Celebrity-led education campaign to increase awareness of causality of ASDs

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At first glance, Rhett Krawitt of California looks like your average seven year old boy. He seems to be a young kid full of life and enthusiasm. Unfortunately, it is not what it seems for Rhett. Instead of spending his days like most seven year olds, outside playing games with friends, he spends his days in and out of hospitals. The main cause of this lifestyle is his leukemia. This disease is only the beginning, as Rhett has been dealt a completely new problem. The new threat to this young boy’s life is measles, a disease that was almost unheard of over the past decade because of advancement in medical vaccinations. Unlike most children, Rhett cannot receive these vaccinations due to his leukemia. He is one statistic in the unvaccinated children debate. However, unlike most other children in this category, Rhett doesn’t have a choice. He now faces an entire new battle for his life, all because of an outbreak fueled by unvaccinated children. Children with the ability to receive the vaccination, but didn’t all because of misjudgments by parents. These parents are just a small portion of this rapidly growing debate sweeping the country.

Two of the major faces of this ongoing feud are talk show host Jimmy Kimmel and actress turned model Jenny McCarthy. Kimmel is pro-vaccine while McCarthy is leading the movement against vaccination in children. Despite their lack of research experience in vaccinations, these two have gained the public’s attention and have influenced parents that choose whether or not to vaccinate their children. A large percentage of the population may not be aware of the vaccination crisis even though it is a major issue. Parents are beginning to refuse to vaccinate their children in the fear that the risks of certain vaccines greatly outweigh the benefits. For many years the United States has been leading the charge of medical advances. The U.S, which was one of the top vaccinated countries in the world is following behind less developed nations (Bragesjo & Hallberg, 2011). This widespread panic has been based on very limited scientific information, with very little data coming from peer-reviewed scientific research. Instead, uneducated celebrities like Jenny McCarthy of swayed public opinion. The accusations that vaccines, specifically the Measles, Mumps, and Rubella (MMR) vaccine, can harm children are unjust when all the given information is taken into consideration

A Scientific Look
Vaccinations against mumps, measles, and congenital rubella syndrome (CRS) have been recommended by health professionals since the 1960s, and as one combination vaccine since the 1980’s. The simple vaccine had such great success rates that in conjunction with government and professional medical organization led efforts, many developed countries practically eradicated measles, rubella, and CRS (Centers for Disease Control and Prevention, 1998). Papania et al.’s (2014) investigation into the elimination of these preventable diseases concluded that through the year 2011, endemic measles, rubella and CRS had been eliminated in the United States with rates of occurrence of .000001, .0000001, and .0000002 respectively (p. 148 ).
Despite these promising results of years of government and professional medical organization led efforts including vaccination requirements by states and school systems, Rhett’s mother is right to be worried for her child. Recently what has been termed the “anti-vaccine” movement is having a pronounced effect on the rate of reported occurrences of measles, rubella, and congenital rubella syndrome (CRS) in the US. The increase in cases of MMR vaccine-preventable diseases has spiked, with a record-setting 644 cases in 2014, the most reported in since its endemic elimination in 2000, and a clear jump compared to the under 200 cases reported in 2013 (CDC, 2015). 2015 is looking to have even higher rates of measles as there has already been 178 cases reported to the CDC as of March 27th. These 178 include the ongoing measles outbreak that started in Disneyland and that has since expanded into six states as well as Mexico. In the official health advisory from the CDC it states that of the 52 cases reported at the time, 55% or 28 cases were unvaccinated and 31% or 17 cases had unknown vaccination status (CDC health alert network, 2015).
These alarming trends are the result of a decrease in the rates of vaccinations in children. The decision by parents to not vaccinate their children with the MMR vaccine has put in jeopardy the herd immunity, or endemic eradication of a disease that prevents uncontrolled outbreaks. Herd immunity is a condition that is reached when the transmission of a pathogen through the population is blocked. This is based on the percentage of a population that is immunized from a disease determined to be the threshold. Once reached, it protects those within a population that cannot be vaccinated. Those too young, too old, or medically unable to be vaccinated are still susceptible to contracting the disease, however the rate of immunization is high enough that the pathogen becomes rare and it is unlikely that they will get the disease. Up until 2011 the conditions for herd-immunity to measles, rubella, and CSR were met in the United States, however the outbreak of measles is an indicator that the rate of vaccination is decreasing, endangering the condition of herd-immunity, and those individuals like Rhett that need its protection (Plans-Rubio, 2012, 184-188).
Majumder, Cohn, Mekaru, Huston, and Brownstein (2015) use the information presented by Plans-Rubio to identify the cause of the recent increase in measles within the context of the December/January outbreak as lack of or incomplete vaccination. The authors calculated the rate of compliance with MMR vaccines for the area exposed to the outbreak was between 50% and 86%, as shown on the figure below.

