Vaccine Hesitancy and Alternative Medicine

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong

Angelo Fasce and colleagues have an article at Human Vaccines & Immunotherapeutics   titled "Endorsement of alternative medicine and vaccine hesitancy among physicians: A cross-sectional study in four European countries"

Abstract

Vaccine hesitancy has become a threat to public health, especially as it is a phenomenon that has also been observed among healthcare professionals. In this study, we analyzed the relationship between endorsement of complementary and alternative medicine (CAM) and vaccination attitudes and behaviors among healthcare professionals, using a cross-sectional sample of physicians with vaccination responsibilities from four European countries: Germany, Finland, Portugal, and France (total N = 2,787). Our results suggest that, in all the participating countries, CAM endorsement is associated with lower frequency of vaccine recommendation, lower self-vaccination rates, and being more open to patients delaying vaccination, with these relationships being mediated by distrust in vaccines. A latent profile analysis revealed that a profile characterized by higher-than-average CAM endorsement and lower-than-average confidence and recommendation of vaccines occurs, to some degree, among 19% of the total sample, although these percentages varied from one country to another: 23.72% in Germany, 17.83% in France, 9.77% in Finland, and 5.86% in Portugal. These results constitute a call to consider health care professionals’ attitudes toward CAM as a factor that could hinder the implementation of immunization campaigns.

From the article

Even though vaccinations are one of the most beneficial medical advances in human history, they have been subject to controversy since the first mass vaccination campaigns—e.g., the numerous anti-vaccination leagues that emerged in the U.S. during the last quarter of the 19th century.Citation1,Citation2 Vaccine hesitancy is a complex phenomenon that encompasses various types and degrees of negative attitudes and behaviors—e.g., outright rejection, delay, or reluctant acceptance of vaccination.Citation3 There are several sources of vaccine hesitancy among the general population, such as complacency, distrust, and conspiracy beliefs,Citation4 which vary depending on the socio-political context and the type of vaccination. For example, complacency (i.e., unwillingness to get vaccinated due to low perceived risk of vaccine-preventable diseases) is particularly salient in relation to the influenza vaccine,Citation5 whereas conspiracy beliefs and science-related populism tend to manifest during threatening and politically charged events, such as the COVID-19 pandemic.Citation6,Citation7 Numerous studies have also observed vaccine hesitant attitudes among health care professionals (HCPs), which are reflected in lower rates of self-vaccination and vaccine recommendation to patients.Citation8

Prior studies among the general population and nurses suggest that complementary and alternative medicine (CAM) is positively related to vaccine hesitancy.Citation9–14 CAM is defined by the World Health Organization as “a broad set of health care practices that are not part of that country’s own traditional or conventional medicine and are not fully integrated into the dominant health care system”Citation15—in Western societies: homeopathy, acupuncture, energy and crystal healing, reflexology, magnet therapy, or anthroposophic medicine.Citation16–18 Due to its potential effect on willingness to recommend and receive vaccines, the analysis of the relationship between vaccine hesitancy and CAM endorsement among physicians is particularly relevant due to their direct contact with the general public and vulnerable populations, as well as to their key role in patients’ vaccine-related decision-making processes.Citation19,Citation20

RFK Jr.'s Antivax Group Expands Activities in Europe

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

This new EDMO BELUX investigation analyzes Robert Kennedy Jr’s anti-vax movement Children’s Health Defense efforts to expand its activities in Europe.  Read the study here.

Executive Summary

•  The Center for Countering Digital Hate identified Robert Kennedy Jr and his organisation as one of the 12 influencers playing a key role in spreading English-speaking anti-vaxdisinformation on Twitter and Facebook. 
• In this piece, “anti-vax” will be used to qualify entities and people having a general hostility towards vaccination which goes beyond COVID-19 vaccination and is based on beliefs and claims which are not endorsed/approved by scientific public authorities. This can apply to online publications of unverified or distorted scientific results as well as false or distorted statements from public health institutions. 
• Since August 2020, the US anti-vaccine group has significantly increased its presence inEurope, creating a legal structure in Belgium and organising events to spread its narratives all over the continent. 
• These events also helped the Children’s Health Defense Europe build strong relationships with like-minded anti-vax activists, creating a de facto network of organisations and people collaborating, sometimes not transparently, to disseminate anti-vaccine ideas in Europe. 
• Brussels has been central to the Children’s Health Defense Europe’s new activities. For example, the group has developed its lobbying efforts targeting the European Parliament, building up relationships with specific MEPs without being registered in the EU transparency register at the time of our study. It also organised two press conferences at the Brussels Press Club. 
• Social media platforms’ efforts to limit the reach of Children’s Health Defense have been limited at best so far, especially in Europe, and the EU remains vulnerable to the influence activities of many questionable actors like US anti-vaxxers. 
• It raises an important question: What can be done to limit the opportunities to manipulate public discussions around vaccines in the EU?

