California became ground zero in the fight over childhood vaccines in 2015, and the lessons learned in that battle will likely be studied by public health advocates for years.
How did a pediatrician legislator and some moms change California’s school vaccination requirement from loose to one of the tightest in the nation? Recently, state Senator Richard Pan and vaccine advocates Leah Russin and Renee DiResta outlined the strategy that worked against all odds.
“It started with my son and my desire to protect him,” Russin told an audience at the UC Berkeley School of Public Health in November 2015. She lives in a pocket of California where she said a lot of parents don’t believe in vaccinating their children—some because they don’t want the government telling them what to do, others because they fear that vaccines are more dangerous than diseases.
Declining immunization rate sparks fear
Statewide, vaccine rates were falling. From 2004 to 2014 immunizations for DTP (diphtheria-tetanus-pertussis [whooping cough]) and for measles decreased by nearly 3 percent in California kindergartners. In 2014, measles broke out at Disneyland in California and spread to 17 other states, infecting 178 people.
“We missed a lot of fun events because I didn’t want to expose him to these other children,” Russin said. “When he had a fever I was afraid to take him to urgent care because of what he might get that shouldn’t be there.”
Russin founded Vaccinate California, and contacted Sen. Pan. Together with legislator Ben Allen, they sponsored SB 277, a law that would no longer allow children in school to forgo vaccines for religious or personal beliefs.
Much of the country allows parents to opt out for personal objections—in most states all they have to do is check a box. So opposition mobilized quickly and vocally.
Winning an uphill political battle
The bill was referred to three separate legislative committees—health, education, and judiciary. Most bills go through just one committee. At each intense hearing, parents opposed to mandatory vaccination spoke and protested. Legislators received so many calls that some set up separate, dedicated phone lines. Pan and Allen received alarming, threatening phone calls, and Pan received extra security for a while.
At several key points, the bill appeared dead, but each time Pan was able to work out a compromise. He and the parents with Vaccinate California focused on educating legislators and the public about the importance of immunizations. They never insisted that every child get shots. Rather, they said, California needs to return to the days when enough children were vaccinated to create community immunity. (When a high percentage of the population is vaccinated, it makes it difficult for a virus to spread to others who aren’t immune.)
“The goal of the bill was not to get every child vaccinated but to restore community immunity,” he said. “We have safe vaccines and while they may not be without risk, they are much safer than diseases.”
The Twitter campaign against vaccines
While the media focused on the packed hearings, DiResta, a self-described data geek with Vaccinate California, started examining social media data to get a better sense of the opposition and its strategy.
Initial opponents said they were concerned that vaccines may be linked to autism—a theory that’s been proven untrue. In fact, the original paper suggesting the link was retracted. But the opposition really took off when the campaign focused on parental rights—the right to choose medical care for your child.
Looking at hashtag comments on Twitter, DiResta discovered that a dozen or so people were sending out thousands of tweets about government interfering with parents’ rights, and, in turn, that was mobilizing the Tea Party and far-right conservatives nationwide.
DiResta showed a data map that illustrated the barrage of tweets and retweets from the opposition. In contrast, people tweeting about the public health need for vaccines were isolated, off on a corner of the map, connecting with few outside the field of public health.
A small, vocal group of people made it appear as if there was widespread opposition to vaccines by leveraging the power of social media, DiResta said.
But in the end, “it didn’t matter,” she said. By the time of the vote in late June 2015, most legislators had seen through the Twitter campaign, and public health prevailed.
A new, model vaccine law
On July 1, 2016, California will join Mississippi and West Virginia in enforcing the strictest vaccination laws in the nation. The new California law requires children to be immunized for infectious diseases, including measles, whooping cough, mumps and rubella, before starting daycare and public and private schools. Those whose parents refuse can be home-schooled or enrolled in an independent study program off campus. Children who can’t be immunized for medical reasons are exempt from the law.
For public health advocates nationwide, what are the take-home lessons from California’s battle over vaccines? Here are a few tips from Russin and DiResta:
- Don’t demonize your opponents. They, too, are concerned parents. Instead, educate them and your community.
- Don’t be intimidated by a seemingly overwhelming campaign against you on Twitter or Facebook. There may be two dozen people sending all those posts.
- And, at last, get savvy about using social media. It’s an opportunity to reach, influence, and help people understand how to prevent disease.
See also: Why Don't Parents Trust Vaccines?