The Somali measles outbreak in Minnesota: Thanks again, Andy (and American antivaxers), for the measles

Normally, I like to mix up my topics, but it’s been one of those weeks where basically discussing the antivaccine movement has taken over. Sometimes when that happens, I just go with the flow. Besides, there really is one more story involving that antivaccine movement that I want to comment on. Remember last week, when the story of how the antivaccine movement had targeted Somali immigrants in Minnesota, with a resultant plunge in MMR uptake among that population over the last decade. Completely unsurprisingly, given that MMR uptake among the Somalis fell from 92% to 42% in over a decade, the Somalis in Minnesota endured a measles outbreak in 2011 and are now at the center of the biggest measles outbreak Minnesota has seen in decades. It’s all thanks to American antivaxers who targeted this population when there was a cluster of autism cases among them in 2008 and were “inspired” by (not to mention aided and abetted by) the most infamous antivaccine quack of all, Andrew Wakefield. These antivaxers are continuing to target them, even in the midst of this latest measles outbreak, which, the last time I checked, has reached 50 cases, many hospitalized.

There is a telling and educational article by Julia Belluz published by Vox.com, in which Belluz interviews a public health official in Minnesota, who explains how Minnesota lost the battle with antivaccine campaigners. It’s a sad tale, but it reveals just how persistent antivaxers have been in targeting this vulnerable community and how incredibly difficult it will be for public health officials to rebuild trust in vaccines, now that it is lost. The first thing we learn is that this was a concerted effort (something that those of us who’ve paid attention to this story already knew) by several antivaccine groups:

Minnesota is currently battling its largest measles outbreak in nearly 30 years, with 50 confirmed cases. And it’s become a case study in how difficult it can be to slay vaccine misinformation once it takes root.

What makes this outbreak so astounding is that it is nearly a decade in the making. In 2008, anti-vaccine advocates — including the Organic Consumers Association and Andrew Wakefield, a British doctor who falsified data suggesting vaccines are linked to autism — began targeting local Somali Americans who had concerns about autism among their children. The activists saw an opening, offering an explanation of a cause when the health department couldn’t provide one.

Why am I not surprised that the Organic Consumers Association is antivaccine? It’s probably because anyone who’s looked at the antivaccine movement for as long as I have knows about anti-GMO and antivaccine go together like dog feces and poo bags. It didn’t take me long searching its website to find articles like Vaccine Studies Debunked, which touts a white paper released by the equally antivaccine ANH-USA released in conjunction with Brian Hooker, the biochemical engineer turned incompetent antivaccine (but I repeat myself) statistician and epidemiologist whose “simplereanalysis of a 2004 study of MMR and autism helped fuel the “CDC whistleblower” conspiracy theory three years ago. Other examples include an article entitled How Mainstream Media Insults the Public’s Intelligence on Vaccines that is chock full of practically every antivaccine trope in the book. If you want to know how far down the rabbit hole of antivaccine propaganda the OCA has gone, just check out its article on Robert F. Kennedy, Jr.’s risible “vaccine challenge.” Such challenges, as I like to put it, are practically the sine qua non of a crank. Basically, the fact that OCA republishes a whole lot of material from Joe Mercola on vaccines should tell you all you need to know about its stance on vaccines.

Belluz spoke to Kristen Ehresmann, director for infectious diseases at Minnesota’s Department of Health, who has been working with the Somali community for nearly a decade. First we learn how the antivaccine movement got traction:

In 2008, there was a news article — based on people’s perception and observation — that a disproportionate number of Somali children were taking advantage of special education services in the Minneapolis public school system. Once that news piece was done, word got out that there appeared to be a disproportionate number of Somalis with autism [which is not true]. And that was the opening point.

Right from the very first meeting that the Department of Health and some community members coordinated, the anti-vaccine folks were there [through public lectures and outreach]. They have been actively working in the community. Andrew Wakefield, the discredited British doctor [who falsified data suggesting vaccines cause autism], has met with the community on at least two occasions.

I discussed this history in depth two weeks ago, with a blow-by-blow of how the antivaccine movement swooped in during 2008 to spread antivaccine misinformation. I also pointed out how the “opening” for antivaxers to do this was a series of stories that appeared that year about an “autism cluster” in the Somali community in 2008. The existence of this cluster was was not confirmed in subsequent studies, the latest of which found that Somali children born in the US were no more likely to be diagnosed with autism spectrum disorder than American children. This study is brought up later in the interview, and Ehresmann is asked if it had any effect. The answer, predictably, is no:

The perception is so strong [that autism rates are higher] in the [Somali] community there was almost a distrust — “You’re just saying the rates are the same.” So that [report] didn’t make a huge difference. I think this outbreak has really provided a good opportunity to try and clarify messages and get more concerted messaging from within the community and from community leaders.

