In 2007, prior to his now infamous and indelible foray into politics, Donald Trump said, “When I was growing up, autism wasn't really a factor. And now all of a sudden, it's an epidemic … My theory is the shots.”
In 2009, as the swine flu ripped through the US, killing roughly 12,000 Americans between April 2009 and February 2010, Trump warned against using vaccines to combat the epidemic, saying, “I think the vaccines can be very dangerous. And, obviously, you know, a lot of people are talking about vaccines with children with respect to autism.”
In 2014, he crystallized his allegiance to this conspiracy theory, tweeting, “Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn't feel good and changes - AUTISM. Many such cases!”
Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn't feel good and changes - AUTISM. Many such cases!
— Donald J. Trump (@realDonaldTrump) March 28, 2014
In 2015, when asked about vaccines, US President Donald Trump said he didn’t “like the idea of injecting bad stuff in your body.”
Luckily, such is the impressionability of Trump that he quickly changed his tune once he entered the White House and received medical advice from more credible sources than social media conspiracy theorists. Donald Trump has hardly been a beacon of disaster preparedness; he has told infected citizens to go to work and referenced bogus statistics to stymie public anxiety. However, he has, at the very least, backtracked on his previous vaccine hesitancy. Admittedly, his understanding of clinical trials leaves much to be desired, in that he thinks a vaccine will be rolled out “relatively soon” despite conservative estimates suggesting it may take 12-18 months. Nevertheless, he has at least acknowledged the need for vaccines.
Even in April 2019, as the number of measles outbreaks surged across the country, Trump urged his citizens to heed the advice of medical professionals, saying, “They have to get the shots. The vaccinations are so important. This is really going around now. They have to get their shots.”
Trump administration health officials and the vast majority of Republican Congressmen support mandatory vaccination. However, vaccine hesitancy has permeated conservative political discourse and found a host in some Republicans in state legislatures, particularly among libertarians, who oppose ‘big government’.
Kentucky Governor Matt Bevin called vaccine mandates ‘un-American’. Oregon Republicans say it violates parental rights. In Washington state, Rep. Paul Harris attempted to end exemptions on measles vaccinations. There are also four states with registered political action committees who lobby for religious exemptions for vaccines.
Aside from its growing political influence, the anti-vaxxer movement also has dire societal consequences. For instance, rates of parental refusal of vaccines have virtually tripled in some parts of Texas, such as Gaines County, where it went up from 3% in 2012 to 9% in 2018. Furthermore, the nationwide vaccination rate for measles, mumps, and rubella (MMR) fell to 94.3% in the 2017-18 school year, the third consecutive year of decline. In 2019, there were roughly 1,300 cases of measles across 25 states, despite the disease being eradicated in 2000.
Considering that the US is often held as the prototype for a developing country like India, could the American anti-vaxxer movement derail India’s crucial progress on vaccinations?
India's childhood vaccination rate increased from 35% in 1992-93, to 44% in 2005-06, to 62% in 2016-16. Although India lags behind countries like China, Vietnam, Bangladesh, and Sri Lanka, it is clear that India is moving in the right direction.
This progress is evident in India’s response to its polio crisis. In 1995, India began its polio eradication program. By 2002, India still accounted for 70% of polio cases worldwide. However, India was dedicated and resilient in the face of a monumental task, and in 2014, the World Health Organization (WHO) bestowed India with the much-coveted 'Polio Free' certification, as over 80% of its population now lives in certified polio-free regions.
In 2019, while the US combatted a resurgent measles epidemic, India remained focused on bringing its number of cases down. Following the launch of an initiative to curb the spread of measles in 2005, measles-related deaths in infants aged 1-59 months decreased from 62,000 in 2005 to 24,000 in 2015, and continue to decrease today.
Overall, India has achieved increased levels of childhood vaccination as part of its Universal Immunization Programme (UIP), which was launched in 1985. This has led to greater levels of education and created a trickle-down effect on future generations, who will follow suit in vaccinating their children and contribute towards improved medical, societal, and economic outcomes.
Additionally, unlike in the US, India enjoys cross-party support for vaccines. While the above-mentioned programs were all launched under the Indian National Congress (INC), their efforts were continued under the Bharatiya Janata Party (BJP), as well. Furthermore, the BJP, too, has launched immunization drives.
For example, in the 80s and 90s, the state of Uttar Pradesh reported roughly 1,000 cases of encephalitis each year, with a fatality rate of 20-30%. After a major outbreak in 2005, the number of annual cases virtually tripled to 3,000 cases and 500-600 deaths, rising all the way until 2017. When Yogi Adityanath of the BJP became Chief Minister of the state in March 2017, he launched a massive vaccination plan for encephalitis covering 8.8 million children. By August 2019, the state reported a 65% decrease in encephalitis-related deaths. In 2019, only 234 children were admitted to hospital for encephalitis, with 22 deaths.
