Monday, February 23, 2015

The Anti-Vaccination Controversy: What the Amish and the Romans Have to Teach Us

 by Nomad

The question is pretty basic when it comes to the controversy about vaccinations. Are we really committed to progress or will be surrender to an illusion of past stability and simplicity?

The anti-vaccination movement is a good reminder that progress is not a steadily upward climb. It's something we tend to forget sometimes. This safe and convenient means of prevention to a disease that has ravaged civilization should, according to common sense, be hailed as a victory of humanity.
Instead it is viewed with superstitious suspicious and ignorance. 
In fact, the whole idea of progress is actually a quite recent phenomena and shouldn't be taken for granted.

The Roman Idea of Progress
Our concept of Progress belongs mostly to the Modern Age. Wikipedia explains it like this:
The Idea of Progress is the idea that advances in technology, science, and social organization can produce an improvement in the human condition... The assumption is that the process will happen once people apply their reason and skills, for it is not divinely foreordained.   

Although this new way of thinking emerged primarily in the Enlightenment in the 18th century, philosophers of the ancient world, particularly the Greeks, had flashes of inspiration on the subject. The Greek philosopher, theologian, poet, and social and religious critic, Xenophanes. for example, wrote:
"The gods did not reveal to men all things in the beginning, but men through their own search find in the course of time that which is better."
It's not surprising. Back the age of antiquity, civilized society had changed little from a thousand years before, Events happened, empires rose and collapsed, but generation after generation saw no material change in progress.

For that reason, it was fairly easy to believe that human civilization was, for the most part, a static thing. Greeks may have had their elaborate philosophies but the Romans were of a more practical nature. Development meant the building of infrastructure and was a matter of administration. The taming of the German clans  and the savages in other outlying regions was purely a matter of conquest.

So what are the things the Romans left us?
Roads to move cargo, in other words, the loot from conquered lands. Concrete to build structures designed to impress and distract the fickle Roman public. A complicated system of legal administration to keep the whole thing running as smoothly as possible. All very practical.

The Roman, from our eyes, seem curiously incurious about science and the advancement of humanity.

Oh, there were occasional flashes of futurism. Seneca the Younger, philosopher, tutor and later adviser to Nero, once said
The days will come when those things which now lie hidden, time and human diligence will bring to light... The days will come when our posterity will marvel that we were ignorant of truth so obvious."
Progress as means of lifting humanity from one level to a higher level never really caught on with the Romans. It really wasn't until the Age of Enlightenment after the Reformation that sustained progress was possible.
Not every society, not every individual, have fully adopted all that goes  with science and progress. We can still find plenty of examples. We still hear people reviling the modern age even as they microwave their breakfasts, wash their clothes in programmable machines, watch television and then drive to work every day, 

The idea that progress - like time itself- can be held in place- sometimes can be an appealing idea for some people. Sometimes the call for a simpler life can be tempting. Especially when the advancement science poses moral challenges that require us to revise our fixed notions. We feel as our great grandparents must have felt when they first sat in this automobile, thrilled by the sensation of forward movement but a little terrified by the sudden loss of control.

We have seen this rejection - this attempt at shutting down  progress for the sake of social harmony. It was almost always coupled with strict religious values as if progress was somehow antithetical to religion and science and faith were necessarily opposites.

In America, which was once symbolic of a new age of humanity,  a product of the Age of Reason, such a mentality has long been considered  at best, quaint, and at worst, backward by many.

That's why the anti-vaccination movement is a important warning sign  the way so many people feel about progress itself.

Disneyland Measles
If there is a price we must pay for progress, then there is also as great a price for backwardness.

A couple of months ago, we saw firsthand the effect of this dangerous kind of nostalgia and the risks of excessively looking back.
More than 100 measles cases in half a dozen states have been linked to people who visited or worked at Disneyland in December or exposure to infected people who went there. California health officials on Wednesday reported 99 measles cases including six new infections with a Disneyland connection.
It was a preventable outbreak too.
Homegrown measles has not occurred in the United States since 2000 due to an aggressive vaccination campaign. But outbreaks have hit in recent years with nearly all cases linked to travelers who caught the virus overseas where measles still rages and spread it in this country among pockets of unvaccinated people.
Since an outbreak of measles in Disneyland in December, there has been a lot of discussion about the anti-vaccination movement (also known as anti-vaxxers). Throughout human history, vaccine-preventable diseases. (like mumps, polio, flu and rubella) have been a major cause of illness, death and disability.
Women exposed to rubella also risk miscarriage or birth deformities in their unborn child. 

Before the introduction of a vaccine, polio used to be a very common illness, for example, and it used to cause severe illness in thousands of people each year before polio vaccine was introduced in 1955. This particular disease was one of the most dreaded childhood diseases of the 20th century.