I hope that’s the case. Ehresmann does highlight the most difficult problem skeptics and science advocates have: Countering personal perceptions with data. Human beings are pattern-forming, storytelling apes who prize the word of people in their community and their immediate circle over data and science. I’ve discussed more times than I can remember how unshakable the belief that vaccines cause autism is among parents whose children exhibited their first symptoms of autism within a few days of vaccines and as a result have come to blame vaccines for their children’s autism. It doesn’t matter how many large, high quality studies you cite demonstrating that vaccines have no correlation with autism risk; they believe their eyes and their human tendency to fall prey to the post hoc ergo propter hoc fallacy and confuse seeming correlation with causation far more than they believe dry scientific studies. Again, it’s human nature. It’s also human nature that, once an impression or narrative becomes established, it’s incredibly hard to change it with data and evidence.

There’s another human trait that puts Minnesota public health officials at an extreme disadvantage:

Over time, we have modified our approach. First we were focusing a great deal on vaccines, and we realized that it’s not enough to say vaccines aren’t the problem. You really have to address the concerns about autism as well. Over time we’ve increased the involvement of the [Somali] community as well as made sure we’re addressing both issues.

One of the big challenges we face is that autism is extremely complex and there are multiple factors that have been identified and that may play a role. And the community really wants an answer — they want to know that X causes autism. We try to explain the level and type of research that’s needed [and that we don’t have answers about the causes of autism], and that was perceived of as, “You don’t care about us.” I don’t think we did a good enough job of conveying that we did care.

Humans crave certainty. I’ve discussed this aspect of human nature on more occasions than I can remember, citing the lyrics to a David Bowie song, “I don’t want knowledge, I want certainty.” It’s a disadvantage that those of us who advocate for science have compared to cranks and quacks like antivaccine activists. Science is nuance. Quackery is certainty. Human nature is to crave certainty. It doesn’t matter if it’s certainty in vaccines, cancer treatment, or cancer screening. That’s why we lose so often.

It’s especially difficult for Minnesota public health officials when the antivaxers who got this impression established in the Somali community are doing their damnedest to reinforce it:

They have redoubled their efforts during this outbreak. They are putting more and more energy … into promoting their message. They scheduled a community meeting on April 30 — it was “an educational community resource meeting,” but it was really an anti-vaccine meeting. The anti-vaccine groups presented their viewpoints… some Somali parents spoke about their concerns about autism. And a number of physicians got up and refuted the information provided.

I discussed this meeting in depth as well. Basically Mark Blaxill, antivaccine activist originally associated mostly with SafeMinds but now most active in the antivaccine political party The Canary Party and its “charitable” offshoot Health Choice rolled into town to lay down a heaping’ helpin’ of antivaccine misinformation, all spiced up with conspiracy theory fear mongering and, in essence, a plea to the Somalis not to let the health authorities “bully” them into “giving in” and vaccinating. Yes, antivaxers are just that depraved and despicable. In the midst of a growing measles outbreak in which children have been hospitalized, they’re still deceiving the Somali community.

Worse, Ehresmann describes how, although Minnesota public health officials are doing the right things, they can’t do them enough because they don’t have the resources:

We’ve hired Somali staff to do outreach, and one of the important things is addressing [the community’s] concerns about autism. We have one Somali outreach worker whose job it is to make sure [concerned parents] are aware of resources they can have for their children if they do have [autism] concerns. Then we have an outreach worker who is focused on providing information on immunizations. We have created a Somali health advisers group and pulled together leaders in the Somali community to get their input. The challenge is we need to be doing this 10- or 100-fold more than what we’re able to do.

All of these actions are good approaches. Unfortunately, even if Minnesota public health officials had adequate funding to do what needs to be done, they would still be facing an uphill battle, thanks to human nature.

As frustrating as the whole situation in Minnesota is, it’s important to remember that the Somali immigrant population refusing MMR vaccination is the victim here. They come from a very poor country with little medical infrastructure, and white, privileged—and, above all, American—antivaxers have targeted them with misinformation and pseudoscience, aided and abetted by a British fraud who got the whole scare blaming the MMR vaccine for autism started in the first place. As a result, not only are the Somali immigrants in Minnesota suffering a large and growing measles outbreak that is endangering the health of their children, but they’re now also being made scapegoats by nativist racist idiots like this one:

Minnesota is facing a bit of a measles crisis, with nearing 50 confirmed cases in the last four weeks — a level that hasn’t been seen in three decades or so.

