Great news: The first clinical trials for a Zika vaccine are slated to start as early as next spring. As the disease has spread, research has shown that Zika can cause devastating birth defects, including microcephaly and associated brain abnormalities. Preventing congenital Zika infections is the primary goal of a Zika immunization initiative, and for good reason: There have already been 16 infants born with Zika-related birth defects and 5 known Zika-related fetal losses in the U.S. Even if the virus does not become epidemic here, international travel and sexual transmission ensures that it will continue to pose a real risk.
It’s worth noting that this once-celebrated rubella vaccine is none other than the infamous MMR, which inoculates recipients against mumps, measles, and rubella (the three individual vaccines were combined in 1971). This was the vaccine targeted by the fraudulent, and ultimately retracted, 1998 Lancet paper that ignited the anti-vaccination movement and cast a dark shadow over the modern vaccine program that the medicine and public health community remains unable to shake off to this day. Though the author of the Lancet paper was disbarred from medicine, and the safety and efficacy of vaccines has been demonstrated definitively and repeatedly, there is a vast and disturbing chasm between the reception the rubella vaccine initially received and the public attitude towards vaccines today.
But then vaccines came in, and they worked. Because of this, these once-feared diseases faded from public consciousness. The risk of harm from vaccine-preventable illness is now widely perceived as remote and purely theoretical. Enter the seductive lure of anti-vaccination as status symbol, and potent marker of cultural and class identity, fashioned from a particularly American array of pro-individual libertarian rhetoric, anti-science sentiment, conspiracy theory, and false worship of what’s “natural.” There’s been spotty progress here and there with strong vaccine policy and advocacy, but by and large as a society we have been complacent. There has been tacit acceptance of anti-vaccination as a legitimate choice falling under the false pretense of personal belief, and there are deep-seated threads of racial, class, and gender discrimination that inform not only the response to anti-vaxxers, but also theresistance of pediatricians acknowledging that the current approach isn’t working.
But Zika presents a different possibility. This is a stealthy disease that can and does cause grave harm to developing babies, including right here in the United States. It feels scarier than the flu, and it’s more tangible than any of these long-eradicated diseases. In many ways, unborn babies are exquisitely vulnerable and bring out some of our more noble tendencies. In fact, Zika is already making people reassess their own risk-related values, as evidenced by thesignificant jump in acceptance of genetically modified Zika-fighting mosquitos among Americans. This is likely thanks to the fact that we see Zika as a real threat that could actually affect us.
Zika could succeed where the HPV vaccine, introduced in the past decade, has failed. Rather than evoke appreciation that a vaccine could dramatically lower one’s chance of some very dangerous cancers, the HPV vaccine instead provoked ridiculous debates over whether we are sexualizing our children by protecting them from deadly diseases (that, yes, happen to be sexually transmitted). It was not widely embraced. While Zika is also transmitted sexually, the fact that the primary means of infection is via mosquitos could help negate this kind of detrimental characterization.
A Zika vaccine could solve a public health problem that currently has no other solutions. It could also help expose the hypocrisy of the anti-vax movement. While we don’t know who will be recommended to get the vaccine in the U.S., it’s easy to imagine a scenario in which there is broad public support—and expectation—for mass immunization in Central and South America. If anti-vaxxers support this movement, it would show that their hesitancy about the use of vaccines in their own lives (and the lives of their children) is not in fact driven by earnest concerns. If they actually believed that the vaccine was inadequately tested for safety, may cause devastating side effects, and contains “unnatural” and toxic substances, then they ought to object to vaccination in these developing countries as unethical. To my knowledge, for all the sensationalism and fear-mongering of the anti-vax movement, there has been no initiative to date to protect the children of sub-Saharan Africa or Bangladesh from the horrors of vaccines. (These areas still see lack of routine vaccination and subsequent outbreak of diseases, but that is the result of funding challenges, not anti-vax sentiment.)