From the report:

The creation of a legal entity called “Children’s Health Defense Europe” (CHD Europe) constituted an important milestone for the expansion of the Children’s Health Defense’s activities in Europe. It was announced in August 2020 by Robert Kennedy Jr. during a press conference in Berlin, organized one day before one of the first major anti-COVID-19 restrictions demonstrations in the German capital. This entity was registered in Belgium as an ASBL (non-profit organisation) on August 27th , 2020, initially counting five administrators based in Belgium, Germany, Italy, and the USA, and presided by Belgian activist Senta Depuydt. Well connected with the international anti-vax movement, Senta Dupuydt participated in the promotion of the infamous anti-vax documentary “Vaxxed” in France in 2017, together with fellow British anti-vaxxer Andrew Wakefield. The Children’s Health Defense Europe’s board composition changed in April 2022. The new chair of the CHD Europe’s board is Catherine Austin Fitts, an American investment banker and a former member of the George H.W. Bush administration, who participated in many events involving the anti-vax organisation in Europe through her personal organisation called “Solari Inc”. Among the other main visible public figures of the organisation’s board, there is Orsolya Györffy, who was presented as the new acting Executive director of CHD Europe until December 2022. According to CHD Europe’s website, she is “intensely” involved in a second organisation called “Doctors for COVID ethics”.

Autism, COVID, and the European Union

In The Politics of Autism, I discuss international perspectives. Comparative public policy on autism services and research needs far more study.

Jordi Cañas, a Spanish member of the European Union Parliament, writes at Parliament:

During the first months of Spain’s strict COVID-19 lockdown, some news shocked me. People on the autism spectrum, and those accompanying them, were being harassed whenever they left their homes, with people believing they were breaking stay-at-home and mask-wearing rules. The Ministry of Health had - quite rightfully and given the needs of people on the autism spectrum - allowed them to do so, but this did not stop the attacks.

This situation worried me, not only because of the negative emotional impact on people on the autism spectrum but also because it showed the general population’s level of unfamiliarity with the disorder. To raise awareness of the situation, people on the autism spectrum began wearing blue T-shirts and bandanas or high-vis vests.

This stigmatising practice should not have been necessary, and shows again how little understanding of autism there is in our society, how important World Autism Awareness Day still is, and how vital associations and their work remain.

A survey conducted by Autism Europe in 2020 showed that 73 percent of respondents felt that the needs of autistic people and their families had not been adequately addressed in relation to the lockdown measures. Moreover, the inconsistency and lack of clarity on the rules and restrictions made it difficult for people on the autism spectrum to access information, and receive the essential support they needed, triggering fear and anxiety in many of them.

Autism, Empowerment, and Western Europe

In The Politics of Autism, I discuss international perspectives. Comparative public policy on autism services and research needs far more study.

At European Policy Analysis, Kate Precious has an article titled "Informed, Involved, or Empowered? Three Ideal types of Autism Policy Eesign in Western Europe." The abstract:

Governments which design policies to empower marginalized groups contribute to reducing the democratic deficit in public policy and improve their efficacy, efficiency, and democratic credentials. This article uses fuzzy set ideal type analysis to propose three ideal types of policy design for political empowerment, according to whether the government views the target group as capable only of being Informed by experts, or of being Involved in policy, or even Empowered to co‐govern. An analysis of Western European autism policy illustrates and confirms the usefulness of the ideal types. England, Wales, and Denmark emerge as countries where governments have the highest expectations for political empowerment. Surprisingly, traditional disability policy groupings seem not to apply, with the UK split across Empowered and Involved, while Spain leaves its Informed Southern European counterparts to join the Involved cohort. This paper is a timely reminder of the importance of lived experience as a policy resource lived experience as a policy resource. 

From the article:

Autism policy has evolved as a discrete subset of disability policy in Western Europe over the past twenty years, with fifteen new autism policies arriving on the policy scene in response to concerns that autistic people were “falling through the gaps” of disability policy (Ravet, 2015). The neurodiversity movement argues that autistic people have untapped potential which remains unrealized due to a hostile environment (Arnold, 2017; Donaldson, Krejcha et al., 2017; Kapp, 2020; Kapp, 2013). If this is true, the autistic community has much to gain from empowerment, and their statistical over‐representation among the under‐employed, unemployed (Mavranezouli, Megnin‐Viggars et al., 2014), and those involved with the mental health (Maddox & Gaus, 2019) and criminal justice systems (King & Murphy, 2014) is all the more concerning.

