five more cases, the Minnesota Department of Health (MDH) issued a press release with additional information. Of the then eight confirmed cases, all were unvaccinated children living in Hennepin County. Seven of the eight were “Somali Minnesotans.” Six of these children were hospitalized.
Over the next three months, as the count of confirmed cases rose to 79, the initial pattern continued. The outbreak was largely confined to children (73 were under 10 years old) who were Somali-American (64 of 79) residents of Hennepin County (70 of 79), most of whom (71 of 79) were unvaccinated. The case count rose quickly to reach 73 by the end of May and then leveled off sharply. Six additional cases were confirmed, until the last case report on July 13.
By late April, MDH was posting daily case updates on their web-site (see HERE). This was both a response to and a stimulus for widespread media coverage, first in local news outlets and then nationally. At the outset, these were brief, factual reports, but it didn’t take long for the MDH to start pointing fingers. On May 5, The Washington Post published the article that caught Rachelle Cohen’s attention, “Anti-vaccine activists spark a state’s worst measles outbreak in decades.” (see HERE). Health officials complained specifically that the Vaccine Safety Council of Minnesota (VSCM) “in the middle of their crisis” was informing Somali-Americans that they had the right according to Minnesota law to opt out of vaccination based on conscientiously held beliefs. Reminding parents of their rights was a message these officials felt was “exactly the opposite of what clinicians and public health officials are urging, which is to get vaccinated as soon as possible.”
On August 25, the MDH officially “declared an end to the measles outbreak of spring and summer 2017.” Their news release, which was not widely reported, described why they waited so long to announce something that had been clear for weeks.
“The outbreak that eventually sickened 79 people, mostly children under 10 years of age, began when the first case was identified April 11. The last case was identified on July 13. Under standard public health practice, the outbreak can be declared over if there are no new cases identified for 42 days. The incubation period for measles is 21 days, meaning that’s how long it can take for someone who has been infected with measles to show symptoms. Health officials wait two incubation periods (42 days) out of an abundance of caution.”
Despite the often-hysterical treatment the outbreak received from the press, it was a relatively modest event. Although measles no longer circulates freely in the U.S., minor outbreaks like this one remain common. Since 2000, measles cases in the U.S. have averaged close to 130 per year, typically sparked by infected travelers entering the country. When larger outbreaks take place, they often occur in communities that have low vaccination rates: an Amish community in Ohio saw nearly 400 cases in 2014; the year before saw two smaller outbreaks, one in an orthodox Jewish community in New York, another in a church community from Texas. Most notorious among recent outbreaks is the one that began in Disneyland in December 2014. By the time it subsided in mid-February, the Disneyland outbreak totaled 147 cases.
By comparison, the Minnesota measles outbreak was a small one. It also appears to have had no lasting health consequences for those infected. According to MDH, 22 of the 79 cases were hospitalized, at first blush a large number. But according to Patti Carroll, a board member of the VSCM, none of these cases were ever in intensive care and all recovered with no known lasting health effects. The hospitalization rate appears to reflect an aggressive response to the initial problem since 6 of the first 8 confirmed cases were taken to the hospital. Of the subsequent 71 cases, MDH data suggest only 16 were hospitalized.
The Vaccine Safety Council of Minnesota event
As MDH began targeting the Somali-American community in mid-April, concerns arose among those families who were targeted. Parents who had made the decision to avoid or delay administering the Merck measles-mumps-rubella vaccine (MMR II) to their children reported intense pressure to vaccinate these children against their wishes. According to the VSCM, “the concerns we hear are based on the bullying and overreach of MDH and doctors lying to parents that they have no options or choice on medical decisions for their children.”
Eager to provide a counterbalance to this pressure, a group of Somali parents reached out to the VSCM and asked them to hold an information session for the Somali community. The VSCM agreed to arrange the session, which was scheduled for April 30th. Originally planned for a community center in Minneapolis, the venue had to be changed after the MDH prevailed on the center to renege on their agreement to host it.
On Sunday April 30th, I was the main speaker at the relocated VSCM briefing session. Although the last-minute change of venue had reduced the audience somewhat, there was a large turnout of Somali families. A number of media outlets attended as well. The room was smaller than the original community center, but it was fairly full.
