frames vaccines as dangerous or unnatural, substituting “vaccine-free” or “intact immune system” for “unvaccinated”

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Vaccine refusal has been a recurring story in the media for well over a decade. Although there is scant evidence that refusal is genuinely increasing in the population, multiple studies have demonstrated concerning patterns of decline of confidence in vaccines, the medical professionals who administer vaccines, and the scientists who study and develop vaccines. As specialists in microbiology, immunology, and infectious diseases, scientists are content experts but often lack the direct contact with individuals considering vaccination for themselves or their children that healthcare professionals have daily. This review examines the arguments and players in the US antivaccination scene, and it discusses ways that experts in infectious diseases can become more active in promoting vaccination to friends, family, and the public at large.
Keywords: antivaccination, internet, misinformation, vaccine denial, vaccine hesitancy
Since the late 1990s, concern has grown regarding a resurgence of the “anti-vaccine movement,” a loosely defined group of individuals who sow doubt about the effectiveness and safety of vaccines. Although the most current iteration of this scare can be traced to the publication of Andrew Wakefield’s (since-retracted) paper linking the measles-mumps-rubella (MMR) vaccine to autism in 1998, anti-immunization sentiment in reality predates the process of vaccination, dating back to objections to the process of variolation in the early 18th century to reduce smallpox morbidity and mortality [1, 2].
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Although vaccine rates have remained high in the United States as a whole [2, 3], national surveys can overlook pockets of vaccine refusal that exist in many communities [4]. Areas with low vaccination rates have resulted in localized outbreaks of vaccine-preventable diseases, including measles and pertussis [5]. Measles cases in the United States reached a 20-year high in 2014 [6]; 90% of those were among individuals who had not been vaccinated or whose vaccination status was unknown [6, 7], suggesting the unvaccinated are drivers of outbreaks. Furthermore, vaccines are victims of their own success. Today, even many physicians have not seen a case of measles, diphtheria, or other vaccine-preventable diseases; parents are a generation more removed from the scourges that polio and rubella represented. As such, antivaccine activists have been able to describe these diseases as harmless consequences of childhood, and vaccines are presented as the danger rather than the disease. Although public health and medical practitioners have been concerned about increasing antivaccine sentiment, programs that have been implemented to change minds and attitudes have been largely ineffective [8, 9].
This review aims to (1) provide infectious disease experts with grounding in the current rhetoric of vaccine denial, (2) introduce the cast of characters who play a role in perpetuating vaccine misinformation and driving vaccine fear, and (3) discuss ways scientists can respond in various venues to demonstrate support of vaccines and the very principles of vaccination.
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THE ARGUMENTS
The arguments against vaccination have changed little over time [1, 2]. These are summarized in Table 1 and will be discussed here briefly. Most objections to vaccination are currently cached in language that makes them highly palatable to parents and difficult for scientists to object to, using terms such as “informed consent,” “health freedom,” and “vaccine safety” [10]. A recent article in Natural Mother Magazine makes it explicit that antivaccine advocates should use language that frames vaccines as dangerous or unnatural, substituting “vaccine-free” or “intact immune system” for “unvaccinated”, and “vaccine-associated diseases” instead of “vaccine-preventable diseases” [11], for instance.

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