Measles Cases Soar in Europe

In The Politics of Autism, I look at the discredited notion that vaccines cause autism. Twitter, Facebook, and other social media platforms have helped spread this dangerous myth.
Palko Karasz at NYT reports that the World Health Organization has reported a resurgence of measles in Europe.

The number of cases in the first half of the year in the European region doubled in comparison with 2018 — with 90,000 people infected, compared with 44,175 in the first six months of last year, the W.H.O. said in a statement.

“We are backsliding; we are on the wrong track,” Dr. Kate O’Brien, the director of the W.H.O.’s immunization department, said at a news conference.

The W.H.O. monitors the elimination of the disease across the region, and countries with continuous transmission of the virus for 12 consecutive months are no longer considered measles-free.

Albania, Britain, the Czech Republic and Greece, which had declared measles eliminated, joined 12 other nations — including France, Germany, Poland, Romania and Russia — where the disease is endemic, the W.H.O. said.

Even countries that had eliminated the disease have seen a return of infections. The United States is experiencing the worst measles outbreak in decades, with a record number of cases since the last large epidemic, in 1992, and since measles was declared eliminated in 2000, according to the Centers for Disease Control and Prevention.

“Elimination” does not mean that the disease is completely absent. It indicates that a country has gone more than 12 months without continuous disease transmission. That is why health experts have called on people to continue to vaccinate children.

But a growing movement promoting skepticism of the vaccine — mainly because of the belief, which scientists have argued against, that it could cause autism in children — has contributed to falling vaccination rates in many developed nations, and the shots are not compulsory everywhere.

Extremism, Populism, and the Antivax Movement

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.  Twitter, Facebook, and other social media platforms have helped spread this dangerous myth.

Kelly Weill at The Daily Beast:

Most anti-vaxxers are not white supremacists, far from it. But the overlap can send some well-meaning parents down the rabbit hole. Far-right groups frequently engage in “entryism,” a tactic that involves seeding a sympathetic mainstream group with extremist ideology, then slowly radicalizing its members. The tactic works well in groups like the anti-vax community.
...
[P]opulist movements, including Donald Trump’s presidential campaign, borrow some of the left’s anti-authority language, casting themselves as anti-elite. On Facebook, anti-vaxxers might rage against the authority of pharmaceutical companies or school vaccination policies, but Trump is a less common target. (Trump has promoted anti-vax conspiracies, too, falsely claiming in 2014 that vaccines cause autism.)

Other conservatives have painted their anti-vax stances as anti-authoritarian by claiming vaccinations are communist. “The idea that we force someone to give up their liberty for the sake of the collective is not based on American values but rather, Communist,” Kelly Townsend, a Republican anti-vaxxer in Arizona’s state House, wrote in a Thursday Facebook post.

In The European Journal of Public Health, Jonathan Kennedy has an article titled "Populist Politics and Vaccine Hesitancy in Western Europe: an Analysis of National-level Data.  The abstract:

Background
Parents’ reluctance to vaccinate their children undermines the effectiveness of vaccination programmes in Western Europe. There is anecdotal evidence suggesting a connection between the rise of political populism and vaccine hesitancy.

Methods
This paper analyses national-level data to examine the link between political populism and vaccine hesitancy in Western Europe. Political populism is operationalised as the percentage of people in a country who voted for populist parties in the 2014 European Parliament elections. Vaccine hesitancy is operationalised as the percentage of people in a country who believe that vaccines are not important, safe and effective according to data from the Vaccine Confidence Project (2015).

Results
There is a highly significant positive association between the percentage of people in a country who voted for populist parties and who believe that vaccines are not important (R = 0.7923, P = 0.007) and effective (R = 0.7222, P = 0.0035). The percentage of people who think vaccines are unsafe just misses being significant at the 5% level (R = 0.5027, P = 0.0669).

Conclusions
Vaccine hesitancy and political populism are driven by similar dynamics: a profound distrust in elites and experts. It is necessary for public health scholars and actors to work to build trust with parents that are reluctant to vaccinate their children, but there are limits to this strategy. The more general popular distrust of elites and experts which informs vaccine hesitancy will be difficult to resolve unless its underlying causes—the political disenfranchisement and economic marginalisation of large parts of the Western European population—are also addressed.