At the outset of my talk, I asked the audience for a show of hands. First, I asked how many knew a child with a measles infection? Almost no one raised their hands, excepting three white doctors sitting together in the center of the room. They were clearly there to represent the public health side of the issue. Next, I asked how many knew a child with autism? Virtually the entire room raised their hands.
The autism issue was the elephant in the room. The Minnesota Somali community, America’s largest, has been devastated by autism. A 2013 study conducted by University of Minnesota researchers, following the method of the CDC’s Autism and Developmental Disabilities (ADDM) network, analyzed autism prevalence in Minneapolis children, including residents of Somali descent. The study reported an overall prevalence rate in Minneapolis children of 1 in 48, a rate nearly as high as the record-setting rate of 1 in 46 reported by the New Jersey ADDM site. But the rate in the Somali community was 1 in 32, higher than any rate ever reported in America. Parents in the audience told me they believe that rate is an underestimate.
So many parents of Somali children with autism have seen a regression following the MMR II vaccine that they call it “the autism shot.” And the concern over autism has led to lower vaccination rates among Somali Minnesotans, making them—like the Amish in Ohio and the orthodox Jews in New York-- more susceptible to measles outbreaks. The chart below from the CDC’s Morbidity and Mortality Weekly Review illustrates the trend: the MDH would call it a “crisis”; others might call it a rational response from informed parents to an urgent childhood health problem.
With the elephant—not to mention three hostile doctors—firmly placed in the room, I proceeded with my talk. I broke the presentation into five sections.
- An overview of American vaccine policy. I contrasted the positions of government officials and “anti-vaxxers” and stated quite clearly that I was not anti-vaccine, but rather a critic of the dramatic expansion in the CDC’s recommended childhood vaccine schedule. I argued that vaccines have both risks and benefits and that public health officials routinely overemphasize the risks of infectious disease while underplaying the risks of vaccine injury.
- Measles risk. I showed CDC data on measles morbidity and mortality in America since 1900. I showed that the risk of death from a measles infection had plummeted throughout the 20th century, but took pains to point out that risk from measles infection remained and that parents should understand that. I shared CDC data on 11 reported deaths from measles since 2000, two of them “verified.” Cancer patients and the immune-suppressed carry the greatest risk.
- Autism in Minnesota. I argued, as I have for years, that the dramatic rise in autism rates is real and an urgent public health crisis. I showed the audience how the Somali autism rate dwarfs rates measured in other parts of the country.
- Research fraud from the CDC in MMR-autism study. I shared publicly released working documents from CDC scientist William Thompson showing that the CDC had found an increased risk of autism in African American children who had received the MMR vaccine early. Their concealment of those findings is described extensively in the movie Vaxxed and provides key evidence casting doubt on the oft-repeated claim that there is no link between vaccines like the MMR II and autism.
- Exemption rights. Finally, I made the point to the Somali parents that it was their right and responsibility to weigh all the information they received and make the decision they felt was best for their child. If, based on their “conscientiously held belief”, they decided to forego or delay vaccination, then they had that right under Minnesota state law.
So that was my hanging offense. Although some journalists reported fairly on the briefing session, others misrepresented what they heard. Emily Sohn, an NPR reporter who attended the meeting also contributed to The Washington Post article that described me as an “anti-vaccine activist.” Soon thereafter, Rachelle Cohen was literally calling for a lynch mob.
Lessons from the outbreak
When your hometown newspaper calls for your execution, it’s an occasion for self-reflection. Was Rachelle Cohen correct? Was I “fanning the flames” of dangerous “anti-vaxxer” sentiment and putting children’s lives at risk? Or was I acting heroically and saving the poor Somali families from the evil clutches of the CDC and their minions at MDH?
Needless to say, neither of these extremes bear much resemblance to the reality I witnessed. While I’m both bemused and a little alarmed by the media backlash, I can honestly say that I’ve never had a moment of regret about the event. Quite the contrary, I believe that when important rights are under attack it’s important to stand up and defend them. So I was proud to stand with my VSCM friends and their colleagues in the Minnesota Somali community. I hope the information I shared that night was useful to some of them.
But my overwhelming impression is that the hysterical government and media reaction--one that Rachelle Cohen carried to an alarming extreme--missed three critical points. First and most importantly, it was hugely disrespectful to the Somali families involved. The racist undertone to the official response was hard to ignore. Instead of the educated, informed and caring Somali parents I met that night, the press would have you believe they were ignorant and uncritical victims easily swayed by charlatans and frauds, including me. Far from me educating them, however, I may have learned more from the attendees at the event than they learned from me. Several of the Somali women I spoke to knew a great deal more about the local prevalence study I cited than I did. I took notes!