Taking into account the assertion from Plans-Rubio (2012) that vaccination rates of 96% to 99% are necessary to prevent outbreaks of a disease as contagious as measles, Majumder et al. (2015) concluded that the lack of compliance in vaccinations is the likely cause of the Disneyland outbreak.

A falsified Report
This lack of compliance is clearly alarming, but not unheard of. In fact, the drive for this “anti-vaccine” movement started in 1998 when Andrew Wakefield and colleagues published a study titled Ileal-lymphoid-nodular Hyperplasia, Non-specific Colitis, and Pervasive Developmental Disorder in Children, which drew connections between the MMR vaccine and Autism Spectrum Disorders(ASDs). The study created initial panic and led to a large amount of research to try to either verify or disprove Wakefield’s claims. The conclusion of this multitude of research is that there is no causal link between the MMR vaccine and ASDs. Taylor, Swerdfeger, and Eslick (2014) performed a meta-analysis on “studies that assessed the relationship between vaccine administration and subsequent development of autism or autism spectrum disorders (ASD)” (p. 3623). Five cohort and five case-control studies were analyzed and data revealed that there was no relationship between vaccines and autism, nor MMR and autism, nor the ingredients of the MMR vaccine including thimerosal or mercury and autism. Statistical analysis revealed odds ratios in the range of .89 to .99 with a 95% confidence interval (Taylor, Swerdfeger, & Eslick, 2014, pp. 3623-3629).
Instead research points to genetic and environmental factors having a correlation with ASDs. Chang, Gilman, Chiang, Sanders, and Vitkup (2015) examine the genetic variability amongst cases of ASDs and the associated neurological effects of the mutations, concluding an association between genetic mutations and expression of neurological conditions of ASDs (Chang et al., 2015, 191-198). In addition to genetic factors Lyall, Schmitt, and Hertz-Picciotto (2014) propose that environmental factors influence the causation of ASDs. Lyall et al. (2014) use three primary examples including organophosphate pesticides, exposure to air pollutants, and maternal nutrition to show a correlation between ASD development and the environment of a child’s growth. (Lyall et al., 2014, 443-464)
In light of this research, Wakefield’s study was retracted by its publisher, “The Lancet”, in 2010. In addition, to the fraudulent study, Wakefield was convicted on dozens of charges including abuse of child test subjects, was stripped of his license, and banned from practice in the United Kingdom. Despite the disproving of his study and the subsequent defaming of Wakefield, the false connection between the MMR vaccine and ASDs became part of public discourse not only in the UK but in many countries including the United States and it remains so to this day (Ziv, 2015 ). The subsequent “anti-vaccine” movement has been amongst both adults with children and those without. In a survey performed by the National Consumers League, it was found that 33% of parents of children under 18 and 29% of adults believe that vaccinations can cause autism (NCL, 2014). That same NCL survey found that almost a quarter of those surveyed trusted TV doctors and personalities such as Dr. Oz to disseminate medical information rather than researching information on whether or not to vaccinate their children for themselves.
It is commonly thought that vaccines are required however, each state’s vaccine requirements differ, with varying exemptions that include religion, medical conditions, and what is called a Personal Belief Exemption. The number of parents refusing to vaccinate their children for this last reason is just 1.8% nationally according to the CDC’s weekly Morbidity and Mortality Weekly Report (Seither et al., 2014, p. 913). However Seither et al. (2014) state also that while the median vaccination rate may be good, low rates of vaccinations, or high rates of exemptions tend to cluster, which results in areas of weak immunity. Looking at California’s high PB exemption rate of 3.15% and the Disneyland outbreak, this relationship is substantial.
The rate of decrease in vaccinations and subsequent effect on herd immunity is not only a danger to the young, old, and sick; it is a public health concern for everyone in the United States. The loss of herd immunity is allowing MMR vaccine-preventable diseases to once again become transmitted amongst the population. This larger pool of at risk people creates a positive feedback effect which further decreases herd immunity and increases rates of contraction. As this continues, healthcare costs among the population will increase in response. This serious public health concern must be addressed; however it is clear that there is an “anti-vaccine” movement that is dissuading people from vaccinating their children. This movement has strong roots in medical misconceptions, and therefore we must find a way break these. In the past there have been successes in public health and safety campaigns by using a spokesperson as a focal point or to disseminate information. In the context of the anti-vaccination movement recently taking the stage with celebrities and the increasing pockets of unvaccinated children in places like southern California, we believe that using a celebrity-led education campaign to increase awareness of the importance of vaccinations will increase rates of completed MMR vaccines in children.