From the article:

Until the mid-20th century, science was seen as the ultimate form of knowledge, but in recent decades social scientists have challenged natural scientists’ claims to epistemological supremacy. This is based on a valid critique of the scientific method and its inability to uncover objective truth. Nevertheless, it helped to create a situation in which many laypeople distrust scientific expertise. Harry Collins refers to this phenomenon as technological or scientific populism. Climate change denial is on manifestation, vaccine hesitancy is another

[It] seems likely that scientific populism is driven by similar feelings to political populism—i.e. profound distrust of elites and experts by disenfranchised and marginalised parts of the population.

Italian Official Quits, Cites Government's Anti-Science Stance

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

In 2017 Italy required vaccinations for pre-schoolers. The Five Star Movement, opposed the move, appealing to the belief that vaccines cause autism. The movement is now part of a coalition government.

From AFP:

The president of Italy's national health research organisation on Wednesday January 2nd said he had been driven to resign due the "anti-scientific" policies of the country's populist government including efforts to undermine confidence in vital vaccinations.

Professor Walter Ricciardi of the National Health Institute (ISS) said an aversion to evidence-based policy among the coalition of Italy's far-right League and anti-establishment Five Star Movement (M5S) put public health at risk.

"Representatives of the government have endorsed unscientific or frankly anti-scientific positions on many issues," he said in an interview with the Corriere della Sera daily.

"It's clear that when the deputy prime minister says that he, as a father, believes there are too many obligatory, useless and dangerous vaccines, that's not just unscientific, it's anti-scientific," he said in reference to League head Matteo Salvini.

...
 "And yet these are issues that are decisive for public health," he said. "All this reminds me of Donald Trump's recommendation to the US National Health Institute to no longer use the term 'evidence-based'. "It's an approach taken by populists, who have great difficulty in interacting with science," Ricciardi added.

Measles Cases Soar in Europe

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Sarah Boseley at The Guardian:

A growing anti-vaccine movement in Europe, fuelled by social media and anti-establishment populists, is putting lives at risk and may be to blame for measles outbreaks surging to a 20-year high, health experts are warning.

A fresh Guardian analysis of WHO data shows that measles cases in Europe will top 60,000 this year - more than double that of 2017 and the highest this century. There have been 72 deaths, twice as many as in 2017.

Health experts warn that vaccine sceptics are driving down immunisation rates for measles, HPV against cervical cancer, flu and other diseases - and that their opinions are increasingly being amplified by social media and by rightwing populists equally sceptical of medical authorities.

…
Anti-vaxxers in the US celebrated the presidential election of Donald Trump, who has expressed scepticism over vaccines and invited Andrew Wakefield – the discredited gastroenterologist who has claimed the MMR vaccine was linked to autism – to his inaugural ball. Trump was also said to have been considering setting up a committee to investigate vaccines under the vocal anti-vaxxer Robert F Kennedy Jnr.

Antivax Sentiment Spreads Worldwide. And So Does Measles.

 In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Angela Giuffrida reports at The Guardian:

Italy’s health minister has sacked the entire board of the Higher HealthCouncil, the country’s most important committee of technical-scientific experts who advise the government on health policy.

In a move on Monday night that shocked Italian scientists, Giulia Grillo, from the Five Star Movement – a vaccine-sceptic party that has supported unproven cures for cancer – said it was “time to give space to the new”.

“We are the #governmentofchange and, as I have already done with the appointments of the various organs and committees of the ministry, I have chosen to open the door to other deserving personalities,” she wrote on Facebook.

The decision will mean the replacement of 30 board members, including the president, Roberta Siliquini, the head of the school of hygiene and preventive medicine at the University of Turin who was nominated in December 2017 by the former health minister Beatrice Lorenzin.

Zachary Young at Politico Europe reports that social media have helped antivax sentiment spread broadly, affecting France.

And if online activity in the U.S. is any indication, some of the vaccine skepticism in Europe could be driven by Russian bots.

In the online war for public opinion on vaccines, the French government is being overwhelmed. According to an October report from the European Commission, only 69.9 percent of French people agree that “vaccines are safe,” placing the country of Louis Pasteur — the 19th century biologist who discovered the principles of vaccination — 26th in the EU28 totem pole, ahead of only Bulgaria and Latvia. When it comes to the seasonal flu vaccine, France ranks last, with 51.8 percent of respondents feeling secure.

Part of the reason that France has fallen so low in EU rankings has to do with anti-vaccination ideas spreading virally on social media, according to health officials and observers of online activity. According to an April report by Printemps Prevention, a preventative health nonprofit, 18 of the 25 most-viewed YouTube vaccines videos in France take a skeptical position. On search engines, the report shows, anti-vaccine queries have increased by 130 percent over five years.
...


