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historical stuff by Gareth Millward

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2001 – September 11

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11 September 2001 – New York, Arlington, VA, Shanksville, PA

xkcd (Source)

xkcd (Source)

The terrorist attacks on “9/11” were horrific. The sheer scale of the damage, the cultural significance of the targets, and the fact that this exposed the vulnerability of “the most powerful nation on Earth” made most of the Western world uneasy. Whatever the geopolitical position in the Middle East, whatever the West’s role in the historical and continued instability in the region, the hijackings were barbaric acts.

I have already discussed terrorism and racialised attitudes towards it in this series. And while I could probably go on at length on the subject, there is another aspect of the attacks that piques my interest. The endurance of the conspiracy theory.

Of course, 9/11 wasn’t the first event to generate an industry of writers and enthusiasts spreading their own particular hypotheses to explain major events. JFK and the Apollo XI Moon Landing come to mind immediately. Then there are various “interesting” positions on vaccination or aircraft vapour trails. And we still find people who believe the Jews run the world, or the Catholics run the world, or the Illuminati run the world, or the Stonemasons run the world, or (that’s enough, Ed.)

My own work recently has had to deal with the vaccination issue. And this has been fascinating, partially because it involves so many different positions on what is largely the same base of evidence. It includes everyone from the hardcore “anti-vaxxers” to the hardcore “pro-vaxxers” – and somewhere in between individuals and parents who actively or passively do not get their children vaccinated without really expressing an opinion that survives in the historical record.

So this isn’t about 9/11. It’s a rant.

One of the reasons that the vaccination conspiracies have attracted so much opinion recently is because they have very tangible results. We can see the vaccination rate go up or down; we can see the disease notification rates fluctuate. And it is one of those group behaviour which, we believe, might affect us. Whether another person (or group of people) choose to vaccinate can lead to a greater risk of disease for another. Or so the “pro-vaxxers” would have you believe. (At this point the author dons his tin-foil hat.)

Ben Goldacre, a science writer, has written about “vaccine scares” in his popular books on Bad Science.1 He notes that these theories about, for example, hepatitis vaccines causing multiple sclerosis, worries over mercury or the realtionship between MMR and autism have tended to respect national boundaries.2 And while for the most part he is correct, these ideas did spread (albeit more slowly) in the pre-internet age. The scare over pertussis (whooping cough) vaccination, for example, had pretty much burnt out in England before it flared in the United States; although there was a contemporary (yet completely separate) issue with the vaccine in Japan.3 It took a number of years for Australia and the US to catch onto Wakefield and MMR (despite how his work had been discredited), and the UK has never really got interested in thimerosal (mercury compounds). In the internet age, however, ideas are spreading quicker as people are more quickly able to find individuals with similar views, and in turn are able to share information which confirms these beliefs.

Let’s be clear, however – pro-vaccine people do similar things. The vast majority of those commenting on vaccination (like the vast majority of the world’s population) are not medically trained in the areas of epidemiology and immunisation. This doesn’t make their opinions invalid, but it does make claims about scientific “truth” very difficult to trust. Vaccines are complicated. The science underpinning them is complicated. I would have to contextualise the opinion of, say, a brain surgeon when opining on MMR. Much like – even though I have a PhD in history – my views and pronouncements on pre-industrial Oviedo should probably be taken with a pinch of salt. The difference is that overwhelming medical opinion supports vaccination as safe and effective. The real questions is – how “safe” is “safe”; and how “effective” is “effective”?

No vaccine is 100% effective. It significantly reduces your chances of getting a disease; which in turn significantly reduces your chances of passing it on. Especially if everyone around you is also vaccinated. After a few generations of the disease, theoretically, a population can rid itself of the disease as it has fewer hosts and fewer people to infect. This concept of “herd immunity” is a well established one, even if it is only in recent (historically speaking) times that we have been able to develop statistical and epidemiological models to predict the impact of vaccines on a population.

And, no vaccine is 100% safe. Any procedure – indeed, anything carries risk. This goes from opening a can, to driving a car. As a proportion of the billions of vaccines administered, a tiny fraction have been injured. Health authorities know many of the contra-indicators which might cause this, and attempt to avoid the complications. But mistakes happen. That is no comfort to the families affected, but it has meant that over the course of the twentieth century the death and injury toll of TB, polio, smallpox, diphtheria, tetanus, measles, whooping cough, mumps, rubella and others has been significantly reduced.

This gives the conspiracy theorists their “in”. Because there are thousands of cases of vaccine damage to point to. Each individual one is a devastating tragedy to that family. There are millions who have been vaccinated, yet caught the disease anyway. Each one makes an individual wonder whether the pain was worth it. And, of course, medical and public health science had become more effective at preventing and curing illnesses from the late nineteenth century. Who is to say that vaccines have caused the final drop in cases? Couldn’t it just be coincidence? Aren’t we just exposing children to unnecessary risk?

