She’s an extremist, a danger to children and she’s coming to a community hall near you. The question facing Immigration Minister Peter Dutton is, should she be allowed?
The difficult ethical issues do not pit good against evil, but good against good. Consider the proposed Australian tour in March of anti-vaccination campaigner Dr Sherri Tenpenny. Putting three different rights in conflict, it pivots on the trust issue that will profoundly shape the future of democracy and, quite likely, the planet; our trust of government, of science and of reason.
You have a right to peddle nonsense, but you don’t have a right to peddle nonsense as truth.
It is a crisis, if you will, of public epistemology. How do we know?
Many people want Tenpenny barred from Australia, as was misogynist pick-up artist Julien Blanc. Tenpenny’s message, playing as it does to parental fears, will almost certainly harm Australian children, so it is easy to argue that she’s not of good character.
Yet Tenpenny’s is, still, a case of good-versus-good – not because there’s any doubt that her anti-vaccination message is dangerous and wrong, but because two critical questions arise. One, should she be allowed to say it anyway? And two, which bad choices are parents entitled to make for their children? Freedom of speech and individual liberty versus public health.
But first to the science. There is little doubt that vaccines work, or that anti-vaccination campaigns are largely snake oil.
Take measles. The World Health Organisation announced in March that Australia had eliminated measles, but every year sees a few hundred cases amongst the unvaccinated. 2014 saw outbreaks in every state, with spikes in Queensland, Victoria and WA. Melbourne recorded 56 cases between January and July, the highest since 1999.
Measles doesn’t sound serious. Certainly I had it, as a child. Yet one in 20 children with measles will develop pneumonia, says the United States Centre for Disease Prevention, and one in 1000, encephalitis. One or two in a thousand, mostly infants, will die. (Tenpenny, a doctor of osteopathy, puts this figure at three in ten million).
Or take pertussis (whooping cough). Between 1981 and 2009, rates across the world roughly halved. In Australia, however, they soared – from 170 cases in 1981 to 29,545 in 2009 – prompting Professor Peter McIntyre, from the National Centre for Immunisation Research and Surveillance, to tag Australia “the world capital of pertussis.”
Partly for this reason, there is speculation that the acellular pertussis vaccine now used (to minimise side-effects) is less enduring than the old version. But that’s a long way from claims made by Tuggerah-based anti-vaccination group Homeopathy Plus! that the pertussis vaccine is unreliable and ineffective, and homeopathic remedies preferable.
In December the Federal Court found these Homeopathy Plus! claims to be “misleading and deceptive,” unsupported by science. Penalties, up to $1 million, will be set in February. Yet Isaac Golden, the “natural vaccination” practitioner associated with Homeopathy Plus!, will share Sherri Tenpenny’s tour.
The irony is that anti-vaccinationists are usually the health-conscious. Amy Parker, now a mother-of-three, writes of her experience as the 1970s child of anti-vaxx health-nuts. Eating only organic, local and unprocessed, hers was a childhood low on fat, sugar and chemicals, high on water, exercise, fresh air and fish oil.
Yet, she writes, “I contracted measles, mumps, rubella, a type of viral meningitis, scarlatina, whooping cough, yearly tonsillitis, and chickenpox, some of which are vaccine preventable.” In her twenties, after so many antibiotics, she was hospitalised with penicillin-resistant quinsy (the disease that killed Elizabeth 1) and contracted precancerous HPV (Gardasil being another of the ‘evil’ vaccines). Only a newfound regard for medicine, she concludes, put her life back on track.
Amy’s disease catalogue is bad enough, but the possibilities are far worse. Diphtheria. Polio. Tetanus. An unvaccinated woman died of diphtheria in Brisbane in 2011, after returning from overseas. Australia’s last polio case was 2007, but in 2014 this dreadful, crippling disease was diagnosed in 10 countries (including Pakistan, where vaccinators were attacked after the CIA used an immunisation program to locate Osama bin Laden), prompting the WHO to declare a polio public-health emergency. The existence of silent carriers means an unvaccinated Australian child could still end up in an iron lung.
The science is in. Vaccines work, and most anti-vaxx scare-myths have been thoroughly busted; in particular the MMR-autism link myth. A 2014 study by Sydney University Associate Professor Guy Eslick collated data from 1.25 million children. Eslick found a “consistent… lack of evidence for an association between autism, autism spectrum disorders and childhood vaccinations.”
The paper that began the whole MMR-autism scare, a 1998 Lancet piece by Dr Andrew Wakefield, has since been retracted, reviled as fraudulent and shown to have several funding-based conflicts-of-interest. The Lancet officially ‘regrets’ the publication.
Yet the myth persists, and Tenpenny perpetuates it. For her, Edward Jenner (smallpox), Jonas Salk (polio) and Samuel Katz (measles) are “villains” while Wakefield is “one of the world’s most respected gastroenterologists.”
What to do? Should Tenpenny be welcomed? Are parents entitled to endanger their children for their beliefs? What about other people’s children – those who, for whatever reason, cannot be immunised? What about antibiotic-resistant bacteria, from treating too many preventable diseases? Are even quacks entitled to speak?
I incline to the Voltairean “I disapprove of what you say but will defend to the death your right to say it.” But UTS Professor of Law Michael Fraser makes two useful points. One, rights are never absolute. Expressive freedom is always limited by the public interest. And two, such freedoms properly pertain to opinions, not faux-facts. You have a right to peddle nonsense, but you don’t have a right to peddle nonsense as truth.
And there’s this. To see the global med-science profession as a conspiracy to harm children is crazy as believing that the Queen is an alien.
Ban Tenpenny by all means. But the trust issue remains. How to distinguish faux from fact? If we cannot blindly trust governments or science – and surely we shouldn’t – the only hope is that most fundamental of rights: universal, high-quality education. That’s the real public interest.
Twitter @emfarrelly