Eleven EU member countries currently fall below the relevant threshold for measles, which requires 93-95 percent vaccination rates, and outbreaks have surged on the Continent since 2017. Whereas the once-rampageous disease was “eliminated” from the Americas in 2016, Europe has this year registered some 41,000 measles cases causing 40 deaths, according to the World Health Organization.

Among 27 European countries measured by the OECD, France has the lowest rate of childhood vaccination for the disease.

Marie Werbregue, from central France, became mobilized in the debate after her daughter became autistic, which she attributes to vaccination. Now, she is president of the association “Info Vaccins France” and co-moderates a 10,319-member Facebook group on the subject.

From the World Health Organization:

Reported measles cases spiked in 2017, as multiple countries experienced severe and protracted outbreaks of the disease. This is according to a new report published today by leading health organizations.

Because of gaps in vaccination coverage, measles outbreaks occurred in all regions, while there were an estimated 110 000 deaths related to the disease.

Using updated disease modelling data, the report provides the most comprehensive estimates of measles trends over the last 17 years. It shows that since 2000, over 21 million lives have been saved through measles immunizations. However, reported cases increased by more than 30 percent worldwide from 2016.

The Americas, the Eastern Mediterranean Region, and Europe experienced the greatest upsurges in cases in 2017, with the Western Pacific the only World Health Organization (WHO) region where measles incidence fell.

“The resurgence of measles is of serious concern, with extended outbreaks occurring across regions, and particularly in countries that had achieved, or were close to achieving measles elimination,” said Dr Soumya Swaminathan, Deputy Director General for Programmes at WHO. “Without urgent efforts to increase vaccination coverage and identify populations with unacceptable levels of under-, or unimmunized children, we risk losing decades of progress in protecting children and communities against this devastating, but entirely preventable disease.”

Europe's Measles Outbreak: A Warning for the United States

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

 Lauren Dunn and Linda Carroll report at NBC:

A raging measles outbreak in Europe may be a warning sign of what could occur in the U.S. if something doesn’t change soon, experts say.

So far this year, there have been 41,000 cases in Europe and 40 deaths, according to the World Health Organization. The European experience may offer a window on how quickly things can go awry when parents choose not to vaccinate their children, doctors caution.

...

What has been happening in Europe is now happening in the U.S. — on a smaller scale at this point,” said Dr. Peter Hotez, director of the Texas Children’s Hospital Center for Vaccine Development at Baylor College of Medicine and author of “Vaccines Did Not Cause Rachel's Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad.”

The problem is the plethora of misinformation online, Hotez said. “The anti-vaccine groups have made very strategic use of the internet and social media,” he added. “It’s estimated that there are more than 400 anti-vaccine websites now, and when you put ‘vaccine’ into a search engine, it’s almost inevitable you’re going to get an anti-vaccine website popping up.”

And it’s not just the internet, Hotez said. “Now there are political action committees popping up in several states, including Texas,” he added.

It’s not clear what exactly is driving the anti-vaccine movement, Hotez said. But “there’s an element of the anti-vaccine movement that is peddling alternative therapies and making money off of phony treatments,” he said. “And there’s an element that have tied themselves to different political groups. In Texas the major anti-vaccine lobby likes to use libertarian garbage terms like ‘medical freedom’ or ‘medical choice.’ ”

The anti-vaxxers have had such a large impact that “now there is a terrific vulnerability in states like Texas and up in the Pacific Northwest,” Hotez said. “People forget that before kids were getting vaccinated we had between 400 and 700 deaths from measles annually in the U.S.” 

Antivax Impact in Italy

In The Politics of Autism, I look at the discredited notion that vaccines cause autism..

Jason Horowitz at NYT writes about Italy's Five Star Movement.

Its co-founder raised links between vaccines and autism. Its political leader campaigned against a law making vaccines obligatory. Its myriad websites drew traffic with posts by vaccine skeptics, and its party representatives blamed vaccines for tumors and allergies. For one senator, vaccine scars were “branding for beasts.”

On Thursday, as school began this week around Italy, the Five Star Movement and its coalition partner, the League, passed a measure that allows children to stay in school as long as their parents attest that they have been vaccinated, or will be by March. No doctor’s note is required.

...
[Former health minister Beatrice Lorenzin] attributed the surge of distrust in vaccines to the fact that the diseases had become so rare as to seem unreal, to the debacle of a since-rejected and retracted report in the scientific journal The Lancet linking vaccines to autism, and to what she called “Doctor Google.”