Broaden Your Mind
Renkert and Nutbeam (2006) define maternal literacy as “the cognitive and social skills that determine the motivation and ability of women to gain access to, understand, and use information in ways that promote and maintain their health and that of their children” (pg. 381). This idea that women who are not as educated as their peers are less likely to vaccinate their children is a main concern of ours. It is said by Johri et al (2015) that “poor health literacy is thought to affect recognition and understanding of health problems and interactions with the healthcare system” (p. 1). This is unfortunate because the country as a whole should have a higher standard with public education. That being said, it is a real problem that must be addressed. By educating the public about the truth surrounding public health and vaccines, we can then increase public health and vaccination rates. Taking into account both rural and urban setting for mothers, Johri (2015) and her peers assessed the association of maternal health literacy child vaccinations in India. The study, published in 2015, revealed that those with less education were less likely to uphold the vaccination programs for their children in both environments (Johri, 2015). This tells us there may not have been any vaccinations at all, or even if vaccinations were administered, the whole series of vaccinations may not have been carried out. The more education the parents had, the more likely they were to immunize the children according to the vaccination schedule (Johri, 2015).
Pati et al (2010) published a study stating that “later immunization status is most strongly predicted by immunization status at 3 months. These results further support the importance of intervening from an early age to ensure that infants are fully protected against vaccine preventable diseases” (2010). They looked at the vaccination rates at three months and seven months old and found that the best predictor for vaccination at seven months was if the child was vaccinated at three months. This shows that the best thing to do is get the parents to the doctors earlier rather than later and make sure that they are getting that initial dose of the vaccine. This needs to be a priority and leading a campaign to educate the public will help spread awareness.
One study suggested that health literacy didn’t have a direct affect on children’s health care, so this lead us to believe that there was a problem with the general idea surrounding vaccines (Sanders, Thompson, Wilkinson, 2007, p. e86). We believe that educating those who are against vaccines in this case will help improve vaccination rates. In Sweden, the vaccination rates for MMR decreased even without a history of infection or anti vaccine movement. It became so bad that many controversies surrounding vaccines were discussed in the media and people started to contact public officials. “The tensions surrounding the MMR vaccination were significant enough to cause acute social turmoil, threatening long-established vaccination practices and trust-based relationships between parents, public health services, and authorities in Sweden, too” (Bragesjo and Halberg, 2011, p. 116).
The hope is that if we educate the public in regards to the use of mercury and other chemical thought to be used in vaccines, they will be able to make an accurately informed decision as to vaccinate their child or not. Hopefully, they will realize that even though there may be side effects to any vaccine, the positive side effects outweigh any potential for negative side effects.

It’s Not a Magic Trick
In the 1980s and 1990s, America was in the middle of an HIV epidemic. The disease was recently discovered and very little was known about it. Non-factual information about the disease spread through the media like wildfire, leading to a general misunderstanding and lack of knowledge about the issue by the public. Rumors began to spread, with the most prominent being that the disease only targeted homosexuals. In 1991, world renowned athlete Earvin “Magic” Johnson announced that he had contracted the HIV virus. Being a married, heterosexual professional basketball player caused the AIDS epidemic spotlight to be thrust upon Johnson. He soon became the face of this public health issue by spearheading an awareness campaign. His status as a role model for sports fans across the world gave him a platform for which he could use for an HIV public health campaign. The speeches and public service announcements he made are directly correlated to the increase in HIV education amongst the public (Spector, 2014). Before Johnson’s’ announcement, HIV/AIDs were something that the public did not understand; only feared. After his announcement, the public was fascinated in understanding how a heterosexual NBA star could contract the virus. This dramatic increase in awareness of a public health issue is the main goal of the celebrity involvement in our campaign. Johnson went on to create television commercials that expressed the need for public education about HIV. In two studies, approximately 2000 people were asked if they associated Earvin Johnson with HIV, and if they did, what sparked an interest in education about the topic. The results showed a majority of those surveyed were influenced in some way by the NBA stars’ involvement (Pollock III, 1994). It is human nature to be more persuaded and influenced by someone with the higher “status” that comes with the title of celebrity.
Overall, the HIV campaign is a prime example of the impact that celebrity led campaigns can have on public opinion of an important issue, as it has led to a substantial increase in the education of AIDs (Spector, 2014). The effect of the campaign sparked so much public concern that the Magic Johnson Foundation, a foundation for the education of the HIV virus and support for victims, was created. According to the foundation, (MJF, 2014), over 250,000 people have been educated about the disease. By using the face of Johnson rather than just numbers and statistics about the disease, education rate about the topic have dramatically increased, and continue to do so today (MJF, 2014). Even though not everyone is aware of who “Magic” Johnson is as an athlete, it cannot be denied that the impact he has had on the education of this disease is substantial. This impact is strengthened by the fact that his involvement in the issue and the rates of condom use and HIV testing are greatly correlated (Pollock III, 1994). Without a celebrity face, this campaign may not have been as successful in spurring public interest.

