“They are everywhere. Like, every event, every forum.”
This is how anti-vaccine activists were described by a community outreach worker in Minneapolis, where the Somali-American population was systematically and incessantly warned against vaccines. Activists including Andrew Wakefield — who published a fraudulent paper in the late ’90s pushing the vaccine-autism myth – made multiple visits to the Minneapolis area to engage a community that was trying to find its place in society.
The campaign led to an increase in mistrust of vaccines, particularly measles, mumps, and rubella vaccine, among Somali-American parents, as well as dangerously low vaccination rates — 41 percent among 24-to-35-month-olds, according to one estimate. You don’t have to be an epidemiologist like me to comprehend the consequences of such drastic drops in vaccination rates.
Minnesota is now experiencing its worst outbreak in 30 years. It’s centered among Somali-Americans.
But the consequences of all this extend far beyond measles infections and far beyond Minnesota.
Measles is not a trivial disease. The virus that causes measles is one of the most infectious human pathogens. Before the introduction of routine measles vaccination, an estimated 3 million to 4 million cases of measles occurred every year in the United States.
The measles virus depresses immunity among those who get infected — thus impairing the body’s ability to respond against other infections. In a recent groundbreaking paper in Science, Michael Mina — then a student at Emory University — confirmed that measles vaccination played a major role in decreasing deaths from other infectious causes.
Recognizing the importance of measles, the Centers for Disease Control and Prevention, along with other key stakeholders, undertook efforts to eliminate indigenous transmission of measles from the country. This effort was successful in eliminating endemic spread of measles in the US by the year 2000. Since then, measles outbreaks have been mainly associated with importation due to travel.
But the major public health success of measles elimination is under threat. The concern that localized outbreaks such as the one in Minnesota can morph into large, national-level epidemics is not far-fetched. Many high-income countries — such as Germany and France — have seen large national outbreaks in recent years. In fact, multiple countries in Europe are in the middle of large measles outbreaks right now.
My colleagues and I assessed the risk of large measles outbreaks in the US. In a paper published in the American Journal of Epidemiology, we reported that approximately 12.5 percent of US children and adolescents are susceptible to measles. Moreover, we found that even a modest drop in the vaccination rate could result in the breach of the “herd immunity threshold” — that could result in breakdown of community level protection against measles.
When such outbreaks happen, it is often minority groups that get blamed for bringing disease into the country. For example during the so-called Disneyland outbreak of 2014-2015, multiple politicians expressed unfounded concerns about illegal immigrants bringing measles into the US. Then there is the not so proud history of blaming infectious disease importation and spread on ethnic and sexual minorities.
It is in this context that many of us in public health, who also believe in civil and human rights, worry about the Minnesota Somali-American community being blamed for something bigger than the current outbreak — even though the community itself has been a victim of an onslaught of propaganda and misinformation disguised as empathy.
If there is a lesson in this unfolding tragedy, it is that public health authorities and practitioners need to work hard to build trust and resilience among minority communities targeted by vaccine skeptics. This resilience to misinformation is important for preventing and controlling outbreaks. But building resilience is also important for ensuring that frequently marginalized communities do not face xenophobic allegations in an environment increasingly inhospitable to communities of immigrants.
Saad B. Omer is the William H. Foege Chair in Global Health and a professor of global health, epidemiology, and pediatrics at Emory University.