By 2015, coverage had declined to about 85 percent. Cases of measles, which can cause blindness, brain inflammation, pneumonia and in some cases death, have been rising.

Italy’s “No-Vax” movement has risen, too. In Rimini, a hotbed of No-Vax activity and the site of a 2012 ruling by a local judge, later overturned, that linked autism to vaccines, anti-vaccination advocates attached streamers to planes that read, “Everyone to School. Freedom of Choice.”
...
Mattia Marchi, a spokesman for the Veneto chapter of Corveleva, a No-Vax umbrella group, said parents skeptical of vaccines still had little choice but to vaccinate.

“No one ever said that a vaccine causes autism,” Mr. Marchi said. “But if a thousand people see a U.F.O., do we want to tell these people that they are crazy or do we want to find a solution?”
...
Beppe Grillo, the co-founder of the Five Star Movement, has raised a link between vaccines and autism, suggested that vaccines weaken the immune systems of healthy children, and claimed that the pharmaceutical industry has pushed them for profit. Members of the party in the European Parliament have proposed eliminating some obligatory vaccinations for some public employees and professed a link between leukemia, tumors, allergies and autism to vaccinations.

At Vox, Julia Belluz cautions that measles outbreaks are not just attributable to the antivax movement alone. 

When describing why measles is spreading, the researchers and public health officials working on the ground in these countries talk about austerity, the economy, and failing public health systems.

• A new paper in the European Journal of Public Health found that the parts of Italy that cut their public health budgets the most had lower rates of vaccine coverage. “Our analysis suggests that austerity measures adopted in Italy contributed significantly to the resurgence of measles,” the authors wrote. “We estimated that each 1% reduction in real public health expenditure per-capita corresponded to a 0.5 percentage points reduction in MMR coverage.”

In other words, an underfunded public health infrastructure may be more to blame for the uptick in measles than anti-vaxxers. “The [public health spending] cuts were mainly on prevention — like preventive clinics and also staff,” the study’s lead author, Veronica Toffolutti, a health economist at Bocconi University in Milan, told me. “Many people were not hired anymore as staff.” And without staff and services in place to vaccinate people, more people aren’t getting vaccinated, and measles is spreading.

Autism, Education, and the European Union

In The Politics of Autism, I discuss the need for more study of the issue in other countries.

At PLOS One, Monika Roleska and colleagues have an article titled: "Autism and the  Right to Education in the EU: Policy Mapping and Scoping Review of the United Kingdom, France, Poland and Spain."  The abstract:

Introduction

Autistic people may have different educational needs that need to be met to allow them to develop their full potential. Education and disability policies remain within the competence of EU Member States, with current educational standards and provisions for autistic people implemented locally. This scoping review aims to map EU and national special education policies with the goal of scoping the level of fulfilment of the right to education of autistic people.

Methods

Four EU countries (United Kingdom, France, Poland and Spain) were included in this scoping review study. Governmental policies in the field of education, special education needs and disability law were included. Path dependency framework was used for data analysis; a net of inter-dependencies between international, EU and national policies was created.

Results and discussion

Each country created policies where the right to free education without discrimination is provided. Poland does not have an autism specific strategy, whereas the United Kingdom, France and Spain have policies specifically designed for autistic individuals. Within the United Kingdom, all countries created different autism plans, nevertheless all aim to reach the same goal—inclusive education for autistic children that leads to the development of their full potential.

Conclusion

Policy-making across Europe in the field of education has been changing through the years in favour of autistic people. Today their rights are noticed and considered, but there is still room for improvement. Results showed that approaches and policies vastly differ between countries, more Member States should be analysed in a similar manner to gain a broader and clearer view with a special focus on disability rights in Central and Eastern Europe

From the article:

This study provided vital information on the right to education of autistic people in the UK, France, Poland and Spain. The scope of this study only included four countries, therefore the results cannot be generalized and clear conclusion on the average level of the fulfilment of the right to education cannot be drawn. More countries should be analysed to get a better picture of the situation across the EU. Additionally, since this is the first in a series of studies that map SEN policy in the EU, the findings have not been able to be triangulated to ensure reliability. Furthermore, the initial pool of identified studies has not been examined by other authors, meaning the reliability of the screening process cannot be guaranteed. More research should also be conducted to establish whether strategies that are in place have an effect on autistic children, such as improved learning, skills and higher rates of participation in education. To the best of our knowledge, there are no previous studies that have examined whether education of autistic people in EU countries is directed to development of their talents, creativity and provides them with skills they need to successfully progress into employment. To this day, the research in the field of education and autism policies in the EU as well as globally is scarce and remains an important gap in autism research. It is for this reason that this study aimed to review existing information as well as attract interest to conduct more research in this field in the future.