The answer is, of course, peer-reviewed data and analysis. It’s the mass trials conducted by many countries over the course of the past hundred years. It’s the data we have of disease rates in areas where vaccination rates drop. It’s the control experiments and analyses that seek to eliminate other causal factors. Nobody serious would claim vaccination was the only reason for the elimination of smallpox. Nobody serious would claim that it wasn’t a significant factor.

There are two aces up the sleeve of the conspiracy theorists, however, which keep the debate alive. The first is to lie, or seriously misrepresent data. To make claims like “nobody has ever tested vaccine safety or efficacy”. They have – just look at the Medical Research Council’s trials of pertussis,4 polio and TB5 vaccines as a starting point. While none is without its problems, it is a flat out lie to suggest they never happened.

The second is to deny the relevance of these findings on the basis that “Big Pharma”™ makes money off the back of vaccines, or that the government wants to exert control. This seems to suggest that if people have ulterior motives, what they say cannot be true, regardless of their evidence. This would be enough to discredit those selling alternative therapies to protect people from disease, who have a vested interest in making you doubt biomedicine. But that’s a debate for another time.

This seems to fall under its own logic. For a start, vaccines are not a big money maker for pharmaceutical companies compared to their overall turnover. While they are becoming a bigger part of pharmaceutical company’s strategy – due to emerging markets in the developing world and increased difficulties bringing new drugs to the market – in 2013 the vaccine industry was worth an estimated $24 billion.6 Yet the industry is valued at over $980 billion.7 Besides – why would a drug company want to cure you of a disease that can cause complications for which it could sell you drugs to treat?

These argument build on those made by historians of medicine over the past few decades about the need to question scientific truth claims by authorities. There are countless examples of the power of the medical profession and the increasingly medicalised state interfering in the lives of its citizens. But there is a fundamental flaw in using this work – meant as a critique of the social, political and economic structures of power – and applying it simply to back up another faulty truth claim on the material reality of the universe. Just because science, scientists and the scientific method are bound up in power structures and the interests of the capitalist state doesn’t make all (or even most) of their conclusions invalid. As humanities scholars we can debate their relevance, but we don’t have the tools to deny their scientific merits. Especially if you are going to appeal to rational science as your basis for anti-vaccinationism.

Credit: Wellcome Library, London. Wellcome Images. (Source)

Credit: Wellcome Library, London. Wellcome Images. (Source)

But if you’re going to lean on my discipline, let’s try this. Let’s assume vaccination is part of a Foucauldian panopticon. It monitors citizens, bringing all children under the surveillance of the state, where their behaviour is controlled through the universal administration of drugs designed to increase the productivity of the whole. It’s purpose is at once to exert state power and to discipline the individual into believing that she has an obligation to herself and others to maintain her health for the good of the nation state. Let’s just say we buy that (and I probably do, on an academic level).

Why would the state continue to support a system that (supposedly) injures its citizens, rendering them and their parents’ nuclear family economic unit less productive? The state has a vested interest in supporting a system it helped create in order to save face. But it has a bigger vested interest in finding the most efficient and safest vaccines so that its citizens grow up to be net producers, not drains on the system.

There are legitimate questions to be raised here on the moral and political level. Is one death from a vaccine one death too many? It it right that the state should compel people through law or societal pressure to undergo a medical procedure? Fine. We can sit and have that debate. But you don’t get to make up scientific data or ignore the mountain of evidence which contextualises or repudiates your claims.

  1. In the interests of transparency, Goldacre is, like me, a research fellow at the London School of Hygiene and Tropical Medicine. Unlike me, he has medical qualifications and is far more successful. I have never met the guy. I’m sure he’s lovely/a corporate schill (delete as applicable according to personal taste). http://evaluation.lshtm.ac.uk/people/members/ (accessed 5 July 2015).
  2. Ben Goldacre, ‘How vaccine scares respect local cultural boundaries’, Bad Science(24 April 2013) http://www.badscience.net/2013/04/how-vaccine-scares-respect-local-cultural-boundaries/ (accessed 5 July 2015).
  3. Jeffrey P. Baker, ‘The pertussis vaccine controversy in Great Britain, 1974–1986‘, Vaccine 21(25-26), 4003-10.
  4. ‘Vaccination against whooping-cough’, BMJ 4990 (25 August 1956), 454-62.
  5. B.C.G. and vole bacillus vaccines in the prevention of tuberculosis in adolescents‘, BMJ 4964 (25 February 1956), 413-27.
  6. Miloud Kaddar, ‘Global vaccine market features and trends’ World Health Organization http://who.int/influenza_vaccines_plan/resources/session_10_kaddar.pdf (accessed 5 July 2015).
  7. Statista, ‘Revenue of the worldwide pharmaceutical market from 2001 to 2013 (in billion U.S. dollars)’ http://www.statista.com/statistics/263102/pharmaceutical-market-worldwide-revenue-since-2001/ (accessed 5 July 2015).
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