The Campaign
The concept of the public’s perception of the celebrity in a campaign was tested in a case study done in Australia (Chapman & Leask, 2001). The public showed concern and lacked interest if the celebrities were being paid to endorse a specific campaign. There was more confidence in the campaign if the celebrity joined due to the fact that they agree with the cause at hand. This campaign focused on educating people about the dangers of smoking and encouraged them to quit. A well-known celebrity was paid to quit smoking, but in the end failed at quitting. The public did not agree with the idea that the face of the campaign was paid for their participation and felt it would have been more successful if the person actually showed a passion and desire for the movement. This study shows the importance of celebrity selection and involvement. If done properly, such as the case with Earvin Johnson, the celebrity outreach can turn out very successful results.
As we mentioned previously, vaccination numbers have been on the decline in the past couple years, thus increasing the number of outbreaks of preventable diseases. We believe that the main reason for this is misinformation. If we can start to educate the public about the benefits of vaccines and the relative low risk we believe that the rates of vaccinations in children should increase. Education is the key here. We have seen in previous case studies that maternal health literacy is indeed a factor when it comes to vaccinations, and if we can educate the mothers we hope to see this positively affect public health.
We’ve seen that low maternal literacy can affect vaccination rates. In a study done by Owais, Hanif, Siddiqui, Agha, and Zaidi (2011) it was found that “a simple educational intervention designed for low-literate populations, improved DPT-3/Hepatitis B vaccine completion rates by 39%” (p. 1). This case study for Pakistan, even though it is dealing with a different vaccine, leads one to believe that education is a key factor when immunization your child. Implementing a simple education campaign and allowing access to many people, will not only educate current mothers, but also allow new mothers the opportunity to gain information they normally would not have access to and give their child the best start possible.
Using a celebrity may seem questionable at first; however, we have decided that a familiar face and friendly communication will lend itself to being well received by the general public. People may find it easy to relate to celebrities, and when given the chance to listen to one, will generally take what they say as true.
To ensure the appropriate information is transferred, we plan on teaming up with an established, reputable organization such as the National Institutes of Health or The Center for Vaccine Awareness and Research, which receives funding from the Center for Disease Control and studies the effectiveness and delivery of vaccines.
In employing a celebrity, we are sure that there will be resistance in some people. They may ask ‘Why are you even using a celebrity?’ ‘What makes them credible?’ and ‘Why should we listen to them?’ In looking for the most effective way to communicate with the largest number of people, as well as communicate effectively and in a timely fashion, one looks toward the media. The media has become an overwhelming resource for people, so we decided to take advantage of the para-social interaction between the celebrities on the television, the internet, and the radio and the audience on the other end. “One of the striking characteristics of the new mass media – radio, television, and the movies – is that they give the illusion of face-to-face relationship with the performer” (Horton & Wohl, 2006, paragraph 1). Horton and Wohl (2006) say that “sometimes the ‘actor’…. is seen engaged with others; but often he faces the spectator, uses the mode of direct address, talks as if he were conversing personally and privately” (paragraph 2). This para-social interaction leads the viewer/ listener to believe that there is a more intimate connection between them and the celebrity, thus increasing the likelihood of them listening to the celebrity.
This being said, the original vaccine dispute was started via a celebrity in the spotlight. This mode worked well to get the word out, so we think that in doing the same thing, we can combat the opposition effectively and equally by putting our message and mission out there next to theirs.

The End to the Debate
The use of celebrity led campaigns on the issue of vaccinating children will significantly benefit the cause. Jimmy Kimmel is already a face for the issue as he has openly spoke about his opinions on the issue on his nationally broadcasted show and in other circumstances. Even though not everyone is up to date on the latest celebrity news, having him endorse the campaign will only benefit the overall goal. As seen by other case studies such as the Magic Johnson HIV campaign, celebrity involvement can greatly increase the amount of awareness and education about the topic. The goal is not to make everyone who sees this campaign an expert but instead to make as many people as possible aware of the epidemic spreading across our country. Vaccination is an extremely important issue. Millions of dollars goes into research that is continuing on at this very moment. It is understood that allergens and religious exemptions do exist. However it often comes down to a simple parental choice. The science has proven that the benefits of vaccines greatly outweigh the risks. The recent outbreak of measles, a previously minor disease since vaccinations began, is a sign of this. To quote Jimmy Kimmel “It’s okay if you don’t want to vaccinate your kids if they were the only ones affected because they are your kids, but they’re not because all unvaccinated kids put all children at risk” (Kimmel, 2015). Vaccination doesn’t only affect your kids but affects children everywhere. The science on the use of vaccines is extensive and well backed up. However, like most other things, it comes down to a simple choice. This campaign, led by Kimmel, will educate people to make the right choice and vaccinate our children.

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