Measles Case Soar in Europe

In The Politics of Autism, I look at the discredited notion that vaccines cause autism..

From the World Health Organization:

Over 41 000 children and adults in the WHO European Region have been infected with measles in the first 6 months of 2018. The total number for this period far exceeds the 12-month totals reported for every other year this decade. So far, the highest annual total for measles cases between 2010 and 2017 was 23 927 for 2017, and the lowest was 5273 for 2016. Monthly country reports also indicate that at least 37 people have died due to measles so far this year.

“Following the decade’s lowest number of cases in 2016, we are seeing a dramatic increase in infections and extended outbreaks,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “We call on all countries to immediately implement broad, context-appropriate measures to stop further spread of this disease. Good health for all starts with immunization, and as long as this disease is not eliminated we are failing to live up to our Sustainable Development Goal commitments.”

Seven countries in the Region have seen over 1000 infections in children and adults this year (France, Georgia, Greece, Italy, the Russian Federation, Serbia and Ukraine). Ukraine has been the hardest hit, with over 23 000 people affected; this accounts for over half of the regional total. Measles-related deaths have been reported in all of these countries, with Serbia reporting the highest number of 14.

Rory Smith at CNN:

And where anti-vaccine sentiment has taken root -- such as in Italy -- measles is generally the first disease to manifest given its contagiousness, according to Heidi Larson, of the London School of Hygiene and Tropical Medicine.

Italy's anti-establishment government recently passed a new amendment that suspends a law requiring parents to provide proof that their children received a series of 10 vaccines -- including the MMR (measles, mumps, and rubella) vaccine -- when enrolling them in nurseries and preschools.

"Now, children who are not vaccinated will endanger other children at school who are too small for vaccines or cannot be vaccinated because they suffer from immunosuppressive diseases," said Dr. Roberto Burioni, a professor of microbiology and virology at San Raffaele University in Milan.

France and Romania, along with Italy, are among European countries with the highest anti-vaccine sentiment, where around 20% of the population believes vaccines are unsafe.

The infamous Wakefield study pubished in 1998 stated that the MMR vaccine caused autism in children who received the vaccine. The results of the study turned out to be untrue and Andrew Wakefield, one of the authors of the study, had his medical license revoked.

Despite the medical fraud, the myth persists, and many vaccine skeptics still believe their children will develop autism if they are immunized.

"Fake News," Autism, and Europe

In The Politics of Autism, I discuss the need for more study of the issue in other countries.

Mickey Keenan and Karola Dillenburger have an article at Societies titled "How ‘Fake News’ Affects Autism Policy."  The abstract:

 Since autism was first recognised, prevalence has increased rapidly. The growing economic as well as social cost to families and society can only be mitigated by effective interventions and supports. It is, therefore, not surprising that there is much heated debate and most governments have developed public policies to address the management of autism. This paper describes how well-known ‘propaganda’ techniques, that have become prevalent in the helping professions have been used to influence autism policies by spreading ‘fake news’ about the scientific discipline of Applied Behaviour Analysis (ABA). Over the past 40–50 years, meaningful evidence has accrued showing that interventions based on ABA can help people with autism reach their potential. In view of this, nearly all of North America has laws to mandate that ABA-based interventions are available through their health care systems. In contrast, across Europe there are no such laws. In fact, the National Institute for Health and Care Excellence (NICE), the body guiding health and social policy in the UK, concluded that it could not find any evidence to support ABA, and therefore could not recommend it. This paper addresses the reasons for these diametrically opposed perspectives.

Early Intervention in Europe

In The Politics of Autism, I discuss the need for more study of the issue in other countries.

At Autism, Erica Salomone and many colleagues have an article titled: Use of Early Intervention for Young Children with Autism Spectrum Disorder across Europe."  The abstract:

Little is known about use of early interventions for autism spectrum disorder in Europe. Parents of children with autism spectrum disorder aged 7 years or younger (N = 1680) were recruited through parent organisations in 18 European countries and completed an online survey about the interventions their child received. There was considerable variation in use of interventions, and in some countries more than 20% of children received no intervention at all. The most frequently reported interventions were speech and language therapy (64%) and behavioural, developmental and relationship-based interventions (55%). In some parts of Europe, use of behavioural, developmental and relationship-based interventions was associated with higher parental educational level and time passed since diagnosis, rather than with child characteristics. These findings highlight the need to monitor use of intervention for children with autism spectrum disorder in Europe in order to contrast inequalities.