But the blame for this crisis is being wrongfully cast on anti-vaccination activists, and not on open border folk, where it more rightfully belongs.

It should be noted these cases came primarily from the Somali community of Hennepin County. They also come from a state with a massive refugee acceptance rate.

It’s the same old time-dishonored narrative about immigrants that racists and xenophobes have been repeating since before the dawn of the republic, that “those” immigrants bring filth and disease into our nice clean white country. But they don’t and the Somalis didn’t. Eleven years ago, they vaccinated at a rate equal to or even higher than that of the local American-born population. Then American antivaxers (and a British fraud) took advantage of exaggerated news stories about an “autism cluster” to blame autism on the MMR vaccine and frighten Somalis into not vaccinating. They succeeded. MMR rates plunged precipitously and continue to plunge a decade later, with no bottom yet in sight. Now they’re being demonized for having been the victim of an antivaccine con. It doesn’t help that our President, Donald Trump, has targeted the Minnesota Somali immigrant community, falsely portraying the community as a hotbed of terrorist sympathizers and a fertile breeding ground for ISIS recruiting:

During a rally in Minnesota on Sunday, Republican presidential candidate Donald Trump reiterated that he would block refugee resettlement in the United States — and specifically targeted the Somali communities in the state.

“Here in Minnesota you have seen firsthand the problems caused with faulty refugee vetting, with large numbers of Somali refugees coming into your state, without your knowledge, without your support or approval,” Trump said against the backdrop of an airport hangar at the Minneapolis International Airport.

“You’ve suffered enough in Minnesota,” he added.

Meanwhile, over at WorldNetDaily, which is just a hair short of Breitbart when it comes to xenophobia, they’re ranting about the Minnesota outbreak, blaming Islam and calling it the “Muslim measles“:

Andrew Bostom, M.D., an academic internist specializing in general internal medicine who has also authored several books about the history of Islam, said Muslim communities often prove difficult to convince that vaccinations are appropriate for their children.

“The case against vaccinations is first an Islamic one,” he said, citing a 2011 article by Dr. Majid Katme, spokesman for the Islamic Medical Association in the United Kingdom.

“We are giving our innocent children haram [forbidden] substances and harmful chemicals that destroy their natural immune systems, causing disease, suffering and death,” Katme wrote.

No, it’s not. This is the same anti-Muslim rhetoric that xenophobes trotted out when certain Muslim communities resisted polio vaccination programs. I discussed the very article by Katme being cited by Bostom (who, as a perusal of his website will really demonstrate, is a ranting Islamophobe, which is no doubt why WND likes to cite him). In essence, there’s nothing uniquely (or even particularly) “Islamic” about antivaccine views. Indeed, we have plenty of Christian antivaxers who use fundamentalist versions of their religions to justify their antivaccine views. I also pointed out, for example, that most Muslim authorities support vaccination and mentioned the example of Iran, a Muslim theocracy, where vaccination rates have traditionally been consistently high for many years. I also can’t help but note that the WND article notes that, although the Minnesota Somali community is the largest such community, there are “other large enclaves in Columbus, Ohio; Seattle; San Diego; Atlanta; Fargo, North Dakota; Sioux Falls, South Dakota; Portland and Lewiston, Maine; and Nashville, Tennessee. If it were Somali Muslim beliefs that were responsible for antivaccine views, then we’d expect to be seeing outbreaks in several, if not all, of these communities as well. We don’t.

The seed was planted by nativists who fear immigration and fertilized by our President when he was a candidate, and these same nativists have seized upon the measles outbreak in the Somali community as a convenient excuse to indulge their hatred of Islam and invoke the ancient false fear of immigrants bearing “disease” to attack the Somali immigrant community in Minnesota and use it as an example of why the US should shut down immigration and stop letting refugees in. The examples I picked are mild, too. Just peruse the comments after the WND article and you’ll see some naked, undisguised bigotry and hatred that will nauseate you to read.

Nearly a decade ago, long before the rise of the alt right or Donald Trump, there was a seemingly anomalous “cluster” of autism cases in Minnesota among the community of Somali immigrants who had settled there after fleeing the chaos and violence in the failed state that claimed to be their country. Antivaxers, in their unshakeable faith that vaccines cause autism, saw a population just begging to be converted, and, unfortunately, they succeeded in converting them. The result is our current situation. To compound the injury to the Somali population, many of whom fled poverty and in the hope of building a better life in the US, our own homegrown racists are now using the measles outbreak that our own homegrown antivaxers (and one Brit) tricked them into inviting.

‘Merica!