Today vaccines have eradicated polio from most countries in the world,  and reduced the worldwide incidence from an estimated 350,000 cases in 1988 to just 223 cases in 2012. If our forefathers could see this present day controversy, they would be both disgusted and amazed. The idea that science could provide a simple means of lessening the risks of a deadly childhood illness and parents would choose to reject it would have been impossible for them comprehend.

The irrationality of the hysterical reaction to Ebola- which, as yet, has no vaccine- to the lackadaisical and selfish refusal of preventative vaccinations  are positions that are to reconcile. (New Jersey Governor Chris Christie in a series of statements and acts personified this dangerously ignorant mentality.)  

The Amish Connection
All the reporting of Disneyland outbreak tended to overlook one fact. The largest US measles outbreak in recent history happened months before in Ohio's Amish country. In that case,  383 people fell ill after un-vaccinated Amish missionaries traveled to the Philippines and returned with the virus.

Amish community, like others in the United States, eschews the conveniences of modern technology. The idea of rejecting all of the benefits of modern life may be as quaint as grandmother's pickles, but it is hardly a practical idea for a civilization.

The Amish (and the other religious sects who think likewise) cannot be, at least, be accused of hypocrisy. They have  also rejected most forms of high-tech, and tools of modernity. Except for their missionary work, they have also chosen to live apart from the rest of society. Contrast that to the anti-vaxxers who want the best of the modern age,  without the accompanying responsibilities.
The idea that we, as individuals, as families, as nations, can still live as discrete units, islands and bubbles is a hard one to shake.

The Ebola response - after years of neglect of the health care system in Africa- was a sign that it can be done with a combination of public concern, personal compassion and medical professionalism. Could it have done even better?
Of course. 
A more important question is why, in this age, should the health care system in Africa have been allowed to become so primitive in the first place.

The Cost of Roman Ignorance 
During Roman Times, medical theory was- when it existed at all- was rudimentary.  Even the brightest scholars had no concept of science as an means of investigation, the nature or causes of contagious illness or how the body functioned. It was vaguely assumed that disease was caused by bad air or miasma.

Horrendous plagues were common and could not be contained. In antiquity, two of the most devastating plagues were the Athenian plague of 430 B.C. and the Justinianic plague of 542 A.D.

Galen of Pergamum, a prominent Greek physician, surgeon and philosopher, witnessed the great Antonine plague of 165–180 AD during the reign of Marcus Aurelius.
The effects are hard for us to imagine. Moreover, the disease was relentless, breaking out not just once but twice, nine years later. At its peak, in the city of Rome alone, it was killing 2000 a day. That's just one city.

It is estimated that as many as five million died from this one onslaught. The disease killed as much as one-third of the population in some areas and devastated the Roman army. Most researchers  conclude that the overall impact of this one plague was severe  "influencing military conscription, the agricultural and urban economy, and depleting the coffers of the State."

Historian William H. McNeill observed that this outbreak coincided with the start of the Roman Empire's 300-year decline. He postulated that it was not merely a coincidence.
"..Rome's pandemics left it with a population too small to support its large military and state apparatus, a predicament that led to further civic and economic unraveling. Collapse was inevitable."
Seneca's Warning 
Historians today debate whether the cause of that particular plague was smallpox or whether it was measles. In either case, today the Antonine plague would have never caused such mayhem.

Indeed, thanks to successful vaccination programs, smallpox was eradicated in 1979. (Today a smallpox outbreak would have to be a deliberate act of terrorism.) 
The scourge of measles- in most developed regions of the world- has been brought under control. Vaccination has resulted in a 75% decrease in deaths from measles between 2000 and 2013 with about 85% of children globally being currently vaccinated.
Those are pretty impressive results. 
As Dr. Sue Desmond-Hellman who works for the Gates Foundation notes, diseases can regain a foothold when we take for granted the very means we have to stop them.
Unfortunately, the remarkable success of vaccines is part of the problem. They’ve been too successful. As Melinda Gates perfectly summarized recently: when you forget what death from measles looks like, it is easy to take vaccines for granted.
This war against measles (as well as other diseases) is as yet unfinished. Sadly, there are some of us who, for fear and doubt, are willing to retreat or desert the battle.

Seneca once wrote in a letter to his friend about the danger of  allowing progress to lapse.
Things which are incomplete must totter and alternate between making progress and sinking or collapsing. But they will sink, unless they have made a firm resolution to go forward and press on. If they slacken their zeal and their firm concentration even a bit, they must backslide. 
And he adds:
So let us press on and persevere; more remains than we have squandered, but a great part of progress consists in the desire to make progress.
The question is then whether we are really committed to progress or whether we would prefer to live in an artificially-induced and unsafe version of the past.