From the article:

A number of relevant findings emerged. First, almost 1 in 10 parents who took part in the survey reported that their child was not currently receiving any type of intervention. At a country level, there was large variation in the overall use of intervention. The proportion of children not receiving any intervention was more than 20% in Denmark, Ireland and the United Kingdom, between 10% and 20% in The Netherlands, Czech Republic and the former Yugoslav Republic of Macedonia, and less than 10% in the rest of the  countries. This figure is much lower than the rate reported by Bowker et al. (2011), the only study reporting on use of any type of intervention (23% in North America and 43% in a smaller sample, n = 63, from Europe and other background). This and other differences in our results might be due to sampling bias and the different recruitment methods employed in our and other studies, as well as availability of different interventions. However, it should also be noted that we enquired about a greater range of interventions (for example, parent training was not included in the Bowker et al. survey) in a much larger sample

...
In the absence of systematic information on differences and similarities in national health and educational policies across Europe, it is not possible to speculate on which might be the most influential factors driving the differences in service use we found. However, our finding that in Southern and Eastern Europe children of individuals with a lower educational level had considerably fewer chances of using interventions suggests per se that there are health inequalities in Europe in respect to intervention for ASD. This is something that policy makers in Europe, both at a national and a union level, need to be made aware of. Furthermore, finding such an effect in this highly educated sample raises the possibility that the gap in terms of use of intervention between richer and poorer sectors of

Euthanasia and Autism in Europe

In The Politics of Autism, I write about the dangers of eugenics and euthanasia.

At The Washington Post, Charles Lane writes of an autistic Dutch psychiatric patient Dutch psychiatric patient known as 2014-77.  Despite his doctor's qualms, he requested and got a fatal dose of drugs.

Thus did a man in his 30s whose only diagnosis was autism become one of 110 people to be euthanized for mental disorders in the Netherlands between 2011 and 2014. That’s the rough equivalent of 2,000 people in the United States.
...

According to an analysis of 66 of the 110 cases from 2011 to 2014, by psychiatrist Scott Kim of the National Institutes of Health and two colleagues, Dutch psychiatric patients were often euthanized despite disagreement among consulting physicians as to whether they met legal criteria. In 37 cases, patients refused possibly beneficial treatment, and doctors proceeded anyway.
...

Among the obvious risks, Columbia University psychiatrist Paul S. Appelbaum writes in a companion article to Kim’s, is “inducing hopelessness among other individuals with similar conditions and removing pressure for an improvement in psychiatric and social services.”

“Will psychiatrists conclude from the legalization of assisted death that it is acceptable to give up on treating some patients?” Appelbaum asks.

Some doctors already have. In 2009, a 37-year-old Belgian woman became distraught after a romantic breakup and began seeking a doctor to euthanize her, per that country’s law, which is similar to Holland’s.

The woman, Tine Nys, had a history of mental illness, including a teenage suicide attempt, but had more recently been doing well. In February 2010, however, she received a new diagnosis of autism and, two months later, a lethal injection. Her two surviving sisters have recently come forward to denounce the administering physician’s “nonchalant” attitude.

France, Autism, and Psychoanalysis

Previous posts have discussed the dismal state of autism treatment in France.  A film titled "The Wall,"by Sophie Robert, explained the ongoing grip of discredited psychoanalytic theories in that country.  Kristina Chew writes:

Robert’s film has been part of an ongoing effort to change the understanding and treatment of autism in France. After the organization Autism Europe lodged a complaint against France in 2002 for failing to educate autistic children, the European Committee of Social Rights said that “France has failed to achieve sufficient progress” in educating autistic children and had made autistics an “excluded group.”

Seeking to help their children, more parents in France have been taking action, lobbying politicians like Daniel Fasquelle, a member of France’s parliament who says in the BBC that it is an “an out-and-out disgrace” that France’s medical community should continue to swear by psychoanalysis as the treatment for autism. David Heurtevent’s Support the Wall project continues the fight for the rights of autistics in France to education and services.

It is perhaps not surprising that the use of psychoanalysis to treat autism should be making its last stand in France, where Freudianism has long been applied not only to the treatment of mental illness but also to the study of literature, philosophy and radical politics. In a new year, it is more than time for the French medical community to acknowledge that it is decades behind the rest of the world in understanding what autism is and in treating and educating autistic individuals in ways that will actually help them achieve all they can.