Measles is one of the most infectious airborne diseases.
Click, click, click. That is all it takes to fall down the rabbit hole of the anti-vaccine movement that has taken root on social media.
Just a few taps on Instagram, for example, and one is deep into the realm of "anti-vax" conspiracies, from pseudo-scientific vindications for disgraced British former doctor Andrew Wakefield's bogus links between the MMR jab and autism in children, to hashtags such as #vaccineskill.
This is viral content in the most literal sense. The World Health Organisation (WHO) has pinpointed "vaccine hesitancy" as one of the 10 biggest global health threats for 2019.
Earlier this month, Simon Stevens, the head of the NHS in the UK, blamed "fake news" by so-called anti-vaxxers on social media for fuelling a tripling in measles cases, with 913 infections recorded in England between January and October last year, compared with 259 in all of 2017.
Similarly, the number of measles infections across Europe tripled to 82,500 in 2018, compared with the previous year — a surge that killed 72 children and adults. And this week Rockland County in New York state banned non-vaccinated children from public places for 30 days to halt an outbreak of measles (declared eradicated from the US in 2000).
Across the world, the anti-vaccine movement is drawing together disparate supporters from the US President, Donald Trump, to Russian trolls; from Hollywood celebrities to hipster parents in Britain's Home Counties.
The World Health Organisation has pinpointed "vaccine hesitancy" as one of the 10 biggest global health threats for 2019. Photo / Supplied
And the scare tactics appear to be registering: across Britain, NHS data shows the proportion of 2-year-olds immunised against measles, mumps and rubella (MMR) fell for the fourth year in a row in 2017-18 to 91.2 per cent (the WHO target is 95 per cent).
Dr Heidi Larson, director of the Vaccine Confidence Project, calls it societal "hubris", where as infectious diseases are brought under control, attention turns to the risk of the vaccine, even if minimal in comparison. In recent years, she says, the sheer scale of anti-vaccine messages online have become far harder for health professionals to contest.
"These emotions and views don't start with social media companies but are amplified by them."
The decision to leave a child unvaccinated, she points out, is not just a threat to them, individually, but also the so-called "herd immunity" — the resistance among any given population to a disease.
"I think it is irresponsible to not vaccinate," she says, given measles is deadly in one in every 1000 cases, while infection can damage the entire immune system and lead to serious complications such as pneumonia and encephalitis (inflammation of the brain).
Larson believes matters are reaching a point where the British Government might need to reconsider leaving the choice to parents.
"I wouldn't wait until there is a crisis."
Religious beliefs are believed to play a role. The number of vaccinated children living in the ultra orthodox Charedi Jewish community in Stamford Hill in north London is estimated to be well under 80 per cent, while Larson says some Muslim communities have raised concerns about gelatin in vaccines.
But it is also in affluent areas where parents, inspired by the natural health movement, are choosing not to vaccinate. Rebecca Whitfield (not her real name), has decided not to vaccinate her son after seeing the children of friends react badly to jabs but also, she says, because he was born premature and she did not want to subject him to any more needles. "The way we live our life is to stay well and really focus on being healthy.
I don't understand this need to protect ourselves from things that won't do our child too much harm."
Certainly, the public health community has little time for such arguments. According to Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, "one unvaccinated child is one too many" and recent measles outbreaks are a sharp reminder of how serious the disease can be.
"We need to cut through the fake news, with evidence-based, easy-to-understand health advice for patients. They should feel equipped to challenge any spurious claims so they can make sensible, informed decisions about the long-term health and wellbeing of their children."
The spectre of Wakefield, drummed out of the British medical profession for his 1998 paper that made a link between MMR and autism, looms large over the vaccine info-wars. Twenty years on, he has rehabilitated his reputation in the US and amassed avowed supporters.
Anna Merlan, journalist and author of forthcoming book Republic of Lies on the rise of conspiracy theorists in America, has interviewed Wakefield. "He is very charismatic and feeds into long-standing suspicions [in the US]."
Campaigners hope such voices will soon be muted. This week, Health Secretary Matt Hancock called for laws forcing social media companies to remove content promoting false information about vaccines.
"There is a lack of information out there, apart from a few very vociferous people shouting loudly," says Professor Arne Akbar, president of the British Society of Immunology. "People are being bamboozled and misled."
