Letter to the Editor: Follow Gandhi’s approach when responding to vaccine aversion
Letters to the Editor
I am a longtime AAP member practicing in San Juan County, Washington, which is a highly
In spring 2014, an outbreak of measles imported from the Philippines created havoc
on our islands. Its cost to county public health services and to several local businesses
was enormous. We attempted to empathically promote science and temper the emotion
as well as refuse to sign the Washington State vaccine exemption form. There was some
success in changing hearts and minds but very limited.
As the outbreak wound down, I recalled the final paragraph of Albert Camus’ “The Plague”:“And, indeed, as he listened to the cries of joy rising from the town, Rieux remembered
that such joy is always imperiled. He knew what those jubilant crowds did not know
but could have learned from books: that the plague bacillus never dies or disappears
for good; it can lie dormant for years and years in furniture and linen chests; it
bides its time in bedrooms, cellars, trunks, and bookshelves; and perhaps the day
would come when, for the bane and the enlightening of men, it would rouse up its rats
again and send them forth to die in a happy city.”
Five years later, vaccine aversion has grown and has been aggressively politicized.
AAP members are at a point in the struggle against anti-vaccine ignorance where we
must begin to think about expanding our efforts on behalf of all children. It is clear
that we may be at a tipping point for measles again becoming endemic in North America.
This is unconscionable and demands increased levels of commitment and action by all
Gandhi used the Sanskrit word Satyagraha, meaning “clinging to truth,” in reference to his campaigns in South Africa and India,
such as the famous Salt Satyagraha march of 1930. Satyagraha is a positive and spiritually-based
form of resistance that starts in the heart of the resister and inevitably produces
creative action. The term is used today to mean both the general principle of “clinging
to truth,” which is necessary for nonviolent work, and direct as in Gandhi’s campaigns
in South Africa and India as well as Dr. Martin Luther King’s in the United States.
Following is a classification of some of the actions that can be used in Satyagraha
campaigns, provided the principles of nonviolence are upheld.
Negotiations and education: pediatricians’ current outreach.
Arbitration: continue to work for elimination of nonmedical exemptions.
Agitation (without breaking the law).
Demonstrations of various kinds (without breaking the law): picketing.
For years, we have done the first two with apparent limited success. Whether the next
two will be of any value is debatable when dealing with the “true believers” and their
opportunistic politician supporters.
Limited strikes of short duration: refusal to sign exemption forms; exclusion of unimmunized
patients from waiting rooms.
General strike: no care for unimmunized children.
Economic boycott of family businesses that do not support vaccination.
Social boycott: exclusion of unimmunized children from child care and extracurricular
We are at this point on the continuum. Pediatricians must refuse to sign exemption
forms and consider at least one national day of office closure (except for true emergencies)
and a day of fasting to reflect on our values. We also should publicly boycott any
business owned by anti-vaxxers and encourage our families who support vaccination
to do the same.
Extensive institutional non-cooperation
One would hope it would never come to this, but all must be held in reserve. So far,
punishing kids by practice exclusion for their parents’ folly has been limited nationally
but may need to be more formally included in the strategy of all physicians.