Anti-vaxxers will argue otherwise, but if they’re given airtime, this will degenerate — like most vaccine discourse — into comparative science, misinformation, name-calling, and finally heated charges of baby-killing.
Someone will say all anti-vaxxers should be locked up, and someone else will invoke Hitler. So we’re skipping that part. If you’re interested in reading it, see the comment sections of every vaccine article ever.
Instead, let’s look at the parents who refuse routine childhood vaccinations — and what that means.
There are two categories of kids without a full complement of routine vaccinations. Researchers call the first category the “undervaccinated”: kids who have not received, for one reason or another, their all of their childhood shots. According to a study published in Pediatrics, these children tend to share several characteristics. Most live near the poverty level, in a central city. Their mothers are unlikely to be married or to have a college degree. And, most tellingly, undervaccinated children tend to be black.
Children without vaccinations, on the other hand, are generally referred to as “free riders”**: kids whose health gets a free ride from the immunity of the vaccinated people surrounding them (i.e. “the herd”). Their parents present a radically different profile from those of the undervaccinated kids. Free riders’ mothers tend to be married and college-educated. Their household income generally averages above $75,000. And those free riders are overwhelmingly white.
It doesn’t take a methodological study to make sense of these numbers. Low-income city-dwelling mothers are less likely to enjoy easy access to the vaccinations themselves; one Los Angeles mother told a reporter that she had to schlep two kids on two different buses to get to her local clinic.
“These simple things were pretty difficult to get through,” she says. This doesn’t count the difficulties of making appointments in between full-time work and childcare, not to mention navigating the bureaucracy of Medicaid. These children’s parents may worry about the ramifications of vaccine-preventable disease. But poverty can make it hard to do much about it. When you’re worried about keeping the lights on, the rent paid, and the car running, routine vaxes understandably aren’t high on your priority list.
Free riders, on the other hand, have easy access to vaccines — but choose not to use them. Free riders’ parents believe vaccination itself to be far more dangerous than the risk of contracting a vaccine-preventable disease. The maladies they attribute to standard childhood shots go way beyond the Jenny McCarthy/Andrew Wakefield autism debacle; they now include mercury and aluminum poisoning, increased risk of asthma, allergies, ADHD, ear infections, sinusitis, and brain damage of all stripes. If you can imagine a health concern, you can blame it on vaccines.
These parents tend to get their information about vaccination from like-minded parents, listservs, online groups, and natural-health gurus like Dr. Mercola and Dr. Tenpenny — both notoriously anti-vaccination. They rely, in fact, not on pediatricians, with their one-size-fits-all vaccine schedule, but on their own research: conducted mostly on the Internet, where stories of legitimate vaccine injury pass through news sites and Facebook groups like a horror-show version of Telephone.
Instead of vaccinations, free riders’ parents claim other means of keeping their kids healthy. As Public Health professor Jennifer Reich argues, parents of non-vaccinated children believe breastfeeding, superior nutrition, and controlled environments (i.e., not daycare) keep disease at bay.
Unfortunately for most kids, these are all benefits of privilege.
With the lack of adequate maternity leave and laws to protect mothers’ rights to pump breast milk, nursing in America has become a purview of the privileged mother, whose job — or whose decision to stay home — allows a stable nursing relationship. And despite WIC, SNAP, and other variations of food stamps, access to fresh, healthy food is also often out of reach for the poor, especially those who inhabit so-called food deserts. Finally, working mothers must rely on some kind of childcare, often institutionalized daycare. Undervaccinated children simply don’t have access to the mythical protection free riders’ parents invoke. As one such mother tells Reich, "I think there are some vaccines that maybe some kids, maybe it’s okay for them to have, because maybe their parents. . . aren’t at all educated and . . . so maybe they do need to rely more on outside sources, because that is being done to them.”
Moreover, in general, children living in poverty have more government intervention in their lives. While it varies from state to state, and even social worker to social worker, many WIC recipients are required to produce shot records for their children. Social Services may use a lack of vaccinations as evidence of neglect. And as Reich says, more privileged parents “address experts as consultants and refuse their advice without fear of reprisal, choices less readily available to less privileged families, whose rejection of expert advice more easily results in state intervention, even around vaccination.” A poor black woman refusing to give her kid an MMR shot might not just get the side-eye. She might earn herself a visit from Social Services.
Free riders’ parents also often claim vaccine-preventable diseases are less dangerous than the vaccines themselves, particularly with illnesses like measles. Chicken pox (varicella) is seen as particularly innocuous, partly because most adults remember suffering through it with little more than an itch or two, and partly because of rumors that the vaccine will leave children vulnerable to shingles later in life (it won’t). Whatever the dangers of the diseases, allowing children to catch them costs time and money: time taken off work to care for them, lost wages, and doctors’ bills. It’s more than many parents can afford, especially those without access to family or medical leave. As a rule, poor people don’t throw pox parties.
Basically: It takes money and time to refuse vaccinations. And it’s a lack of that same money and time that often unintentionally keeps parents from fully vaccinating their children.
This has serious public health repercussions. The head of the Sabin Institute for Vaccine Research, Peter Hortez points out that when vaccine rates start to drop, the people who suffer will be “people who live in poor, crowded conditions. So it’s going to affect the poorest people in our country.”
Privileged, usually white, free riders, who enjoy limited social contact, superior nutrition, and better medical care will likely have a lower incidence of complications of death from those diseases. The undervaccinated will be the ones to suffer: overwhelmingly black children from low-income families.
The anti-vaccine movement, then, affects more than just the privileged children whose parents choose to forgo vaccination. As scientists at Johns Hopkins recently said while investigating a whooping cough outbreak, “geographic pockets of vaccine exemptors pose a risk to the whole community.”
That whole community doesn’t just include the usual suspects: infants, the elderly, the immuno-compromised, the vaccinated for whom the antigen simply didn't take. It also includes the marginalized who lack easy access to basic health care. Those marginalized communities are usually people of color. The anti-vaccination community is overwhelmingly white. In a very real sense, this leaves two distinct undervaccinated populations in America: privileged (largely) white people who’ve chosen to eschew modern medicine, and underprivileged minorities whose poverty has placed them, unwillingly, in that position. And it’s the latter who will suffer more gravely for it, because the same economic and health factors that make their children vulnerable to undervaccination make them vulnerable to the worst effects of the diseases themselves.
Privileged white people refuse the vaccines in the name of individual freedom.
And public health suffers; this especially affects the lives of the poor. This will, of course, provoke unmitigated outrage from the anti-vaccination community as a whole.
Is the anti-vax movement itself racist? No. But it’s buttressed by class and race privilege.
A drop in vaccination rates poses a danger to us all. But it poses a special danger to those least able to cope with serious illness, and least likely to be (unintentionally) fully vaccinated: minority, city-dwelling children.