Alongside cross-party support for vaccines, lack of vaccine coverage among the poor in India is more due to a lack of access and resources rather than vaccine hesitancy. The Indian poor are likely to accept medical advice at face value as they are unable to afford curative care and hence prefer preventative care. In comparison, their American counterparts would be able to afford a greater level of skepticism as they can afford curative care should they get sick, thus giving them a higher margin for error in their decision-making.
In addition, there is presently a lack of influential Indian political action groups lobbying for the anti-vaxxer cause.
Therefore, due to India’s relatively unquestioning respect for Western medicine, cross-party support, and a lack of lobbying groups, vaccine hesitancy has yet to significantly take force in India.
However, there are disconcerting indications that the American anti-vaxxer movement is slowly beginning to penetrate Indian political discourse.
Given India’s population of 1.37 billion, misinformation can spread like wildfire and become difficult to contain. Additionally, while the average cost of a smartphone in the US is $567, in India it is just $157, with the average price of cellular data in the country falling below $1 per gigabyte in 2017. Furthermore, the percentage of India's population covered by a 4G connection increased from around 5% in 2012 to over 80% in 2017. Consequently, Indians have a gigantic online presence, as evidenced by the fact that India has the largest amount of users on both Whatsapp and Facebook, with 400 million and 260 million users on each platform, respectively.
With this greater connectivity, however, comes the inherent dangers and risks of these smartphone users falling prey to false information originating from the US.
For example, a report by the Wall Street Journal says that anti-vaxxer social media posts from American pages are now spreading among Indian Whatsapp users, impeding the efforts of Indian health authorities to eradicate diseases like measles and rubella. Owing to these American-made Whatsapp forwards, some of which implored “Don't use vaccinations. Save the lives of your children”, dozens of schools in Mumbai “refused to allow health officials to carry out vaccinations” in 2019, believing that it causes autism and other disorders. In fact, an Indian UNICEF official said, “It's rumors on WhatsApp that are the chief culprit. They've traveled faster than the vaccines.”
In February 2019, it was reported that Facebook was used to promote anti-vaccine content to at least 900,000 people interested in “vaccine controversies”. In response, in March 2019, Facebook announced that it would begin taking action against accounts promoting vaccine ‘hoaxes’ as per the standards of the World Health Organization (WHO) and the US’ Centre for Disease Control and Prevention (CDC). Instagram, too, began blocking misleading vaccination content on its explore and hashtag pages. However, many of these accounts and pages now operate privately and are still able to attract huge audiences and spread misinformation across social media platforms, including Whatsapp, right under the noses of Facebook watchdogs.
It is also discomforting to know that increased levels of education or literacy cannot guard against such unmitigated dissemination of false information. For example, in 2017 in Kannur, Kerala, a city in India's most literate state, Whatsapp forwards led to over 240,000 parents refusing to give their children the MMR vaccine. Similar episodes have been observed in hundreds of schools across the states of Gujarat and Maharashtra.
Although vaccines currently enjoy cross-party support, there is a danger of the anti-vaxxer movement gaining a foothold in India, particularly considering that, under the overlapping reigns of the Republicans’ Trump and the BJP’s Modi, the American Christian-right has become more closely aligned with India’s Hindu-right. While this thriving bonhomie has not resulted in Indian politicians displaying the same skepticism towards government-mandated medical procedures as their American counterparts, there is a notable shift towards the increasing importance placed on alternative medicine, like Ayurveda, as a substitutive rather than supplemental form of healthcare.
For example, in 2018, health minister JP Nadda introduced the National Medical Commission Bill in the Lok Sabha. Among other things, the bill proposed licensing Siddha, Ayurvedic, and homeopathic practitioners as allopathic healthcare providers upon completion of a ‘bridge course’.
In addition, in 2019, the BJP announced plans to build 4,2000 Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH) centers, illustrating a clear pivot towards traditional medicine.
There are elements of Ayurveda that are useful as cost-effective complementary treatments for non-life threatening conditions; however, by modern scientific principles, Ayurveda cannot be considered a science as it relies too heavily on largely untested hypotheses and metaphysics.
Therefore, alongside the spread of the American anti-vaxxer movement into India, the prevalence of Ayurvedic practitioners eulogizing the healing properties of Ayurvedic products during the 2018 NIPAH virus outbreak and the ongoing coronavirus pandemic have further compounded the struggles of Indian health officials in disease control. In fact, AYUSH itself, a government ministry, was lambasted for suggesting alternative medicine as an immunity booster against the coronavirus as it provided no scientific evidence to back its claims.
Between 1990 and 2016, India reduced the mortality rate of children below five from 126 deaths per 1,000 live births to 43. It became ‘polio free’ in 2014, eliminated neonatal tetanus in 2015, and has overseen an exponential decrease in vaccine-preventable deaths. Yet, despite this progress, 500,000 Indian children die every year from vaccine-preventable diseases, and India continues to have the largest number of unimmunized children worldwide.
Hence, while the government works to address the service gaps that limit the coverage of its immunization programs, the ominous cloud of the American anti-vaxxer movement threatens to wreak havoc on India’s hard-achieved progress by imposing a new, deadly hurdle of vaccine hesitancy.