Vaccinations – ‘It’s more complicated than that’

John Oliver tackled vaccination on his HBO series Last Week Tonight

British satirist John Oliver tackled vaccination on the 25 June episode of his HBO series Last Week Tonight. There has been a series of measles outbreaks in Western Europe and North America among the populations who ought to have the best access to the vaccine against it. So why do parents not present their children for vaccination? What are their arguments? Who is persuading them to forego the recommendations of public health authorities?

I won’t go into all the issues raised by Oliver in this piece. For the most part it was standard fare from the British comedian. Oliver has a tendency to “preach to the converted” in his long-form pieces, but he usually does two crucial things. First, he lets his audience know “yes, you’re right, but here is the solid evidence for your opinions”. And second, “now you have this evidence, do you accept it’s also a little more complicated than you first thought?”

Throughout, Oliver attacked the ringleaders of anti-vaccination while acknowledging why parents might have doubts about the claims of both sides of the debate. The anger and vitriol was saved for people like Andrew Wakefield, Robert F. Kennedy and Dan Burton rather than parents just trying to work out how to keep their kids safe. As Heidi Larson et al’s work here at the School demonstrates, very few parents are totally pro- or totally anti-vaccination. Hectoring does little good to sway those on the fence.

Image from Wellcome Images

I don’t think the piece will convince the hard-core, but it was never meant to. It was supposed to use humour and evidence to reassure parents of the importance of vaccination and the dangers to all of us from having an under-vaccinated population.

But I think there were two points that stood out to me as central to the debate.

First, Oliver offers a beautiful metaphor. A growing number of parents choose to spread out vaccine doses, believing that children get too many in one go. They don’t. The CDC and NHS carefully plan vaccine schedules based on the aetiology of the disease, the way the vaccine works and the risks to certain children of particular ages. Spreading out vaccines reduces their effectiveness and there is no scientific evidence that it is safer than the existing recommendations.

Many of us are reasonable people. Between the extreme of anti-vaccination and doggedly abiding by official recommendations, spacing vaccines seems like a decent compromise. But, as Oliver argues, it’s the middle ground between sense and nonsense.

“It’s like saying ‘eating a bar of soap is stupid, so I’m only going to eat half’”.

Image from Wellcome Images

The parallels here are obvious in so many debates in public life. This idea that in any debate both sides have equal merit is what has allowed climate change denial to remain on the agenda long after it ought to have been abandoned. But that is another soap box for another time…

The second crucial point was his closing remarks. John Oliver recently had a son. He was born prematurely: but Oliver declared that junior would be fully vaccinated – and on schedule.

Whether we think they should or they shouldn’t – “celebrity” endorsements matter. (And those of us that remember Oliver from The Bugle podcast and the first series of Mock the Week are giggling at the idea of him being a celeb’.) Jenny McCarthy is well known in the US for convincing parents to avoid vaccines. As is Rob Schneider, who appeared in Oliver’s piece. A trusted public figure can sway opinion for or against official advice. There was a reason Elvis Presley was used in the polio vaccine campaign. I’m not saying John is Elvis… but he is a journalist and trusted public figure.

The segment appears to have resonated with people, and has received a lot of media attention. It is a very useful primer on the main anti-vaccine arguments and the clear refutations of those positions based on evidence. But when public health authorities strive for vaccination rates in excess of 95%, even a few holdouts can cause problems – especially when they are concentrated in tight geographical areas. Will arguments like Oliver’s convince all parents? Possibly not. But if they convince hesitant parents to reconsider their position, that can only be a welcome start.

The video may be hard to find outside the US as HBO region locks Oliver’s show now on YouTube. We would obviously never encourage you to search around for it or use any form of software to get around the restrictions, but it should be available to download for those of you with a Sky Atlantic subscription. It is worth a watch. For educational purposes, obviously.

Gareth Millward, 19 July 2017