Second, what the media response showed most clearly is how complex phenomena like an isolated measles outbreak is made meaningful only to the degree it can be twisted to fit some other pre-existing narrative. As Chicago politician Rahm Emmanuel famously said, “never let a serious crisis go to waste.” And as public health officials have learned with the Disneyland outbreak, measles outbreaks provide a golden opportunity to advance their policy agenda of mandatory vaccination. Friendly partners in the media are only too happy to oblige. As the friendly media has also learned, the threat of a plague makes great television.
So, the VSCM event became less about the facts and a few dozen Somali children who had to stay home for a few days. Instead, it was quickly turned to familiar themes and characters. The Washington Post went on at length about a visit Andrew Wakefield made to Minneapolis many years ago, pinning blame on him for the decline in vaccine compliance instead of valid concerns about vaccine injury that Somali families have witnessed firsthand.
But in our increasingly polarized media environment, a serious crisis can be twisted to fit multiple narratives. On another edge of the political spectrum, Michael Patrick Leahy of Breitbart (see HERE) sought to turn the outbreak into a story about the dangers of too many (and disease-carrying), illegal, Islamic immigrants. But there’s a problem with that narrative too. Somali Minnesotans are legal immigrants, invited by the State of Minnesota as part of a deliberate policy. Whether or not one agrees with that policy or the extent of immigration involved, there is no denying that the Somalis I encountered were affluent, educated and well connected to Minnesota society. Like so many of us in the autism parent community, they are simply worried about the health of their children and their right to make their own decisions about vaccination.
Third, the real public health issues end up subordinated by the official narrative on vaccines and autism, which reared its ugly head again here: Wakefield! Anti-vaxxers! Vaccines never ever cause autism! Measles! Crazy parents are dangerous!
But there’s an odd issue when it comes to measles outbreaks, which have been exploited while other more worrisome public health issues are ignored. Measles is the news, but the most serious issues of infectious disease in “vaccine-preventable diseases” aren’t measles. In the last couple of years, a serious mumps epidemic has been sweeping through the country, including Minnesota, with over 3000 cases reported so far this year. While mumps is usually harmless in children, a mumps infection is far more serious in adults (according to CDC statistics, between 2000 and 2014, the number of “reported” deaths from mumps were exactly same as measles). Why is there no publicity on the very real dangers of our current mumps epidemic? Because the vast majority of mumps infections occur in the vaccinated. The mumps epidemic is evidence of a widespread failure of the mumps component of the MMR II vaccine (a whistleblower lawsuit filed by two Merck scientists argues that Merck covered up evidence of this problem (see HERE )). Like the mumps epidemic, there’s little mention of an even more pervasive problem, the widespread incidence of whooping cough, which has shown up in hundreds of thousands of reported cases since 2000. But again, like the mumps problem, whooping cough (aka pertussis) overwhelmingly infects those who have already been vaccinated.
Since these are crises that can’t be put to use, we hear little about them. And the Minnesota measles outbreak received widespread attention because public health officials want to abolish vaccine exemption rights. They have chosen to use recent measles outbreaks to go on the political offensive and attack groups like VSCM that defend exemption rights. Which led Rachelle Cohen, perhaps unwittingly, to me.
It’s possible, however, that this time these forced narratives backfired, or at least failed to have their desired effect. Did the prospect of a made-for-Breitbart narrative (unclean, disease-carrying, Islamic immigrants!) neutralize the pharma-friendly narrative we saw on outlets like The Washington Post and NPR? Perhaps so, since unlike the Disneyland outbreak, the Minnesota measles outbreak hasn’t yet spawned a new attack on exemption rights. At least not in Minnesota, where the VSCM stands guard. Will that change soon? Only time will tell.
In the meantime, I still walk the streets of Boston safely. No lynch mobs have been sighted. And if Rachelle Cohen or her colleagues ever want to sit down and have a civil conversation about public policy, I’d welcome the opportunity.
Mark Blaxill is Editor-At-Large for Age of Autism. His new book, co-authored with Dan Olmsted, is called Denial How Refusing to Face the Facts about Our Autism Epidemic Hurts Children, Families, and Our Future and is available now.