A Grain Of Saul: What India Taught Me About The Anti-Vaccination Movement In The U.S.

The United States has a problem, but we can fix it.

A Grain of Saul is a weekly column that digs into some of the biggest issues we face as a nation and as an international community in search of reliable data, realistic solutions, and — most importantly — hope.  

There is a great threat to children in the United States taking shape, and it's one we should have overcome a long time ago: the unrelentingly fierce anti-vaccination movement. 

And if one country knows how to beat it, it's India.

While the anti-vaxxers in America have swelled in numbers and conviction, an opposite trend has taken place over the last few decades in India. Despite a population that was in part resistant to the practice of inoculation— a resistance built upon religious beliefs and conspiracy theories — health workers in India have successfully prevented the spread of polio in a country that used to see close to 200,000 new cases annually. There hasn't been a new case in six years.

In India, most concerns about vaccinations came from deep-seated fears about the government intersecting with religious convictions. Imagine waking up one day to a government health worker you've never met at your front door. They've come from a city hours away, and they want to pour two little drops into your child's mouth from a vial. What would you do?

When the Indian government got behind a concerted polio vaccination push in 1997, millions of Indians were faced with this question. And the resistance that followed far exceeded simply avoiding vaccination.

A healthcare worker administers an oral polio vaccine to a child in Moradabad City, India. 
A healthcare worker administers an oral polio vaccine to a child in Moradabad City, India.  Logan Tittle

During a recent trip I took to India to cover the success of polio vaccinations, one health care worker told me a frightening story that showed just how resistant some people were. He and his team had heard about a strict Muslim family that wouldn't let any of the volunteers vaccinate their children. This, despite the fact that they already had a daughter who had been paralyzed after contracting polio.

When they arrived, the healthcare worker asked her if she would allow them to vaccinate her newborn child. After initially saying no, she seemed convinced by the worker's coaxing and indicated that she would let the worker administer the vaccine. But the health care worker said her body language "looked all wrong."

Sensing something was amiss, he pressed her before administering the vaccine. "What will you do when we leave?" he asked. Her answer shocked him: she would kill the baby before her husband got home. Why? She said that her husband had promised to kill her if he found out that she had allowed health care workers to give her child this "potion," a vaccine many in her rural community suspected broke Muslim dietary restrictions or was part of a government effort to make the religious minority impotent.

Two years later, that same health care worker went back to the same home, approached the same family and administered the same vaccine with no resistance. What changed?

A group of children gather around to watch a child get a vaccine inside his home. 
A group of children gather around to watch a child get a vaccine inside his home.  Isaac Saul

For one, health care workers had collaborated with imams to endorse the polio vaccinations. Rather than changing the mind of one local anti-vaxxer at a time, they found people the vaccine skeptics trusted and assured them that the vaccines were both safe and met Muslim dietary restrictions.

Once they had accomplished that and shown the imams that — in fact — vaccinating children would keep the Muslim community healthy, imams began telling their communities to inoculate their children. Some even took the vaccines themselves, in front of their own congregations during major Muslim holidays, so worshippers could see it met dietary restrictions. Others vaccinated their own children and grandchildren during nationally broadcasted services, a ritual that opened the floodgates for support in Muslim communities across India.

In addition to the aid workers' outreach to Muslim religious leaders, famous Bollywood actors, popular musicians, radio hosts, politicians and basically every kind of public figure you can imagine used their platforms to endorse the vaccines. They spread awareness by having trusted and well-liked voices deliver a message that the country, which had been so ravaged by polio, actually had a chance to eradicate it.

By 2009, about 12 years after the Indian government and the World Health Organization began an official, collaborative effort to eradicate polio, there were only 749 new cases. In 2010, there were just 42. And in 2011, there were no new cases of polio reported in the entire country. Perhaps most impressive, though, is that they accomplished this feat by vaccinating approximately 170 million children at least twice a year for more than a decade.

Children wave goodbye to healthcare workers after they vaccinated several young girls and boys in their neighborhood.
Children wave goodbye to healthcare workers after they vaccinated several young girls and boys in their neighborhood. Isaac Saul

Meanwhile, during the same period of time in the United States, vaccination rates for diseases like diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella and hepatitis B have been wavered. Nine states across the country have only administered these essential vaccines for less than two-thirds of children between 19 months and 35 months old, a ratio so dangerously low it could lead to the next measles outbreak, according to The New York Times. Measles, by the way, is a deadly disease that killed 100,000 children last year and infected more than 4 million Americans as recently as the 1950s. 

Yet, despite this risk, anti-vaxxers persist. Fake news that vaccinations cause autism, public figures joining the anti-vaxxer movement, and misinformation about the efficacy of vaccines have all fanned the flames of the anti-vaxxer movement. It isn't just the children of anti-vaxxers who are endangered by their parents' choices — it's also the community around them.

Claims that vaccinations can lead to autism in children are the number one driver of this movement, despite being debunked repeatedly. While the American Academy of Pediatrics published a 21-page report highlighting all the studies that show there is no link between autism and vaccines, various conspiracy websites and films like Vaxxed: From Cover-Up to Catastrophe, promote the myth that vaccines are dangerous.

So, what can we do? 

Along with laws like the ones in California that no longer allow parents to skip vaccinations for their children "based on personal beliefs," health care workers should be approaching leaders that are trusted by the anti-vaccination movement. 

President Donald Trump, who has tweeted erroneous correlations between vaccines and autism, would be a great place to start. 

Since taking office, it appears he has cozied up to Robert Kennedy Jr., a vaccine skeptic who may be tasked with leading a commission on autism. If health officials could sit down with Trump and convince him of the incredible risk posed by unvaccinated children, along with overwhelming evidence that there is no link between autism and vaccines, he could spearhead a cause to kill the anti-vaccination movement once and for all by simply speaking out against it. He has, after all, proven to be quite malleable.

But Trump isn't alone in his skepticism. Just like imams largely act as thought-leaders in the Muslim community of India, public figures in the United States hold an incredible amount of political sway. Each of these people should be a top target for vaccine experts, the same way imams and Bollywood actors were leveraged in India's successful fight against polio.

After all, if India can reduce the number of new polio cases to zero by vaccinating 170 million children annually in the face of intense religious resistance and misinformation, the United States should be able to reduce the number of unvaccinated children to zero in the face of unfounded claims about vaccines causing autism. 

You can follow Isaac Saul on Twitter at @Ike_Saul